IMSAFE checklist – It’s not just for aircrew

1. IMSAFE checklist – It’s not just for aircrew Dr Richard Ronan Murphy, MBChB FAA Designated Aviation Medical Examiner CAP Medical Officer, Paine Field Squadron

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

3. Illness IMSAFE

4. 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

5. 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

6. 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)

7. Medication IMSAFE

8. 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.

9. 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

10. 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”

11. 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.

12. 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…?

13. 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

14. STRESS!!! IMSAFE

16. Stress • Physiological or Physical • Environmental • Illness and Fatigue • Emotional • Relationships, Family • Situational/Social • Work, School, Finances, Obligations Stress affects judgment and concentration.

18. Alcoholand other drugs IMSAFE

19. 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.

20. Alcohol • Title 49C.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

21. 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

22. Fatigue IMSAFE

23. 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.

24. 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.

25. 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 ***

26. 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 ***

27. Enough … physical requirements IMSAFE

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

30. 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.

31. Enough • The body has basic needs • In aviation it is just as important to consider if these are being metas 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

32. Enhanced Learning IMSAFE Review/Questions

33. “I” stands for? IMSAFE

34. Illness Who has responsibility in determining if illness is causing a problem with safety? • The pilot or individual • The medical officer or AME • Any other person involved in the operation • All of the above

35. Illness Who has responsibility in determining if illness is causing a problem with safety? • The pilot or individual • The medical officer • Any other person involved in the operation • All of the above The 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.

36. “M” Stands for? IMSAFE

37. 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 age How long do I have to wait before I can fly?

38. 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?

39. “S” Stands for IMSAFE

40. 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?

42. “A” stands for? IMSAFE

43. Alcohol AND OTHER DRUGS

44. Fatigue IMSAFE

45. 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

47. “E” stands for? IMSAFE

48. 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?

49. What Questions Do You have?