Fit to Fly?

FAA Safety Briefing
Cleared for Takeoff
4 min readJan 4
Magazine department.

By Dr. Susan Northrup, FAA Federal Air Surgeon

Many pilots incorporate the I’M SAFE checklist (Illness, Medication, Stress, Alcohol, Fatigue, and Emotion) into the go/no-go decision process. While its use is not explicitly required by FAA regulations, pilots are required to determine fitness to operate an aircraft prior to every flight. A surprising number of pilots don’t understand they have this responsibility even if they don’t hold an FAA medical certificate. All pilots, including those who fly ultralights or operate drones, have an obligation to ensure that they are medically fit to fly before operating the controls as a required crew member. Let’s review the regulations.

Photo of sick person.

All pilots, including those who operate drones, have an obligation to ensure they are medically fit to fly before operating the controls as a required crew member.

Medical regulations exist to ensure that an aircrew member is physically and mentally able to safely meet flight duty requirements. The United States and United Kingdom military implemented them during WWI due to the high number of mishaps directly attributed to medical causes. The accident rate dropped dramatically with implementation of medical standards. We can trace today’s guidance back to these standards, modified as medicine has advanced.

All pilots who fly with a certificate issued under 14 CFR part 61 are subject to one of the three paragraphs of 14 CFR section 61.53. There is separate guidance for those who operate aircraft under 14 CFR parts 103 (ultralight vehicles) and 107 (small unmanned aircraft systems).

For pilots seeking FAA medical certification, the aviation medical examiner (AME) determines whether the pilot meets standards on the day of the examination. The expectation is that the pilot will likely remain medically qualified for the duration of the medical certificate as long as nothing changes (new conditions, worsening, medications/treatments, etc.). It is also expected that the pilot truthfully disclose all medical conditions, medications, and disabilities. If something does change, paragraph A of 14 CFR section 61.53 addresses your obligations whether it’s short-term (e.g., a cold) or long term (e.g., heart disease, cancer). For pilots who do not meet the medical standards in 14 CFR part 67, the FAA can authorize exceptions (special issuance, statements of demonstrated ability, or letters of evidence) if evaluation demonstrates that flight safety can be maintained. Remember, FAA issues to over 99.5% of medical certificate applicants!

Glider and balloon pilots do not need a medical certificate or a driver’s license, but must self-certify that they are medically fit to fly. 14 CFR section 61.53(b) covers these pilots. Note, though, that a new rule requires commercial balloon pilots to hold at least a Class II FAA medical certificate when conducting non-instructional commercial balloon operations. The NTSB recommended this action, and Congress directed the FAA to proceed. The final rule published on Nov. 22, 2022.

Paragraph C of 14 CFR section 61.53 covers pilots who operate under BasicMed or as a Sport Pilot. They must hold a driver’s license and also must self-certify. Pilots who fly using BasicMed also have online training every two years and a medical evaluation every four years.

Pilots operating remotely piloted aircraft should self-certify prior to each flight in accordance with 14 CFR section 107.17. For pilots of ultralight aircraft, 14 CFR part 103 does not specifically address medical fitness, but it does speak to hazardous operations.

Regardless of which rules we fly under, we are obligated to ensure we can do so safely without endangering ourselves or the public. Even a medical certificate issued yesterday does not guarantee that you are ready to fly today. Being truthful at the time of a FAA medical exam is critical but being truthful with yourself at flight time is even more important. As PIC, you are responsible for determining your fitness to fly before each flight. Preflight checklists for your aircraft are the hallmark of aviation safety. The I’M SAFE checklist is an excellent tool for making your pre-flight go/no-go decision, and should be your personal safety hallmark.

Dr. Susan Northrup, FAA Federal Air Surgeon

Dr. Susan Northrup received a bachelor’s degree in chemistry, a medical degree from The Ohio State University, and a master’s degree in public health from the University of Texas. She is double board-certified by the American Board of Preventive Medicine in Aerospace Medicine and Occupational Medicine. She is a retired U.S. Air Force colonel and a former regional medical director for Delta Air Lines. She is also an active private pilot.

This article was originally published in the January/February 2023 issue of FAA Safety Briefing magazine.



FAA Safety Briefing
Cleared for Takeoff

Official FAA safety policy voice for general aviation. The magazine is part of the national FAA Safety Team (FAASTeam).