fitness for duty it’s not just for - nbaa fitness for duty – it’s not just for flight crew...
TRANSCRIPT
Fitness for Duty – It’s Not Just for
Flight Crew Members
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
Thursday, February 5, 2015 1:00–2:30 p.m. and 3:30-5:00 p.m.
• 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 Committee Fitness For Duty Working Group
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
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
What does FFD mean?
NBAA web cast - FFD
Fitness for Duty Fitness for Duty
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 long-
term 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
Origin Destination
In-flight
The Health Continuum
24
Healthy
Impaired Incapacitated Fit for duty
Ill Risk
factors
Chronic
controlled
Discussion
Medical Certification
Pilot Incapacitation
Impairment
Health condition
Investigation
Safety reports GBMS
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
Quay Snyder, MD, MSPH AMAS | Aviation Medicine Advisory Service
Other Psychological Causes may include:
Work Stress
Substance Abuse
Anxiety Disorders
Loss of desire to fly or work
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
Quay Snyder, MD, MSPH AMAS | Aviation Medicine Advisory Service
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
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)
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
What does FFD mean?
NBAA web cast - FFD
Warning Signs
• Stress
• Illness
• Medications
• Substance abuse
• Mental illness
• Family issues
• Non – compliance with medications or treatment
FFD contributors
OSHA
Shared responsibility
Source: NTSB / Dr. Mark Rosekind /2011
Flight Crew Members (Pilots and flight attendants)
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.
FFD considerations
NBAA & Flight Safety Foundation: April 2014 updated guidelines published
Maintenance Technicians
Physiological
Fatigue: working overtime to resolve an AOG issue and required to
report to work without a proper rest period
Company expectations?
FFD considerations
Scheduler
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.
FFD personal considerations
NBAA Flight Plan podcast
Scheduling
• 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
FFD International & domestic trip / crew scheduling challenges
Pre-Trip FFD considers for Scheduling
Real life scheduling experience
Communicate & prepare in advance for known issues that could easily de-rail your trip
Drinking water
Food preparation Quiet crew rest locations
Altitude sickness
FFD International Operational Awareness
• 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
Where are you going? Discuss known issues - communicate!
World Health Organization
Mitigation
• 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
FFD suggestions
Resources
• 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
Scheduler’s due diligence
Flight Department Challenge
PHOTO CREDIT: Dead-Tired.eu // Andreas Tittelbach (p. 5) // Pilot fatigue Barometer
It’s a known killer, overcome the stigma attached to admitting “I’m not FFD”.
Keep Chart Colors Within
the Branding Palette.
Questions?
Debbi Laux – MedAire, Inc.
Dr. Paulo Alves - MedAire, Inc.
Sharon B. Forbes - DuPont Aviation
Dr. Quay Snyder - AMAS Virtual Flight Surgeons, Inc
