FAR/AIM: Section 1. Fitness for Flight

1. All pilots except those flying gliders and free air balloons must possess valid medical certificates in order to exercise the privileges of their airman certificates. The periodic medical examinations required for medical certification are conducted by designated Aviation Medical Examiners, who are physicians with a special interest in aviation safety and training in aviation medicine.
2. The standards for medical certification are contained in 14 CFR Part 67. Pilots who have a history of certain medical conditions described in these standards are mandatorily disqualified from flying. These medical conditions include a personality disorder manifested by overt acts, a psychosis, alcoholism, drug dependence, epilepsy, an unexplained disturbance of consciousness, myocardial infarction, angina pectoris and diabetes requiring medication for its control. Other medical conditions may be temporarily disqualifying, such as acute infections, anemia, and peptic ulcer. Pilots who do not meet medical standards may still be qualified under special issuance provisions or the exemption process. This may require that either additional medical information be provided or practical flight tests be conducted.
3. Student pilots should visit an Aviation Medical Examiner as soon as possible in their flight training in order to avoid unnecessary training expenses should they not meet the medical standards. For the same reason, the student pilot who plans to enter commercial aviation should apply for the highest class of medical certificate that might be necessary in the pilot's career.

   CAUTION-

   The CFRs prohibit a pilot who possesses a current medical certificate from performing crewmember duties while the pilot has a known medical condition or increase of a known medical condition that would make the pilot unable to meet the standards for the medical certificate.

1. Even a minor illness suffered in day‐to‐day living can seriously degrade performance of many piloting tasks vital to safe flight. Illness can produce fever and distracting symptoms that can impair judgment, memory, alertness, and the ability to make calculations. Although symptoms from an illness may be under adequate control with a medication, the medication itself may decrease pilot performance.
2. The safest rule is not to fly while suffering from any illness. If this rule is considered too stringent for a particular illness, the pilot should contact an Aviation Medical Examiner for advice.

1. Pilot performance can be seriously degraded by both prescribed and over‐the‐counter medications, as well as by the medical conditions for which they are taken. Many medications, such as tranquilizers, sedatives, strong pain relievers, and cough‐suppressant preparations, have primary effects that may impair judgment, memory, alertness, coordination, vision, and the ability to make calculations. Others, such as antihistamines, blood pressure drugs, muscle relaxants, and agents to control diarrhea and motion sickness, have side effects that may impair the same critical functions. Any medication that depresses the nervous system, such as a sedative, tranquilizer or antihistamine, can make a pilot much more susceptible to hypoxia.
2. The CFRs prohibit pilots from performing crewmember duties while using any medication that affects the faculties in any way contrary to safety. The safest rule is not to fly as a crewmember while taking any medication, unless approved to do so by the FAA.

1. Extensive research has provided a number of facts about the hazards of alcohol consumption and flying. As little as one ounce of liquor, one bottle of beer or four ounces of wine can impair flying skills, with the alcohol consumed in these drinks being detectable in the breath and blood for at least 3 hours. Even after the body completely destroys a moderate amount of alcohol, a pilot can still be severely impaired for many hours by hangover. There is simply no way of increasing the destruction of alcohol or alleviating a hangover. Alcohol also renders a pilot much more susceptible to disorientation and hypoxia.
2. A consistently high alcohol related fatal aircraft accident rate serves to emphasize that alcohol and flying are a potentially lethal combination. The CFRs prohibit pilots from performing crewmember duties within 8 hours after drinking any alcoholic beverage or while under the influence of alcohol. However, due to the slow destruction of alcohol, a pilot may still be under influence 8 hours after drinking a moderate amount of alcohol. Therefore, an excellent rule is to allow at least 12 to 24 hours between “bottle and throttle,” depending on the amount of alcoholic beverage consumed.

