MEDICATION — GUIDANCE FOR AIR TRAFFIC CONTROLLERS
(a)Any medication can cause side effects, some of which may impair the safe exercise of the privileges of the licence. Equally, symptoms of colds, sore throats, diarrhoea and other abdominal upsets may cause little or no problem whilst not exercising the privileges of the licence, but may distract the air traffic controller and degrade their performance whilst on duty. Therefore, one issue with medication and the safe exercise of the privileges of the licence is the underlying condition and, in addition, the symptoms may be compounded by the side effects of the medication prescribed or bought over the counter for treatment. This guidance material provides some help to air traffic controllers in deciding whether expert aero-medical advice by an AME, AeMC or Medical Assessor is needed.
(b)Before taking any medication and exercising the privileges of the licence, the following three basic questions should be satisfactorily answered:
(1)Do I feel fit to control?
(2)Do I really need to take medication at all?
(3)Have I given this particular medication a personal trial whilst not exercising the privileges of my licence to ensure that it will not have any adverse effects on my ability to exercise the privileges of my licence?
(c)Confirming the absence of adverse effects may well need expert aero-medical advice.
(d)The following are some widely used medicines with a description of their compatibility with the safe exercise of the privileges of the licence:
(1)Antibiotics. Antibiotics may have short-term or delayed side effects which can affect the performance of the air traffic controller. More significantly, however, their use usually indicates that an infection is present and, thus, the effects of this infection may mean that an air traffic controller is not fit to control and should obtain expert aero-medical advice.
(2)Anti-malaria drugs. The decision on the need for anti-malaria drugs depends on the geographical areas to be visited, and the risk that the air traffic controller has of being exposed to mosquitoes and of developing malaria. An expert medical opinion should be obtained to establish whether anti-malaria drugs are needed and what kind of drugs should be used. Most of the anti-malaria drugs (atovaquone plus proguanil, chloroquine, doxycycline) are compatible with the safe exercise of the privileges of the licence. However, adverse effects associated with mefloquine include insomnia, strange dreams, mood changes, nausea, diarrhoea and headaches. In addition, mefloquine may cause spatial disorientation and lack of fine coordination and is, therefore, not compatible with the safe exercise of the privileges of the licence.
(3)Antihistamines. Antihistamines can cause drowsiness. They are widely used in ‘cold cures’ and in treatment of hay fever, asthma and allergic rashes. They may be in tablet form or a constituent of nose drops or sprays. In many cases, the condition itself may preclude the safe exercise of the privileges of the licence, so that, if treatment is necessary, expert aero-medical advice should be sought so that so-called non-sedative antihistamines, which do not degrade human performance, can be prescribed.
(4)Cough medicines. Antitussives often contain codeine, dextromethorfan or pseudo-ephedrine which are not compatible with the safe exercise of the privileges of the licence. However, mucolytic agents (e.g. carbocysteine) are well tolerated and are compatible with the safe exercise of the privileges of the licence.
(5)Decongestants. Nasal decongestants with no effect on alertness may be compatible with the safe exercise of the privileges of the licence.
(6)Nasal corticosteroids are commonly used to treat hay fever, and are compatible with the safe exercise of the privileges of the licence.
(7)
(i)Common pain killers and antifebrile drugs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and paracetamol, commonly used to treat pain, fever or headaches, may be compatible with the safe exercise of the privileges of the licence. However, the air traffic controller should give affirmative answers to the three basic questions in paragraph (b) before using the medication and exercising the privileges of the licence.
(ii)Strong analgesics. The more potent analgesics including codeine are opiate derivatives, and may produce a significant decrement in human performance and, therefore, are not compatible with the safe exercise of the privileges of the licence.
(8)Anti-ulcer medicines. Gastric secretion inhibitors such as H2 antagonists (e.g. ranitidine, cimetidine) or proton pump inhibitors (e.g. omeprazole) may be acceptable after diagnosis of the pathological condition. It is important to seek for the medical diagnosis and not to only treat the dyspeptic symptoms.
(9)Anti-diarrhoeal drugs. Loperamide is one of the more common anti-diarrhoeal drugs and is usually safe to take whilst exercising the privileges of the licence. However, the diarrhoea itself often makes the air traffic controller unable to exercise the privileges of the licence.
