The CAME designation makes you a physician appointed by Transport Canada's Minister to examine the medical fitness of licence applicants and report your findings to the Civil Aviation Medicine Division. Prepare by mastering Standard 424 of the Canadian Aviation Regulations: your examination and reporting duties, how flexibility works, who resolves difficult cases, and the applicant-facing logistics your candidates will ask about.
What the CAME designation actually is
A Civil Aviation Medical Examiner is a physician appointed by the Minister of Transport to examine the medical fitness of candidates for pilot and Canadian civil aviation personnel licences, reporting the findings to the Civil Aviation Medicine Division.
Standard 424 of the Canadian Aviation Regulations defines the role precisely. Appointments are made on an individual basis to provide the CAME service in a particular area, typically to physicians in private practice.
Authorization can also be issued to Canadian Forces Flight Surgeons for examining Canadian Forces members and Air Cadets, under an amendment effective December 17, 2025.
The Handbook for Civil Aviation Medical Examiners (TP 13312) adds context on how the role is positioned: as a CAME you are usually the only person who physically examines the pilot or air traffic controller, and you act as an agent of the Minister while performing the function.
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17; Handbook for Civil Aviation Medical Examiners – TP 13312 — Foreword, Section 1, diabetes guidelines and Appendix 1
The legal framework you work within
Canadian aviation medical requirements live in Part 404 of the Canadian Aviation Regulations, with the actual medical standards in Standard 424, aligned with international ICAO standards.
Minimum medical fitness requirements for licence types are broadly defined by international agreement through the International Civil Aviation Organization, and Canadian procedures and standards reflect those international practices.
The regulations also build in flexibility. CAR 424.05 allows Civil Aviation Medicine to certify pilots and controllers who technically miss a standard, where an accredited medical conclusion shows that exercising the licence privileges is not likely to affect air safety.
The handbook supplements the rules with guidance in the areas that cause the most certification difficulty: neurology, cardiology, diabetes, asthma, and psychiatry including SSRI policies. Treat those sections as your core clinical reading list for the designation.
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17; Handbook for Civil Aviation Medical Examiners – TP 13312 — Foreword, Section 1, diabetes guidelines and Appendix 1
Your duties at the examination
Under paragraph 424.17, you examine the applicant against recognized medical practice and the licensing standards, record your findings on Form 26-0010, and submit the report to the Minister.
The examination must be thorough enough to determine whether the applicant meets the standard for the medical category sought. The report must record your clinical findings, confirmation that health promotion activities took place, and the category, where the applicant meets its requirements.
Where the applicant meets the renewal standards, you sign, date and stamp the medical certificate as fit. Where you cannot reach a conclusion, you omit the category and refer the report to Civil Aviation Medicine staff for assessment or advice.
The applicant has obligations too. At the examination they must sign a declaration about previous aviation medical examinations, answer your pertinent questions, authorize disclosure of medical information to a physician they name, and undergo any other tests you require.
The report form is the Civil Aviation Medical Examination Report, Transport Canada Form 26-0010, and it requires the signature of both you and the applicant. Pertinent specialist and laboratory reports go to the appropriate regional office for the attention of Civil Aviation Medicine Division medical staff.
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17
Medical categories and flexibility
Medical categories grade the fitness needed for different aviation activities, and flexibility lets specific applicants who miss a standard still fly, under strict conditions and with the licence endorsed with limitations.
Category 1, for example, is the standard for the professional pilot and covers licences involving flying for hire and reward. Applicants wanting a higher category than their licence needs must tell you, and specialist tests for that higher assessment can be arranged with the applicant's agreement.
Flexibility under 424.05 requires an accredited medical conclusion that the failure to meet a requirement is not likely to affect air safety, consideration of the applicant's relevant ability, skill and experience, endorsement of the licence with any needed limitations, and the applicant's compliance with required conditions.
When you judge that an applicant's demonstrated ability compensates for a missed standard, you report the case to the Regional Aviation Medical Office. Applying flexibility is then a joint responsibility of the Civil Aviation Medicine Division and Transport Canada's Personnel Licensing Branch.
