The Economic and Social Council,
Having consulted the International Civil Aviation Organization, the World Health Organization, the Commission on Narcotic Drugs and the International Criminal Police Organization,
Having noted their views,
Calls the attention of Governments to:
(a) The opinion of the World Health Organization41/ that narcotic drugs are required for use in emergencies on board aircraft engaged in international flight;
(b) The legal advice of the United Nations Secretariat;
(i) That the import certificate and export authorization system provided for in chapter V of the International Convention relating to narcotic drugs signed at Geneva on 19 February 1925 does not apply to narcotic drugs which, under appropriate safeguards, are carried in first-aid kits of aircraft engaged in international flight for the sole purpose of being readily available for administration in emergency cases to persons on board the aircraft as long as the drugs do not cross the customs lines at points of transit or destination other than those of the country of registration of the aircraft concerned, either because they are not removed from the aircraft, or if so removed at stopovers for a short period, are locked in bonded storage facilities of the operator concerned, and in any case remain under the control of the aircraft commander;
(ii) That such drugs carried in first-aid kits are not exempted from the other relevant provisions of the narcotics treaties;
1. Governments should not subject such drugs so carried (section I above) to the import certificate and export authorization system of chapter V of the 1925 Convention;
2. Governments should take all necessary measures to ensure proper use and to prevent misuse and diversion to the illicit traffic of such drugs, and to this end the following principles should be observed:
(a) Only such small amounts of narcotic drugs should be carried as are required for emergency purposes;
(b) The narcotic drugs should be used only in emergencies, e.g. in the event of a sudden serious illness or injury caused by a crash or otherwise;
(c) Only those crew members42/ adequately qualified should be permitted to administer narcotic drugs and wherever possible after seeking medical advice;43/
(d) The first-aid kits should be safeguarded against fraud, theft and other diversions for illicit purposes;
(e) The operator and each aircraft carrying narcotic drugs in first-aid kits on international flights should keep records in which each individual issue, receipt, expenditure and other movement of these drugs should be entered in such a way as to give a full account of them and to prevent fraud;
(f) Periodic reports should be made to government control officers by the operators concerned on the acquisition, use, other disposal and stock of narcotic drugs to be used in the first-aid kits and should include also in these reports all other data required to explain the balance in the stock;
(g) Inspections should be made periodically by operators' officials and governmental control officers to establish whether the provisions governing the carriage of narcotic drugs in first-aid kits are being fully implemented, but these inspections should not, however, be made by government officers in countries of transit except in special circumstances determined by the local authorities concerned (see annex 9 to the Convention on International Civil Aviation signed at Chicago on 7 December 1944, chapter 5, entitled "Traffic Passing Through the Territory of a Contracting State"), and if undertaken in a country of transit in such circumstances they should, in general, be limited to examining whether the seals of the first-aid kits are intact;
(h) The narcotic drugs needed for the first-aid kits should normally be acquired in the country of registry of the aircraft, and by arrangement with the local authorities concerned, the operator may maintain small stocks under proper safeguards (sub-paragraph (d) above) in bonded storage facilities at stopovers en route:
(i) Only operators which are capable of organizing the safeguards required by these rules should be permitted to carry narcotic drugs in the first-aid kits;
(j) The countries of transit and destination should recognize that it is the responsibility of the State of registry of the aircraft to enact the necessary laws and regulations and to issue appropriate permits and licences, and actual conditions prevailing in accordance with such laws, regulations, permits and licences, and actions taken in agreement therewith should be accepted as satisfactory by the local authorities;
(k) Governments should communicate to each other, through the Secretary-General of the United Nations, laws and regulations governing the carriage of narcotic drugs in first-aid kits;44/
(l) The Secretary-General should transmit copies of each law and regulation so received to the International Civil Aviation Organization and to the World Health Organization, and also to the International Criminal Police Organization;45/
3. Governments should take into account, in implementing the above-mentioned recommendations, the suggestions contained in the annex to this resolution.
1129th plenary meeting,
25 July 1960.
40/ The safeguards recommended in the resolution or suggested in its annex need be applied only to first-aid kits actually containing narcotic drugs.
41/ World Health Organization, WHO/Av.Med./1 transmitted to the Commission on Narcotic Drugs under symbol E/CN.7/L.208), pp. 10, 11 and 18; See also World Health Organization: Technical Report Series No. 188, section 5.
42/ The term "crew members" as used in these rules also applies to unlicensed flight personnel.
43/ In case of a crash, deviation from this and other rules might be justified under the relevant national legal principles relating to emergency situations.
