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substances and upon determination that the person’s continued performance of the function is unlikely to
jeopardize safety.
Note.— Guidance on suitable methods of identification (which may include biochemical testing on such
occasions as pre-employment, upon reasonable suspicion, after accidents/incidents, at intervals, and at
random) and on other prevention topics is contained in the Manual on Prevention of Problematic Use
of Substances in the Aviation Workplace (Doc 9654).
A definition of psychoactive substances is given in Chapter 1 of Annex 1:
Psychoactive substances. Alcohol, opioids, cannabinoids, sedatives and hypnotics, cocaine, other
psychostimulants, hallucinogens, and volatile solvents, whereas coffee and tobacco are excluded.
OTHER MEDICAL PROVISIONS IN
THE ANNEXES
Some other medical provisions exist in Annexes 2 (Rules of the Air) and 6 (Operation of Aircraft) and are
given in the following extracts.
Use of psychoactive substances
A Standard restricting the use of psychoactive substances (such as alcohol, narcotics and certain drugs) is
provided in Annex 2, 2.5, as follows:
2.5 Use of psychoactive substances
2.5.1 No person whose function is critical to the safety of aviation (safety-sensitive
personnel) shall undertake that function while under the influence of any psychoactive substance,
which might render him unable to safely and properly exercise that function.
2.5.2 No such person shall engage in any kind of problematic use of substances.
It is important to note that 2.5.1 relates to any person who has recently taken a psychoactive substance
and for that reason is temporarily unsafe, whereas 2.5.2 relates to a person who is a habitual user of
psychoactive substances.
Flight crew fatigue and fitness
Annex 6 has two parts. Part I covers International Commercial Air Transport, and specifies limitations on
flight time to ensure that fatigue does not endanger the safety of a flight as follows:
4.2.9.3 An operator shall formulate rules limiting the flight time and flight duty periods of flight
crew members. These rules shall also make provision for adequate rest periods and shall be such
as to ensure that fatigue occurring either in a flight or successive flights or accumulated over a
period of time due to these and other tasks, does not endanger the safety of a flight. These rules
shall be approved by the State of the Operator and included in the Operations Manual.
Note.— This Standard does not preclude a State from establishing regulations specifying the
limitations applicable to flight crew members of aeroplanes registered in that State. Guidance on
the establishment of limitations is given in Attachment A.
ICAO Circular 52 - Flight Crew Fatigue and Flight Time Limitations - contains a compendium of States’
actions to implement Annex 6, Part I, 4.2.9.3. It must be noted that “flight time” is only one of several
factors which can contribute to fatigue. Other important factors to be considered are the type of aircraft
flown, the size of the crew, the nature of the route, the general operating conditions encountered, in
particular the weather, the number of landings, the time of day or night, and the crossing of time zones.
Part II of Annex 6 covers international general aviation, and has less stringent provisions which give
the responsibility of flight crew fitness to the pilot-in-command as follows:
4.12. Fitness of Flight Crew Members
The pilot-in-command shall be responsible for ensuring that a flight:
a) will not be commenced if any flight crew member is incapacitated from performing his duties
by any cause such as injury, sickness, fatigue, the effects of alcohol or drugs;
b) will not be continued beyond the nearest suitable aerodrome when flight crew members’ capacity
to perform functions is significantly reduced by impairment of faculties from causes such as
fatigue, sickness, lack of oxygen.
Use of oxygen in flight
Measures to reduce the possibilities of hypoxia which would affect flight safety are specified in Annex 6,
Part I:
4.3.8 Oxygen supply
Note.- Approximate altitudes in the Standard Atmosphere corresponding to the values of absolute
pressure used in the text are as follows:
Absolute Pressure Metres Feet
700 hPa (700 mb) 3 000 10 000
620 hPa (620 mb) 4 000 13 000
376 hPa (376 mb) 7 600 25 000
4.3.8.1 A flight to be operated at altitudes at which the atmospheric pressure in personnel
compartments will be less than 700 hPa (700 mb) shall not be commenced unless sufficient stored
breathing oxygen is carried to supply:
a) all crew members and 10 per cent of the passengers for any period in excess of 30 minutes that
the pressure in compartments occupied by them will be between 700 hPa (700 mb) and 620 hPa
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Manual of Civil Aviation Medicine 1(13)
