3.9.1. AMC/A3 will establish policy for implementation of the Fatigue Countermeasures (CM) Management Program and ensure compliance with its provisions, and AMC/SG will provide clinical oversight, guidance and materials for fatigue CM education and mitigation.
3.9.2. OG/CCs will ensure Unit Operational Risk Management (ORM) programs include use of the basic fatigue countermeasures found in the AvORM worksheet. Both the manual and automated ―MAF Mission Aviation ORM Worksheet‖ incorporate a fatigue CM risk
assessment model. They are available on the AMC/A3V website under the ―Pubs‖ tab,
―Operational Risk Management (ORM)‖ section, and will be used by all three tiers of mission planners, as well as aircrew during the mission execution phase.
3.9.3. Flight surgeons or Aerospace/Operational Physiologists will use the AMC-approved (lead command) fatigue CM training CDs and pamphlets provided by AMC/SGP to educate their operational fliers in venues such as clinic visits, flight physicals, Safety Down Days, pre-deployment briefings, readiness training, Commanders‘ Calls, First-Term Airmen Courses, base orientations and safety meetings.
3.9.4. The primary fatigue CM available to aircrew members is appropriate management of their sleep/rest cycles. Secondary CM include smart scheduling procedures aimed at managing those cycles, strategic inflight and/or ground napping techniques, and proper diet and exercise.
3.9.5. An additional fatigue CM tool available to aircrew is the No-Go Pill. The occasional use of a No-Go Pill by MAF aircrew to improve sleep quality and/or adjust circadian rhythm sleep/wake cycles is voluntary. Each individual aircrew member will, with the aid of their home station flight surgeon, determine how/if to implement the use of No-Go Pills as a fatigue CM.
3.9.6. The following directives concerning the use of No-Go Pills are as important and unbreakable as the ―12 hour bottle to throttle‖ restriction for alcohol consumption:
3.9.6.1. Aircrew members on flight orders will not use No-Go Pills in flight.
3.9.6.2. Aircrew members will complete ground testing for any No-Go Pill they wish to use for operational purposes and document using MAF No-Go Pill Form 1, Ground Testing of No-Go Pills. In order to avoid possible drug interactions, aircrew members will inform the flight surgeon of any over-the-counter medications and/or nutritional supplements they are taking. During ground testing, aircrew members will be DNIF on an AF Form 1042 for the minimum ‗DNIF‘ periods prescribed in paragraph 3.9.6.4.
After ground testing of a particular No-Go Pill, the flight surgeon will complete the bottom half of the Form 1 and a ―return to fly‖ AF Form 1042. Successful ground testing of a particular No-Go Pill establishes clearance to use it operationally.
3.9.6.3. Aircrew members may obtain NoGo Pills from any USAF or other authorized flight surgeon while at home station or off-station while TDY/deployed. Off-station/deployed flight surgeons can verify individual aircrew ground testing results via the ―MAF Aircrew Medication Ground Test Card‖ all MAF aircrew members are required to carry.
3.9.6.4. In no case will an individual perform aircrew duties while under the effects of No-Go Pills. Individuals will use the mission report or legal for alert time to determine the latest time to take a No-Go Pill. No-Go medications can affect individuals very differently. To comply with the ―no aircrew duties while under the effects‖ restriction, it is the responsibility of each individual aircrew member to be aware of their own minimum ‗DNIF‘ period for any No-Go Pill they use, based on their ground trial results and/or previous experiences. The following are the minimum ‗DNIF‘ periods (no AF Form 1042 required) after consuming a No-Go Pill:
3.9.6.4.1. Sonata (Zaleplon) – 4 hours minimum ‗DNIF‘
3.9.6.4.2. Ambien (Zolpidem) – 6 hours minimum ‗DNIF‘
3.9.6.4.3. Restoril (Temazepam, Class IV Controlled Substance) – 12 hours minimum ‗DNIF‘
3.9.6.5. Aircrew members will consider the following examples of missions prone to causing fatigue and/or sleep disruptions in their decision to use a No-Go Pill:
3.9.6.5.1. Home station night launch missions with 2000-0530L show times and greater than four hours‘ duration.
3.9.6.5.2. Crew rest facilities lacking an optimal (i.e., quiet, air-conditioned, darkened) sleeping environment.
3.9.6.5.3. Off-station missions that are four or more time zones from home station.
3.9.6.5.4. Rotating or stair-stepped flying schedules with greater than 6-hour flight time duration.
3.9.6.5.5. Missions that run consistently near a 12 to 14 hour duty day.
3.9.6.6. The MAF‘s worldwide mobility mission makes accountability for this program challenging; therefore, the following are aircrew member responsibilities:
3.9.6.6.1. Aircrew members will not operate heavy equipment during the minimum
‗DNIF‘ period for each No-Go Pill outlined in paragraph 3.9.6.4.
3.9.6.6.2. Aircrew members will not take No-Go Pills within 12 hours of consuming alcohol, as their combined use unpredictably increases the effects of both.
3.9.6.6.3. Aircrew members will limit use of Ambien (Zolpidem) and Restoril (Temazepam) to a maximum of seven consecutive days and no more than 20 days in a 60-day period. Flight surgeons should prescribe 60 days‘ worth of medication (20 pills) at a time if requested by the aircrew member, unless clinically inadvisable.
3.9.6.6.4. Aircrew members will limit use of Sonata (Zaleplon) to a maximum of 10 consecutive days and no more than 28 days in a 60-day period. Flight surgeons should prescribe 60 days‘ worth of medication (28 pills) if requested by the aircrew member, unless clinically inadvisable.
3.9.6.6.5. If an aircrew member uses Sonata in combination with either of the other types of No-Go Pills, the seven consecutive days and 20-days in a 60 day period restrictions apply (overrides the 10 consecutive days and 28 days in a 60-day period for Sonata).
3.9.6.6.6. Aircrew members may consume more than one No-Go Pill in a 24-hour period, if operationally necessary. A second No-Go Pill of the same or different type will not be consumed while in the minimum ‗DNIF‘ period for the previous pill.
3.9.6.6.7. The ―MAF Go Pill Usage/Refill Form‖ will be used to document No-Go Pill use and refill authorization, and placed in the aircrew member‘s medical record. Non-duty station flight surgeons will forward the form to the aircrew member‘s home station aerospace medicine clinic to be placed in their medical
record. Flight surgeons will immediately discuss any concerns about an aircrew member‘s use of No-Go Pills with the individual‘s commander if any question of misuse arises.
3.9.6.6.8. Aircrew members on Personnel Reliability Program (PRP) status will follow PRP notification procedures if prescribed No-Go Pills.
3.10. Crew Rest/Enroute Ground Time. OG/CCs shall establish procedures to place