1. Fatigue continues to be one of the most treacherous hazards to flight safety, as it may not be apparent to a pilot until serious errors are made. Fatigue is best described as either acute (short‐term) or chronic (long‐term).
2. A normal occurrence of everyday living, acute fatigue is the tiredness felt after long periods of physical and mental strain, including strenuous muscular effort, immobility, heavy mental workload, strong emotional pressure, monotony, and lack of sleep. Consequently, coordination and alertness, so vital to safe pilot performance, can be reduced. Acute fatigue is prevented by adequate rest and sleep, as well as by regular exercise and proper nutrition.
3. Chronic fatigue occurs when there is not enough time for full recovery between episodes of acute fatigue. Performance continues to fall off, and judgment becomes impaired so that unwarranted risks may be taken. Recovery from chronic fatigue requires a prolonged period of rest.
4. OBSTRUCTIVE SLEEP APNEA (OSA). OSA is now recognized as an important preventable factor identified in transportation accidents. OSA interrupts the normal restorative sleep necessary for normal functioning and is associated with chronic illnesses such as hypertension, heart attack, stroke, obesity, and diabetes. Symptoms include snoring, excessive daytime sleepiness, intermittent prolonged breathing pauses while sleeping, memory impairment and lack of concentration. There are many available treatments which can reverse the day time symptoms and reduce the chance of an accident. OSA can be easily treated. Most treatments are acceptable for medical certification upon demonstrating effective treatment. If you have any symptoms described above, or neck size over 17 inches in men or 16 inches in women, or a body mass index greater than 30 you should be evaluated for sleep apnea by a sleep medicine specialist.
   (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html) With treatment you can avoid or delay the onset of these chronic illnesses and prolong a quality life.

1. Stress from the pressures of everyday living can impair pilot performance, often in very subtle ways. Difficulties, particularly at work, can occupy thought processes enough to markedly decrease alertness. Distraction can so interfere with judgment that unwarranted risks are taken, such as flying into deteriorating weather conditions to keep on schedule. Stress and fatigue (see above) can be an extremely hazardous combination.
2. Most pilots do not leave stress “on the ground.” Therefore, when more than usual difficulties are being experienced, a pilot should consider delaying flight until these difficulties are satisfactorily resolved.

1. Hypoxia is a state of oxygen deficiency in the body sufficient to impair functions of the brain and other organs. Hypoxia from exposure to altitude is due only to the reduced barometric pressures encountered at altitude, for the concentration of oxygen in the atmosphere remains about 21 percent from the ground out to space.
2. Although a deterioration in night vision occurs at a cabin pressure altitude as low as 5,000 feet, other significant effects of altitude hypoxia usually do not occur in the normal healthy pilot below 12,000 feet. From 12,000 to 15,000 feet of altitude, judgment, memory, alertness, coordination and ability to make calculations are impaired, and headache, drowsiness, dizziness and either a sense of well‐being (euphoria) or belligerence occur. The effects appear following increasingly shorter periods of exposure to increasing altitude. In fact, pilot performance can seriously deteriorate within 15 minutes at 15,000 feet.
3. At cabin pressure altitudes above 15,000 feet, the periphery of the visual field grays out to a point where only central vision remains (tunnel vision). A blue coloration (cyanosis) of the fingernails and lips develops. The ability to take corrective and protective action is lost in 20 to 30 minutes at 18,000 feet and 5 to 12 minutes at 20,000 feet, followed soon thereafter by unconsciousness.
4. The altitude at which significant effects of hypoxia occur can be lowered by a number of factors. Carbon monoxide inhaled in smoking or from exhaust fumes, lowered hemoglobin (anemia), and certain medications can reduce the oxygen‐carrying capacity of the blood to the degree that the amount of oxygen provided to body tissues will already be equivalent to the oxygen provided to the tissues when exposed to a cabin pressure altitude of several thousand feet. Small amounts of alcohol and low doses of certain drugs, such as antihistamines, tranquilizers, sedatives and analgesics can, through their depressant action, render the brain much more susceptible to hypoxia. Extreme heat and cold, fever, and anxiety increase the body's demand for oxygen, and hence its susceptibility to hypoxia.
5. The effects of hypoxia are usually quite difficult to recognize, especially when they occur gradually. Since symptoms of hypoxia do not vary in an individual, the ability to recognize hypoxia can be greatly improved by experiencing and witnessing the effects of hypoxia during an altitude chamber “flight.” The FAA provides this opportunity through aviation physiology training, which is conducted at the FAA Civil Aeromedical Institute and at many military facilities across the U.S. To attend the Physiological Training Program at the Civil Aeromedical Institute, Mike Monroney Aeronautical Center, Oklahoma City, OK, contact by telephone (405) 954-6212, or by writing Aerospace Medical Education Division, AAM-400, CAMI, Mike Monroney Aeronautical Center, P.O. Box 25082, Oklahoma City, OK 73125.

   NOTE-

   To attend the physiological training program at one of the military installations having the training capability, an application form and a fee must be submitted. Full particulars about location, fees, scheduling procedures, course content, individual requirements, etc., are contained in the Physiological Training Application, Form Number AC 3150-7, which is obtained by contacting the accident prevention specialist or the office forms manager in the nearest FAA office.

