TPM Review – MED

TPM Review – MED

61ST ANNUAL CONFERENCE, 23-27 May 2022

WP No. 78

TPM Review – MED

Presented by PLC



Over the past few years, PLC came to the conclusion that the TPM was in need of a significant overhaul in order to ensure consistency throughout the manual and with ICAO. Every year, several slight changes are made to individual policies, but there is a need to look at the entire TPM in a holistic way.


1.1. The TPM is the main document used by TOC, PLC, ICAO representatives and other liaison officers as well as Member Associations, when there is a need to advocate a position on behalf of IFATCA or to push IFATCA’s policies at the global level. It is obvious that, for these reasons, the manual has to be as up to date as possible and as easy to use and refer to as it can be; this brings the need for a significant update this year.

1.2. This paper is one of multiple papers that will look at some editorial changes to the MED (Medical Matters) section of the TPM. This paper does not propose changes to the content or the intent of policies; changes proposed are purely editorial, but since they affect policies, they need to be presented in due form to Committee C at Conference.


2.1. In MED 9.1.1, 3rd paragraph, it is not clear who ATC authorities represent; it is therefore proposed to replace “ATC authorities” with “ANSP”, for clarity:

IFATCA TPM (2019), MED 9.1.1 – General

The cost of the examinations should be borne by the ATC authorities ANSP.


2.2. In MED 9.1.1, the 7th paragraph requests MAs to put pressure on their government to establish and publish statistics on medical problems experienced by controllers. It can be argued that such statistics shall not be made public, as requested by the policy, because of obvious confidentiality issues (the policy does not specify de-identification anywhere). The paragraph should be deleted:

IFATCA TPM (2019), MED 9.1.1 – General

Member Associations are requested to act on their governments to have them establish and publish statistics on all medical problems of air traffic controllers. 


In the 8th paragraph, the requirements for medical examination are covered already by ICAO Annex 1, 1.2.4, 1.2.5, etc. and also in Annex 1, Chapter 6. It is also covered by the 11th paragraph of MED 9.1.1: “The medical requirements for ATC employment must be stated by the appropriate ATC authorities and should be based on the criteria laid down in Annex 1 to the ICAO Convention.” It is therefore proposed to delete this paragraph of the policy:

IFATCA TPM (2019), MED 9.1.1 – General

Air traffic controllers should be subject to medical examination, both prior to employment in the profession and on a regular basis during their career. Such examinations should be capable of detecting any medical deficiencies prior to or during ab-initio training and provide for a thorough monitoring of the air traffic controller’s health throughout his career.


In the 9th paragraph, it is proposed to amend slightly the policy as presented below, since ICAO is the governing body that determines the medical standards for air traffic controllers, and not each State. Furthermore, the TPM should not refer to “countries” but rather to “member associations”, since some of our MAs represent more than one country.

IFATCA TPM (2019), MED 9.1.1 – General (cont’d)

Each country member association should carry out medical studies to determine medical standards for air traffic controllers, including the identification of on the cause of stress among air traffic controllers, and investigate methods of prevention of such stress as well as diagnosing and treating its manifestations.


In the 10th paragraph, last sentence, it is unclear what exactly is the role of training facilities in maintaining health standards for controllers. The last sentence of the paragraph should be deleted.

IFATCA TPM (2019), MED 9.1.1 – General (cont’d)

Air traffic controllers should be provided with adequate protection measures designed to prevent loss of licence on medical grounds. This protection should include the availability of the appropriate training facilities to assist the air traffic controllers concerned in maintaining the required health standards. 


2.3. On the second page of MED 9.1.1, 1st paragraph, it is proposed to replace “must” with “shall” for consistency.

Further down, the second portion of the policy stands alone without any title and would read better than as a list, as it is currently.

In the 3rd portion of the policy, to be in line with last year’s changes to the IHB, information should be forwarded to the Office who will dispatch as appropriate.

Finally, in the last portion, it is proposed to remove the words “after consultation with the Chairman of PLC”, since the Executive Board (and in particular EVPP) will consult in any case, as required, with the appropriate resources.

IFATCA TPM (2019), MED 9.1.1 – General (cont’d)

The medical requirements for ATC employment must licensing shall be stated by the appropriate ATC authorities and should be based on the criteria laid down in Annex 1 to the ICAO Convention.


Physical fitness programme:

a) National administrations should consider the health of air traffic controllers by setting up a physical fitness programme open to all controllers on a voluntary basis.

b) No direct relationship should exist between a physical fitness programme and annual medical examination (if any).

c) Participation in a physical fitness programme shall have no effect whatsoever on the controller’s annual leave or spare time and the costs involved shall be carried by the employer.

MAs who have information relating to the medical aspects of the ATC profession, which they consider to be of interest, should forward such information to PLC the IFATCA Office.

IFATCA representation should participate at national and / or international aviation medical conferences or seminars whenever this is considered to be relevant to MAs, to be decided by the Executive Board, after consultation with the Chairman of PLC.


