Mind Over Matter: Are You Mentally Fit to Fly?

May 2, 2016

Germanwings Flight 9525, an Airbus A320 carrying 144 passengers and six crew, apparently was intentionally flown into a mountain in France, killing all aboard. This accident was the result of actions taken by a pilot with a psychological disorder. Even though such events are extremely rare, in the immediate aftermath of the March 2015 crash the reaction of the flying public shifted from “Is the aircraft safe?” to “Is the pilot mentally stable?”

After the loss of Germanwings 9525, regulatory authorities huddled with experts to seek solutions that might reassure uneasy travelers, yet protect the privacy of pilots and the legal and financial interests of aircraft operators.

The European Aviation Safety Agency (EASA) presented draft proposals on how to implement recommendations of a 150-expert task force. The proposals included:

• “Strengthening” the psychological part of the pilots’ recurrent medical assessment.
• Drug and alcohol testing for pilots in the context of their initial medical assessment, as well as an ongoing testing program.
• Creation of a European repository of pilots’ aeromedical data.

EASA Executive Director Patrick Ky said, “We need to act quickly if we want to minimize the risk of another catastrophe such as the Germanwings accident.”

There was speculation that EASA would attempt to rapidly implement new rules by applying, for the first time, a new regulatory fast-track tool known as “operational directives.” However, stakeholders such as the EASA Advisory Board pushed back, and it appears more likely there will be impact-assessment discussions this spring, with regulatory developments emerging possibly by the end of this year.

Germanwings parent company Lufthansa did not wait for regulators. The company announced in May 2015 that pilots would be subject to surprise medical checks to detect medications and drugs, and reportedly the Bundestag (the lower house of Germany’s parliament) is considering similar fitness-for-duty measures that would apply to all pilots with German airlines. Officials in other countries have also proposed periodic psychometric testing of air carrier pilots.

RULES COULD APPLY TO BUSINESS PILOTS

Although the primary focus has been on airline pilots, any such scheme implemented in Europe could also apply to crews of chartered business aircraft, which are lumped together with commercial air carriers under the current EASA regulatory structure.

In the United States, at the urging of the Commercial Aviation Safety Team, the FAA formed a Pilot Fitness Aviation Rulemaking Committee (ARC). The purpose of the ARC is to examine the awareness and reporting of emotional and mental health issues, methods used to evaluate pilot emotional and mental health, and barriers to reporting issues.

Margaret “Peggy” Gilligan, FAA’s associate administrator for aviation safety, said regulators want to develop more effective ways in which pilots could come forward with depression or other mental disabilities, rather than hide them.

“We don’t want to drive pilots underground,” Gilligan said, but instead provide them with a way to get back into the cockpit following successful treatment. She said, “a pilot who has no path back” to possibly resuming flying duties has “no incentive to let you know” about mental health issues.

A report from the Pilot Fitness ARC meetings had been expected by the end of 2015, but had not been released as of early this year.

Perhaps the best insight on what might result from those discussions are recommendations made to the FAA by the Aerospace Medical Association (AsMA) pilot mental health expert working group. Instead of routine “in-depth psychological testing for detecting serious mental illness,” which the group deemed “neither productive nor cost-effective,” the experts advised more attention to “more common mental health issues and conditions” such as grief, stress, depression, anxiety, panic disorders, personality disorders and substance abuse.

Experienced and previously well-performing professional aviators do not have a decline in skills and function without an explainable and potentially treatable reason.

The AsMA also advocated utilizing methods for building “rapport and trust” between the pilot and his or her aviation medical examiner (AME) “in a non-threatening environment.” For example, during a pilot’s six- or 12-month examination for an aeromedical certificate, questions could be “woven into the conversation” about the pilot’s mood, quality of sleep, sources of stress, and possible alcohol and substance use.

