General Medical Officer (GMO) Manual: Administrative Section
Care and Disposition of Aviation Personnel
Department of the Navy
Bureau of Medicine and Surgery
Background Medication use Flight Physical Examinations
Aircrew members operate in a uniquely stressful environment, and require special handling from a medical standpoint. Aircrew are exposed to reduced ambient pressures with altitude, hypoxia, extremes of heat and cold, high acceleration and G-forces, angular rotations, and sensory illusions, to name a few. See the section on altitude-related illness for discussion on one of these. In addition to general medical standards, special duty medical standard also apply.
Medications, even over the counter (OTC) drugs, may have unpredictable side effects when combined with these stressors. The aircraft environment is very confining and can produce discomfort with reduced mobility, especially during extended operations. Furthermore, flying aircraft demands that the aviator be at peak performance. Any diminished mental or physical capacity impacts the safety of flight in this most unforgiving of environments. A simple upper respiratory infection, mild gastroenteritis, or musculoskeletal discomfort, which might be inconsequential on the ground, may have significant consequences during flight. For these reasons, all but the most trivial illnesses in the flight crew require that they be grounded and given a "down chit." Any provider may ground aircrew members when medically indicated; flight surgeon consultation is not required. However, only flight surgeons or aviation medical officers are authorized to return grounded aircrew to flight status following an illness. Any use of medications while flying absolutely requires flight surgeon approval. These same principles apply to air traffic controllers, even though they aren’t actually flying aircraft. Every time aviation personnel visit a sick call clinic or emergency room, their aeromedical disposition MUST be addressed. The general medical officer is often the responsible party for providing health care to aviation personnel and he or she must determine whether the condition requires grounding. In general, injuries, illnesses, and any use of medication will require that the patient be given a "down chit." This is accomplished by:
- Verbally advising the patient of their down status.
- Commenting on the aeromedical disposition on the SF 600 entry.
- Making an entry on the Special Duty Medical Abstract, NAVMED 6150/2, located under the SF 88/93 in the outpatient medical record jacket.
- Completing and issuing to the member a Grounding Notice, NAVMED 6410/1 commonly referred to as a "down chit."The service member is in a down status until the illness has resolved and medication is completed. A flight surgeon or aviation medical officer must screen the member to determine the eligibility and qualification for return to flight status. If qualified, the member will be given an Aeromedical Clearance Notice "up chit" (NAVMED 6410/2). If a flight surgeon is not available, as is the case in some remote locations, per BUMEDINST 6410.5A, any specifically designated medical department representative may issue an Aeromedical Clearance Notice provided approval is received from an aviation-qualified medical officer (flight surgeon or aviation medical officer). Such approval may take the form of verbal, written, or message correspondence regarding each individual case.
Occasionally, flight personnel may call upon the GMO to provide an annual flight physical exam. However, according to Manual of the Medical Department, article 15-65, flight physicals are performed only by aviation authorized medical officers. Since the extent of the exam to be conducted and the special duty medical standards to be applied are a function of the type of duty to be performed, coordination with a local or theater flight surgeon is required.
Reference
Revised by CAPT Charles O. Barker, MC, USN, Bureau of Medicine and Surgery MED-23, Washington, D.C. (1999).