2.4. In MED 9.2.2, it is proposed to direct the findings to the IFATCA Office instead of PLC directly, as for any such communication. It is also proposed to slightly edit the last part of the sentence for clarity:

IFATCA TPM (2019), MED 9.2.2 – Ocular Problems

Member Associations shall approach their national administrations in order to establish a regular ophthalmic examination scheme including a written record of the finding in an appropriate form, and shall advise PLC of results of this communicate to the IFATCA Office the results and any other relevant studies.


2.5. MED 9.2.3 is in toto guidance material that should be removed from the TPM and inserted in the IFATCA Guidance Material on CISM (2019). It is proposed to move the entirety of the policy to that guidance material.

IFATCA TPM (2019), MED 9.2.3 – Stress and stress management

Occupational stress is now recognised as an increasingly global phenomenon, affecting all categories of workers, all work places and all countries. Several studies have revealed with scientific integrity that considerable levels of occupational stress reactions have been identified among different groups of air traffic controllers. […]



2.6. In MED 9.2.4, the 1st and 5th paragraph contain relevant information, but are not actual policy. They would be better housed as intro to the policy. It is proposed to move them above the policy.

IFATCA TPM (2019), MED 9.2.4 – Critical Incident Stress Management

Stress prevention at the work place has proved particularly effective in combating stress, by attacking its roots and causes, rather than merely treating its effects.


(Critical incident stress management (CISM) is a wide range of programmes and intervention strategies which have been designed to mitigate the impact of stress in personnel and to assist them in managing and recovering from significant stress. (Adapted from Jeffrey Mitchell Ph.D.) [San José 86.C.6-8, amended Taipei 97.C.6].



2.7. In MED 9.2.5, 4th paragraph, it is proposed to replace “must” with “shall” for consistency. In the following paragraph, it is proposed to replace “POLSTATs elsewhere refers” by the appropriate reference, i.e. WC 8.3.1. In the 7th paragraph, the definition of strategic nap should be moved to acronyms and terms:

IFATCA TPM (2019), MED 9.2.5 – Fatigue in Air Traffic Control

The provision of a satisfactory working environment appropriate rostering, rest periods, facilities, use of overtime, relief controllers and education in human factors shall be agreed with the air traffic controllers involved. Attention must shall be given to individual differences, age and gender.

In exercising the responsibilities of designing of duty rosters (POLSTATs elsewhere refers see WC 8.3.1), management shall be responsible for providing physical arrangements (relief controllers and adapted rest area) and sufficient break periods for controllers to try to maintain their daily eating habits regardless of which shift they are working. […]

A strategic nap is defined as a short period of sleep taken at specific times during a night shift. Recommended duration of a strategic nap varies from maximum 20 minutes for a nap early in the night to maximum 50 minutes late in the night (after 4am).

[EDITORIAL: move definition to “Acronyms and Terms”.]


2.8. On the following page, it is proposed to replace “air traffic service providers” by the appropriate term, i.e. “air navigation service providers”. The provisional policy that follows (on FRMS) can now be deleted, since its goal has been achieved with the publication of “Fatigue Management Guidance For ATS Providers” IFATCA/ICAO co-signed guidance material document (2016), and with the FRMS provisions contained in PANS-ATM, which became applicable in November 2020.

IFATCA TPM (2019), MED 9.2.5 – Fatigue in Air Traffic Control (cont’d)

The Regulator / Legislator should: […]

  • require all air traffic navigation service providers (ANSPs) to maintain auditable fatigue management systems and establish this as a key element of a target level of safety.

IFATCA Provisional Policy is:

The FRMS elements model


2.9. In MED 9.2.6, 1st paragraph, it is proposed to replace “must” with “shall” and, in the 3rd paragraph, to add “shall” after “Pregnant ATCOs”, for consistency:

IFATCA TPM (2019), MED 9.2.6 – Work as ATCO When Pregnant

Pregnancy is a normal female human condition which must shall not result in automatic suspension of an ATCO’s licence.


Pregnant ATCOs shall have the right to expect that the possible physiological problems associated with pregnancy will be accommodated by their employers in the form of available relief staff.


2.10. In MED 9.2.9, to be consistent with terminology used elsewhere in IFATCA documents, it is proposed to reword slightly the policy to make it plural and fully gender neutral:

IFATCA TPM (2019), MED 9.2.9 – ATCOs With Disabilities

If an ATCOs losing their loses his/her license due to a permanent disability, he/she should where possible be offered an alternative position.



3.1. The TPM is in need of a significant overhaul in order to ensure consistency throughout the manual and with ICAO. This paper is one of several papers addressing this issue, addressing in particular the editorial changes needed for the MED (Medical Matters) Section of the manual.


4.1. It is recommended that the abovementioned sections of the Technical and Professional Manual (TPM) be amended accordingly, as described in Section 2 of this working paper.


IFATCA. (2019). IFATCA Technical and Professional Manual (TPM). 2019 Ed. Montréal, Canada: International Federation of Air Traffic Controllers’ Associations.


Last Update: July 30, 2022  

July 20, 2022   244   Jean-Francois Lepage    2022    

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