Abstract
Background
Fighter pilots are a specific population in which any adverse drug reaction can unpredictably interact with aeronautical constraints and thus compromise flight safety. This issue has not been evaluated in risk assessments.
Aim
To provide a semi-quantitative assessment of the risk to flight safety of self-medication in fighter pilots.
Method
A cross-sectional survey that aimed at identifying the determinants of self-medication in fighter pilots was conducted. All medications consumed within 8 h preceding a flight were listed. A modified Failure Mode and Effects Analysis was performed, and any adverse drug reaction reported in the French marketing authorization document of a drug was considered a failure mode. The frequency of occurrence and severity were evaluated using specific scales to assign each to three risk criticality categories: acceptable, tolerable, and unacceptable.
Results
Between March and November 2020, the responses of 170 fighter pilots were analyzed, for an overall return rate of approximately 34%. Among them, 78 reported 140 self-medication events within 8 h preceding a flight. Thirty-nine drug trade names (48 different international nonproprietary names) were listed, from which 694 potential adverse drug reactions were identified. The risk criticality was considered unacceptable, tolerable and acceptable for 37, 325 and 332 adverse drug reactions, respectively. Thus, the risk criticality was considered unacceptable, tolerable and acceptable for 17, 17, and 5 drugs, respectively.
Conclusion
This analysis suggests that the overall risk to flight safety of the current practice of self-medication in fighter pilots may be considered at least tolerable, or even unacceptable.
Similar content being viewed by others
References
Noone J, Blanchette CM. The value of self-medication: summary of existing evidence. J Med Econ. 2018;21(2):201–11.
Cohen J, Millier A, Karray S, et al. Assessing the economic impact of Rx-to-OTC switches: systematic review and guidelines for future development. J Med Econ. 2013;16(6):835–44.
Asseray N, Ballereau F, Trombert-Paviot B, et al. Frequency and severity of adverse drug reactions due to self-medication: a cross-sectional multicentre survey in emergency departments. Drug Saf. 2013;36(12):1159–68.
Berreni A, Montastruc F, Bondon-Guitton E, et al. Adverse drug reactions to self-medication: a study in a pharmacovigilance database. Fundam Clin Pharmacol. 2015;29(5):517–20.
Locquet M, Honvo G, Rabenda V, et al. Adverse health events related to self-medication practices among elderly: a systematic review. Drugs Aging. 2017;34(5):359–65.
Hetland A, Carr DB. Medications and impaired driving. Ann Pharmacother. 2014;48(4):494–506.
McKay MP, Groff L. 23 years of toxicology testing fatally injured pilots: Implications for aviation and other modes of transportation. Accid Anal Prev. 2016;90:108–17.
DeJohn CA, Greenhaw R, Lewis R, et al. Drug use reported by U.S. Pilots, 2009–2014. Aerosp Med Hum Perform. 2020;91(7):586–91.
Hormeño-Holgado AJ, Clemente-Suárez VJ. Effect of different combat jet manoeuvres in the psychophysiological response of professional pilots. Physiol Behav. 2019;208:112559.
Sicard B, Desmants F. Médication et aviation embarquée. Méd Aéro Spat. 1990;29(116):275–7.
Sicard B, Desmants F. Consommation de médicaments chez les pilotes de chasse embarquée : évolution des comportements. Méd Aéro Spat. 1997;36(143):205–8.
Paris JF, Magrit C, Martel V, et al. Effets secondaires des médicaments. Automédication, hypnotiques, mélatonine et activité aéronautique. Enquête anonyme chez 1000 pilotes. Méd Aéro Spat. 1999;38(152):225–30.
du Baret de Limé M, Monin J, Leschiera J, et al. Self-medication among military fighter aircrews. Aerospace Med Human Perform. 2022;93(7):571–80.
Rah JE, Manger RP, Yock AD, et al. A comparison of two prospective risk analysis methods: traditional FMEA and a modified healthcare FMEA. Med Phys. 2016;43(12):6347.
