Heartfelt with Dr Melissa Walton-ShirleyView all posts »
SOS: Does the FAA really know your pilot's risk of sudden cardiac death? Unequivocally "NO"Jun 22, 2009 00:36 EDT
I grounded a medical helicopter pilot once …….at least I grounded him from flying from MY facility with MY patients………….. and I would do it again.
Before the days of PCI without surgery on site, I walked with a critically ill patient to the helipad and headed for the office. As I drove from the parking lot, I spied a middle-aged man in an olive green jump -suit peering around the corner of the building. A plume of smoke was billowing from his head. I promptly got on the phone with his supervisor and demanded that he not fly another patient from my facility, pointing out that he was a smoker with NO co-pilot. The company complied with my request but informed me that the FAA had no restriction with regard to tobacco use. Needless to say, I was shocked. The pilot died a couple of years later of pancreatic cancer but I never knew if he was allowed to fly for other facilities after that fateful day.
With the untimely death of the Continental Airline pilot last week, retirement age will most certainly become the bone of contention, especially in light of the relaxation of the standard from age 60 to age 65 in 2007. That would be a huge mistake and a missed opportunity. "VASCULAR AGE", not numeric age should become the main focus of this discussion and additional risk factors for sudden cardiac death should also be considered including primary and second hand smoke exposure. (yes, second hand smoke really counts).
HAS THE FAA ACTUALLY REVIEWED ITS MEDICAL REQUIREMENTS SINCE THE 1970’s????
Pilots do require a stress ECG, stress echo or stress nuclear assessment. They must achieve at least 85% of MPHR. They are disqualified if they develop 1mm ST segment depression unless stress echo or stress nuclear is negative for ischemia. An echo with an EF of < 40% or with a drop by 10% EF compared with a prior study are other grounds for disqualification. The blood pressure must be below an archaic but “acceptable level” of 150/90. It is unbelievable that there is no mention of a BMI cut-off or a calcium score. There is an outdated “substance abuse” clause which states that “Substance dependence means a condition in which a person is dependent on a substance OTHER THAN TOBACCO or ordinary xanthene-containing beverages. ARE YOU KIDDING? TOBACCO USE DOESN’T COUNT as a risk?
For Pilots with a diagnosis of “significant CAD, angina and a history of myocardial infarction”, according to the FAA’s medical certification requirements a “six month recovery period must elapse” and a “six month post- event “ angiogram “ with a negative nuclear perfusion scan” must be performed. .The actual ECG strips must be included for review and the pilot must have discontinued their beta blockers for 48 hours prior to testing. For me and mine, I don’t mind flying with a pilot who is a cardiac patient as long as they have a co pilot. Even Oprah figured that one out a few years ago when she refused to fly with a single operator. I’m with her.
Personally, I think most cardiologists would rather fly with a pilot that’s completely sobered up after a weekend binge than fly with a guy who just stubbed out a cigarette before boarding. (Rightly so, the FAA is "all over" alcohol use, but severely lacking with regard to cigarette use). I’d rather have a 70 year old pilot with a low calcium score and a normal BMI in my cockpit than a 50 year old pilot with a calcium score of 1500 or an abnormal 3 hour GTT. I’d also feel better with a captain who has an annual “clean” holter to rule out intermittent atrial fibrillation that would address a middle aged pilot's risk of CVA. Throw in a normal IMT and I'll really relax and enjoy the flight,......kind of like that feeling we all get when the pilot turns off the seatbelt sign. Finally, someone at the controls with a normal hsCRP would bring me in for a really smooth landing.
If the FAA seizes this opportunity to cruise into the 21st century for pilot health assessment, it will have finally earned its wings . A simple invitation to “Fly the friendly skies” just isn’t enough anymore.