Medical fitness to fly
Medical fitness to fly
by BALPA OpsAvMed Group
About eighteen months ago we published an article explaining how a pilot’s life could be made far more exciting than intended by not declaring medical conditions which might make them unfit to fly to their aeromedical examiner (AME). If this is discovered (and these things invariably are) then the fun can really start with an unexpected offer from the regulator to take a trip to CAA HQ to be interviewed under caution. If that interview doesn’t go well – as in not well for the pilot - then the next stage may include prosecution by the regulator for a violation of the rules that are clearly set out on every pilot’s medical certificate.
We highlighted this issue over a year ago because of the concerning rise in the number of pilots falling foul of the regulator following their own incorrect assessment of their medical fitness to fly. This trend, unfortunately, is continuing and recent AME discussions on this topic indicate that the regulator expects AMEs to notify them whenever a pilot has not declared any possible decline in medical fitness. It would seem the AMEs now have little discretion which they can apply and this is resulting in transgressions being reported more frequently to the CAA’s investigations and enforcement team. Information about how this team operates is readily obtained from any internet search but the fact that its name contains the word ‘enforcement’ will hopefully spur you to read on.
What follows is a repeat of the guidelines and reference material to help pilots arrive at the correct decision regarding their medical fitness and advises pilots to contact their AMEs if they are at all uncertain about their fitness to fly. We know it can be a very difficult decision to juggle the pressures of company rostering teams, management, personal finances and a genuine concern about whether your medical may be suspended for an indeterminate amount of time and hence fully understand some pilots’ reticence to report various ailments. Bear in mind, though, that if you do fall foul of the Regulator’s “enforcers” then regaining your Class 1 might suddenly become the least of your problems. BALPA’s OpsAvmed team enjoy being able to guide pilots through the often tortuous medical processes they are often faced with but certainly do not enjoy having to tell pilots that, instead of medical advice, what they actually need is to get a lawyer. We have had to give some pilots this advice rather more often than we would like over the past few years and this is the reason for repeating this advice.
So, once again, here is a step-by-step guide to keeping a clean sheet with the aviation medics and their band of humourless heavies on the enforcement team.
Step 1: read your medical certificate
The back of each medical certificate provides the most important and readily available clues to avoiding trouble by simply reminding pilots of the regulations. It states:
“Subpart A - GENERAL REQUIREMENTS
Section 1 - General
Item MED.A.020 Decrease in medical fitness
a) Licence holders shall not exercise the privileges of their licence and related ratings or certificates, ...at any time when they:
1. are aware of any decrease in their medical fitness which might render them unable to safely exercise those privileges;
2. take or use any prescribed or non-prescribed medication which is likely to interfere with the safe exercise of the privileges of the applicable licence;
3. receive any medical, surgical or other treatment that is likely to interfere with the safe exercise of the privileges of the applicable licence.
BALPA’s experience shows the terminology used may be open to some interpretation or, more worryingly, misinterpretation. If, therefore, a pilot is still in any doubt after reading the above the next part of the legislation, also repeated on the Class 1 medical carried with his / her licence, gives further guidance by stating:
(b) In addition, holders of a medical certificate shall, without undue delay and before exercising the privileges of their licence, seek aero-medical advice from the aeromedical centre (AeMC), AME or general medical practitioner (GMP), as applicable, when they:
(1) have undergone a surgical operation or invasive procedure;
(2) have commenced the regular use of any medication;
(3) have suffered any significant personal injury involving incapacity to function as a member of the flight crew;
(4) have been suffering from any significant illness involving incapacity to function as a member of the flight crew;
(5) are pregnant;
(6) have been admitted to hospital or medical clinic;
(7) first require correcting lenses.
(c) In the cases referred to in point (b):
(1) holders of class 1 and class 2 medical certificates shall seek the aero-medical advice of an AeMC or AME. In that case, the AeMC or AME shall assess their medical fitness and decide whether they are fit to resume the exercise of their privileges;
To summarise the important guidelines briefly:
1. If you think you might not be fit to fly (and, perhaps more importantly) …
2. … think the authorities might consider you unfit to fly, and …
3. … you really don’t want to risk ending up having a series of one-sided interviews with the authorities’ enforcement teams, which may require the presence of an expensive lawyer (which you will more than likely have to pay for), then go to Step 2 immediately.
Step 2: consult your AME
Consulting your AME before you go to work is every pilot’s easy way of avoiding trouble. It is your AME who is qualified to make the decision for you and, if you are then declared unfit, it will be the AME who will decide when you are fit to fly again. All AMEs now seem to be expected to notify the Regulator of any possible infringement of these rules and most would rather you discuss any issues with them in the first instance rather than being put in the position where they feel forced to ‘grass’ on you to the CAA, which none of them want to do. Some may charge pilots a fee for this advice but that’s part and parcel of the private sector, whether it be medical work or piloting. To put this into some context, legal advice remains a magnitude more expensive than any medical advice pilots may receive.
Some guidance for self-assessment of fitness
Typically, in aviation, there is a mnemonic that may help us sort out our thinking process, and this aide-memoire is ‘I’MSAFE’. You can ignore the apostrophe. Unfortunately, the ghost of my former English teacher still casts his shadow over me.
Pilots should ask themselves the following questions for each flight. if the answer to any of the items below is ‘yes’, then it may have an impact on flight safety.
‘IMSAFE’ stands for:
I = Illness
M = Medication
S = Stress
A = Alcohol
F = Fatigue
E = Emotion
Use those items as a checklist and, if in any doubt, either refer to ‘Step 1’ above or jump straight into ‘Step 2’ and get on the phone to your AME.
Medications (this includes ‘over the counter’ medications)
All medications can have side effects which are not always predictable, even if you’ve taken that particular medication before. If the side effects include light headedness, visual disturbances, dizziness or drowsiness, then this should immediately lead you to a ‘no fly’ decision.
Consider also the following:
a. Side effects may impact flight safety and/or mask the condition the pilot is trying to treat, which may itself be a threat to flight safety and hence a contraindication to flying.
b. If the untreated condition is one that would prevent safe flying, then the pilot should make the decision not to fly until the condition improves, whether he or she take the medication or not.
c. If you are going to depend on a particular medication to keep you well during the flight, then you should also make the decision not to fly.
Acceptable prescribed medications
The list of approved medications is constantly being re-evaluated and updated but the UK CAA provides some useful guidance here.
IFALPA also publishes some useful guidance here.
Summary
If you are in any doubt about your medical fitness then don’t take a chance of assessing yourself incorrectly. Instead, consult your AME. If you don’t consult your AME and it is later discovered that you were probably unfit then the regulatory authority may decide to investigate you. You could then be considered guilty of flying in contravention of the ANO as per the regulations stated on the reverse side of your Class 1 medical certificate. If the authority considers the potential seriousness of the misdemeanour warrants legal sanctions then they are at liberty to throw the book at you, which they sometimes do. Hence us repeating this article.