Fitness for DutyDebbi Laux, MedAire

2July 6, 2016

Fitness for Duty…It’s For Everyone

Debbi Laux MedAire, Inc.

NBAA Safety Committee - Fitness for Duty Working Group

Canadian Business Aviation Association Convention & Exhibition

“In a physically and mentally demanding environment, a clear

mind and healthy body is essential to safe business

aircraft operation, maintenance and management.

Operators must address fatigue, sleep apnea, improper use

of medications and many other physical and psychological

aeromedical issues.”

Source: NBAA website

SAYS:

www.Charlestack.com

“The NBAA Safety Committee promotes safety as the

cornerstone value of business aviation by identifying

significant industry risks and serving as a center of

leadership on a wide range of safety matters.”

http://www.nbaa.org/ops/safety

Dr. Quay Snyder (Lead)

Peter Agur

Gene Benson

Dan Dominguez

Jeremy Barker

Dan Boedigheimer

Greg Farley

Debbi Laux

Leigh White

Brooke O'Brien

Kacy Speiker-Vorce

Mark Larsen (NBAA)

Peter Korns (NBAA)

NBAA Safety Committee Leadership Team

Safety Committee

Fitness For Duty Working Group

Safety Committee Fitness For Duty

Focus Areas

3-Year Project Goals:

2014 -15

Build Awareness / Needs

Assessment

2015 - 16

Data Gathering / Refine

Deliverables

2016 - 17

Field Industry Resource

Deliverable

www.nbaa.org/ops/safety/top-safety-focus-areas

3 of 10 of the NTSB “MOST WANTED” Related to

Fitness for Duty

What IS“Fitness for Duty”

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.

NBAA web cast - FFD

Fitness for DutyFitness For Duty Means:

NBAA web cast - FFD

Fitness for Duty

Six Factors Potentially Compromising Safety & Performance:

1. Medical2. Psychological3. Fatigue4. Cognitive5. Pharmacological6. Nutritional

Fitness For Duty

Flight Crew Members – Pilots & Flight Attendants

Schedulers – Flight Coordinators - Dispatchers

Maintenance Personnel

Passengers

Fitness for DutyWho Does Fitness for Duty Affect?

EVERYONE!!

AND… FFD affects the safety of your operations

Why is Fitness for Duty a Priority ?

o Long-Standing Universal Dilemma o Lack of Guidanceo NBAA Safety Committee Focus 2014-17 o NTSB 2016 Ten Most Wanted o Safe Efficient Reliable Operatorso Recent Events

PhysiologicalFatigue: 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.

NBAA & Flight Safety Foundation: April 2014 updated guidelines published

Flight Crew members: Pilots, Flight Attendants /Technicians

Statistics show

fatigue as a major

cause of

transportation

accidents.

Physiological - Medical Causes Results from Actual Evaluations

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

Scheduler

Physiological

Fatigue: Flight following & after hours responsibilities. Is expectation to provide 24/7 support to the company and still report to work daily, regardless of what may have transpired operationally the night before? What’s the impact?

Cognitive Skills: Crew scheduling. Overlooking a crucial “logistical” detail may not be not always be a safety of flight issue, but a missed detail may impact the flight department’s performance.

NBAA Flight Plan podcast

Medical Categories – Business Aviation

Source MedAire, Inc. 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.

The Health Continuum

Healthy

Impaired IncapacitatedFit for duty

IllRisk

factors

Chronic controlled

Level of Impairment

Source MedAire, Inc.

• 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

Acute medical problems may cause various levels of impairment/incapacitation

Medical Categories for Incapacitation

Source: FAA Report

Acute medical problems may cause various levels of impairment/incapacitation

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 11 retired

4

Note : All pilots had potential medical causes of *MCI treated before evaluation / treatment – noticeable decline in memory or thinking skills – not usually severe enough to affect daily life.

Quay Snyder, MD, MSPH AMAS | Aviation Medicine Advisory Service

Other Cognitive Causes:

Substance dependence

Surgery

Brain injury / Bleed / Tumor

Crew, Schedulers & Dispatchers

• Crew scheduling errors

• Flight following demands

• Duty day length

• Times zones

• Circadian penetration

• Recovery time

• FAA & Global regulations

• Industry recommendations and best practices

• Workload (congested airports / language issues)

• Company policies

• Individual behavior

• Staffing – Personal Time Off

• Training

International & domestic trip / crews

Maintenance Technicians

Physiological

Fatigue: working overtime to resolve an AOG issue and required to report to work without a proper rest period.

What are your company’s

expectations?

The “Dirty Dozen”Maintenance-related Causes of Errors

US Dept of Transportation FAA Advisory Circular

(1) Lack of Communication(2) Complacency(3) Lack of Knowledge(4) Distraction(5) Lack of Teamwork(6) Fatigue(7) Lack of Resources(8) Pressure(9) Lack of Assertiveness(10) Stress(11) Lack of Awareness(12) Norms

The mnemonic “I’M SAFE” Relates to Fitness For Duty (FFD) Factors, too

I’M SAFE Checklist FFD Factors

Illness – Symptoms Medical

Medicine – Prescriptions or OTC Pharmacological

Stress – Job, Financial, Health,

Family

Psychological Cognitive

Alcohol/drugs 8 Hours? 24

Hours?

