Guidance for Medical 

Screening of Commercial 

Aerospace Passengers

Melchor J. Antuñano1

Denise L. Baisden1

Jeffrey Davis2

John D. Hastings2

Richard Jennings2

David Jones2

Jon L. Jordan1

Stanley R. Mohler2

Charles Ruehle1

Guillermo J. Salazar1

Warren S. Silberman1

Phillip Scarpa2

Frederick E. Tilton1

James E. Whinnery1

1

Office of Aerospace Medicine

Federal Aviation Administration

2

Consultant

January 2006

Final Report

DOT/FAA/AM-06/1

Office of Aerospace Medicine

Washington, DC 20591
NOTICE

This document is disseminated under the sponsorship 

of the U.S. Department of Transportation in the interest 

of information exchange. The United States Government 

assumes no liability for the contents thereof.

___________

This publication and all Office of Aerospace Medicine 

technical reports are available in full-text from the Civil 

Aerospace Medical Institute’s publications Web site: 

www.faa.gov/library/reports/medical/oamtechreports/index.cfm
i

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. 

DOT/FAA/AM-06/1 

4. Title and Subtitle 5. Report Date 

Guidance for Medical Screening of Commercial Aerospace Passengers January 2006 

6. Performing Organization Code 

 

7. Author(s) 8. Performing Organization Report No. 

Antuñano MJ,1Baisden DL,1 Davis J,2 Hastings J,2Jennings R,2

Jones D,2 Jordan JL,1 Mohler S,2 Ruehle C,1 Salazar GJ,1 Silberman WS,1

Scarpa P,2 Tilton FE,1 Whinnery JE1

1

Office of Aerospace Medicine 2Consultant

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) 

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 11. Contract or Grant No. 

Oklahoma City, OK 73125 

12. Sponsoring Agency name and Address 13. Type of Report and Period Covered 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave., S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 

15. Supplemental Notes 

 

16. Abstract 

This document provides general guidance for operators of manned commercial aerospace flights 

(suborbital and orbital) in the medical assessment of prospective passengers.

This guidance is designed to identify those individuals who have medical conditions that may result in 

an inflight medical emergency or inflight death, or may compromise in any other way the health and safety 

of any occupants (crew members and passengers) onboard a commercial aerospace vehicle. Space flight 

exposes individuals to an environment that is far more hazardous than what is experienced by passengers who 

fly onboard current airline transports. With orbital and suborbital flights, pre-existing medical conditions can 

be aggravated or exacerbated by exposure to environmental and operational stressors such as acceleration, 

microgravity, and solar/cosmic radiation, among others. 

 

17. Key Words 18. Distribution Statement 

 

 

Manned Commercial Aerospace Flights, Medical 

Conditions, Environmental and Operational Stressors 

Document is available to the public through the 

Defense Technical Information Center, Ft. 

Belvior, VA 22060; and the National Technical 

Information Service, Springfield, VA 22161

 

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 9 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized 

1

Guidance for Medical Screening of Commercial Aerospace Passengers

Introduction

This document provides general guidance for operators of manned commercial aerospace flights (suborbital 

and orbital) in the medical assessment of prospective 

passengers. This guidance is designed to identify those 

individuals who have medical conditions that may result 

in an inflight medical emergency or inflight death, or 

may compromise in any other way the health and safety 

of any occupants (crew members and passengers) onboard 

a commercial aerospace vehicle. 

Space flight exposes individuals to an environment 

that is far more hazardous than what is experienced by 

passengers who fly onboard current airline transports. 

With orbital and suborbital flights, pre-existing medical 

conditions can be aggravated or exacerbated by exposure 

to environmental and operational stressors such as acceleration, microgravity, and solar/cosmic radiation, 

among others.

Categories of Passengers

In view of the wide variety of possible approaches that 

can be used to design and operate manned commercial 

aerospace vehicles in the foreseeable future, the medical 

screening guidance described in this document apply 

differently to two categories of passengers:

1. Passengers Participating in Suborbital Aerospace 

Flights (or exposed to a G-load of up to +3Gz

 during any phase of the flight). 

These passengers should complete a simple medical 

history questionnaire (see Appendix A) prior to every 

suborbital flight (single or multiple). A physician who 

is experienced or trained in the concepts of aerospace 

medicine should review the completed questionnaire. 

