READ MORE MEDICATION Main takeaways from study Pilots are not always willing to consult their AME. All pilots surveyed had had a minor ailment. Not all need to be reported for example, a cold. However, only 14% of the pilots had contacted their AME. Pilots self-medicate. They use OTC medication without consulting an AME. For example, one-third of pilots surveyed had used pseudoephedrine before flying. This drug can affect performance, is a performance enhancer, and can cause insomnia and dizziness. Pilot guidelines for minor ailments are much needed. This is to specify the common conditions that dont need a consultation with AME, and to state under which conditions even those that do not need to be reported pilots should not fly, and for how long. These guidelines should also list what medication is safe to use while flying. Pharmacists are not always aware that they are dealing with a pilot, or of the specific needs of this patient group. We should not assume that the pharmacists recommendation is compatible with our fitness to fly. Pharmacists need an aviation-specific formulary. This would be a guide to the medicines that pilots can take without affecting their fitness to work. It could be extended to other professions requiring high levels of safety and concentration. Captain Lluis Vallverdu-Palau Former Senior Lecturer at Kingston University, pharmacist, PhD in chemistry, and airline pilot Amir Anwar Pharmacist, Kingston University Dr Reem Kayyali, Professor, Head of Department of Pharmacy, Kingston University AVIATION INDUSTRY AND MEDICINES Do pilots and pharmacists need guidelines on the use of non-prescription medication when flying? By Captain Lluis Vallverdu-Palau, BALPA member and pharmacist ow many times have we heard that safety is the number one priority in aviation? It is a well-established concept, ingrained in every airman and airwomans mind, and has led to the reputation that aviation holds. Over the years, our industry has pioneered safety developments, such as training, automation, standard operational procedures (SOPs), checklists, threat and error management, and so on. As a result of their success, these developments have been extrapolated to many other disciplines, including pharmacy and medicine. The study of human factors especially the effect of fatigue has become a major issue within aviation, and is attracting a huge amount of research. There are also tough regulatory limits on alcohol consumption, and many companies have strict guidelines to prevent pilots from exceeding those limits. However, there has not been much focus on the effect of non-prescription or over the counter (OTC) medicines on pilot performance. These medicines, as their classification indicates, are relatively safe. However, they may pose a risk because of secondary effects and interactions with other drugs. It is not uncommon for air accidents to involve flight crew that have taken some form of medication. The National Transportation Safety Board (NTSB) published a study of 633 accidents involving 646 fatalities and found that 42% of pilots had drugs in their biological samples. Before I trained as a pilot, I specialised in pharmacy, as a community pharmacist and university lecturer. Despite having both perspectives, I have more questions than answers on this topic and imagine that many of my colleagues, in both fields, lack answers to similar queries. As a pilot, I have asked myself many times whether I and my colleagues should take certain OTC medication. From a pharmaceutical point of view, I also question whether pharmacists look at the effects of OTC medicines on a patients ability to do their job safely. HOW PILOTS DECIDE WHAT MEDICATION TO USE Previous experience 8% AME 2% Internet Friend recommended 2% Pharmacist recommended 22% 27% READ MORE 88% Self medication MINOR ILLNESSES ENCOUNTERED BY PILOTS Main takeaways from study 22% Hayfever 27% 12% Flu Earache 20% Diarrhoea Cold 35% 71% Back pain Pharmacists must not only consider the side effects of the medicines they supply, but also their interactions with other medication that the pilot may be taking. Pilots should be made aware that some medicines could cause cognitive impairment, even if the pilot feels normal. Furthermore, they may not be fit to fly for a set period of time after taking OTC medicines such as sedating antihistamines, pain-relief medication, decongestants and certain dietary supplements all of which are available without prescription in pharmacies, supermarkets, petrol stations and convenience stores. Aeromedical examiners (AMEs) are the first line of contact for any medical condition. They assess whether pilots are fit to fly and how long it should be before they return to work. When pilots are affected by minor ailments, however, they dont always contact their GP or AME. Could pilots be reluctant to expose their condition and risk the possible consequences for their licence? The Civil Aviation Authority (CAA) and Federal Aviation Administration (FAA) have medication guidelines for AMEs, but none exist at pilot, pharmacist or GP level. A research study carried out by Kingston University investigated OTC medication use by pilots and the role of pharmacists, and was divided into two parts. The first assessed those minor ailments that affect pilots most frequently, where they go to seek advice for their condition, and what medication they use. The second looked at whether, during a consultation, pharmacists consider the occupation of the patient, as well as their knowledge of those medications that should be avoided by pilots while working. For the data-collection procedure, two types of surveys were designed one directed at pilots, and the other directed at pharmacies around Hounslow (Heathrow Airport) and Crawley (Gatwick Airport). The main highlights of this study are outlined in the panel (see Read More, above). Ultimately, this work is trying to assess if there is a need for an accessible formulary/ guideline to help pharmacists respond to the needs of pilots appropriately and safely. THERE HAS NOT BEEN MUCH FOCUS ON THE EFFECT OF NON-PRESCRIPTION MEDICINES ON PILOT PERFORMANCE