Pilot Incapacitation: Extent of the Problem.

The study by Evans et.al. highlighted a linear trend in incapacitation rates from the pilots in 20s to those in their 60s, with those in 60s accounting for 15% of incapacitation [4]. Both cardio- and cerebro-vascular conditions being responsible for 50% (18/36) of incapacitation events, including 2 of the 4 sudden deaths, endorse the present practice of screening for underlying coronary artery disease by aviation medical regulators the world over. However an interesting fact that emerged is the number of psychiatric episodes of incapacitation and impairment. Though not life threatening to the individual suffering from, say, panic attacks it is definitely a hazard for flight safety! Does it warrant that the regulators must pay increased attention to such maladies of the mind in the future?

Evans et al., found that the annual rate of a medical event with the potential to affect flight safety was 0.8% (130/16,145) [4]. Earlier, DeJohn et al., had reported an incapacitation rate of 0.045 per 100,000 flying hours and an impairment rate of 0.013 per 100,000 flying hours but the fatality rate was limited to 0.00467 per 100,000 flight hours [13]. Fatality due to in-flight adverse medical event has been reported in the only available study by Raboutet and Raboutet. They reported a rate of 0.04 fatalities per year amongst French commercial pilots over a period of 25 years [14].

There may now be a clamour for the regulators to be more stringent. Regulators, however, know it well that short of preventing pilots with heart diseases (or similar debilitating diseases) from flying, the regulatory efforts always aim at ensuring flight safety with scientifically acceptable compromises on pilots with disabilities. Though the jury is still out for the passengers and the pilots alike but it must be said that the regulators invariably strive hard, applying Evidence Based Medicine in ADM, to serve the larger interests of the safety in the skies without compromising the individual well-being.

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4.  Evans S, Radcliffe SA. The annual incapacitation rate of commercial pilots. Aviat Space Environ Med 2012; 83: 42-9

5. Tunstall-Pedoe H. Acceptable cardiovascular risk in aircrew. Eur Heart J 1988; 9(Suppl G): 9-11

6. Bennett G. Medical-cause accidents in commercial aircrew. Eur Heart J 1992; 13(Suppl H): 13-5

7. Chaplin JC. In perspective – the safety of aircraft, pilots and their hearts. Eur Heart J 1988; 9(Suppl G): 17-20

8. Evans ADB. International regulation of medical standards. In Rainford DJ, Gradwell DP (editors) Ernsting’s Aviation Medicine. Fourth Ed. Hodder Arnold: London; 2006: 547-566

9. Chapman PJC. The consequences of in-flight incapacitation in civil aviation. Aviat Space Environ Med 1984; 55: 497-500

10. DeJohn CA, Wolbrink AM, Larcher JG. In-flight medical incapacitation and impairment of U.S. airline pilots. Aviat Space Environ Med 2006; 77:1077-9

11. Evans A. In-flight incapacitation in United Kingdom public transport operations: Incidence and causes 1990-1999. [Abstract] Aviat Space Environ Med 2002; 73:242

12. Newman D. Pilot incapacitation: analysis of medical conditions affecting pilots involved in accidents and incidents 1 January 1975 to 31 March 2006. Canberra : Australian Transportation Safety Board; 2007; ATSB Transport Safety Report B2006/0170 Jan 2007

13. DeJohn CA, Wolbrink AM, Larcher JG. In-flight medical incapacitation and impairment of U.S. airline pilots: 1993 to 1998. Washington , DC : Federal Aviation Administration, Office of Aerospace Medicine; 2004. Tech Rep No DOT/FAA/AM-04/16

14. Raboutet J, Raboutet P. Sudden incapacitation encountered in flight by professional pilots in French civil aviation, 1948-1972. Aviat Space Environ Med 1975; 46 :80-1.

Acknowledgement  Image courtesy Freedigitalphotos.net

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