AIR AMBULANCE SAFETY
FAA DRUG & ALCOHOL TESTING
Federal drug and alcohol testing requirements apply to employees who perform specific safety-sensitive aviation functions. But in the air medical environment, not everyone aboard the aircraft necessarily falls within those federally defined categories.
WHO DOES THE FAA REQUIRE TO BE TESTED?
Under 14 CFR Part 120, FAA-mandated drug and alcohol testing applies to individuals who perform specific safety-sensitive aviation functions for covered employers, including Part 135 operators. The requirement is based on the duties an employee performs, not simply the employee's job title.
Flight Crewmember Duties
Pilots and other individuals performing flight crewmember duties are covered by the FAA testing requirements.
Flight Instruction Duties
Individuals performing covered flight instruction duties are subject to testing.
Aircraft Dispatcher Duties
FAA-regulated aircraft dispatchers are included.
Aircraft Maintenance and Preventive Maintenance Duties
Mechanics and others who perform maintenance or preventive maintenance on covered aircraft are subject to testing. This can also include contract personnel.
Operations Control Specialist Duties
Employees performing operations control specialist duties are also specifically listed by the FAA.
WHAT ABOUT FLIGHT NURSES AND FLIGHT PARAMEDICS?
FAA drug and alcohol testing requirements apply to employees who perform specific safety-sensitive aviation functions. Coverage is based on the duties an employee performs, not simply the employee’s job title.
Flight nurses and flight paramedics are not separately listed among the FAA’s safety-sensitive categories under 14 CFR Part 120.
As a result, a flight nurse or flight paramedic is not automatically subject to FAA-mandated drug and alcohol testing merely because they routinely work aboard a Part 135 air ambulance.
An air-medical operator may still require flight nurses and flight paramedics to participate in an employer drug-testing program under company policy, state law, accreditation requirements, hospital policy, or other employment rules. That is separate from participation in the federally regulated FAA drug and alcohol testing program.
A pilot, flight nurse, and flight paramedic may fly together on the same Part 135 air-ambulance mission, yet federal aviation drug-testing requirements may not apply to all three in the same way.
THREE REAL-WORLD CASES INVOLVING DRUGS OR ALCOHOL
Kingfisher, Oklahoma — 2010 EagleMed AS350 B2, N918EM
Andalusia, Alabama — 2022 Air Methods AS350 B2, N124LN
Kingfisher, Oklahoma — 2010 EagleMed AS350 B2, N918EM
The helicopter crashed during a repositioning flight, killing the pilot and flight nurse and seriously injuring the flight paramedic. The NTSB determined that the pilot’s impaired judgment due to medications led to an abrupt low-level maneuver and impact with trees and terrain. The FAA later noted that the pilot had been taking multiple disqualifying medications that had not been properly reported.
Kentucky — 2023 Air Evac Lifeteam Flight 79
Andalusia, Alabama — 2022 Air Methods AS350 B2, N124LN
Kingfisher, Oklahoma — 2010 EagleMed AS350 B2, N918EM
An Air Evac EMS pilot flew an air-ambulance helicopter from Corbin to Richmond, Kentucky, while under the influence of alcohol. After landing, testing showed a blood-alcohol concentration of .35. The pilot later pleaded guilty to operating an air common carrier while under the influence of alcohol and was sentenced to eight months in federal prison.
Andalusia, Alabama — 2022 Air Methods AS350 B2, N124LN
Andalusia, Alabama — 2022 Air Methods AS350 B2, N124LN
Andalusia, Alabama — 2022 Air Methods AS350 B2, N124LN
The air-medical helicopter crashed after the pilot lost consciousness, seriously injuring all three occupants. Post-accident testing detected alcohol as well as cocaine metabolites. The NTSB concluded that the pilot was likely impaired to some degree by alcohol and may also have been experiencing effects associated with cocaine use, although investigators could not determine whether those substances caused the medical event that led to the crash.
WHAT DOES FAA-MANDATED DRUG TESTING NOT ROUTINELY TEST FOR?
FAA/DOT drug testing is not a broad toxicology screen. The federally mandated program tests for five drug categories: marijuana, cocaine, amphetamines, opioids, and phencyclidine (PCP).
That means many other substances are not part of the standard FAA/DOT drug panel, including:
Benzodiazepines
Medications such as alprazolam (Xanax), diazepam (Valium), and clonazepam are not included in the standard DOT drug panel.
Sedative-Hypnotics and Sleep Medications
Many prescription sleep aids and other sedating medications are outside the standard testing panel.
Antidepressants and Other Psychiatric Medications
These medications are not part of routine FAA/DOT drug testing.
Many Other Prescription and Over-the-Counter Medications
A medication can impair performance or be medically disqualifying without being one of the substances tested in the standard FAA/DOT drug panel.
Alcohol is handled separately from the drug panel under FAA/DOT regulations. Post-accident testing of a covered surviving safety-sensitive employee can include both the five drug categories and alcohol when the employee's performance contributed to the accident or cannot be completely discounted as a contributing factor.
Passing an FAA/DOT drug test does not establish that an individual is free from every potentially impairing medication or substance.
SELF-REPORTING PLAYS A MAJOR ROLE
FAA oversight does not rely solely on laboratory drug testing. For many medications, medical conditions, and substance-use issues, the FAA medical certification system depends heavily on information reported by the airman.
Pilots applying for an FAA medical certificate complete FAA Form 8500-8 through MedXPress. The application asks whether the pilot currently uses any prescription or nonprescription medication and requires disclosure of specified medical-history items.
The FAA requires applicants to report current medications and relevant medical history to their Aviation Medical Examiner. Certain medications may require additional review, deferral, or clearance before the pilot may exercise the privileges of a medical certificate.
This means the FAA drug-testing program and the FAA medical-certification process serve different purposes. A substance may not be included in the standard FAA/DOT drug-testing panel but may still be medically significant, restricted, or disqualifying if it is reported through the medical-certification process.
For many potentially impairing medications and medical conditions, detection begins with accurate disclosure by the airman rather than routine toxicology testing.