Liu HC, Zhang LJ, Ping YJ, et al. Failure mode and effects analysis for proactive healthcare risk evaluation: a systematic literature review. J Eval Clin Pract. 2019;26(4):1320–37.
Fratus L, Brocq FX, Lepoyvre A, et al. La prise de médicaments chez les pilotes. Le rôle du pharmacien d’officine. Méd Aéro Spat. 2011;52(195):89–100.
Ministère des solidarités et de la santé. Base de données publique des médicaments. 2022. https://base-donnees-publique.medicaments.gouv.fr/index.php. Accessed 09 May 2023.
Marotte H. Physiologie Aéronautique : comportement de l'organisme humain dans l'environnement aéronautique et spatial. 1st ed. Editions SEES; 2004. ISBN: 2-908414-24-4.
Duijm NJ. Recommendations on the use and design of risk matrices. Saf Sci. 2015;76:21–31.
Ni H, Chen A, Chen N. Some extensions on risk matrix approach. Saf Sci. 2010;48(10):1269–78.
Scarlett L, Linkov I, Kousky C. Risk management practices: cross-agency comparisons with minerals management service. RFF Press; 2011.
Prudhomme MB, Ropp LG, Sauer SW, et al. Aeromedical risk assessment of pharmaceuticals using evidence-based medicine. Aerosp Med Hum Perform. 2015;86(9):824–9.
Cronrath CM, Klick MP, Merfeld CM, et al. Medication adverse reaction, risk stratification (MAR2S) model. Aerosp Med Hum Perform. 2019;90(10):896–900.
Pascarella G, Rossi M, Montella E, et al. Risk analysis in healthcare organizations: methodological framework and critical variables. Risk Manag Healthc Policy. 2021;14:2897–911.
Peace C. The risk matrix: Uncertain results? Policy Pract Health Saf. 2017;15(2):131–44.
Cossmann M, Kohnen C, Langford R, et al. Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance. Drugs. 1997;53:50–62.
Golightly LK, Greos LS. Second-generation antihistamines: actions and efficacy in the management of allergic disorders. Drugs. 2005;65(3):341–84.
Carter NJ. Bilastine: in allergic rhinitis and urticaria. Drugs. 2012;72(9):1257–69.
Davies M, Wilton LV, Shakir SAW. Safety profile of esomeprazole: results of a prescription-event monitoring study of 11 595 patients in England. Drug Saf. 2008;31(4):313–23.
Thompson G, Bundell C, Lucas M. Paracetamol allergy in clinical practice. Aust J Gen Pract. 2019;48(4):216–9.
Hider-Mlynarz K, Cavalié P, Maison P. Trends in analgesic consumption in France over the last 10 years and comparison of patterns across Europe. Br J Clin Pharmacol. 2018;84(6):1324–34.
Acknowledgements
We would like to express our sincere thanks to, in alphabetical order: Dr. Laura Bareau, Dr. Pauline Brocaires, Dr. Adeline Coqueblin, Dr. Jonathan Duquet, Dr. Eléna Labourdère, Dr. Julie Leschiera, and Dr. Jean Baptiste Raingeval for their participation in the conduct of the original study.
Funding
This study has been promoted and funded by the French Military Medical Service, registered under number 2019PPRC04 dated 26th July, 2019.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors have no conflicts of interest to declare. The French Military Medical Service had no editorial control over the content of any publication regarding this study. The opinions or assertions expressed here are the private views of the authors and are not to be considered as official or as reflecting the views of the French Military Medical Service or the French Air Force.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chiniard, T., Dib, É., Guénot, F. et al. Flight safety risk assessment of self-medication among fighter pilots: a cross-sectional study. Int J Clin Pharm 45, 1415–1423 (2023). https://doi.org/10.1007/s11096-023-01611-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-023-01611-y