Aco Av Med Form 1 - Air Cadet Medical History
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1
2ACO Av Med Form 1
OFFICIAL - SENSITIVE - MEDICAL (WHEN COMPLETE)
CONDITIONS REQUIRING MEDICAL ASSESSMENT FOR VGS GLIDING/AEF FLYING
TO COMPLETE TICK RESPONSE Y/N
CONDITIONS REQUIRING SCRUTINY
YES / NO
IF YES
DO NOT FLY WITHIN 24HRS OF TREATMENT. IF APPLICABLE
o
o
Has the Cadet had a recent immunisation (inoculation / vaccination) or given a blood donation?
No
Yes
GIVE DATE OF TREATMENT IN FURTHER INFO BOX.
Does the Cadet suffer any acute or chronic illness/condition or started a new course of
o
o
treatment which would be aggravated by flight? This includes unstable illnesses which are
No
Yes
DO NOT FLY UNTIL RECOVERED
likely to cause sudden incapacitation within the timescale of flight.
Is the Cadet impaired by an injury limiting the use of their limbs? For example sprains, strains
o
o
No
Yes
DO NOT FLY UNTIL RECOVERED
or broken bones?
o
o
Is the Cadet suffering from an ear, nose, throat or sinus conditions?
No
Yes
DO NOT FLY UNTIL RECOVERED
o
o
Is the Cadet pregnant?
No
Yes
DO NOT FLY
o
o
Does the cadet have a condition that requires the use of oxygen therapy?
No
Yes
DO NOT FLY
Does the Cadet have a limited exercise capacity or tolerance, due to chest (heart or lung)
o
o
illness or disease? If the Cadet can walk 50 yards/metres at a normal pace or climb one flight of
No
Yes
DO NOT FLY
stairs without severe breathlessness select NO.
o
o
Does the Cadet experience fits, faints or blackouts (including epilepsy)
No
Yes
DO NOT FLY
Has the Cadet undergone a recent surgical procedure or had a general, spinal or epidural
DO NOT FLY UNTIL FULLY RECOVERED - MINIMUM 7 DAYS. IF
o
o
anaesthetic? Note: For dental (local) anaesthetics Cadets are not permitted to fly for 24Hrs after
No
Yes
APPLICABLE GIVE DATE OF TREATMENT IN FURTHER INFO
procedure.
BOX.
DO NOT FLY FOR 1 MONTH FROM LAST TREATMENT. IF
Does the cadet suffer from a pneumothorax (a 'collapsed lung' where air is trapped between
o
o
No
Yes
APPLICABLE GIVE DATE OF TREATMENT IN FURTHER INFO
lung and chest wall)?
BOX.
Does the Cadet have an acute, unstable or untreated psychiatric conditions. For example: Fear
o
o
No
Yes
DO NOT FLY UNTIL TREATED AND SYMPTOMS STABLE
of flying, claustrophobia or panic attacks.
Does the Cadet have any stable chronic disease not covered above or any disease with a
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
No
Yes
sudden or unpredictable onset or deterioration.
PROCEDURE - REF: ACTO 31 / 32
Does the Cadet have stable Asthma (STEP 1 or 2)? The Cadet is considered unstable if they
have night symptoms waking them more than once a week or if they require daytime reliver
FIT TO FLY IF CONDITIONS STABLE - MUST CARRY
o
o
No
Yes
medication more than 3 times a week. If Cadet has used oral steroids or antibiotics to treat
MEDICATION IN FLIGHT
Asthma within the last 6 months start F6424 procedure.
Does the Cadet have Asthma which is not stable (STEP 3 or above)? This includes the use of
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
No
Yes
long-acting beta agonists, oral treatments or high-dose steroids?
PROCEDURE. REF: ACTO 31 / 32
Does the Cadet have Type 1 Diabetes.
Note:
Type 1 Diabetes is acceptable if blood sugars are well controlled. An insulin pump (if used)
FIT TO FLY IF CONDITIONS STABLE - MUST CARRY GLUCOSE
o
o
No
Yes
must be able to be moved as to be fitted in to flying clothing. Check sugars prior to flight.
IN FLIGHT
Type 2 Diabetes is acceptable.
Does the Cadet have a haematological (blood) disorder? For example: Sickle-Cell disease,
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
No
Yes
Anaemias or Haemophilia. Note: All haematological disorders should be considered.
PROCEDURE. REF: ACTO 31 / 32
RISK ASSESS. DO NOT FLY WITH SYMPTOMS OR ATTACK CAN
o
o
Does the Cadet have a history of Migraines?
No
Yes
OCCUR WITHIN FLIGHT TIMEFRAME
Does the Cadet have a cognitive, emotional, behavioural or developmental condition? For
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
No
Yes
example: ADHD, conduct disorders, dyspraxia and autism spectrum disorders.
PROCEDURE. REF: ACTO 31 / 32
Is the Cadet impaired by any stable injury, illness or congenital condition limiting mobility or
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
No
Yes
use of limbs?
PROCEDURE. REF: ACTO 31 / 32
ATC SQN OC / CCF (RAF) SECT CDR START F6424
o
o
Does the Cadet have any psychiatric disorder?
No
Yes
PROCEDURE. REF: ACTO 31 / 32
Does the Cadet suffer from any severe allergy (requiring the use epipen or equivalent)? Cadets
FIT TO FLY IF CONDITIONS ARE ACCEPTABLE TO FLIGHT
o
o
with very severe allergies which are unstable or unpredictable are unfit for flight. Those likely to
No
Yes
ENVIRONMENT. MUST CARRY MEDICATION IN FLIGHT
be exposed to allergens in flight (Rubbers, Plastics) are also unfit to fly.
Further Information:
Cadet Name:
ATC Sqn / CCF (RAF) Section:
ATC Wing / CCF (RAF) Contingent:
Signature of Cadet:
Date:
Declaration: I hereby declare that I have carefully considered the statements made above and that to the best of my belief they are complete and correct and that I have not withheld any
relevant information or made any misleading statements. I also confirm that should the cadets medical history change since the medical examination above, I will ensure that the relevant
ATC Sqn OC / CCF (RAF) Section Cdr is informed and a new ACO Av Med Form 1 is produced.
Parent/Guardian Signature:
VERSION 1.02 (PAPER)
PERIOD OF VALIDITY: VALID FOR THREE MONTHS FROM DATE OF DECLARATION
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