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Losing the Right Stuff !
Pilot Fitness for Duty
A Review
Quay Snyder, MD, MSPH
Aviation Medicine Advisory Service
Business Aviation Safety Standdown
May 5, 2016
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TaskLoad
Duration
Personal Capabilities
Task Requirements
Margin of Safety
Task Element
Task Element
Task Element
Task Element
Task Element
Task Load vs. Capabilities
Task Load vs. Capabilities
•
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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TaskLoad
Duration
Personal Capabilities
Task Element
Task Element
Task Element
Task Element
Task Element
Margin of SafetyTask Requirements
SafetyDeficit
Task Load vs. Capabilities
•
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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OVERVIEW
What is the Challenge?
How To Recognize Problems
Barriers to Evaluation
Findings to Date
Strategy – Minimize Risk – Maximize Safety
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What Is The Challenge?
The “Failing” Aviator
• CRM Challenge
• Reliability Question
• Efficiency / Productivity Drain
• Personnel Dilemma – HR / Legal / AD / CP
• SAFETY HAZARD !!!
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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What Is Fitness For Duty?
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
A person is able to perform essential job functions and is not limited because of: • Physiological – Medical • Cognitive • Psychological and/or• Psychiatric conditions
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Not Just for Flight Crew!
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
Fitness for duty applies to pilots,
maintenance technicians, flight attendants,
dispatchers, and ground handlers.
However, my work to date
has concentrated mainly on
pilots and that is what I will
present here.
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What Is Fitness For Duty?
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
It is NOT an On/Off Switch!
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FFD is a Soft Threshold!
Anything we can do
to improve personal capabilities
is a positive step in
advancing safety.
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Why Are We Talking?
• Long Standing Universal Dilemma
• Lack of Guidance
• NBAA Safety Committee Priority 2014 - 17
• NTSB Ten Most Wanted – 2015 - 2016
• Safe Efficient Reliable Operations
• Recent Events
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Absence of Guidance
No Standardized Evaluation System
Little FAA Oversight after Initial Certs/Ratings
PRIA documents non-specific
ASAP / FOQA data deidentified
FAA Medical certificate limited value
Training Vendors Philosophies / Limitations
Military / Airline evaluation models not used
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB Ten Most Wanted - 2015
• Fitness For Duty
– Medical
– Psychological
– Cognitive
• End Substance Impairment in Transportation
– OTC’s
– Prescription
– Illicit and Alcohol
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB Ten Most Wanted -2015
Fitness For Duty
– Medical
– Psychological
– Cognitive
End Substance Impairment in Transportation
– OTC’s
– Prescription
– Illicit and AlcoholFSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB Ten Most Wanted – 2015/6
• Fitness For Duty
– Medical
– Psychological
– Cognitive
• End Substance Impairment in Transportation
– OTC’s
– Prescription
– Illicit and Alcohol
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Sleep Apnea – New Policy
• BMI > 40 referral for eval
• AME still issues medical certificate
• Eval by private MD or sleep MD
• 90 days to comply & notify FAA
• Home sleep studies allowed
• Evidence of effectiveness / compliance
– Usage 75% of days, > 6 hrs/day, pilots w/ 2 CPAPs
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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16FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB 10 Most Wanted
Eliminate Substance Impairment in Transportation
• NTSB SS 14/01 - “Drug Use Trends in Aviation –
Assessing the Risk of Pilot Impairment”
– 1990 - 2012 fatal accidents – toxicology results
– Did not evaluate Alcohol
– OTC, Prescription and illicit drugs, overlap
– Societal trends increasing use
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB SS 14/01 Findings
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB SS 14/01 Findings
• Impairing meds/conditions – 17% 40%
• 10% diphenhydramine (Benadryl)
• Marijuana use increasing
• Older pilots have more impairing conditions
• Older pilots use more Narcotics
• Younger pilots use more illicit drugs
• Pilots w/o medicals had higher rates
• Lack of medication info / education
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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NTSB SS 14/01 Findings
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Recent History
• Airline Hiring Practices – FFD Programs
• FAA Policies – SSRI’s, OSA, Substance Abuse
• FAA ARC – Pilot Fitness 2015
• NBAA Safety Committee
– Fatigue Working Group
– Fitness For Duty WG
• NTSB Ten Most Wanted
• Germanwings Event
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Identifying the Problem
In the Aircraft
• FMS Programming Errors
• Checklist Omissions
• Altitude Deviations
• SOP Non-Compliance
• Missed Radio Calls / Clearances
• Requests for Physical Assistance
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Identifying the Problem
In the Flight Department
• Training Problems
• Do Not Pair Requests
• Frequent Sick Leave Use
• Repeated Fatigue Calls
• Emphasizing Outside Troubles
• Suspected Impairment
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Assessing the Failing Aviator
• What Triggers Initiating Action?