A practical flight test can form part of the evaluation. It is requested by the Regional Aviation Medical Officer or an Aviation Medical Officer and approved by the Regional Director Aviation Licensing, and only when needed to evaluate the applicant's capabilities accurately.
The standard gives worked examples. A monocular applicant can be certified for licences requiring Category 3 or lower after an ophthalmologist's report on the better eye, an adequate adaptation period, and a satisfactory practical test, with an eye specialist's report at each renewal. Paraplegic applicants can be certified for permits and licences below commercial level, with the licence endorsed for hand-controlled aircraft types demonstrated by flight test, and a validity period limited to twelve months.
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17
Who decides, and how unfit assessments are appealed
Both you and the regional medical staff assess examination reports. Where assessments differ, the regional or clinical assessment applies, and unfit applicants have defined reconsideration and appeal routes.
Medical examination reports are assessed by the Civil Aviation Medical Examiner and by the Regional Aviation Medical Officer or Aviation Medical Officer. Where their assessment differs from yours, theirs applies, and specialist reports may go to the Chief, Clinical Assessment for consultation.
An applicant assessed unfit at the regional level can submit additional reports from CAMEs, specialists and laboratories for reconsideration, and can ask for the file to go to the Aviation Medical Review Board.
Appeal can also be made to the Civil Aviation Tribunal where a holder is assessed unfit to exercise licence privileges or a renewal is refused. In practice, Transport Canada emails unfit applicants a description of the assessment and how to appeal it.
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17; How to apply – Medical fitness for aviation, Transport Canada — Initial applications, renewals, telemedicine, fees
What your applicants will experience
Applicants book with a designated CAME from the published list, bring identity and medical documents, and receive a medical certificate label if assessed fit. Fees are set by the examiner, not by Transport Canada.
Only a physician designated as a CAME may perform the official exam within Canada, so candidates find a nearby examiner on Transport Canada's approved list and book an appointment.
Applicants are told to bring photo ID, a medication list with dosage and frequency, a lens prescription, their family doctor's contact details, their pilot permit or licence number if they hold one, their last twelve months of flight time, and information on their personal and family medical history including prior examination reports, audiograms and electrocardiograms.
If the applicant is fit, Transport Canada issues the certificate as a label to place in the aviation document booklet; aviation students receive a standalone certificate. Renewal exams are required anywhere from every six months, for professional pilots 40 and over, to every five years, for private or balloon pilots under 40.
Renewal can also happen by telemedicine, but eligibility is narrower. As of March 4, 2025, applicants qualify only if their previous examination was in person, and a telemedicine renewal is valid for at most twelve months, or six months for applicants 60 or older, or 40 or older flying single-pilot with passengers. New applicants and anyone whose certificate expired before March 17, 2020 must renew in person.
Costs split in two: the CAME sets the examination fee and explains it at booking, while any Transport Canada processing fee is invoiced separately and paid online.
Official sources used: How to apply – Medical fitness for aviation, Transport Canada — Initial applications, renewals, telemedicine, fees
How deep the handbook guidance goes: the diabetes protocol
Handbook TP 13312 gives operational protocols for the main aeromedical problem areas. Its insulin-treated diabetes rules are a good example of the detail level you are expected to know.
For applicants on glucose-lowering medication, agents with low hypoglycemic risk must be at a stable dose for at least three months, and higher-risk agents for at least six months. Blood glucose control must be stable for at least three months, with A1c generally between 6 and 8.5, and monitoring uses a memory-chip glucometer with a glucose source carried in flight.
Cardiovascular risk assessment starts at diagnosis or initial application and continues annually, with cardiac screening after age 40. Certification validity under this protocol is no greater than one year.
For insulin-treated pilots, the in-flight rules are specific: blood glucose must be above 6.0 mmol/L but not above 15 mmol/L within the 30 minutes before flight, checked every 60 minutes during flight, with 10 g of carbohydrate taken if a reading falls below 6.0 mmol/L. A single-pilot pilot must land as soon as safely possible if glucose ever exceeds 15 mmol/L. The exercise below lets you apply these rules step by step.
