Medical fitness is a core requirement for every pilot, and EASA maintains strict standards to protect flight safety. This guide explains what those standards are, how the medical process works, and what aspiring and current pilots should know about obtaining and keeping an EASA medical certificate – with a focus on the Class 1 medical for professional pilots.
Introduction to EASA Medical Certification
EASA medical requirements are defined in Part-MED (Medical Requirements) of EU Regulation 1178/2011. These rules set common medical standards for pilots across all EASA member states and ensure they are applied consistently.
Why Medical Standards Matter
From an operational standpoint, the main concern is pilot incapacitation. Even relatively mild medical issues can affect judgment, reaction time or performance. Serious events – especially those that occur suddenly – can have catastrophic consequences in a cockpit environment.
The regulatory approach is deliberately conservative and evidence-based. Pilots are examined regularly, changes in health are monitored over time, and potential problems are meant to be detected early. At the same time, the system tries to balance safety with fairness, so that pilots with well-controlled conditions can continue to fly under appropriate supervision or limitations.
Medical Certificate Classes
EASA defines different medical certificate classes that match the privileges of the license held.
Class 1 Medical Certificate
Class 1 is required for:
- Commercial Pilot Licence (CPL)
- Airline Transport Pilot Licence (ATPL)
- Multi-Pilot Licence (MPL)
- Under 40 years: 12 months
- 40–50 years: 12 months
- Over 50 years: 6 months
- Over 65 years: 6 months, with additional checks as required
Class 2 Medical Certificate
Class 2 is required when exercising PPL privileges. Standards are less strict than Class 1, and validity is longer:
- Under 40 years: 60 months
- 40–50 years: 24 months
- Over 50 years: 12 months
LAPL Medical Certificate
The LAPL medical applies to holders of the Light Aircraft Pilot Licence. It can often be issued by a suitably authorized general practitioner rather than a specialist AME.
Validity:
- Under 40 years: 60 months
- Over 40 years: 24 months
Class 1 Medical Examination
Because professional pilots need Class 1, the rest of this guide concentrates on those requirements.
Finding an Aeromedical Examiner (AME)
Class 1 examinations are carried out either at:
- Aeromedical Centers (AeMCs) approved by the national aviation authority, or
- Individual Aeromedical Examiners (AMEs) working under that authority.
For an initial medical or if you know you have a potentially complex medical history, choosing a well-established AeMC with experienced examiners is often a good idea.
Preparing for Your Medical Examination
Before the Appointment
You will need:
- Valid photo ID
- Any previous medical certificates (if you already hold one)
- Glasses or contact lenses you use for normal activities
- A list of current medications and dosages
- Relevant medical records for any conditions you plan to declare
Honesty is essential. Undeclared conditions that later come to light can have far more serious consequences than disclosing them from the start.
Pre-Examination Health Check
Many candidates choose to see their regular doctor first, especially if they suspect issues with blood pressure, weight, or other routine parameters. Correctable problems (for example, untreated hypertension or outdated glasses) are best dealt with before the official aviation medical. If you are considering refractive surgery such as LASIK, it is worth discussing timing and documentation requirements with an AME in advance.
Initial Class 1 Medical Examination Components
The initial exam follows a structured format and covers several areas.
Part 1: Administrative Details and History
You will complete a medical history questionnaire covering personal and family medical history, surgeries, hospitalizations, medications, alcohol and substance use, mental health, and any previous accidents, injuries or episodes of incapacitation. There are also aviation-specific questions about previous denials or restrictions, as well as your ability to perform pilot duties.
Part 2: Physical Examination
The physical exam includes:
- A general assessment (height, weight and BMI, blood pressure, pulse, overall appearance)
- Cardiovascular examination with heart and vascular checks and a mandatory resting ECG
- Respiratory examination with lung auscultation and, if indicated, spirometry and chest X-ray
- Abdominal and musculoskeletal assessment, looking at organs, joint function and range of motion
- Neurological checks such as reflexes, coordination, balance and basic cognitive function
Part 3: Vision Testing
Vision is a major focus of the exam:
- Distant visual acuity must be at least 6/9 in each eye separately and 6/6 binocularly, with or without correction.
- Near and intermediate vision are tested at different distances (for charts, instruments and cockpit tasks).
- Color vision is typically assessed with the Ishihara test; if that is not passed, other tests (e.g. anomaloscope, lantern tests) may be used to determine whether you still have “safe color perception”.
