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An overview about contemporary global challenges to aviation regulators and airlines1Dr Tom Gaffney, 2Dr Elizabeth Wilkinson1Irish Aviation Authority, Dublin, Republic of Ireland2British Airways Health Services, Harmondsworth, UKRegulatory aviation medicine/aeromedicine, a subsection of occupational medicine, aims to determine whether pilots are medically fit to fly either routinely or in response to a decrease in medical fitness. Traditionally, change occurs very slowly in aviation medicine, new treatments and technologies must be evidence based and well established before the standards will change. The role of the aviation medical regulator (‘medical assessor’) has become more demanding in the past 20 years as many complex ongoing clinical conditions have now been deemed compatible with safe flight. Therefore, many pilots are now deemed fit to fly where formerly their careers would have ended. In addition, regulators (competent authorities) around the world determine the medical standard for their own jurisdictions and standards differ both within and between jurisdictions. Formerly in Europe, aeromedical standards were more prescriptive, now they are more risk based and open to interpretation. Pilots frequently change competent authority and jurisdiction; this presents a challenge to medical assessors. Due to recent adverse events, more aspects of pilot medical assessments are becoming mandatory including formal psychological assessment, drug and alcohol testing and peer support for both pilots and aeromedical examiners. There is also a drive to include health promotion and preventative medicine as an integral part of routine medical examinations for pilots. This has been strikingly absent to date as the routine medicals focus on a ‘pass/fail’ system. As with any change in aeromedicine, a way that is acceptable to all involved is being established currently. Regulatory aeromedicine is truly international largely due to the ‘client’ base and the many medical services and regulators they encounter around the world in the course of their careers. For these very reasons, it is also an exciting field to work in.In March 2015 another ‘unthinkable’ happened in aviation with the Germanwings disaster. The world was shocked as events unfurled, and for commercial aviation the tragic situation had to be risk assessed with speed. Individual airlines considered their own risk assessment and the European Aviation Safety Agency, EASA, set up a Task Force in May 2015, their report being published in July 2015. The Task Force made the following 6 recommendations:The principle of ‘two persons in the cockpit at all time’ should be maintained.Pilots should undergo a psychological evaluation before entering airline service.Airlines should run a random drugs and alcohol programme.Robust programme for oversight of aeromedical examiners should be established.A European aeromedical data repository should be created.Pilot support systems should be implemented within airlines.The French accident investigation report (BEA) was also published with its own recommendations. Such detailed analysis of all aircraft accidents is required to help improve flight safety and recommendations often follow, some more controversial than others. This presentation will review some of the recommendations in detail discussing the implications, implementation, and benefits to flight safety.