Sunday, July 19, 2015

Thinking About the Unthinkable...

UPDATE: 8/31/15  The following was posted by a wife of a pilot...

My husband was in the TF 160. He flew the sling load for Operation Mount Hope. He loved flying. Many times he came close-wires, vision, etc. You all know the drill. When he retired, he went corporate aviation after Fixed Wing. He did this for another 20 years without incident.
I am posting this because many of you will take the same path possibly my husband did. It was not flying that got my husband. In the end, at age 59, it was lack of knowledge regarding his EKG results from the flight surgeon and the FAA. He had a widow maker heart attack.
We were married 27 years, together 30. When he had his heart attack, we had no knowledge of any previous abnormal EKG. For over 20 years, we had been told they were completely normal. When the hospital asked me of any heart issues, I said no.
Not true. When I picked up the EKG records from the flight surgeon, there were six abnormal EKG's. All were deemed unimportant by the surgeon and the FAA. First degree heart block three times in 10 years. Short QT interval 2 times in 10 years. These by themselves are not significant; however when they repeat, some in back to back years, well, you would want to have the opportunity to have it checked out.
I have spoken to the FAA directly regarding my husband as well as the flight surgeon. They have no remorse in not saying these things were found on the EKG and did not think our family had a need to know. Exact quote was "If you had gone to a cardiologist, he would have told you it was not important." The key is we never had the opportunity but we did have the opportunity to have 100 blockage in the left ventricle without ANY signs whatsoever. No swelling, dizziness, nothing. The man took nothing but vitamins and went the gym that morning.
So hookers, this post is not a sob story about what happened to our family. This is a warning to you all about your EKG's. If you get one via a flight surgeon or the FAA, get a copy. Ask/demand to see it. It is all on you guys to protect yourself.
Hope this finds everyone well, safe, and in good health...

If a pilot complains of chest or arm pain, or heartburn, you should investigate prior to liftoff.  If you are in the air, ask him or her to land.

We single-pilot HEMS folks have a dark worry that we tend to leave in our brain's broom-closet.

What if the pilot suffers a stroke, a heart-attack, or sudden cardiac death - a "Widowmaker."

Sudden cardiac death is the largest cause of natural death in the United States, causing about 325,000 adult deaths in the United States each year. Sudden cardiac death is responsible for half of all heart disease deaths  Click here to see information from the Cleveland Clinic.

What if your pilot suffers from a sudden-onset debilitating health problem. What if she slumps over the controls and pushes the cyclic forward.

It will be all over 'cept for some hollering. There is no backup plan for this occurrence. Maybe, if the stars align and luck is in our corner we can improvise - as long as the event is not a dead-right-there situation.

On December 29, 2010, at 0223 eastern standard time, a Eurocopter BK117-C2, N854EC, ... was landed hard during an emergency landing at Cherry Point Marine Corps Air Station (Cunningham Field) (NKT), Cherry Point, North Carolina, after the pilot became partially incapacitated.,,

A medical crewmember seated in the left front seat manipulated the collective control with the pilot's instructions and the pilot manipulated the cyclic control with his left hand. The pilot elected to make a run on landing and upon contact with the runway, the helicopter became airborne again, and then touched down again.

click here for full NTSB report...

As a pilot, I worry about sudden cardiac death from the perspective of not wanting to cause injury or death to the crews I care about and work with.  My father died of an MI at 43.  I am 58. I think about this. As it turns out, sudden cardiac death strikes people much younger than me.

I am married to a flight nurse, who every 4th day climbs into a helicopter with a single pilot. I like having her around. Not long ago, one of her pilots was at home working on a project in his garage. He experienced a sudden-onset bout of weakness and disorientation, and dropped to a knee. Had this happened to him while he was flying...

If you are a crew member, you should think about the sudden-onset things that could cause your pilot to be unable to continue flight.

Sidebar: As crew, it is your job to be aware of your pilot's apparent mental and physical state, and to speak up if anything seems wrong - or even different. Any change in behavior is cause for discussion.
If a pilot complains of chest or arm pain, or heartburn, you should investigate prior to liftoff. 

If you are in the air, ask him or her to land.

This topic has been taken up on the Pilot's Professional Rumor Network... Click here to check that out.

NetFlix recently added a documentary film to the list of programs available online, "Widowmaker." This is a fascinating film, and reveals a dark side to health care - the side that is more interested in money than a patient's best interest. The film tells the story of stents and  "calcium screening."

As they explain, when deposits form in a person's cardiac arteries, the body's defensive response is to deposit calcium at the site of the plaque/cholesterol buildup. It is the buildup that causes SCD or stroke, either because blockage prevents blood to the heart muscle or a chunk of stuff breaks loose and travels to the brain blocking flow there. A machine exists that can scan for the calcium, and can predict a future problem, which can then be dealt with using drugs, diet, and exercise. A scan is relatively cheap, a stent is expensive.

A state senator from Texas managed to get these calcium scans approved for all Texans of a certain age, as the procedure saved his life. NASA elected to make the scans a requirement for all astronauts, as a cardiac event or stroke while on a space flight could mean real trouble. (Who knew that an astronaut on Apollo 15 suffered a cardiac event on the moon?)

NASA's rationale makes sense. If one of their astronauts goes tango-uniform on a mission it could be real trouble. Does this resonate?

So, perhaps we should have a discussion about the things that could render our single-pilot unable to fly, and use any tools available that have a potential to predict such an event - like a scan for calcium deposits or a check for cardiac-risk factors. (edited 6/20)

As "Ascend Charlie" wrote on PPRUNE..,

If the pilot collapses forward onto the controls, you will be upside down and dead before being able to push him back, hold him there, and then work the cyclic.

Image courtesy www.wired.co.uk

Click here to read what the author of the South Beach Diet has to say about calcium scans...

Click here to read about research on calcium scans versus Framingham risk factors.

1 comment:

  1. While none f us like to entertain the idea of this scenario, it is a real, albeit infrequent, concern.I agree, med crews should be "investigative " of their pilot if something looks not right prior to lift. (pilot not as smooth with the collective due to unannounced left arm pain, or the pilot that is massaging his chest like he has heart burn or a "funky feeling in his chest.) Pilots too should stay vigilant about being honest with themselves. If you don't feel right, turn down the flight. And yes, i know, were all under pressure to run out the door and go help someone in need, but i don't have to lay out the consequences of flying while uncertain about your health or how you're feeling at the moment.
    I will say this though; at my base, we train for this scenario. I began approaching my pits about this a year or so ago and proposed a "what do we do if....?". Surprisingly, they were all very receptive to teaching us what to do in a situation of an incapacitated pilot. I know, we all fly different aircraft in HEMS. At my program, we almost all fly in the Airbus H135/P2. This aircraft is outfitted with an autopilot due to our IFR nature. IN the event of an incapacitated pilot, we can "simply" engage the heading and altitude knobs and maintain straight and level flight. Following that we have trained on how to adjust course, change altitude, operate the pilots radios and bring an aircraft in on an "approach" bv lowering collective, reducing airspeed and reducing altitude. The hope is that in the most dire of situations, we could hopefully, at least, get us on the ground so the fire guys can surround and drown. While its a terrifying scenario, i like it a lot more than the thought of doing cartwheels until i knock on the earths door.
    I like to think that theres something we can do at every program to at least attempt to mitigate such a horrifying scenario. Even if it is reaching over and trying to "fly" from the SIC seat. (good luck with that. I, even as a nurse, see that as almost an impossible task). But, lets use our brains and our experience to look at this potential situation and talk about a plan, as a crew. Anything is better than simply saying, "well, if that happens, just accept your fate".


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