(10)Hormonal contraceptives and hormone replacement therapy usually have no adverse effects and are compatible with the safe exercise of the privileges of the licence.
(11)Erectile dysfunction medication. This medication may cause disturbances in colour vision and dizziness. There should be at least six hours between taking sildenafil and exercising the privileges of the licence; and 36 hours between taking vardenafil or tadalafil and exercising the privileges of the licence.
(12)Smoking cessation. Nicotine replacement therapy may be acceptable. However, other medication affecting the central nervous system (buproprion, varenicline) is not acceptable for air traffic controllers.
(13)High blood pressure medication. Most anti-hypertensive drugs are compatible with the safe exercise of the privileges of the licence. However, if the level of blood pressure is such that drug therapy is required, the air traffic controller should be monitored for any side effects before exercising the privileges of the licence. Therefore, consultation with the AME, AeMC or Medical Assessor as applicable, is needed.
(14)Asthma medication. Asthma has to be clinically stable before an air traffic controller can return to exercising the privileges of the licence. The use of respiratory aerosols or powders, such as corticosteroids, beta-2-agonists or chromoglycic acid may be compatible with the safe exercise of the privileges of the licence. However, the use of oral steroids or theophylline derivatives is usually incompatible with the safe exercise of the privileges of the licence. Air traffic controllers using medication for asthma should consult an AME, AeMC, or Medical Assessor, as applicable.
(15)Tranquillisers, anti-depressants and sedatives. The inability to react, due to the use of this group of medicines, together with the underlying condition for which these medications have been prescribed, will almost certainly mean that the mental state of an air traffic controller is not compatible with the safe exercise of the privileges of the licence. Air traffic controllers using tranquillisers, anti-depressants and sedatives should consult an AME, AeMC, or Medical Assessor, as applicable.
(16)Sleeping tablets. Sleeping tablets dull the senses, may cause confusion and slow reaction times. The duration of effect may vary from individual to individual and may be unduly prolonged. Air traffic controllers using sleeping tablets should consult an AME, AeMC, or Medical Assessor, as applicable.
(17)Melatonin. Melatonin is a hormone that is involved with the regulation of the circadian rhythm. In some countries it is a prescription medicine, whereas in most other countries it is regarded as a ‘dietary supplement’ and can be bought without any prescription. The results from the efficiency of melatonin in treatment of jet lag or sleep disorders have been contradictory. Air traffic controllers using melatonin should consult an AME, AeMC, or Medical Assessor, as applicable.
(18)Coffee and other caffeinated drinks may be acceptable, but excessive coffee drinking may have harmful effects, including disturbance of the heart’s rhythm. Other stimulants including caffeine pills, amphetamines, etc. (often known as ‘pep’ pills) used to maintain wakefulness or suppress appetite can be habit forming. Susceptibility to different stimulants varies from one individual to another, and all may cause dangerous overconfidence. Overdosage causes headaches, dizziness and mental disturbance. These other stimulants should not be used.
(19)Anaesthetics. Following local, general, dental and other anaesthetics, a period of time should elapse before returning to exercising the privileges of the licence. The period will vary considerably from individual to individual, but an air traffic controller should not exercise the privileges of the licence for at least 12 hours after a local anaesthetic, and for at least 48 hours after a general, spinal or epidural anaesthetic.
(e)Many preparations on the market nowadays contain a combination of medicines. It is, therefore, essential that if there is any new medication or dosage, however slight, the effect should be observed by the air traffic controller whilst not exercising the privileges of the licence. It should be noted that medication which would not normally affect air traffic controller performance may do so in individuals who are ‘oversensitive’ to a particular preparation. Individuals are, therefore, advised not to take any medicines before or whilst exercising the privileges of their licence unless they are completely familiar with their effects on their own bodies. In cases of doubt, air traffic controllers should consult an AME, AeMC, or Medical Assessor, as applicable.
(f)Other treatments Alternative or complementary medicine, such as acupuncture, homeopathy, hypnotherapy and several other disciplines, is developing and gaining greater credibility. Such treatments are more acceptable in some States than others. There is a need to ensure that ‘other treatments’, as well as the underlying condition, are declared and considered by the AME, AeMC, or Medical Assessor, as applicable, for assessing fitness.