6. Hypoxia is prevented by heeding factors that reduce tolerance to altitude, by enriching the inspired air with oxygen from an appropriate oxygen system, and by maintaining a comfortable, safe cabin pressure altitude. For optimum protection, pilots are encouraged to use supplemental oxygen above 10,000 feet during the day, and above 5,000 feet at night. The CFRs require that at the minimum, flight crew be provided with and use supplemental oxygen after 30 minutes of exposure to cabin pressure altitudes between 12,500 and 14,000 feet and immediately on exposure to cabin pressure altitudes above 14,000 feet. Every occupant of the aircraft must be provided with supplemental oxygen at cabin pressure altitudes above 15,000 feet.

1. As the aircraft cabin pressure decreases during ascent, the expanding air in the middle ear pushes the eustachian tube open, and by escaping down it to the nasal passages, equalizes in pressure with the cabin pressure. But during descent, the pilot must periodically open the eustachian tube to equalize pressure. This can be accomplished by swallowing, yawning, tensing muscles in the throat, or if these do not work, by a combination of closing the mouth, pinching the nose closed, and attempting to blow through the nostrils (Valsalva maneuver).
2. Either an upper respiratory infection, such as a cold or sore throat, or a nasal allergic condition can produce enough congestion around the eustachian tube to make equalization difficult. Consequently, the difference in pressure between the middle ear and aircraft cabin can build up to a level that will hold the eustachian tube closed, making equalization difficult if not impossible. The problem is commonly referred to as an “ear block.”
3. An ear block produces severe ear pain and loss of hearing that can last from several hours to several days. Rupture of the ear drum can occur in flight or after landing. Fluid can accumulate in the middle ear and become infected.
4. An ear block is prevented by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the eustachian tubes. Oral decongestants have side effects that can significantly impair pilot performance.
5. If an ear block does not clear shortly after landing, a physician should be consulted.

1. During ascent and descent, air pressure in the sinuses equalizes with the aircraft cabin pressure through small openings that connect the sinuses to the nasal passages. Either an upper respiratory infection, such as a cold or sinusitis, or a nasal allergic condition can produce enough congestion around an opening to slow equalization, and as the difference in pressure between the sinus and cabin mounts, eventually plug the opening. This “sinus block” occurs most frequently during descent.
2. A sinus block can occur in the frontal sinuses, located above each eyebrow, or in the maxillary sinuses, located in each upper cheek. It will usually produce excruciating pain over the sinus area. A maxillary sinus block can also make the upper teeth ache. Bloody mucus may discharge from the nasal passages.
3. A sinus block is prevented by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the sinus openings. Oral decongestants have side effects that can impair pilot performance.
4. If a sinus block does not clear shortly after landing, a physician should be consulted.

1. A pilot or passenger who intends to fly after scuba diving should allow the body sufficient time to rid itself of excess nitrogen absorbed during diving. If not, altitude decompression sickness due to evolved nitrogen gas can occur during exposure to reduced barometric pressure (i.e., low cabin pressure) associated with increased altitude and may lead to a serious inflight emergency.
2. The recommended wait time before going to flight altitudes up to 8,000 feet is at least 12 hours after diving that did not require a controlled ascent (i.e., non-decompression stop diving), and at least 24 hours after diving that required a controlled ascent (i.e., decompression stop diving). The recommended wait time before going to flight altitudes above 8,000 feet is at least 24 hours after any SCUBA dive. These recommended altitudes are actual flight altitudes above mean sea level (AMSL) and not pressurized cabin altitudes. This takes into consideration the risk of aircraft decompression during flight.