The handbook notes itself that it is an introduction to aviation medicine rather than a full textbook, so expect to build on it with further study in each condition area.
Worked exercise
Under the handbook's protocol for insulin-treated pilots, blood glucose must be above 6.0 mmol/L but not above 15 mmol/L within the 30 minutes before flight, monitored every 60 minutes in flight. If a reading falls below 6.0 mmol/L, 10 g of carbohydrate is taken; if an in-flight check cannot be done for operational reasons, 10 g of carbohydrate is taken, but not on two consecutive 60-minute occasions without a measurement. A single-pilot applicant measures 5.6 mmol/L, 25 minutes before departure. In flight, the 60-minute check is missed for operational reasons; the check at 120 minutes reads 5.2 mmol/L. State what the protocol requires at each step, and what applies if a later in-flight reading exceeds 15 mmol/L.
Show answer
Before departure: 5.6 mmol/L is below the 6.0 minimum, so the applicant takes 10 g of carbohydrate, and the pre-flight requirement is not met until a recheck within the 30-minute window shows a value above 6.0 mmol/L and not above 15 mmol/L. At the 60-minute mark: because the check could not be done for operational reasons, 10 g of carbohydrate must be taken at that point, and this fallback cannot be repeated on the next consecutive 60-minute occasion without an actual measurement, so a reading is required at the following check. At 120 minutes: the 5.2 mmol/L reading is below 6.0, so another 10 g of carbohydrate is taken. If any in-flight reading exceeded 15 mmol/L, no further caloric intake is allowed until after retesting, and because this applicant flies single-pilot, they must land as soon as safely possible.
Each step maps directly to a rule in the handbook's protocol: the 6.0 to 15 mmol/L pre-flight band within 30 minutes of flight, the 10 g carbohydrate response to any reading below 6.0 mmol/L, the carbohydrate fallback for a missed in-flight check with its two-consecutive-occasions limit, and the exceed-15 mmol/L rules including the single-pilot landing requirement. The distractor to avoid is treating the missed 60-minute check as excused without consequence: the protocol explicitly substitutes carbohydrate intake and then demands a real measurement at the next check.
Official sources used: Handbook for Civil Aviation Medical Examiners – TP 13312 — Foreword, Section 1, diabetes guidelines and Appendix 1
Preparing for the designation
Read Standard 424 and the current handbook sections directly, rehearse the decision pathways, and take administrative details from Transport Canada's live pages rather than from memory.
A workable sequence: start with Standard 424 so the definitions, duties and flexibility conditions are exact, then work through the handbook's neurology, cardiovascular, diabetes, asthma and psychiatry sections as your clinical priorities.
Practise the role boundary explicitly. For any finding you meet in practice, ask three questions: does the applicant meet a category, do I report the case to the Regional Aviation Medical Office, or do I omit the category and refer the file to Civil Aviation Medicine staff? Those are the pathways the standard actually defines.
For administrative ground that shifts, such as telemedicine eligibility, fees and certificate validity, verify against the medical fitness pages on the Transport Canada site. The handbook's online page notes that the older 2004 PDF was removed because it is not the current version, which is a reminder to work from live documents.
If you are a physician seeking the designation itself, the sources confirm appointments are made individually for a particular area; check Transport Canada's CAME pages for the current application process, which the retrieved documents do not detail.
- Read Standard 424 end to end, focusing on 424.05, 424.11, 424.12, 424.16 and 424.17
- Study the handbook's protocol sections: neurology, cardiovascular, diabetes, asthma, psychiatry (SSRIs)
- Rehearse the three decision pathways: certify a category, report to the regional office, or refer the file
- Verify live administrative rules, including telemedicine eligibility and fees, on Transport Canada's pages
Official sources used: Standard 424 – Medical Requirements – Canadian Aviation Regulations (CARs) — Divisions I–V, especially 424.05, 424.11, 424.12, 424.16, 424.17; How to apply – Medical fitness for aviation, Transport Canada — Initial applications, renewals, telemedicine, fees; Handbook for Civil Aviation Medical Examiners – TP 13312 — Foreword, Section 1, diabetes guidelines and Appendix 1
Official sources used
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