By Robert N. Rossier, EAA 472091
This piece originally ran in Robert’s Stick and Rudder column in the October 2022 issue of EAA Sport Aviation magazine.
One of the most important things we do before every flight is evaluate the health and airworthiness of our aircraft. Before it’s even out of the hangar or off the tiedowns, we inspect our aircraft to identify any damage or issues. We check the fuel and oil, examine the fuselage and flight controls, check the landing gear and brakes, look under the cowl, check the propeller, check for blockages of the pitot-static system, and look for any signs that something is amiss. But we don’t stop there. Before we commit to the air, we verify that the systems are operating properly. We check brakes, engines, magnetos, vacuum system, electrical system, flight instruments, and so on. By the time we’re rolling down the runway, we have a pretty good idea that the aircraft can fly safely.
Of course, we need to ensure that we are also of good health and airworthiness. This is perhaps something that we don’t evaluate as completely as the aircraft we fly. Perhaps the reason is that we simply don’t recognize some of the risks that can be present. But data suggests this is an area where we need to focus a bit more of our attention. In fact, our personal fitness for flight — or lack thereof — can be a contributor to accidents, even at times when we think we’re good to go.
A Frightening Trend
Somewhat surprisingly, the NTSB does not cite the use of drugs or medications by pilots involved in many fatal accidents. The Civil Aerospace Medical Institute (CAMI) Forensic Toxicology laboratory took the lead to investigate the potential contribution of drugs and medicine in fatal accidents. They sampled fatal aviation toxicology reports over a five-year period from 2012 to 2016. They received autopsy reports for 1,415 fatalities and specimens for 1,338 victims. According to CAMI, 1,051 positive results were found in a total of 570 pilots — a staggering 41 percent of the fatal accidents. While those results identified 166 different drugs, most pilots involved in these fatalities had prescription or over-the-counter (OTC) medications in their systems. The most common: antihistamines, especially diphenhydramine.
Tripping Points for Pilots
A common myth is that OTC medications are inherently safe and can be used by pilots. Unfortunately, this is often far from the truth. A broad variety of OTC medications can in fact cause an impairment that puts us at risk when flying.
Among medications we should avoid are those that can cause some level of drowsiness, including the following:
- Allergy medications
- Muscle relaxants
- OTC dietary supplements
- Pain medications
- Pre-medication or pre-procedure drugs
- Sleep aids
- Any medication, prescription or OTC, that carries a warning label that it may cause drowsiness or advises the user to be careful when driving a motor vehicle or operating machinery.
In many cases, medications can impair our ability to fly, even if we feel fine and don’t notice any symptoms.
Another way we can trip up as pilots is when we combine prescription medications with OTC remedies and dietary supplements. One example, according to the FAA, is an adverse reaction that occurs when an individual taking medications for high blood pressure also takes decongestants. Besides raising blood pressure and heart rate, symptoms can include chest pain, shortness of breath, dizziness, or difficulty speaking. It’s easy to imagine the problems such symptoms could cause for a pilot, even in good flight conditions.
Surprisingly, another way we can put ourselves at risk is when we combine certain foods with medications. For example, grapefruit or grapefruit juice can affect how long a medication stays in our system, and can result in dangerous side effects. According to a report by the National Institutes of Health, “grapefruit juice possesses high interaction with almost all types of drugs. The juice modifies the body’s way of metabolizing the medication, affecting the liver’s ability to work the drug through a person’s system.”
The report goes on to state that the overall exposure of some drugs can be increased by more than fivefold when taken with grapefruit juice, with the attendant increased risk of adverse effects. Other foods and health supplements can also cause adverse reactions with prescription and OTC drugs — a matter to be taken seriously especially by all of us who fly.
Waiting It Out
A number of strategies can be applied to avoid the issues of impairment when flying. The first is to wait until we truly don’t need any OTC medications. Most times, we can just make a deliberate choice to not fly when we aren’t 100 percent.
But what if we do take a medication that can cause impairment or adverse reaction? How long should we wait before again taking to the air as pilot-in-command (PIC)? As a general rule, the FAA warns us to wait a minimum of five times the pharmacological half-life of the medication after taking the last dose. In other words, if the time prescribed interval between doses is four to six hours, for example, we should wait 30 hours (5 times 6 hours) before flying. At that point, the medication should be out of our system.
Am I Safe to Fly?
Most of us are familiar with the I’M SAFE mnemonic checklist used for making a preflight evaluation of our physical and mental condition, but it’s worth a quick review in case we’ve forgotten any of the elements. Each letter stands for a factor that can adversely impact our ability to safely pilot an aircraft. Here are the items to consider in our personal evaluation of fitness for flight:
Illness — Consider any illness or physical malady that could affect our ability to act as PIC. Anything from a cold, to allergies, to muscular pain or physical injuries can degrade or impair our capabilities.
Medication — As we’ve just discussed, any prescription or OTC medication is worthy of consideration. Be aware of potential adverse reactions and consult your aviation medical examiner or doctor.
Stress — Life comes with lots of different stresses. It’s important to consider which ones may be influencing our abilities and decision-making process for any given flight.
Alcohol — No alcohol within the previous eight hours, or blood alcohol content of 0.04 percent or higher. This is roughly half the blood alcohol content allowed for drivers in most states.
Fatigue — This one can sneak up on us. Fatigue has many of the same effects as consuming alcohol.
Emotion — Our emotional state can influence our decision-making ability, so consider it carefully.
I’ve also seen this list with eating (nutrition) substituted for emotion. Poor eating habits or lack of healthy foods can put us in a physiologically compromised situation, again affecting our perceptions, focus, motor skills, and decision-making abilities. A hangry pilot is likely not a safe pilot.
When we think about it, our personal airworthiness may be as important — or even more so — than the condition of our aircraft. So, while we might think we’re “fine,” we should dig a little deeper to identify the (often unrecognized) risks, and determine if we really are ready and able to fly safely.
Robert N. Rossier, EAA 472091, has been flying for more than 40 years and has worked as a flight instructor, commercial pilot, chief pilot, and FAA flight check airman.