Part 4: Hearing Testing
Hearing is tested with pure-tone audiometry at key frequencies (typically 500, 1,000, 2,000 and 3,000 Hz). There are maximum allowable thresholds in decibels for each frequency when each ear is tested separately without aids.
If you use hearing aids, they may still be acceptable, but you must show that you meet the necessary standards with them and can discriminate speech effectively.
Part 5: Laboratory Tests
Standard lab investigations include:
- Full blood count
- Kidney and liver function tests
- Lipid profile (cholesterol, triglycerides)
- Glucose and sometimes HbA1c
Part 6: Psychological Assessment
Mental health is assessed both formally and informally. Questionnaires may screen for depression and anxiety, while the examiner will look at sleep quality, stress, coping mechanisms and substance use. If there is a history of significant mental health conditions or current treatment with psychotropic medications, further psychological or psychiatric evaluation may be required.
Examination Duration and Cost
An initial Class 1 typically takes between two and four hours, depending on how much additional testing is needed. Renewals are shorter, often around one to two hours.
Costs vary by country and clinic, but a realistic range is:
- Initial Class 1: about €500–€800
- Renewals: about €300–€500
- Additional specialist assessments: often €200–€500 or more
Medical Standards and Common Conditions
The following sections summarize how some common medical issues are viewed in the Class 1 context. Many cases are not simply “yes or no” but require individual assessment.
Cardiovascular Conditions
Hypertension
Hypertension is common and not automatically disqualifying as long as:
- Blood pressure is controlled, generally below 160/95 mmHg
- There is no significant end-organ damage
- Medication does not interfere with safe performance
Arrhythmias and Cardiac Events
Benign, occasional rhythm disturbances may be acceptable, while sustained or symptomatic arrhythmias are more problematic. A history of myocardial infarction or coronary artery disease requires a significant recovery period and detailed testing. In some cases, pilots can return to flying with limitations such as an Operational Multi-Pilot Limitation (OML), regular follow-up and stricter monitoring.
Vision and Eye Conditions
Refractive errors such as myopia, hyperopia and astigmatism are usually acceptable if corrected within defined diopter limits and with good final acuity. Age-related presbyopia is typically managed with reading glasses or progressive lenses.
Refractive surgery is widely accepted if performed safely and documented correctly, but requires a waiting period and proof of stable results. Conditions like cataracts, glaucoma or retinal disease are assessed individually, with the key question always being: can the pilot meet the vision standards with or without treatment, and is the condition stable?
Color vision deficiency is treated carefully. If a pilot cannot pass standard color tests, further operational testing may be used to determine whether safe color perception exists. In some cases, operational limitations may be imposed.
Diabetes
Diabetes is an area where policy has evolved.
- Type 2 diabetes controlled by diet or certain oral medications is often compatible with flying if glucose values are stable and HbA1c remains within defined limits.
- Insulin-treated diabetes, including Type 1, was historically disqualifying for Class 1 but may now be accepted under very strict protocols, usually with an OML, continuous glucose monitoring and detailed follow-up. These cases are managed very carefully on a case-by-case basis.
Respiratory Conditions
Mild, well-controlled asthma is usually acceptable, especially if lung function tests are normal and there have been no recent severe exacerbations. More severe asthma, or frequent attacks, may require additional testing and tighter conditions.
Obstructive sleep apnea (OSA) has become a major focus. Pilots with OSA can often be certified if they are effectively treated (for example with CPAP), can demonstrate good compliance and have their daytime alertness restored. Without proper treatment, OSA is a significant safety risk.
Neurological and Psychological Conditions
A history of epilepsy is generally incompatible with Class 1 certification, particularly if seizures are unprovoked or recurrent. Single seizures under specific circumstances may sometimes be assessed more leniently after a seizure-free period and investigation.
Mental health conditions are assessed with nuance. Mild, well-controlled depression or anxiety may be compatible with flying, sometimes even with certain medications, if properly monitored. More severe conditions such as bipolar disorder or psychosis are usually disqualifying. PTSD and ADHD are assessed individually, with attention paid to symptom stability and any medications used.
Substance Use
Alcohol and drugs are taken very seriously. Any pattern of misuse, dependence or repeated incidents (e.g. DUI) can threaten both the medical and the license. Examiners and authorities may use history, clinical impressions and specific lab markers to monitor for problems. Illicit drug use is usually disqualifying and requires long-term abstinence and proof of recovery before any return to flying is considered.
Disqualifying Medications
Not all medications are compatible with flying. In general, drugs that impair alertness, cognition, reaction time, coordination or judgment are problematic.
