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GENERAL HEALTH
While piloting an aircraft, an individual should be free of conditions which are harmful to alertness,
ability to make correct decisions, or affect reaction times. Persons with conditions that are apt to produce
sudden incapacitation, such as seizures, serious heart trouble, uncontrolled diabetes or diabetes requiring
insulin, and certain other conditions hazardous to flight, are medically unfit. Conditions such as acute
infections, anaemias and peptic ulcers are disqualifying while they last. Consult your designated medical
examiner when in doubt about any aspect of your health status, just as you would consult a licensed
aviation mechanic when in doubt about the engine status.
SPECIFIC AEROMEDICAL FACTORS
Fatigue
Fatigue generally slows reaction times and causes errors due to inattention. In addition to the most
common cause of fatigue, insufficient rest and loss of sleep, the pressures of business, financial worries
and family problems can be important contributing factors. If your fatigue is marked prior to a given
flight, don’t fly. Ensure you obtain a good night’s sleep before you fly and if scheduling prevents this,
discuss your situation with an aviation medicine specialist.
Hypoxia
Hypoxia, in simple terms, is a lack of sufficient oxygen to keep the brain and other body tissues
functioning properly. Wide individual variation occurs with respect to susceptibility to hypoxia. In
addition to a progressive lack of oxygen at higher altitudes, anything interfering with the blood’s ability to
carry oxygen can contribute to hypoxia (e.g., anaemias, carbon monoxide, certain drugs).
ICAO Preliminary Unedited Version — October 2008 V-2A-2
Your brain has no built-in alarm system to let you know when you are not getting enough oxygen. A
major early symptom of hypoxia is an increased sense of well-being (referred to as euphoria). This
progresses to slowed reaction, impaired thinking ability, unusual fatigue, and a dull headache.
The symptoms are slow but progressive, insidious in onset, and become marked at altitudes above 10 000
feet (3 300 metres). Night vision, however, can be impaired at altitudes even lower than that.
If you observe the general rule of not flying above 10 000 feet without supplemental oxygen, you will not
get into trouble.
Alcohol
Do not fly while under the influence of alcohol. An excellent rule is to allow twenty-four hours between
the last drink and take-off time. Even small amounts of alcohol in the system can adversely affect
judgement and decision-making abilities. Even at sea level alcohol impairs judgement and reaction time
therefore ALCOHOL AND FLYING DO NOT MIX.
Your body metabolizes alcohol at a fixed rate, and no amount of coffee or medication will alter this rate.
Do not fly with a hangover or a “masked hangover” (symptoms suppressed by aspirin or other
medication).
Medication
Self-medication or taking medicine in any form when you are flying can be extremely hazardous. Even
simple home or over-the-counter remedies such as aspirin, antihistamines, cold tablets, cough mixtures,
laxatives, tranquillizers and appetite suppressors may seriously impair the judgement and co-ordination
needed while flying. The safest rule is to take no medicine while flying, except on the advice of your
aeromedical advisor. It should also be remembered that the condition for which the medicine is required
may of itself be hazardous to flying, even when the symptoms are suppressed by the medication.
Certain specific medicines which have been associated with aircraft accidents in the past are:
antihistamines (widely prescribed for hay fever and other allergies); tranquillizers (prescribed for nervous
conditions, hypertension, sleep disorders and other conditions); weight reducing drugs (amphetamines
and other appetite suppressing drugs can produce sensations of well-being which have an adverse effect
on judgement); barbiturates or nerve “tonics” (barbiturates produce a marked suppression of mental
alertness).
Following general anaesthesia, a period of at least 48 hours should be spent on the ground. Twelve hours
is reasonable for a local anaesthetic. If in any doubt concerning the right time to resume flying, then seek
appropriate medical advice.
Spatial Disorientation
On the ground we know which way is “up” by the combined use of three senses:
a) Vision - we can see where we are in relation to fixed objects.
b) Pressure - gravitational pull on muscles and joints tells us which way is down.
c) Special parts in our inner ear - the otoliths - tell us which way is down by gravitational pull.
ICAO Preliminary Unedited Version — October 2008 V-2A-3
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Manual of Civil Aviation Medicine 2(160)