Cognitive

Fatigue – Adequately rested Fatigue

Eating – Adequately nourished Nutritional

“Prevention

of acute

cases

requires

applying I’M

SAFE”

Dr. Paulo Alves MedAire, Global Medical Director, Aviation Health

Potential Causes –Illness- Medical

• Sleep Disorders / Sleep Apnea / Fatigue

• Medication Side Effects

• Heart / Lung Disease

• Endocrine – Diabetes, Thyroid

• Hearing / Vision Deterioration

• Acute Medical Conditions

• Neurological Disease

Potential Causes - Fatigue

• Duty hours• After- hours work • Sleep disorders• Stress• Medical• Time zone changes

Remind You of Anyone?

Potential Causes –Pharmacological

• Alcohol

• Over-the-Counter (OTC)-Prescription Medications

• Medications - often shared, abused or overused

• Availability of illicit drugs – younger pilots use more

• Marijuana use increasing – LEGAL in Canada in Spring 2017?

• Lack of medication info / education

Controlled Substances

NTSB SS 14/01 Findings

Potential Causes –Psychological

• Life Events:

Family/Self, Legal, Financial, Work, Health, Marriage/Divorce, Growing family/Loss of child, Aging parents

• Post-Traumatic Stress Disorder – PTSD

• Depression

• Substance abuse

• Anxiety disorders

• Personality traits

• Loss of desire to work

Potential Causes –Cognitive

• Mild Cognitive Impairment – Reversible

• Alzheimer’s / Dementia

• Surgery

• Substance Dependence

• Brain Injury / Bleed / Tumor

• Impairing Medications

• Aging - Partial Risk Factor

• Most Treatable / Cognitive Rehab

Potential Causes –Nutritional

Do we have a problem?

Time for a Stress Test?

Do you have a FFD in your

operation to identify and manage

fitness for duty issues?

What is YOUR organization’s approach to FFD concerns?

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

4. If we have a plan, it isn’t for everyone

Study on Aviation Department FFD Policy

Quay Snyder, MD, MSPH AMAS | Aviation Medicine Advisory Service

Measure Risks - No Plan

• Puts principals and others in danger

• Aviation department workload is impacted

• National Airspace System is threatened

• Personal health of personnel at risk

• Physical / Psychological / Cognitive well-being not at maximum level

• Treatable medical conditions not identified

• Ineffective training

• Company reputation – Brand recognition

• Financial impact

• Other risks?

Why we don’t talk about FFD? • Potential Loss of Career / Income

• Protection of Self, Fellow Workers and Friends

• Denial - “Not That Serious – We Can Cover”

• Rationalization – “It’s a Temporary Problem”

• Fear of Getting Involved - Retaliation

• Busy Meeting Operational Demands

• FAA Medical Certification Fears (for pilots)

• Not included in our Safety Management System

• Safety hasn’t been compromised…YET !

3 Key Recommendations for Fitness for Duty

1. Address and develop a plan for flight departments BEFOREneeded

2. Discuss strategies for long-term and acute concerns of individuals - specific to your operation

3. Follow your plan, once implemented

1. Build a Fitness for Duty Plan:Risk Assessment -Identify Concerns

Establish Goals

Develop Strategies –Solutions Together

Educate and Practice

Implement Process

Analyze Success

Revise, as needed

2. Strategy and Tactics

Strategy comes from planning:

Getting yourself in the Right Place with the

Right People at the Right Time – Identify and

Anticipate Needs

Tactics are used during design of your plan:

Challenges, needs, staffing and overcoming

obstacles including using company-relevant

information – Use Resources - Communicate

3. Shared responsibility

Source: NTSB / Honorable Mark R. Rosekind, Ph.D. Former NTSB Board Member 2011

Role of the Manager

Manager must:

Develop and maintain a safe, healthy, and productive work environment.

Identify and intervene with employees who may be physically, mentally, or emotionally unable to perform the job safely.

Consider “graceful” exit strategy

• Ethical – Fair to all

• Optimize health

• Reduce liability

• Reduce costs

• Integral to your Safety Management System (SMS)

• Meets operational needs and policies

• Financial protection – Insurance disability

• Maximize resources – Minimize liability

Fitness For Duty Plan Considerations:

Some Barriers to Address

Legal / HR - Discrimination - Fairness

Privacy concerns

No written policy or procedure / SMS

Operational demands are high

Lack of insurance / Disability coverage

Internal staff not trained to identify risks and mitigation

Absence of independent experts to assist

Someone else’s responsibility

Other barriers?

• Complete physical exam - review of all medications• Testing and monitoring for sleep disorders

• Depression / Anxiety

• Professional aviation medical examiner or evaluator

• Counseling encouraged - Employee Assistance Program (EAP), Clergy, Family or Marital counseling

• Leadership – Guidance, understanding and support

• Process – Clearly defined with timeline

• Legal – Negligible liability profile – 3rd party

• Human Resources – Regular communication, adequate benefits

Fitness For Duty

• Aviation Manager/Director – Staff availability estimate –Honest, realistic

• Ground- based medical and security assistance provider

• Federal Aviation Administration - FAA

• National Transportation Safety Board - NTSB

• National Business Aviation Association - NBAA

• American For Disabilities Act – US Dept of Labor

• “Safety Program Manager” for all team members

Fitness For Duty

Open, honest dialog - Adequate staffing

Company policy established

Americans with Disabilities Act ADA

Family and Medical Leave Act FMLA - not a stigma

Random drug tests – preventative

Company medical exam or IME (independent medical exam) for clearance before returning to “work status” (pilots)

Have a FFD plan and understand it,

BEFORE you need it

Fitness For Duty Last Thoughts

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.

I don’t think of ‘work as work’ &

‘play as play’. It’s all LIVING.

Richard Branson - Founder of the "Virgin"

companies

Fitness for DutyIt IS For Everyone…