Head Cold, Sedating Antihistamine, and a Two-Sector Duty
A first officer due to operate two sectors in a pressurized turboprop reports at 06:45 with nasal congestion, a sore throat and a temperature of 37.9°C. He took a sedating antihistamine at 22:00 and another dose at 06:00 because he felt worse. He says he now feels 'much better', but his left ear is not equalizing comfortably and he has pain over the left maxillary sinus. The flight cruises at 25,000 ft with a cabin altitude of 8,000 ft; the second sector is a night stop. There is no standby pilot, and cancelling would delay 48 passengers. The captain observes that the first officer looks tired and is speaking more slowly than usual. The company manual requires a fit-to-fly assessment and mentions the possibility of a positioning ferry or sick leave.
1. Evaluate the first officer's fitness to fly, including the medication, the infection, and the barotrauma risk.
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The first officer is not fit to fly. The sedating antihistamine is the clearest disqualifier: two doses, the most recent only 45 minutes before report, with a known side-effect of drowsiness and slowed reaction time. 'Feeling much better' is not evidence that the drug effect has worn off; subjective improvement often reflects the drug's sedating effect rather than recovery. The captain's observation of slowed speech and tired appearance is consistent with residual sedation.
The infection adds a second problem. A sore throat, fever and nasal congestion cause swelling of the Eustachian tube and sinus ostia. The pain over the left maxillary sinus indicates that the sinus is already having difficulty equalizing. In a pressurized aircraft with an 8,000 ft cabin, the pressure change on climb and especially descent can produce severe sinus or ear barotrauma, including incapacitating pain, hearing loss, and in rare cases vertigo. A pilot who cannot equalize comfortably on the ground is at high risk during descent, when the pressure gradient is greatest.
The combination is more than the sum of the parts: sedation reduces the pilot's ability to monitor his own ear and sinus symptoms, and pain or vertigo during a critical phase could cause sudden incapacitation. The absence of a standby pilot and the 48 passengers are commercial pressures, not aeromedical factors. The correct assessment is unfit for duty.
2. What decision should the captain make, and how should it be communicated to the first officer and to operations?
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The captain should remove the first officer from the flight and arrange sick leave or a medical assessment. A positioning ferry is not a safe alternative while the first officer is symptomatic and recently medicated; even as a passenger, he could suffer barotrauma, and the company manual's mention of a ferry does not override fitness requirements. If the captain cannot operate without a qualified second pilot, the flight should be delayed or cancelled until a replacement is available. The passengers' delay is regrettable but is not a reason to fly an impaired crew member.
The conversation should be direct and non-punitive: 'You have a fever, you are on a sedating antihistamine, and your sinus is painful. That makes you unfit today; this is a safety decision, not a judgement of your commitment.' The captain should avoid asking the first officer to decide for himself, because illness and medication can impair judgement. The first officer should be told not to drive himself home if he feels drowsy, and should be given contact details for the company medical adviser.
Operations should be informed immediately with the reason: unfit due to upper respiratory infection and sedating medication. The captain should request a replacement pilot and document the decision in the company system. If operations press for a ferry or a 'one-sector' compromise, the captain should repeat the specific risks: sinus pain, inability to equalize, sedation, and fever. The captain's authority to refuse an unfit crew member should be exercised clearly and early.
3. What follow-up and documentation should occur after the first officer is removed from duty?
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The first officer should be referred to the company medical adviser or an aeromedical examiner, with a clear instruction not to fly until the symptoms have resolved and the medication has been stopped for the period specified in the company manual. He should not self-certify a return to flying while still symptomatic. The company should record the removal from duty, the medication, the fever, and the sinus pain, so that the case can be reviewed if there is a recurrence.
The captain should complete an occurrence or fitness-for-duty report, not a disciplinary report. The report should distinguish between the first officer's decision to report for duty and the captain's decision to remove him; the former may reflect presenteeism and pressure from the lack of standby cover. The operator should review why a pilot with a fever and sedating medication felt he had to report, and whether standby coverage is adequate.
The first officer should be given a copy of the aeromedical guidance on upper respiratory infection, barotrauma, and sedating antihistamines. If he repeatedly reports for duty while unfit, the company should address it through its safety-management system rather than informally. The captain should also consider whether the first officer was pressured by the delay to 48 passengers; if so, that pressure should be discussed in the debrief so that it is not repeated.