GENERAL INFORMATION

NARRATIVE

[O] The Safety Board has investigated many accidents in all passenger transportation modes in which the use of a licit medication by a vehicle operator has been causal or contributory. As a result, the Safety Board has previously recommended that various agencies take certain actions to address issues pertaining to the use of medications. In this letter, the Board makes new recommendations to the DOT, modal administrations, and the U.S. Food and Drug Administration. [Recommendations] A-00-6. Establish and implement an educational program targeting pilots that, at a minimum, ensures that all pilots are aware of the source of information described in Safety Recommendation A-00-5 regarding the hazards of using specific medications when flying. [Responses] FAA LTR DTD: 3/30/00 The FAA agrees that providing education programs and materials to airmen regarding the hazards of unapproved medications is beneficial. In addition to regulatory requirements regarding the prohibitions on flying while impaired, the FAA has ongoing educational programs that discuss this topic. Some of these ongoing programs are: * Regional monthly aviation safety seminars, sponsored by the flight standards district offices, include topics on medical issues. * AME's are trained through aviation medical seminars and computer-based training programs to educate pilots on medical issues and medications. * Airmen, AME's, and flight standards employees receive medically relevant educational material through the Federal Air Surgeon's Medical Bulletin published quarterly and medically oriented safety pamphlets. * The Aeronautical Information Manual, available to all pilots, devotes an entire chapter to Medical Facts for Pilots. This chapter states, in part, that pilot performance can be seriously degraded by both prescribed and over-the-counter medications, as well as the medical conditions for which they are taken. Any medication that depresses the nervous system like a sedative, tranquilizer, or antihistamine can make a pilot much more susceptible to hypoxia. The FAA believes that these ongoing educational programs adequately address the hazards of medication and flying. The FAA is currently developing a series of presentations at Civil Aeromedical Institute to be released within the next year that will address numerous aeromedical issues, including medications and flying. In addition, the FAA will address this issue in the summer edition of the Federal Air Surgeon's bulletin, which is distributed to all AME's. The FAA is committed to reviewing and updating these programs periodically to ensure that the latest information is delivered to pilots. I believe that the FAA's education programs currently in place address the full intent of this safety recommendation, and I plan no further action in response to this safety recommendation. NTSB LTR DTD: 9/7/00 The FAA states that it agrees that providing education programs and materials to airmen regarding the hazards of unapproved medications is beneficial. The FAA indicates that, in addition to regulatory requirements regarding the prohibitions on flying while impaired, it has ongoing educational programs that discuss this topic. The FAA states that it believes that these ongoing educational programs adequately address the hazards of medication and flying. The Safety Board is concerned that the FAA may have misunderstood the intent of this safety recommendation. The Board's intent in issuing this recommendation was for the FAA to effectively disseminate the information produced in response to Safety Recommendation A-00-5. Until actions taken in response to A-00-5 are nearing completion, the Board recognizes that the FAA cannot establish and implement the needed educational program. The Board asks the FAA to reconsider its response to this recommendation. Pending establishment and implementation of an educational program that ensures that all pilots are aware of the source of information described in Safety Recommendation A-00-5 regarding the hazards of using specific medications when flying, Safety Recommendation A-00-6 is classified "Open Unacceptable Response." FAA LTR DTD: 3/22/01 The FAA has reviewed its previous position in response to this safety recommendation and believes that the ongoing educational programs outlined in the FAA's letter dated March 30, 2000, adequately address the hazards of medication and flying. These educational programs include distribution of medical publications to Aviation Medical Examiners (AME) to make available to airmen, providing material to AME's for presentation to airmen at flight safety meetings, providing FAA support for training airmen at aviation events and activities. The FAA fully understands the intent of this safety recommendation and has educational programs currently in place to address this safety recommendation completely. I consider the FAA's action to be completed in response to this safety recommendation. NTSB LTR DTD: 1/25/05 The FAA agrees that providing education programs and materials for pilots regarding the danger associated with the use of over-the-counter (OTC) and prescription medications is useful. The FAA outlined a variety of educational programs and information sources currently available to both AMEs and pilots through seminars, bulletins, the Aeronautical Information Manual, and the FAA Web sites. The FAA reports that a new brochure is under development to update and expand information on OTC and prescription medications and their impact on flying. The brochure will be electronically published on the FAA's Web site, distributed to all AME offices, and made available at seminars and special events. The Safety Board requests that the FAA provide a draft copy of the brochure before it is published so that we may have an opportunity to provide comments. Pending completion of the updated brochure about the use of OTC and prescription medications, Safety Recommendation A-00-05 is classified "Open-Acceptable Response." The distribution plans outlined by the FAA for the updated brochure will make it available in a variety of venues to the pilots who are looking for the information. As discussed at the June 21, 2004, meeting, the Safety Board believes that every active pilot (that is, one with a current medical certificate) must be provided with a copy of the brochure to ensure that they are aware of this source of information. To address the intent of Safety Recommendation A-00-06, the FAA needs to develop a plan to distribute the information using a variety of methods such as direct mail, electronic mail, distribution by AMEs during recurrent medical examinations, or some other process. Pending development and implementation of an acceptable distribution plan, Safety Recommendation A-00-06 is classified "Open-Acceptable Response." FAA LTR DTD: 1/9/06 The Federal Aviation Administration has completed its efforts to address these safety recommendations. The following is a list of these items: * Issued a brochure and poster entitled "Medications and Flying." The brochure informs the reader of specific things to consider when making the decision to go/no go after taking over-the-counter drugs. The brochure also lists common side effects of frequently used medications. The brochure is available at the FAA's Web site at the following address: http://www.faa.gov/pilots/safety/pilotsafetybrochures. The brochure was mailed to all aviation medical examiners (AME) with instructions on how to obtain additional brochures. * Published an article in the Federal Air Surgeon's Medical Bulletin informing AMEs that the brochure and poster are available for download from the Civil Aerospace Medical Institute at: http://www.faa.gov/library/reports/medical/fasmb. * Published an editorial written by the Federal Air Surgeon in the Federal Air Surgeon's Medical Bulletin to stress the need for AMEs to communicate medication information to airmen. The FAA issued an FAA News release encouraging advocacy groups (i.e., the Airline Pilots Association, the Aircraft Owners and Pilots Association, and other aviation organizations) to disseminate information to their members regarding the brochure and its content. I have enclosed a copy of the brochure, the Federal Air Surgeon's Medical Bulletin, and the FAA News release for the Board's information. I believe that the FAA has satisfactorily responded to this safety recommendation, and I look forward to your response. NTSB LTR DTD: 6/23/06 In addition to creating and distributing this brochure to all AMEs, the FAA took several actions to ensure that pilots are aware of the brochure, including publishing an article in the Federal Air Surgeon's Medical Bulletin (FASMB) informing AMEs that the brochure and a poster with the same information are available for downloading. An editorial written by the Federal Air Surgeon in the FASMB also stressed the need for AMEs to communicate medication information to airmen. In addition, the FAA issued a news release encouraging advocacy groups such as the Air Line Pilots Association, the Aircraft Owners and Pilots Association, and other aviation organizations to disseminate information to their members regarding the brochure and its contents. Although we would have preferred that every active pilot (that is, one with a current medical certificate) be provided with a copy of the brochure, the FAA has developed and implemented a program for distributing to pilots this important information and brochure. Therefore, Safety Recommendation A-00-6 is classified "Closed-Acceptable Action." ?? ?? ?? ?? 4

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