These passengers need not be required to undergo a 

physical examination or complete medical laboratory testing. However, nothing in this guidance should preclude 

the physical examination of any prospective aerospace 

passenger as deemed necessary by the physician who is 

authorized by a commercial aerospace vehicle operator 

to conduct medical assessments. Also, if the possibility 

exists that the G-load profile of any suborbital flight could 

exceed +3Gz, the passenger should be evaluated according 

to the recommendations for passengers participating in 

orbital aerospace flights.

2. Passengers Participating in Orbital Aerospace 

Flights (or exposed to a G-load exceeding +3Gz

 during any phase of the flight). 

These passengers should complete a more comprehensive medical history questionnaire (see Appendix B) and 

undergo a physical examination with laboratory testing. 

This recommendation applies to passengers involved in 

orbital flights of any duration (short or long) or in suborbital flights with high G-load profiles. The medical 

history, physical examination, and medical tests should 

be valid for a period of one (1) year. However, one to 

two weeks prior to each flight it is recommended that 

passengers should have their medical history updated 

and undergo an abbreviated physical examination to 

ensure that no significant medical changes have occurred 

since the completion of the initial medical screening 

examination.

This medical screening guidance is based on the 

assumption of an inflight cabin environment with a 

barometric pressure not exceeding 8,000 ft (10.91 psi), 

where passengers are not required to wear a pressurized 

suit. In addition, passengers are expected to be able to 

perform an emergency evacuation without assistance 

and not compromise the safety of other occupants (crew 

members and passengers).

For passengers who fly onboard an aerospace vehicle 

that accelerates faster than +3Gz, assumptions are made 

that such a vehicle will not exceed a maximum acceleration load (G-load) of +4Gz

 (gradual onset) during any 

phase of the flight, and passengers will not be required 
2

to use an anti-G suit. In general, the acceleration envelope recommended for the aerospace vehicle should not 

exceed +4Gz (-2Gz), ±4Gx and ±1Gy.

Acceleration Risks

The main risks for problems with acceleration in 

aerospace flight are associated with the neurological, 

cardiovascular, and musculoskeletal systems. To avoid 

the potential for compromising neurological function, 

acceleration forces are preferably applied in the frontto-back (+Gx

) direction (eyeballs in). An individual is 

very tolerant to +Gx acceleration, and with the heart and 

brain located at approximately the same level within 

the acceleration field there is little risk for acceleration 

(G)-induced loss of consciousness (G-LOC). Acceleration stress is known to be dysrhythmogenic (changes in 

cardiac rate, rhythm, and conduction). 

Higher and longer exposures to acceleration increase 

the frequency of dysrhythmias. As long as the head, neck, 

and spine are stabilized before the acceleration exposure 

and remain so until the exposure is completed, the potential for musculoskeletal injury is markedly reduced. 

An individual’s tolerance to head-to-foot (eyeballs down) 

acceleration (+Gz) is dependent on the individual’s anatomic and physiologic characteristics and the nature of 

the acceleration profile. 

The maximum +Gz level, exposure duration, and the 

rate of onset of the +Gz are important determinants of 

the risk of neurologic compromise, cardiac rhythm disturbances, and musculoskeletal (especially neck) injury. 

Onset-rates greater than 0.1G/second are considered 

rapid, since they exceed the ability of the cardiovascular system to fully respond to preserve adequate central 

nervous system blood flow. Rapid-onset rates of 1.0G/

second and greater can result in G-LOC without visual 

warning symptoms. 

Conservative relaxed, unprotected tolerance of completely healthy humans to +Gz

 acceleration is considered 

approximately +3Gz (normal range 3.1 to 4.0)for rapidonset profiles and increases to approximately +3.5Gz

(normal range 3.7 to 5.6) with gradual-onset profiles. 

Individuals with compromised cardiovascular anatomy 

or function may have reduced tolerances. Care should 

be exercised with rapid-onset profiles to +3Gz or more, 

sustained for 5 seconds or longer.

