IMSAFE checklist – It’s not just for aircrew

Dr Richard Ronan Murphy, MBChBFAA Designated Aviation Medical ExaminerCAP Medical Officer, Paine Field Squadron

IMSAFE Checklist

• I - Illness• M - Medication• S - Stress• A - Alcohol• F - Fatigue• E - Enough (food, water,other)

Illness

IMSAFE

Illness• CFR 61.53

– Prohibition on operations during medical deficiency.

• (1) (The Pilot) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for medical certificate necessary for pilot operation.– Responsibility rests with the pilot– Online resources include AOPA, FAA website, Google– Or call your local AME

Light Sport, Glider & Everything Else

• CFR 61.53– Prohibition on operations during medical deficiency.

• 2(b) Operations that do not require a medical certificate. For operations provided for in Sec. 61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

Responsibility rests with the pilot

You are responsible for ensuring your health is good

You are responsible for your health

Any medical condition that would make the person unable to operate the aircraft in a safe manner.

• Flu/Cold• Medical Illness• Wearing corrective lenses when required• Contacts – are you going to be in a dusty, windy environment?• Do you have medications needed to treat known medical

conditions? (e.g. inhaler, epi-pen)

Medication

IMSAFE

Medication• CFR 61.53

– Prohibition on operations during medical deficiency.

• (2) Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary

• What medications?– Anything that make the person unable to operate the

aircraft in a safe manner.

Medication• Medications that may cause drowsiness or dizziness.

• Many Over-the-counter medications can cause drowsiness or sedation, especially:

– Most antihistamines– Many cold medicines (contain antihistamines)– Motion sickness medication

FAA Allowed Medications

• Over the counter non-steroidal anti-inflammatories (Tylenol, Ibuprofen Naproxen)

• Non-sedating antihistamines:– Loratidine (Claritin)– Desloratidine (Clarinex)– Fexofenadine (Allegra)

• AFTER an adequate initial “trial period”

Antihistamine Trial Period• “Nonsedating” antihistamines are allowed, but even these

may affect some individuals. It is recommended to take the medication for at least a couple of days before deciding if it is safe to fly.

• If you have taken an antihistamine medication that is not allowed, you need to wait “5 half lives”, or 5 times the maximum dosing interval before flying.

• For example, if recommended dose is once or twice per day, you must wait 5 days after the last dose before you can legally fly.

• Call your local AME if you need advice on a medication.

Motion sickness medicine

• None are allowed by the FAA for PIC• Scopolamine+Dextroamphetamine (Scop-

Dex)allowed for military pilots, but not CAP pilots.

• Scopolamine patch may be used by pilots in initial training, but not when acting as pilot in command.

• Prevention…?

Motion Sickness Prevention

• Eat a light meal before flying(or other travel) – an empty stomach makes it worse

• Avoid Alcohol, >24 hours preferable• Do not smoke• Be prepared for the flight (or travel) – reduces

stress, increases safety• Relax – flying is fun, enjoy it

STRESS!!!

IMSAFE

STRESS

Physical

Emotional

Situational

Stress• Physiological or Physical– Environmental– Illness and Fatigue

• Emotional– Relationships, Family

• Situational/Social– Work, School, Finances, Obligations

Stress affects judgment and concentration.

Stress Fatigue

Alcoholand other drugs

IMSAFE

Alcohol• Title 14 CFR 91.17• (a) No person may act or attempt to act as a crewmember

of a civil aircraft—– (1) Within 8 hours after the consumption of any alcoholic

beverage;– (2) While under the influence of alcohol;– (3) While using any drug that affects the person's faculties in any

way contrary to safety; or– (4) While having an alcohol concentration of 0.04 or greater in a

blood or breath specimen. Alcohol concentration means grams of alcohol per deciliter of blood or grams of alcohol per 210 liters of breath.

Alcohol

• Title 49 C.F.R. PART 655—PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS

• No covered employee tested under this subpart who is found to have an alcohol concentration of 0.02 or greater but less than 0.04 shall perform or continue to perform safety-sensitive functions for an employer

Alcohol

• Alcohol is removed from the body slowly; about 0.04%BAC, or about one half of a beer per hour.

• The effects on concentration and thinking linger longer. Motion sickness may increase.

• 8 hours is not enough time. 12h is better, 24h may be needed after drinking to intoxication.