44/ Article 21 of the 1912 Convention; article 30 of the 1925 Convention; and article 21 of the 1931 Convention, all three as amended by the 1946 Protocol; the related article 16 of the 1936 Convention does not seem to be relevant in this connexion.
45/ In accordance with para. 40 of the revised arrangements concerning consultations with non-governmental organizations contained in Council resolution 288 B(X) of 27 February 1950.
It is suggested that in regulating the carriage of narcotic drugs in first-aid kits of aircraft engaged in international flight, the International Standards and Recommended Practices for the facilitation of international air transport as set forth in the International Civil Aviation Organization's annex 9 to the Convention on International Civil Aviation, the detailed proposals made in the document prepared by the World Health Organization on the "Carriage of Narcotics in First-aid Kits of Aircraft Engaged in International Flights"46/ and the views of the International Criminal Police Organization47/ might usefully be taken into consideration. In particular, the principles outlined in part II, paragraph 2 above, might be implemented by the following measures:
As regards clause (a):
For reasons of uniform practice, the drug chosen would preferably be a morphine salt and should never be diacetylmorphine. A supply of 200-400 milligrammes of a morphine salt would be sufficient, the actual amount to be carried within these limits to depend on the size of the aircraft. The best form would be that of auto-injectable ampoules each containing 10 mg of a morphine salt. It is advisable that a specific morphine antagonist--e.g., nalorphine--be available.
As regards clause (b):
If in need of narcotics during the flight, sick passengers, other than those mentioned in this clause, should provide themselves with the necessary supplies and the documents required under relevant national provisions relating to narcotic drugs in their possession.
As regards clause (c):
It would be advisable to train as many crew members as possible in a knowledge of first-aid--a knowledge at least equivalent to that required for the First-Aid Certificate of the Red Cross, Red Crescent, and similar societies. It would, moreover, be useful if the crew had special instructions in the practical use of the auto-injectable type of ampoule, in the uses and dangers of narcotics and their specific antagonists, and in the rules regarding safe custody. Even crew members who are trained nurses should receive this special instruction. The narcotic drugs should be administered subcutaneously. Each administration should be authorized by the aircraft commander. If a physician is among the passengers he should be consulted before administration of the narcotic drug. In other cases, and wherever practicable, medical advice should be sought by radio.
As regards clause (d)
The aim of this clause might be accomplished by keeping the drugs in a special sealed section of the first-aid kit. It is advisable that the first-aid kit be kept in a locked compartment of the aircraft. It would be useful to divide the narcotic drugs in two equal quantities, one to be kept in a first-aid kit in the vicinity of the flight deck and the other in a first-aid kit near the tail of the aircraft, both secured as suggested above. On landing, the first-aid kits may be kept on the aircraft if a responsible member of the crew or ground staff remains on duty. Otherwise the aircraft should be locked. In any case the first-aid kits may on this occasion be removed from the aircraft and kept under lock and key in bonded storage facilities under the control of the operator. They should at all times be under the responsibility of the aircraft commander. Only persons authorized by him should have access to the first-aid kits.
As regards clause (e):
1. The operator should keep in its office records indicating:
(a) For each acquisition of a narcotic drug to be used in first-aid kits, the date, name and quantity of the drug and the name and address of the supplier;
(b) In the case of each issue to and return from an aircraft, the date, name or other designation of the aircraft, name of the person issuing or returning the drug, as well as of the person receiving it, name and amount of the drug, and reference number of first-aid kit;
(c) In the case of disposals other than issue to the first-aid kits, the date, quantity, name and address of the recipient;
(d) All other data required to explain the balance.
2. Each aircraft should keep on board records indicating:
(a) For each receipt of a narcotic drug, the date, name of the person issuing the drug and of the person receiving it, reference number of the first-aid kit, name and quantity of the drug received;
(b) For each administration, the date, name of the aircraft commander authorizing the administration, of the person giving the injection, identity of the patient, the reason for the injection, name and dose of the drug used;
(c) For each return, the date, reference number of the first-aid kit, name of the person returning the narcotic drug and of the operator's official receiving it, name and quantity of the drug returned;
(d) The names and maximum quantities of narcotic drugs of which the transport is authorized by laws or regulations as well as the balance in the first-aid kit;
(e) All other data required to explain the balance.
3. It might be useful if the first-aid kit contained a check list giving the names and quantities of the narcotic drugs included.
As regards clause (g)
Subject to what has been stated in this clause, it would be useful to check records, locks and seals, and exceptionally in appropriate cases the contents of the first-aid kit, and all the other circumstances relevant to establishing whether the rules governing the carriage of the drugs are being fully implemented. It would also be useful to check the records and stocks of narcotic drugs held by the operator itself.
46/ World Health Organization WHO/Av.Med./1.