Most Preflight
Written by: James R. Elliott, MD (FAA)
As pilots, we thoroughly prepare for our flights. We check the weather, NOTAMS, and TFRs. We conduct a detailed walk around the aircraft, making sure the tires and brakes are good, all the control surfaces move as they should, there is enough oil, and enough of the correct fuel without any water condensation. We check the aircraft lights if we are going to fly at night or in IMC. Before we take off, we perform an engine run-up and mag check. We do all this to ensure we have a safe flight. Yet how many of us perform the same level of preflight check on ourselves? If you were an airplane, would you fly yourself today?
Several years ago, the FPA annual meeting was at the Greenbrier Resort in West Virginia. At breakfast the first morning, one of our members said he had just arrived because he had an add-on surgery case that kept him in the OR until 10 pm the night before. After an extended day in the OR, he then flew single pilot IFR through the mountains all night and made an instrument approach to an uncontrolled airport he had never been to before. I remember thinking that read like the introduction to an NTSB accident report. We are doctors. We have had years of training encouraging us to abuse our bodies and to press on, no matter what. That doesn’t translate well to the aviation environment. It might be one reason why so many doctors die in airplanes.
The pilot and airplane are two components of a system. If either fails, the consequences usually are not good. We owe it to ourselves, our passengers, and our family members to preflight ourselves as thoroughly as we do the airplane. Are we safe to fly today or should we postpone the flight for another time?
Most of us have heard the IMSAFE acronym. But how many of us use it every time we fly? IMSAFE is one of the most common tools to assess your medical fitness to fly. It’s an acronym for Illness, Medication, Stress, Alcohol, Fatigue, and Emotion. Some people add a second E for Eating.
ILLNESS—Even a mild illness can slow thinking and reaction time, cloud judgement, and create a distraction to take our attention off flying safely. We tend to accept lower performance standards when we are not feeling well. An upper respiratory infection may result in an ear or sinus block. A lower respiratory infection may contribute to hypoxia.
MEDICATION—We should consider why we are taking the medication, the anticipated clinical effects, and adverse side effects. FAR 91.17 prohibits acting as a flight crewmember while using any drug that affects the person’s faculties in any way contrary to safety. Antihistamines can cause decreased alertness and vestibular dysfunction. Diphenhydramine is the most common medication found in fatal aviation accident toxicology. Because of the long half-life, the FAA recommends not flying for 60 hours after taking either diphenhydramine or Nyquil. The recommended rule is to wait for five half-lives after taking any medication that may adversely impact flying safety.
If you don’t know the half-life, use five dosing intervals. The FAA publishes a list of Do not fly, do not issue medications https://www.faa.gov/ame_guide/media/DNI_DNF_tables.pdf.
This isn’t a comprehensive list. But it covers the major categories of medications.
STRESS—We have stressful jobs. That is a hazard of our profession. We normally do a good job at compartmentalizing and can leave other worries on the ground when we fly. For some of us, that escape and mindfulness is one of the reasons we fly. However, if the stress level is higher than normal and causes a distraction or impulsive behavior, wait to fly another day.
ALCOHOL—14 CFR Part 91.17 states that no person may act or attempt to act as a crewmember of a civil aircraft while under the influence of alcohol, while having a blood or breath alcohol concentration of 0.04 or greater, or within 8 hours after the consumption of any alcoholic beverage. The US military requires 12 hours between bottle and throttle.
Even a low level of alcohol can impair performance, especially when combined with altitude. The prolonged effects of excessive alcohol use or a hangover may persist for several days.
FATIGUE—Physicians are used to working long hours despite abundant evidence of decreased performance and adverse impact on patient safety. After 16 hours of continuous wakefulness, our brains show measurable cognitive impairment with prolonged reaction time, inattention, and reduced quality of decision making. After 18 hours, our cognitive and motor performance are impaired to the same degree as someone with a BAC of 0.05. After 24 hours of continuous wakefulness our performance is the same as someone with a BAC of 0.10. We should not be driving home, much less operating an airplane.
EMOTION—Like stress, adverse emotions can distract you from the important tasks of safely flying the airplane, cause impulsive behaviors, or contribute to unwise decisions. If you can’t leave it on the ground, don’t fly with it. Wait for another day. Make go/no go decisions with the logical part of your brain, not the emotional part. If there is somewhere you absolutely have to be that day, crashing your airplane won’t get you there any faster.
E can also be used for EATING—Adequate nutrition and hydration promote alertness, cognitive performance, and mood.
Taken together, IMSAFE is a useful tool to assess your readiness to fly safely. The best time to preflight yourself is before you leave for the airport. But it is a good idea to do it a second time before climbing into the aircraft. There have been two times when I have pre-flighted my airplane, then decided I just wasn’t up to the flight I had planned that day. I don’t regret either of those decisions. I’m here to fly another day.
Finally, the FAA has a new campaign encouraging you to pre-flight your airman medical certificate exam. Help the FAA to help you get your medical certificate faster. If you have a Special Issuance, bring a copy of your SI authorization letter and the required medical information to the exam. If you have a new medical condition, contact the AME to determine what medical information is required. Get it done before your exam and bring it with you. The AME can electronically transmit your medical records to the FAA with your exam. If your exam has all the required medical information, the FAA can issue a new medical certificate in an average of 32 days. If they have to request additional medical information, that adds another 100 days to the average clearance time.
