Introduction and summary of principal conclusions of the Second European Workshop in Aviation Cardiology.

Aviation is the only system of mass transportation regulated by international statute. The responsible agency is the International Civil Aviation Organization (ICAO), a safety directorate of the United Nations Organization. In 1995 almost 1-3 billion passengers were carried by the airlines of the world, the previous decade having seen a 50% growth in the number of passengers and the amount of freight carried. The total complement of professional pilots world-wide is approximately 455,000, although a significantly greater number of licence holders are involved in private or recreational flying. Approximately 11,500 large commercial transport aircraft are in service. All nations are signatories to the Chicago Convention of 1944, which, with its Annexes, forms the legal basis for an international agreement on aviation safety. Chapter six of Annex I contains the 'International Standards and Recommended Practices' (ISARPs) for the medical licensing of personnel which have been adopted and revised from time to time by the ICAO. The standards are interpreted by the relevant chapter in the Manual of Civil Aviation Medicine, first published in 1974 and last revised 18 years ago. Its status is only advisory, and it is currently being rewritten. As a part of the European harmonization process, the Joint Airworthiness Authorities directorate (now the Joint Aviation Authorities (JAA)) was set up as a supranational European body to agree explicit standards for the 29 signatory nations, and to regulate all aspects of certification. The new medical standard, which is complementary to that of the ICAO, is due to be promulgated in July 1999 whilst the cardiological standard, which has already undergone comprehensive revision, has yet to be agreed. Hafner has reviewed the JAA process in this supplement.