Classes That Often Cause Problems
Examples include:
- Benzodiazepines and most sleeping pills
- Strong opioid painkillers
- Many antipsychotic drugs and some mood stabilizers
- Most stimulant medications used for ADHD
- Certain anti-arrhythmics and some beta-blockers
Commonly Acceptable Medications
Many everyday medications pose no problem, such as non-sedating antihistamines, proton pump inhibitors, most antibiotics, paracetamol, moderate use of ibuprofen, and many standard blood pressure medications. Even then, it is good practice to discuss any new long-term medication with your AME before you continue flying with it.
Medical Certificate Denial and Appeals
Reasons for Denial or Deferral
A certificate may be deferred if the examiner needs more information or specialist reports before making a decision. This is not a refusal, but a pause.
A denial occurs when you do not meet the required standards even after full evaluation. Common reasons include uncontrolled medical conditions, serious mental health issues, substance dependence, or incomplete or inaccurate information.
Appeal Process and Special Issuances
If you are denied, you can normally request the reasons in writing and submit additional evidence such as specialist reports or follow-up test results. The case may then be reviewed by a medical board at the aviation authority. In some situations, a certificate with limitations can be issued – for example with an OML (never fly as sole pilot), more frequent examinations or restrictions on the type of operation.
Maintaining Medical Fitness
Between Examinations
The responsibility for fitness does not stop with the expiry date of the certificate. Pilots are expected to self-monitor and ground themselves whenever they are unfit to fly – because of illness, injury, medication, fatigue, stress or any other factor that could compromise performance.
Good habits go a long way: regular exercise, a balanced diet, reasonable weight management, adequate sleep, and active management of stress. Routine health checks with your family doctor, dental care and regular vision and hearing assessments are all sensible.
When to Seek Help or Report
Certain events must be reported to your AME or authority, such as:
- Hospital admission
- Major surgery
- Diagnosis of a significant new condition
- Start of a new long-term medication with central effects
EASA Learning Objectives
LO 040.02: Medical Fitness
Under the ATPL learning objectives, medical fitness includes:
- Knowledge of certificate classes and validity periods
- Awareness of how common medical conditions affect pilot performance
- Understanding how medications can impact alertness and ability
- The principle of self-assessment and the duty to declare when unfit
Exam Tips & Common Question Areas
Typical topics that appear in exams include:
- Validity rules for Class 1, Class 2 and LAPL
- Thresholds for blood pressure and audiometry
- Basic vision standards, including color vision
- Conditions that are clearly incompatible with flying (e.g. uncontrolled epilepsy, untreated severe diabetes)
- Reporting obligations after hospital stays, surgery or serious new diagnoses
Simple mnemonics can help, but the main objective is to understand the underlying logic: if something could significantly and unpredictably affect your ability to operate safely, it must be taken seriously.
Practical Application
Before Starting Training
For anyone planning flight training, the medical is at least as important as the license itself. It makes sense to:
- Clarify your medical status early, preferably before committing large sums to training
- Deal with correctable issues such as untreated hypertension or poor fitness
- Budget realistically for initial and recurring medical costs
Airline Perspective
Airlines expect applicants to hold a valid, unrestricted Class 1 medical. A history of frequent deferrals, special issuances or repeated medical issues may prompt further questions, because it can affect reliability and long-term employability. Many operators also have their own internal medical policies and health programs.
A loss of medical can, in the worst case, mean a loss of flying employment – which is why income protection or loss-of-license insurance is an important topic for many professional pilots.
Recent Developments
In recent years, mental health and chronic disease management have received more attention. There is growing emphasis on:
- Better screening and support for mental health, including peer-support programs
- More refined policies for conditions such as insulin-treated diabetes, supported by modern monitoring technology
- Use of data from wearables and continuous monitoring devices in research to better understand fatigue, sleep and health trends in pilots
Conclusion
Medical certification is not a one-off hurdle but an ongoing part of being a pilot. Understanding EASA medical requirements – especially for Class 1 – helps you make better decisions about your health, training and career.
The process can feel demanding, but it is there to protect you, your colleagues and your passengers. If you maintain good health habits, stay honest and proactive with your medical care, and work with your AME rather than against them, you can navigate the system successfully and keep your medical – and your flying career – in good standing.
Your pilot license depends on your medical; looking after your health is one of the most important professional skills you will ever develop.
Related Articles:
- EASA Licensing Process
- EASA Part-FCL Regulations
- Human Performance and Limitations [?]
- Medical Certificate Guide [?]