Alcohol and civil aviation.

In aviation medicine until the early 1960s the idea that pilots would fly while under the influence of alcohol was taboo. In the United States of America, the taboo was broken when it became known that 30% of fatally injured pilots in general aviation had been under the influence of alcohol. Since then the rate has declined to 10%. No fatal accidents involving alcohol have been recorded in airline passenger transport. The prevalence of pilots flying under the influence of alcohol is unknown. The lowest studied blood alcohol concentration (BAC) with impaired flying skill today is 0.025%, effectively suggesting that the permitted level should be zero, but many aviation authorities have not yet translated such findings into rules and regulations. In the early 1970s the US Federal Air Surgeon began to re-issue licences for rehabilitated alcoholic pilots. Previously alcoholism had been a reason for mandatory permanent grounding. The possibility of returning to the cockpit first opened the way to early recognition of alcoholic pilots on a larger scale. Today many airlines have their own alcohol programmes. This paper gives a brief account of the Swissair programme with its four phases: observation, intervention, treatment and follow-up.