Fitness for Duty It s Not Just for Flight Crew Members Thursday, February 5, 2015 1:00 2:30 p.m. and 3:30-5:00 p.m. PRESENTED BY: Debbi Laux - NBAA Safety Committee - Fitness for Duty Working Group Paulo Alves, MD, MSc, FAsMA MedAire, Inc. Sharon Forbes DuPont Aviation Schedulers & Dispatchers Conference San Jose, CA February 3 6, 2015
NBAA Safety Committee Fitness For Duty Working Group Dr. Quay Snyder (Lead) Gene Benson Dan Dominguez Debbi Laux Ed Thayres Jay White Leigh White Mark Larsen (NBAA) Peter Agur Dr. Paulo Alves Francois Lassale NBAA Safety Committee Leadership Team
NBAA Safety 2014/15 Fitness For Duty Focus Area www.nbaa.org/ops/safety/top-safety-focus-areas 3 Year Project: Year 1 Build Awareness / Needs Assessment Year 2 Data Gathering / Refine Deliverables Year 3 Field Industry Resources
Fitness for Duty Fitness for Duty What does FFD mean? FFD means you go to work in a physical, mental and emotional state able to perform your work responsibilities in a manner that does not threaten the safety of oneself, co-workers or company property. Schedulers Maintenance Flight Crew Members NBAA web cast - FFD
Today s Focus: Can YOU do anything to help ensure fitness for duty for the next trip? Do you have a plan in your flight department to manage fitness for duty issues?
Fitness For Duty (FFD) = Factors potentially compromising safety & performance: Medical Psychological Fatigue Cognitive Pharmacological Nutritional
Your organization s approach to address concerns about Fitness for Duty? 1. Yes, we have a FFD policy that is: a) Standard and consistent or b) Ad hoc, depending on circumstances 2. No, we don t have a FFD policy in place 3. I don t know if we have a FFD policy
Is there a problem?
Questions to consider: Have you had FFD concerns about a professional pilot or other team member in your organization? Do you feel that safety has ever been compromised because of FFD for duty issues within any organization you ve worked? In the flight department, who can these FFD factors affect adversely?
Fitness for Duty Key Elements Need to address and develop a plan for individuals & flight departments BEFORE action is required Discussion to include strategy specifics for longterm and acute concerns of individuals Follow your plan once implemented
Evaluation Barriers Protection of fellow pilots / workers / long time friends
Evaluation Barriers Potential Loss of Career / Income / Friendship $$$
Evaluation Barriers Needed for mission demands
Evaluation Barriers Not Bad Enough I can cover for him/her I can cover.
Evaluation Barriers Denial personal or other pilots
Evaluation Barriers Rationalization Just having a rough spell Sorry I missed all those radio calls today. He s OK just having a rough spell.
Evaluation Barriers FAA medical certification fears That condition is disqualifying.
Evaluation Barriers Fear to be involved
Bottom Line Fitness for Duty Concerns are Critical Threats & Risks to Safety: Cockpit workload National airspace system safety People and equipment at risk Reputation of aviation department
Some Barriers Legal / HR - Discrimination Suit Privacy concerns No Written Policy / Procedure Operational Demands Lack of Insurance / Disability Coverage Internal medical staff not trained for pilots Absence of Independent expert evaluators Someone else s responsibility
Considerations Critical Personal Health Issue Treatable conditions missed Physical / Psychological / Cognitive well being SAFETY! SAFETY!! SAFETY!!! Staffing decisions Training Effectiveness / CRM Improved Health / Longevity Career Protection Financial Protection Pilot Insurance / Disability Company Maximize Resources, Minimize Liability
Fitness for Duty Acute Medical Problems Paulo M. Alves, MD, MSc, FAsMA Global Medical Director Aviation Health MedAire, Inc. An International SOS Company
The Ground-Based Medical Support Perspective In-flight Origin Destination
The Health Continuum Healthy Risk factors Chronic controlled Ill Fit for duty Impaired Incapacitated 24
Discussion Pilot Incapacitation Impairment Health condition Investigation Safety reports GBMS Medical Certification
Case 1 60 years old male pilot Hawker 800, Malpensa Charleston Severe back pain plus nausea Advil (ibuprofen) 500 mg, taken twice 45 minutes prior to contact Recommended diphenhydramine (Benadryl ) to relieve nausea
Case 2 22 years old male co-pilot Van Nuys to Tapachula (Mexico) Shaking both hands, racing heart, difficulty breathing Reports taking coffee and Rockstar prior to the flight
Case 3 35 years old male G-VI, Münster Osnabrück Bradley International 5 hours to destination, 1 hour to Shannon Vomiting, diarrhea initiated 3 days prior, now diarrhea with blood Tired and weak, severe stomach cramping
MedAire Experience 29 months 89 cases flight deck in-flight medical events were retrieved out of 59,143 total in-flight cases In 50 (60.9%) cases, a medication was recommended or taken before contacting ground-based medical support.
Age distribution (77 cases) Median: 43 Range: 24-63
Aging Pilots Fitness for Duty Dr. Schaie s Seattle Study
Flight duration distribution (88 cases) Median: 453 min Range: 45 938 min
Medical categories MedAire experience
Level of impairment MedAire experience Loss of consciousness occurred in 10 cases (8 syncope and 2 seizures). In 29/82 (35.4%) cases, treatment was deemed to interfere with cognitive function
Medical Categories for Incapacitation FAA Report
Treatment dilemma Should Ground Based Medical Support recommend treatment for in-flight events affecting pilots? Should any protocol to be followed? Ethics of reporting?