Dr. Quay Snyder, president and CEO of the Aviation Medicine Advisory Service and leader of the NBAA Safety Committee’s Fitness for Duty (FFD) Working Group, said airlines have peer protections in place, such as their professional standards committees, to address concerns about a pilot’s ability to fly safely. “However, in the business aviation world there’s a reluctance to raise issues about another pilot who may be having problems flying. It’s a smaller environment. Everyone knows each other. There’s not typically union protection. So there’s a reluctance to identify a potential problem.”

Knowing that a fitness issue could quickly lead to loss of a required medical certificate and potentially ruin a career, pilots hesitate reporting concerns or may rationalize that they can “cover” for a fellow crewmember’s shortcomings, dismissing warning signs as a temporary “rough spell.”

In a survey, Dr. Snyder said only 36 percent of pilots thought they “dealt effectively” with an issue that concerned them about a fellow pilot. About 28 percent handled the situation “with difficulty,” and 11 percent “ignored it.” One in 10 pilots was “not sure,” eight percent “didn’t know how” to resolve the issue, and another eight percent insisted “all pilots are safe and effective.”

MedAire’s Debbi Laux, a member of the FFD Working Group, said pilots need to “self-recognize when they need to have help, or speak up when someone else they’re working with may not be in prime condition to operate an aircraft. If I’m going to fly with you and I notice that you sound like you’re inebriated or have some impairment, or I smell alcohol on your breath, it’s my responsibility to say something before we get into the cockpit.”

BE ALERT FOR WARNING

The FFD Working Group has a threephase program to address fitness issues. The first phase was intended to raise awareness of the scope of issues that can affect fitness. The second phase is gathering data from participating flight departments on how to identify problems and possible remediation processes. The third phase will seek to provide resources to NBAA members so they can conduct evaluations and deal with fitness issues while attempting to balance company responsibility with pilot privacy and health.

“Mental health is only one aspect of pilot fitness,” Dr. Snyder noted. The FFD Working Group is addressing the gamut of potential fitness-for-duty issues – psychological, medical and cognitive.

FFD evaluations that Snyder’s organization have conducted show 57 percent involved psychological issues, 43 percent cognitive, and 42 percent diagnosed medical conditions. Some pilots had more than one active condition.

Revealing or acknowledging a serious health issue is not necessarily a careerkiller. About two-thirds of pilots return to flying careers after treatment. The FAA-approved Human Intervention and Motivation Study program has an 85-percent success rate for pilots with alcohol and drug challenges.

Flight department team members are not in a position to diagnose a pilot’s health. However, they can be alert for warning signs: flight management system programming errors, checklist omissions and other non-compliance with SOPs, altitude deviations, missed radio calls or clearances, or loss of situational awareness inflight. If a pilot is often sick or fatigued, has repeated problems during training, or requests not to be paired with certain crewmembers, these could be signs of trouble.

“Experienced and previously well-performing professional aviators do not have a decline in skills and function without an explainable and potentially treatable reason,” Dr. Snyder noted.

HAVE A FITNESS-FOR-DUTY PLAN

MedAire Global Medical Director for Aviation Health, Dr. Paulo M. Alves, advises pilots to have a plan for evaluating their personal fitness for duty, starting with the mnemonic self-assessment checklist, I’M SAFE – Illness, Medications, Stress, Alcohol, Fatigue, Eating (including hydration).

“Incapacitation is not an on-and-off state. It’s progressive, from mild to moderate impairment to full incapacitation. It may be [due to] side effects from a new medication, or cramps from food poisoning. Typically, there are warning signs that should not be neglected.”

“If you are not feeling 100 percent, it is better to have second thoughts about your immediate fitness for duty,” continued Dr. Alves. “Consider not flying that day. In business aviation, there is greater pressure [to fly] than in airlines because it’s not always easy to find a substitute, especially if you are overseas. But pilots don’t need to make the decision on their own; expert help is available. Call your doctor or medical service.”

“Denial is the number one reason for delay in receiving proper care,” concluded Dr. Alves. “We have this sense of immunity and invulnerability. However, the unexpected happens to people. Don’t disregard the signs, and don’t cross any dangerous lines.”

Learn more about fitness for duty.