Alcohol and flying just don’t mix

Fatigue

IMSAFE

Fatigue

• Lack of sleep impairs concentration and working memory i.e. Makes you stupid ;-)

• Sleep deprivation may be “acute” – i.e. not enough sleep over one night, or “chronic” – a little bit at a time over many nights.

• Fatigue may also occur as a result of prolonged stress, even with normal sleep.

Fatigue

• Sleep deprivation may not cause obvious tiredness all the time, especially if over time.

• Warning signs of sleep deprivation.– Feeling tired, not constant, but intermittently– Needing daytime naps– Missing items on checklists– Missing radio calls

• It can take several days, to more than a week of EXTRA sleep to recover.

Duty limits• CAP regulation 60-1, 2.2(d) Operation limits.

– Updated March 24th 2011• Maximum duty time for pilots in one day is 14 hours• Pilots will not plan to fly more than 8 hours without a

period of rest.• Pilots must have 10 hours of rest between duty cycles• Wing commander or higher may approve a flight for duty

cycle of greater than 8 hours, provided the PIC agrees• PIC and commander must assess risk

*** Responsibility rests with the pilot ***

Duty limits

• Crew duty day begins when commencing official CAP activity and ends upon completion of the CAP duty

• Non CAP work time or flight is no longer included in the CAP regulation

• Just because it is legal, does not necessarily make it a good idea – always assess risk

• Whatever activity you plan to do, make sure you get enough rest in advance.

*** Responsibility rests with the pilot ***

Enough … physical requirements

IMSAFE

As a memory aid, consider:“The 4 classical elements”

• Air• Water

• Earth• Fire

Fitness

FoodOxygen

Fluids

Enough …

• Food - Nutrition, Healthy diet• Water– Altitude is dehydrating, physical activity, hot OR dry

environment increases needs.– Even mild dehydration impairs your cognitive performance.– (more about dehydration later)

• Air – High altitude is dehydrating• Physical fitness– Physical condition is directly linked to mental performance.

Enough

• The body has basic needs– In aviation it is just as important to consider if

these are being met as it is to consider if there is fuel, oil, etc. in an aircraft

• The body needs to be kept in good condition– This is necessary for safe flight, just as it is

important to mechanically maintain an aircraft

Enhanced Learning

IMSAFE

Review/Questions

“I” stands for?

IMSAFE

Illness

Who has responsibility in determining if illness is causing a problem with safety?A) The pilot or individualB) The medical officer or AMEC) Any other person involved in the operationD) All of the above

IllnessWho has responsibility in determining if illness is causing a problem with safety?A) The pilot or individualB) The medical officerC) Any other person involved in the operationD) All of the aboveThe pilot or individual is always responsible.But, if you see a problem in a colleague, you should make it known (part of medical illness e.g dehydration may include difficulty in recognizing the problem).It is OK to ask an individual with medical knowledge for advise if in any doubt.

“M” Stands for?

IMSAFE

Medication

I took a Benadryl (Diphenhydramine)The directions say:– take every 4 to 6 hours– do not take more than 6 times in 24 hours– adults and children 12 years and over:1 to 2 tablets– children 6 to under 12 years1 tablet– children under 6 years do not use this product in

children under 6 years of ageHow long do I have to wait before I can fly?

Benadryl

• This is a sedating medication

• Must wait 5x longest dosing interval

• Dosing interval says “take every 4-6 hours”

• I must wait 30 hours before I can fly as PIC

• How does this apply to other CAP activities?

“S” Stands for

IMSAFE

Stress

I have to get this plane back to KPAE by 6pm, its is 4pm now, and I am in Centralia.

The pilot who is due to fly the plane next just called me and said I better not be late, or he’ll give me “what for”!

Am I safe to fly?

STRESS

Physical

Emotional

Situational

“A” stands for?

IMSAFE

Alcohol

AND OTHER DRUGS

Fatigue

IMSAFE

Fatigue

I have been studying for a difficult exam.I stayed up late last few nights, cramming.I took the exam this morning.I feel relieved now that the exam is over.

I want to fly, or participate in other CAP activity where my good performance is critical, this afternoon

Stress Fatigue

“E” stands for?

IMSAFE

Enough

I’m out of shape.

I had a Twinkie and a Mountain Dew for lunch.

Have I been drinking enough fluids?

Have I planned enough for this activity?

Have I had enough rest?

What Questions Do You have?