1. Various complex motions and forces and certain visual scenes encountered in flight can create illusions of motion and position. Spatial disorientation from these illusions can be prevented only by visual reference to reliable, fixed points on the ground or to flight instruments.
2. The leans. An abrupt correction of a banked attitude, which has been entered too slowly to stimulate the motion sensing system in the inner ear, can create the illusion of banking in the opposite direction. The disoriented pilot will roll the aircraft back into its original dangerous attitude, or if level flight is maintained, will feel compelled to lean in the perceived vertical plane until this illusion subsides.
   1. Coriolis illusion. An abrupt head movement in a prolonged constant‐rate turn that has ceased stimulating the motion sensing system can create the illusion of rotation or movement in an entirely different axis. The disoriented pilot will maneuver the aircraft into a dangerous attitude in an attempt to stop rotation. This most overwhelming of all illusions in flight may be prevented by not making sudden, extreme head movements, particularly while making prolonged constant‐rate turns under IFR conditions.
   2. Graveyard spin. A proper recovery from a spin that has ceased stimulating the motion sensing system can create the illusion of spinning in the opposite direction. The disoriented pilot will return the aircraft to its original spin.
   3. Graveyard spiral. An observed loss of altitude during a coordinated constant‐rate turn that has ceased stimulating the motion sensing system can create the illusion of being in a descent with the wings level. The disoriented pilot will pull back on the controls, tightening the spiral and increasing the loss of altitude.
   4. Somatogravic illusion. A rapid acceleration during takeoff can create the illusion of being in a nose up attitude. The disoriented pilot will push the aircraft into a nose low, or dive attitude. A rapid deceleration by a quick reduction of the throttles can have the opposite effect, with the disoriented pilot pulling the aircraft into a nose up, or stall attitude.
   5. Inversion illusion. An abrupt change from climb to straight and level flight can create the illusion of tumbling backwards. The disoriented pilot will push the aircraft abruptly into a nose low attitude, possibly intensifying this illusion.
   6. Elevator illusion. An abrupt upward vertical acceleration, usually by an updraft, can create the illusion of being in a climb. The disoriented pilot will push the aircraft into a nose low attitude. An abrupt downward vertical acceleration, usually by a downdraft, has the opposite effect, with the disoriented pilot pulling the aircraft into a nose up attitude.
   7. False horizon. Sloping cloud formations, an obscured horizon, a dark scene spread with ground lights and stars, and certain geometric patterns of ground light can create illusions of not being aligned correctly with the actual horizon. The disoriented pilot will place the aircraft in a dangerous attitude.
   8. Autokinesis. In the dark, a static light will appear to move about when stared at for many seconds. The disoriented pilot will lose control of the aircraft in attempting to align it with the light.
3. Illusions Leading to Landing Errors.
   1. Various surface features and atmospheric conditions encountered in landing can create illusions of incorrect height above and distance from the runway threshold. Landing errors from these illusions can be prevented by anticipating them during approaches, aerial visual inspection of unfamiliar airports before landing, using electronic glide slope or VASI systems when available, and maintaining optimum proficiency in landing procedures.
   2. Runway width illusion. A narrower‐than‐usual runway can create the illusion that the aircraft is at a higher altitude than it actually is. The pilot who does not recognize this illusion will fly a lower approach, with the risk of striking objects along the approach path or landing short. A wider‐than‐usual runway can have the opposite effect, with the risk of leveling out high and landing hard or overshooting the runway.
   3. Runway and terrain slopes illusion. An upsloping runway, upsloping terrain, or both, can create the illusion that the aircraft is at a higher altitude than it actually is. The pilot who does not recognize this illusion will fly a lower approach. A downsloping runway, downsloping approach terrain, or both, can have the opposite effect.
   4. Featureless terrain illusion. An absence of ground features, as when landing over water, darkened areas, and terrain made featureless by snow, can create the illusion that the aircraft is at a higher altitude than it actually is. The pilot who does not recognize this illusion will fly a lower approach.
   5. Atmospheric illusions. Rain on the windscreen can create the illusion of greater height, and atmospheric haze the illusion of being at a greater distance from the runway. The pilot who does not recognize these illusions will fly a lower approach. Penetration of fog can create the illusion of pitching up. The pilot who does not recognize this illusion will steepen the approach, often quite abruptly.
   6. Ground lighting illusions. Lights along a straight path, such as a road, and even lights on moving trains can be mistaken for runway and approach lights. Bright runway and approach lighting systems, especially where few lights illuminate the surrounding terrain, may create the illusion of less distance to the runway. The pilot who does not recognize this illusion will fly a higher approach. Conversely, the pilot overflying terrain which has few lights to provide height cues may make a lower than normal approach.

