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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
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
Rationalization – “Just having a rough spell”
Sorry I missed all those radio
calls today.
“He’s OK – just having a rough spell.”
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 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.
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
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
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
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
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.
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
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