NoGo Requests

Policy Below.... and Forms at the bottom to download - <3 Cale

The updated No-Go Policy memo is currently being routed.  The AMC countermeasure program was updated this month and is attached for your review.  In the meantime, we will continue to follow the current policy memo. 

BOTTOM LINE: No-Go requests will be requested in writing from the AC and should be in compliance with AMC’s Fatigue Countermeasure Program.  The minimum information requested is used to comply with the attached reference and for the safety of prescription ordering.

Background: Although the policy memo doesn’t specifically state that the request needs to be in writing, it was left somewhat vague to allow last minute requests for no-notice missions and is not meant for interpretation.  It is meant to provide the Flight Surgeons leeway in the event we need to do a verbal request for mission needs.   Ultimately ALL prescriptions are at the discretion of the Flight Surgeon.   Verbal requests should only be made when there is a no-notice mission with less than 72hrs notice.  The Flight Surgeon can still mandate a written request with notice of less than 72hrs.  It is the responsibility of the AC to ensure the request is necessary for the mission, emailed to the appropriate medical personnel more than 72hrs prior to mission, and that an MFR is signed by the Commander should the AC need to pick-up medications for all crew members.

No-Go pills are not to be generically issued for all missions and should only be issued/used when other routine sleep hygiene methods cannot be used (e.g. Inadequate sleep/rest cycle or changing of sleep schedule by more than 4hrs per stop).  The number of pills requested will be based on specifics related to the mission.  This justification should be included in the request.  Please use your SAFTE-FAST tool and review Appendix 5 and Appendix 8

Per AMC Pharmacological Fatigue Countermeasure Program (dated 4 September 2024) “Non-pharmacological fatigue countermeasures (e.g. scheduling, aircrew augmentation, strategic napping, circadian rhythm shifting, caffeine, etc.) are the preferred methods of combating fatigue and making operational risk management decisions. The use of pharmacologic countermeasures for combating fatigue are an additional fatigue mitigation strategy available in consultation with the Wing/Installation Chief of Aerospace Medicine(SGP), or deployed equivalent, when a fatigue risk remains despite command’s best efforts.” The approval to use no-go medications in leu of normal sleep hygiene because of mission parameters is at the discretion of the line leadership.  However, issuance of the no-go pills is solely at the discretion of the Flight Surgeon prescribing them.  These are controlled substances.  The Drug Enforcement Agency monitors these prescriptions and audits prescribers, and improper issuance can impact a prescriber’s license and a member’s health.   Additionally, and just as importantly, there is the potential for Airmen using these medications to become physically and/or psychologically dependent on these medications and use them to the exclusion of non-pharmacologic countermeasures.  We must prescribe them with caution.

To summarize, unless the mission notice is less than 72hrs, a written request, by the AC, is required so that we can properly document the operational need of the request in the medical record.  It is at the Flight Surgeon’s discretion if verbal requests can be made with less than 72hrs notice.  The Flight Surgeon can deny the issuance of No-Go prescriptions at their clinical discretion.

As a reminder No-Go requests will be made by the AC and include the following at a minimum:

-   Full name of crew member’s requesting

-   Date of Birth

-   DoD ID

-   Mission Number

-   AC Name

-   Duration of mission

-   Number of planned crew rests

-   Number of requested no-go pills

It is suggested that No-Go requests include justification (e.g. mission stop alters sleep schedule by more than 4hrs, ect.)

No policy will ever override a Flight Surgeon’s clinical decision making or ability.  However, if you have concerns with this policy, please direct them to our Chief of Aerospace Medicine, Col Vermilion. 

Operational Medication Request Process Instruction

No-Gos

Criteria for No go request for missions:

a.     Must have completed initial ground testing.

b.     Received NO GOs within the last year AND have received Face-to-Face counseling by FS (Annual PHA)

c.      May only request one TCON fill every 20 days.

d.     Maximum of 5 tabs and no refills. Other requests require FS approval FIRST.

e.     No history of alcohol or drug abuse

f.      No altered mental status

g.     No recent significant changes to health status

Instructions

1.     Receive MFR request from AC

2.     Verify the patient has ground trialed the requested medication (cleared) and is not DNIF in ASIMS.

3.     Verify in MHS Genesis medication list their last NO GO requested.

a.     Must have completed face-to-face with FS within the last year (Fly PHA)

b.     May NOT have more than 20 pills in the last 60 days

c.      Review documentation (Flight Medicine encounters)

4.     Open new TCON for Patient

-        To: USAF Travis Flight Surgeon On Call

-        High priority

5.     Communicate request through scripted Autotext (all No Refills)

a.     Ambien – 5mg (female)or 10mg (female or male)

b.     Sonata – 5 tabs

c.      Restoril – 5 tabs

6.     Have patient review FS safety & usage restrictions if member has questions refer them to the FS.

7.     Once medication is approved. ordered forward to pharmacy with timeline request, call pharmacy (423-7657) to verify full request.

8.     Notify member when medication will be ready for pick up

MHS-G AutoText

Name, date of birth and allergies verified. Successful ground test verified without problems.

(SQ) crew member on flight orders for a multi-day mission crossing multiple time zones. Member requests operational no-go pill fill.

S/he has been given authorization by aircraft commander, --, to use no gos for jet lag, during this mission

S/he has not exceeded in permissible number of no gos in the last 60 days

S/he understands the med has an expiration date, and cannot use them past that date

Crew duty restrictions have been reviewed:

- Ambien - no crew duties within 6 hrs of ingestion

- Sonata - no crew duties within 4 hrs of ingestion

- Restoril - no crew duties within 12 hrs of ingestion

Do not take for more than 7 (10 for Sonata) consecutive days or more than 20 (28 for Sonata) pills in 60 days due to increased risk of insomnia.

This medicine will aid in gaining adequate sleep, and assists in adjusting to new time zones, but does not create circadian rhythm synchrony.

No alcohol within 12 hours of anticipated use of any of the “no-go” pills.

IAW AMC policy the member may receive Ambien 10mg #20/60 days for operational use without CC letter.

Member has been briefed by Flight Surgeon on appropriate fatigue management strategies and the role of “no-go” pills as option of last resort.

3. MFR No Go AC Request NEW 18 Jun 2025

https://chat.il4.dso.mil/usaf-60amw/channels/312th-as-files

4. MFR Template Sqcc No Go Permission.docx

https://chat.il4.dso.mil/usaf-60amw/channels/312th-as-files