1. Under conditions of dim illumination, small print and colors on aeronautical charts and aircraft instruments become unreadable unless adequate cockpit lighting is available. Moreover, another aircraft must be much closer to be seen unless its navigation lights are on.
2. In darkness, vision becomes more sensitive to light, a process called dark adaptation. Although exposure to total darkness for at least 30 minutes is required for complete dark adaptation, a pilot can achieve a moderate degree of dark adaptation within 20 minutes under dim red cockpit lighting. Since red light severely distorts colors, especially on aeronautical charts, and can cause serious difficulty in focusing the eyes on objects inside the aircraft, its use is advisable only where optimum outside night vision capability is necessary. Even so, white cockpit lighting must be available when needed for map and instrument reading, especially under IFR conditions. Dark adaptation is impaired by exposure to cabin pressure altitudes above 5,000 feet, carbon monoxide inhaled in smoking and from exhaust fumes, deficiency of Vitamin A in the diet, and by prolonged exposure to bright sunlight. Since any degree of dark adaptation is lost within a few seconds of viewing a bright light, a pilot should close one eye when using a light to preserve some degree of night vision.
3. Excessive illumination, especially from light reflected off the canopy, surfaces inside the aircraft, clouds, water, snow, and desert terrain, can produce glare, with uncomfortable squinting, watering of the eyes, and even temporary blindness. Sunglasses for protection from glare should absorb at least 85 percent of visible light (15 percent transmittance) and all colors equally (neutral transmittance), with negligible image distortion from refractive and prismatic errors.

1. Scanning the sky for other aircraft is a key factor in collision avoidance. It should be used continuously by the pilot and copilot (or right seat passenger) to cover all areas of the sky visible from the cockpit. Although pilots must meet specific visual acuity requirements, the ability to read an eye chart does not ensure that one will be able to efficiently spot other aircraft. Pilots must develop an effective scanning technique which maximizes one's visual capabilities. The probability of spotting a potential collision threat obviously increases with the time spent looking outside the cockpit. Thus, one must use timesharing techniques to efficiently scan the surrounding airspace while monitoring instruments as well.
2. While the eyes can observe an approximate 200 degree arc of the horizon at one glance, only a very small center area called the fovea, in the rear of the eye, has the ability to send clear, sharply focused messages to the brain. All other visual information that is not processed directly through the fovea will be of less detail. An aircraft at a distance of 7 miles which appears in sharp focus within the foveal center of vision would have to be as close as ⁷/₁₀ of a mile in order to be recognized if it were outside of foveal vision. Because the eyes can focus only on this narrow viewing area, effective scanning is accomplished with a series of short, regularly spaced eye movements that bring successive areas of the sky into the central visual field. Each movement should not exceed 10 degrees, and each area should be observed for at least 1 second to enable detection. Although horizontal back‐and‐forth eye movements seem preferred by most pilots, each pilot should develop a scanning pattern that is most comfortable and then adhere to it to assure optimum scanning.
3. Studies show that the time a pilot spends on visual tasks inside the cabin should represent no more that ¹/₄ to ¹/₃ of the scan time outside, or no more than 4 to 5 seconds on the instrument panel for every 16 seconds outside. Since the brain is already trained to process sight information that is presented from left to right, one may find it easier to start scanning over the left shoulder and proceed across the windshield to the right.
4. Pilots should realize that their eyes may require several seconds to refocus when switching views between items in the cockpit and distant objects. The eyes will also tire more quickly when forced to adjust to distances immediately after close‐up focus, as required for scanning the instrument panel. Eye fatigue can be reduced by looking from the instrument panel to the left wing past the wing tip to the center of the first scan quadrant when beginning the exterior scan. After having scanned from left to right, allow the eyes to return to the cabin along the right wing from its tip inward. Once back inside, one should automatically commence the panel scan.
5. Effective scanning also helps avoid “empty‐field myopia.” This condition usually occurs when flying above the clouds or in a haze layer that provides nothing specific to focus on outside the aircraft. This causes the eyes to relax and seek a comfortable focal distance which may range from 10 to 30 feet. For the pilot, this means looking without seeing, which is dangerous.

REFERENCE-

FAA AC 91-61, A Hazard in Aerobatics: Effects of G-forces on Pilots.

1. Airways, especially near VORs, and Class B, Class C, Class D, and Class E surface areas are places where aircraft tend to cluster.
2. Remember, most collisions occur during days when the weather is good. Being in a “radar environment” still requires vigilance to avoid collisions.

1. Pilots need to move their heads to see around blind spots caused by fixed aircraft structures, such as door posts, wings, etc. It will be necessary at times to maneuver the aircraft; e.g., lift a wing, to facilitate seeing.
2. Pilots must ensure curtains and other cockpit objects; e.g., maps on glare shield, are removed and stowed during flight.

1. Day or night, use of exterior lights can greatly increase the conspicuity of any aircraft.
2. Keep interior lights low at night.