What Have We Seen? Business Aviation Community 32 FFD evaluations in 3 years 3 pilots evaluated but not entered into FFD program 3 pilots retired immediately after entry Well-defined Process Exists Approval by Company and Pilot Group FAA Buy-In and Support Medical Providers Aeromedical / Safety Focus
Medical Causes Diagnoses Cases Pending* Grounded Flying Sleep Apnea & Restless Legs 5 3 0 2 Medication Side Effects 2 1 0 1 Eyes 2 2 0 0 Hearing Loss 2 0 0 2 Heart Disease 3 1 1 1 Lung Disease 2 2 0 0 Anemia 1 1 0 0 Neurological Disorder 1 0 1 0 Cancer 1 0 0 1 Diabetes* (3 others not related) 3 2 1 0 Heavy Metal Toxicity 1 0 0 1 Total 23 12 3 8 Quay Snyder, MD, MSPH AMAS Aviation Medicine Advisory Service
Psychological Causes Diagnoses Cases Pending Grounded Flying Family Issues / Counseling 4* 1 0 3* Post Traumatic Stress Disorder 3* 0 0 3* Depression requiring Meds 2 1 0 1 Personality Issues 3 2 1 0 Total 11 4 1 6 Other Psychological Causes may include: Work Stress Substance Abuse Anxiety Disorders Loss of desire to fly or work Quay Snyder, MD, MSPH AMAS Aviation Medicine Advisory Service
Cognitive Causes Diagnoses Cases Pending Grounded Flying Alzheimer s Disease - Probable 4 1 3 0 Mild Cognitive Impairment* 11 5 1 1 retired 4 Note : All pilots had potential medical causes of *MCI treated before evaluation / treatment Other Cognitive Causes: Substance dependence Surgery Brain injury / Bleed / Tumor Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment NTSB-SS-14/01 Quay Snyder, MD, MSPH AMAS Aviation Medicine Advisory Service
A recent discussion The insulin-treated diabetic pilot
Medical Summary Acute medical problems may cause various levels of impairment/incapacitation Gastrointestinal and neurologic events are responsible for more than 50% in-flight medical situations Prevention of acute cases requires applying I M SAFE: Illness, Medication, Stress, Alcohol, Fatigue, Eating Need for help
Fitness for Duty From a Scheduler s Point of View Sharon B. Forbes Scheduler DuPont Aviation
Fit for Duty (FFD) What does FFD mean? FFD means you go to work in a physical, mental and emotional state able to perform your work responsibilities in a manner that does not threaten the safety of oneself, co-workers or company property. Schedulers Maintenance Flight Crew Members NBAA web cast - FFD
Warning Signs FFD contributors Stress Illness Medications Substance abuse Mental illness Family issues Non compliance with medications or treatment OSHA
Shared responsibility Source: NTSB / Dr. Mark Rosekind /2011
Flight Crew Members (Pilots and flight attendants) FFD considerations Physiological Fatigue: we all understand there are strict FAA regulations about flight crew scheduling and off duty periods, however, managing off duty time and ensuring adequate rest can be a challenge LIFE Happens! Statistics show fatigue as a major cause of transportation accidents. NBAA & Flight Safety Foundation: April 2014 updated guidelines published
Maintenance Technicians FFD considerations Physiological Fatigue: working overtime to resolve an AOG issue and required to report to work without a proper rest period Company expectations?
Scheduler FFD personal considerations Physiological Fatigue : caused by Flight Following & After Hours responsibilities; is the expectation to provide 24/7 support to the company and report to work daily, regardless of what may have transpired operationally the night before? Impact Cognitive skill impairment: crew scheduling ; overlooking a crucial logistical detail may not be not always be a safety of flight issue, however most certainly a missed detail will impact the flight department s performance. NBAA Flight Plan podcast
Scheduling FFD International & domestic trip / crew scheduling challenges Duty day length, times zones, circadian penetration, recovery time, workload (congested airports / language issues) FAA & Global regulations, industry recommendations, company policies, individual behavior Staffing, vacation, training
Pre-Trip FFD considers for Scheduling Communicate & prepare in advance for known issues that could easily de-rail your trip Altitude sickness Drinking water Quiet crew rest locations Food preparation Real life scheduling experience
FFD International Operational Awareness Where are you going? Discuss known issues - communicate! India: general drinking water issues; food poisoning Africa: Yellow Fever ; Ebola South America: altitude sickness Resources available to assist with pre-trip preparedness Company medical office / direct to in-country site contacts In flight medical service & security providers WHO web site Register with the STEP program World Health Organization
Mitigation FFD suggestions Open dialog with the flight department about FFD Adequate staffing Company policy established to address everyone s potential fatigue ADA open discussions FMLA - not a stigma Random drug tests preventative Company medical exam or IME (independent medical exam) to ensure FFD status has been returned FAA medical exam required Have a FFD plan and understand it, BEFORE you need it
Resources Scheduler s due diligence Company medical department and/or company medical examiner Independent Aviation Medical Examiner (AME) In - flight medical support provider Fixed Base Operator (FBO) International handling company Company policy - Safety Management System
Flight Department Challenge It s a known killer, overcome the stigma attached to admitting I m not FFD. Keep Chart Colors Within the Branding Palette. PHOTO CREDIT: Dead-Tired.eu // Andreas Tittelbach (p. 5) // Pilot fatigue Barometer
Questions? Debbi Laux MedAire, Inc. Debbi.Laux@MedAire.com Dr. Paulo Alves - MedAire, Inc. Paulo.Alves@MedAire.com Sharon B. Forbes - DuPont Aviation Sharon.B.Forbes@dupont.com Dr. Quay Snyder - AMAS Virtual Flight Surgeons, Inc Doctors@AviationMedicine.com