• How Should the Evaluation Progress?
• What Expertise Is Required?
• Will It Be Fair? Comprehensive?
• Potential Outcomes?
• Company / Individual
Liabilities?
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Barriers to Evaluation - Cockpit
• Protection of Fellow Pilots / Friends
• Potential Loss of Career / Income
• “Not That Serious – I Can Cover”
• Meeting Operational Demands
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Barriers to Evaluation - Cockpit
• DENIAL – Personal or Other Pilots
• FAA Medical Certification Fears
• Fear to get Involved
• Rationalization “Just having a Rough Spell”
BASS May 13, 2015 Weston FL
Dr. Quay Snyder
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Evaluation Barriers - Management
• Aviation Department Leadership
• Operational Demands
• Not in SMS / IS-BAO
• No FAA Guidance
• Internal Medical Staff / AME Not Trained
• Absence of 3rd Party Evaluator/ Resources
• Independent & Knowledgeable
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Evaluation Barriers - Management
• Legal
• Age Discrimination Suit
• Privacy Concerns
• Not in Pilot Contract
• Human Resources
• No Written Policy / Procedure
• Lack of Insurance Coverage for Evals
• Lack of Disability / LOL Insurance
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Dr.. Quay Snyder
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Why Evaluate?
Critical Threat & Safety Risk!
Aviation Department
• National Airspace System
• Cockpit Workload
• Puts Principals at Risk
• Reputation
Pilot – Personal Health
• Physical / Psychological / Cognitive Well Being
• Treatable Medical ConditionFSF/NBAA BASS May 5, 2016
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Why Evaluate?
SAFETY!!! SAFETY!!! SAFETY!!!
• Staffing Decisions
• Training Effectiveness / CRM
• Improved Health / Longevity
• Career Protection
• Financial Protection
– Pilot – Insurance Disability
– Company – Maximize Resources – Minimize Liability
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Fitness For Duty Evaluations
Fundamental Assumptions
• Experienced & Previously Well- Performing
Professional Aviators Do Not Have a Decline in
Skills and Function Without an Explainable, and
Potentially Treatable Reason.
•Assessments Can Identify Pilots Who Can be
Safely Returned to the Cockpit with Treatment
and Identify Those Who Cannot Safely Fly.
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Dr.. Quay Snyder
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Fitness For Duty Evaluations
• Professional Pilots
• 48 pilots evaluated to date
• Age a risk, but not exclusively
• Common theme – Cognitive impairment
• 1/3 each – Medical / Psychological / Cognitive
• ~ 55% treated returned to flying safely
• Some voluntarily retire - 25%, Perm DQ – 20%
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Fitness For Duty Evaluations
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
0
2
4
6
8
10
12
< 45 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70+
Age Cohort
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Antidepressant Medications
FAA Policy Change – April 2010
– Celexa, Prozac, Zoloft, Lexapro - > 6 months
– Extensive testing/documentation annually
– Psychiatrist visit quarterly
– Cognitive testing annually
– HIMS sponsor AME
– Very high hurdles – coming down
– May add Wellbutrin to allowed medications
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Dr.. Quay Snyder
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Potential Causes – Medical
• Sleep Apnea / Sleep Disorders Fatigue
• Medication Side Effects
• Heart / Lung Disease
• Endocrine – Diabetes, Thyroid
• Hearing / Vision Deterioration
• Acute Medical Conditions
• Neurological Disease
•Anemia / Heavy Metal PoisoningFSF/NBAA BASS May 5, 2016
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Fitness For Duty
• Professional Pilots
• 40+ pilots evaluated to date
• Age a risk, but not exclusively
• Common theme – Cognitive impairment
• 1/3 each – Medical / Psychological / Cognitive
• ~ 70% treated returned to flying safely
• Some voluntarily retire
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Potential Causes – Psychological
• Life Events (Family, Legal, $$$, Work)
• Post-Traumatic Stress Disorder – PTSD
• Depression
• Substance Abuse
• Anxiety Disorders
• Personality Traits
•Loss of Desire to Fly / Work
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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FAA Mental Health Policy
• Counseling Encouraged
– EAP, Clergy, CIRP – Not Reportable
– Family / Marital counseling Not Reportable*
• Depression / Anxiety Reportable
– No medications / Off meds 2 mo.