Medical Conditions That May Contraindicate 

Passenger Participation in Suborbital or Orbital 

Flights 

In general, medical conditions that may be contraindicated for aerospace flights include:

Any deformities (congenital or acquired), diseases, 

illnesses, injuries, infections, tumors, treatments (pharmacological, surgical, prosthetic, or other), or other 

physiological or pathological conditions that: 

1. may result in an inflight medical emergency, 

2. may result in an inflight death, 

3. may compromise the health and safety of the passenger or other aerospace vehicle occupants, and/or 

the safety of the flight, 

4. may interfere with the proper use (don and doff) and 

operation of personal protective equipment, or 

5. may interfere with inflight emergency procedures 

or emergency evacuation, or 

6. may have a negative effect on the passenger’s health as 

a result of exposure to aerospace flight. Any medical 

condition that may result in an unexpected inflight 

medical emergency represents a potential risk to the 

safety of the flight.

An established clinical diagnosis or finding of any of 

the following conditions may contraindicate participation in aerospace flight and should be further evaluated 

on a case-by-case basis:

• Acute or chronic use of any medication (prescription 

and/or non-prescription), drug, or substance

•	 Cancer

• Severe trauma or invasive medical procedures (diagnostic or therapeutic) associated with significant 

functional deficit
3

• Severe acute or chronic infections or communicable/

contagious diseases (including blood borne infectious 

diseases)

• History of individual exposure to ionizing radiation 

(single dose or cumulative) that exceeds the maximum 

exposure limit of 5 mSv in 5 years recommended 

by the International Commission on Radiological 

Protection

• Current pregnancy, recent post-partum (less than 6 

weeks), or recent spontaneous or voluntary termination of pregnancy

• Any psychiatric, psychological, mental, or behavioral 

disorder that would cause an individual to become a 

potential hazard to him/herself or to others

• Any other diseases, illnesses, deformities, injuries, 

infections, tumors, or treatments that may result in 

significant functional impairment or that may be aggravated by exposure to environmental or operational 

stress factors of aerospace flight

Disposition of Prospective Aerospace Passengers 

Who Have Medical Conditions That May

Contraindicate Participation in Aerospace Flight

Prospective aerospace passengers who have medical conditions that may contraindicate participation 

in aerospace flight could be given medical clearance, 

on a case-by-case basis, by a physician retained by the 

operator and who is trained or experienced in aerospace 

medicine.

Based on the specific nature of the medical condition, 

an individual should be temporarily prohibited from 

participation in aerospace flight until the medical condition resolves or until it can be effectively brought under 

medical control and it is no longer likely to result in: 

1. Inflight medical emergency 

2. Inflight death 

3. Compromising the health and safety of the passenger 

or other aerospace vehicle occupants, and/or the 

safety of the flight 

4. Interference with the use (don and doff) and operation of personal protective equipment 

5. Interference with inflight emergency procedures or 

emergency evacuation 

6. Having a negative effect on the passenger’s health 

as a result of exposure to aerospace flight. Prospective passengers should be cautioned on the 

potential hazards to health of aerospace flight, 

including the hazards of exposure to solar and 

cosmic radiation, acceleration, and microgravity. 

It must also be recognized that no conclusive data 

exist concerning the potential adverse physiologic 

and pathologic effects of space flight on infants 

or young children. For this reason, operators may 

wish to establish a minimum age for passengers 

participating in aerospace flights. 

A1

APPENDIX A

Medical History Assessments of Passengers 

in Suborbital Aerospace Flights

These prospective aerospace passengers should complete a questionnaire about their medical history of any 

of the following conditions: 

• Otitis, sinusitis, bronchitis, asthma, or other respiratory disorders

• Dizziness or vertigo

• Fainting spells, or any other loss of consciousness

• Seizures

• Tuberculosis

• Surgery and other hospital admissions

• Visits to physicians in the last 3 years

• Recent significant trauma

• History of decompression syndrome (DCS)

• Anemia or other blood disorders

• Heart or circulatory disorders, including implanted 

pacemaker or defibrillator

• Mental disorders

• Claustrophobia

• Attempted suicide

• Use of medications

• Alcohol or drug dependence or abuse

• Date of last menstrual period, current pregnancy, recent 

post-partum (less than 6 weeks), or recent spontaneous 

or voluntary termination of pregnancy

• Diabetes

• Cancer

• Rejection for life or health insurance

B1

APPENDIX B

Medical History Assessments of Passengers 

in Orbital Aerospace Flights

Prospective orbital aerospace passengers should complete a questionnaire about their medical history if they 

have a history of any of the following conditions:

