Syncope occupational recommendations for Role 1 GPs
| Syncope classification | Subclassification | Applicability | Definitive provoking factor | Episode number | Occupational grade | Comment | ||
|---|---|---|---|---|---|---|---|---|
| Recruits | Serving Personal | Aircrew | ||||||
| Reflex (neurally mediated) syncope | X | X | X | Yes | 1 | P2 MFD | If a single episode with reversible provoking factor. In aircrew must be discussed with military MAME before flying status is confirmed37 | |
| X | No | 1 | P2 MFD | Must be 12-month syncope-free prior to P2 | ||||
| X | Yes or No | ≥1 | P7 MND (referral to OM for P8) | |||||
| X | X | No | ≥1 | P7 MND | Unfit flying Non-deployable, pending further review | |||
| X | Yes | ≥1 | P2 MFD | Must have avoidable triggers and prodromal symptoms | ||||
| X | Yes | ≥1 | P2 MFD | Must have recognised and avoidable triggers which are unrelated to flying | ||||
| Syncope secondary to orthostatic hypotension | Requiring medication to control syncope | X | Yes or No | ≥1 | P7 MND (referral to OM) | |||
| X | X | Yes or No | ≥1 | P7 MND (referral to OM) | Unfit flying non-deployable, pending further review | |||
| Responsive to conservative measures (PCM, hydration, etc) | X | Yes or No | ≥1 | P7 MND (referral to OM) | Requires CA/OM approval | |||
| X | Yes or No | ≥1 | P2 MFD | |||||
| X | Yes or No | ≥1 | P2 MFD | Requires clearance by CA/ Av Med | ||||
| Reversible cause (eg, medication cessation) | X | X | X | Yes or No | ≥1 | P2 MFD | Requires confirmation of reversal | |
| Unresponsive to therapy, pervasive unpredictable | X | Yes or No | recurrent | P7 MND (referral to OM for P8) | ||||
| X | X | Yes or No | recurrent | P7 MND | Unfit flying non-deployable, pending further review | |||
| Syncope secondary to arrhythmias as the primary cause | Congenital abnormalities | X | NA | NA | P7 MND referral to OM for P8) | Unless cleared by CA/OM | ||
| X | X | NA | NA | P7 MND | Unfit flying non-deployable pending further review | |||
| Requiring pacemaker | X | NA | NA | P7 MND (referral to OM for P8) | ||||
| X | X | NA | NA | P7 MND | Unfit flying non-deployable, pending further review | |||
| Requiring ICD | X | NA | NA | P7 MND (referral to OM for P8) | ||||
| X | X | NA | NA | P7 MND | Unfit flying non-deployable, pending further review | |||
| Requiring medication to control syncope | X | NA | NA | P7 MND (referral to OM for P8) | Unless as a bridge to successful ablation | |||
| X | X | NA | NA | P7 MND | Unfit flying non-deployable, pending further review | |||
| Successful ablation | X | NA | NA | P2 MFD | Requires confirmation of success | |||
| X | X | NA | NA | P2 MFD | Initial downgrading P7, non-deployable, unfit to fly until confirmation of success and CA review | |||
| Syncope secondary to structural disease | X | Any | ≥1 | P7 MND (referral to OM for P8) | ||||
| X | X | Any | ≥1 | P7 MND | Unfit flying non deployable, pending further review | |||
Av Med, Aviation Medicine; CA, Consultant Advisor; ICD, implantable cardioverter defibrillator; MAME, Military Aeromedical Examiner; MFD, medically fully deployable; MND, medically non-depoyable; NA, not applicable; OM, occupational medicine; PCM, physical counterpressure manoeuvre.