– Pilot / Counselor Agree OK
• April 2010 – 4 SSRI’s Allowed
– Testing and Monitoring
– Single Dose/Single medication – 6 monthsFSF/NBAA BASS May 5, 2016
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Germanwings Event
• History of Depression 2009 and subsequent
• Treated w/ Meds & Psychotherapy
• FAA Required Info 2010
• Minimized On-going Rx
• EASA DQ’s Medications
• FAA / TC Allow Meds / Talk
• Counselors – Report vs. Privacy/Effectiveness
• Social Stigma / Financial Impact Conceal
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Dr.. Quay Snyder
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Evaluation Limitations
• Absence of Medical Records
• Heavily Reliant on Individual Responses
• Validation Questions
• Identifies Traits
• Generally Not Predictive
• Historical / Future Factors
• Depression / Substance Abuse Questionnaires
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Potential Causes - Cognitive
• Mild Cognitive Impairment – Reversible
• Impairing Medications
• Alzheimer’s / Dementia
• Substance Dependence
• Surgery – Older Pilots
• Brain Injury / Bleed / Tumor
• Most Treatable / Cognitive Rehab
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Aging Pilots Fitness For Duty
FSF/NBAA BASS May 5, 2016
Dr.. Quay Snyder
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Case Identification
Observations
• Fellow crewmembers are critical
partners in HR QA
• Training needs to be highly
disciplined and an advocate for
Safety. Should you send an
unbiased observer to relieve the
vendor from this responsibility?
• Management [9%] can not be the
first line of assurance in HR QA.
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33%
31%
24%
9%
2%
Initial Sources of Challenge Identification
Ops Trng Pro Stan Mgt Other
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Identified Conditions
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42% - Medical
57% - Psychological
43% - Cognitive
2% - No Diagnosis
0%
10%
20%
30%
40%
50%
60%
70%
Series1
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Case Dispositions
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Dr.. Quay Snyder
55%
45%
Case Disposition
Returned End of Service
55% - Return to Duty
25% - Elective Retirement – No Rx
20% - Permanent DQ
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Personal Assessments
AIM Section 8 – 1 – 1 I’M SAFE
I - Illness
M – Medications
S – Stress
A – Alcohol
F – Fatigue
E – Eating/Hydration
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Fitness for Duty Solutions
• Ethical – Fair to All
• Optimizes Health
• Reduces Liability
• Reduces Costs
• Integral to SMS
• ENHANCES SAFETY!
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Key Elements - Company
• Leadership – Understanding and Support
• Process – Clearly Defined with Timeline
• Legal – Negligible Liability Profile – 3rd party
• HR – Regular Comm, Adequate Pilot Benefits
• Aviation Director – Pilot Availability Estimate
• SAFETY PROGRAM – Principals, Pilots, Public
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Key Elements - Pilots
• Confidentiality / Dignity / Respect
• Benefits Protection – Disability, Loss of License
• Evaluation
– Comprehensive for Health
– Aeromedical Context & Expertise
– Update on Progress Routinely
• FAA Medical Certification Advocacy
• Safety Health Career
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NBAA FFD WG Future Efforts
• Accepted
– Scenario Based Webinars
– NBAA Web Page resources
– Provider / Partner links
– Guide to Create/Execute FFD
– ? Seminars / Workshops
• Excluded
– NBAA insurance programs
– Stand alone I’M SAFE assessment tools
– ORM matrices
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FFD Program Goals
• Ethical Program – Unlike Status Quo
• Policy Emphasis, Not Regulatory
• Financial Protections for All
•Return to Optimum Health
• Graceful Exit, if Necessary
• Safety Priority – Balances Many Factors
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Fly Safely! Stay Healthy!
Fitness For Duty Plan
Enhances Safety
Optimizes Health
Preserves Careers
Reduces Risks
Textron Safety Stand Down 1/4/16
Dr.. Quay Snyder
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Aviation Medicine Advisory Service
7000 S. Yosemite St., Suite 110
Centennial, CO 80112
866- AERO MED (237-6633)
www.AviationMedicine.com