•	 Otitis, sinusitis, bronchitis, asthma, upper respiratory 

infections, or other respiratory disorders

•	 Allergies

•	 Dizziness or vertigo

•	 Significant motion sickness requiring medication

•	 Fainting spells or any other loss of consciousness

•	 Seizures, convulsions, epilepsy, stroke, muscular weakness, or paralysis

•	 Tuberculosis, hepatitis, AIDS, or other chronic infectious disorder

•	 Surgery, recent or remote, or other admission to hospital

•	 Recent significant trauma

•	 Anemia or other blood disorders

•	 Heart or circulatory disorders, including implanted 

pacemaker or defibrillator

•	 Uncontrolled high or low blood pressure

•	 Mental disorders (including depression, anxiety, fear 

of flying, fear of heights, fear of closed spaces, fear of 

open spaces, etc.)

•	 Attempted suicide 

•	 Use of medications

•	 Alcohol or drug dependence or abuse

•	 Date of last menstrual period, current pregnancy, recent 

post-partum (less than 6 weeks), or recent spontaneous 

or voluntary termination of pregnancy

•	 Severe hay fever or allergies

•	 History of pneumothorax (collapsed lung)

•	 Kidney stones or blood in urine

•	 Gallstones or gallbladder disease

•	 Diabetes

•	 Cancer

•	 History of radiation treatment or occupational exposure 

to radiation

•	 Rejection for life or health insurance

•	 History of decompression syndrome (DCS)

•	 History of previous space flights

Physical Examination Assessments of Passengers in 

Orbital Aerospace Flights

Prospective aerospace orbital passengers should receive a general physical examination that includes:

•	 Vital signs (heart rate, respiratory rate, temperature, 

blood pressure)

•	 Head, face, neck, and scalp

•	 Nose, sinuses, mouth, throat, ears (including eardrum 

integrity and function, Eustachian tube function)

•	 Ophthalmological evaluation (including pupil function, ocular motility)

•	 Lungs and chest

•	 Heart (including precordial activity, rhythm, sounds, 

murmurs)

•	 Peripheral vascular system

•	 Abdomen and viscera (including hernia)

•	 Genitourinary system

•	 Upper and lower extremities

•	 Spine

•	 Lymphatics

•	 Rectal, pelvic, and breast examination should be performed only if indicated by medical history

•	 General neurological evaluation

•	 General psychiatric evaluation (appearance, behavior, 

mood, communication, and memory)
B2

Medical Testing of Passengers in Orbital 

Aerospace Flights

Prospective passengers in Orbital Aerospace Flights 

should complete the following general medical tests:

•	 Routine hematology

•	 Clinical chemistry (serum)

•	 Urinalysis

•	 Resting EKG

•	 Chest X-rays (PA & lateral)

•	 Visual acuity (corrected)

•	 Pregnancy testing (optional)

•	 Hearing (conversational voice at 6 ft)

•	 Tympanometry and/or tonometry (if clinically indicated)

•	 Pulmonary function testing (if clinically indicated)

Pre-Flight Medical Interview and Physical 

Examination Requirements for Passengers in 

Orbital Aerospace Flights

Prior (within one to two weeks) to the actual departure 

of an orbital commercial aerospace flight, all passengers 

should be subjected to an abbreviated pre-flight medical 

interview and physical examination. The purpose of 

this pre-flight medical screening is to ensure that these 

passengers have not developed medical conditions that 

may have occurred since the last medical clearance was 

issued. Such a pre-flight medical screening should include vital signs and a brief medical history and physical 

examination concentrating on the following: eye, ear, 

nose, throat, cardiopulmonary, gastrointestinal tract, 

musculoskeletal, and neurological systems. A brief mental status assessment should also be obtained. Because 

of the potential hazards of aerospace flight (including 

exposure to solar and cosmic radiation, acceleration, 

and microgravity), it is recommended that a female of 

child-bearing age be offered a pregnancy test. Operators 

may wish to consider excluding pregnant women from 

participating in aerospace flights.