Federal Air Surgeon’s Medical Bulletin Aviation Safety Through Aerospace Medicine Vol. 48, No. 3 For FAA Aviation Medical Examiners, Office of Aerospace Medicine Personnel, U.S. Department of Transportation 2010-3 Flight Standards Inspectors, and Other Aviation Professionals. Federal Aviation Administration WAKE UP!! It was approximately 3:00 a.m., so Fatigue, Poor Sleep Affect Safety they were returning at the worst pos- By Fred Tilton, MD sible time with respect to their circadian rhythm cycle, and they were exhausted. 3 CEERTIFICATIONRTIFICATION UPPDATEDATE: ello, everyone, and welcome to They had configured the airplane for UNNACCEPTABLEACCEPTABLE MEEDSDS Hsummer. landing. The autopilot was engaged, and “Wake up!” is not what one wants to they were flying a coupled ILS approach. hear on the flight deck. The pilot told me he woke up when the 4 AAAMAM STTAFFAFF MEEMBERSMBERS REECEIVECEIVE A former airline pilot recently told me auto-throttles retarded at the beginning INNDUSTRYDUSTRY AWWARDSARDS this story about one of his missions. He of the final descent to the airport. and his crew were completing a round- He looked over to discover that his 5 LEETTERSTTERS TTOO TTHEHE EDDITORITOR robin trip with several intermediate stops copilot was fast asleep. that had taken up most of their crew Fortunately, the story has a happy duty day. This was the third day in a row ending. He yelled at his co-pilot to wake 6 CYYSTICSTIC FIIBROSISBROSIS ((CCAASESE REEPORTPORT) that he and his copilot had flown. They up, and they completed an uneventful had left their home domicile in the late landing. Everyone went home safely to afternoon, so they had been up several their families, and no one outside of the 8 AAMEME REESOURCESSOURCES hours before their departure. flight deck was ever aware of these events. Continued on page 2 8 SLLEEPEEP APPNEANEA BRROCHUREOCHURE PUUBLISHEDBLISHED In Memoriam Dr. Smith was both a Senior AME and Human Intervention Motivation Dr. Margaret Dennis Smith, a Study (HIMS) program sponsor for 8 MEEDICATIONSDICATIONS AANDND FLLYINGYING dedicated pilot and Aviation Medi- the Federal Aviation Administration. BRROCHUREOCHURE REEVISEDVISED cal Examiner since Her love of aviation was deep and com- 1994, tragically mitted. Dr. Smith found the time to passed away in a fa- make flying a significant part of her 9 OPPTICTIC NEEURITISURITIS ((CCAASESE REEPORTPORT) tal aircraft accident life. In many ways, she represented the involving her single- true spirit of American medicine. Her 1100 TRRANSIENTANSIENT GLLOBALOBAL AMMNESIANESIA IINN engine Cirrus SR22 extraordinary kindness and profes- AANN AIIRLINERLINE PIILOTLOT ((CCAASESE REEPORTPORT) on Monday July 5, sionalism have been a great benefit to 2010. She was pilot- Revock Jeff Photo by FAA the health and well-being of our pilot ing her plane on a trip from Plattsburgh, community. 1122 HEELLOLLO, AAMEMES! N.Y., to her home base in New Jersey, Dr. Smith was Senior Associate along with two other family members, Dean and Professor of Clinical Medi- 1122 AVVIATIONIATION MEEDICALDICAL EXXAMINERAMINER who also died in the accident. cine at New York Medical College, as SEEMINARMINAR SCCHEDULEHEDULE She was an accomplished rheu- well as the Program Director for Inter- matologist, educator, avid flyer and nal Medicine at St. Vincent’s Hospital talented AME. Few will impart to in Manhattan, N.Y. 1122 ORRDERINGDERING FOORMSRMS AANDND others as much as Dr. Margaret Smith. She was a distinguished physician, SUUPPLIESPPLIES MAADEDE EAASYSY Her devotion to her family, colleagues, professor, and program director for resi- patients, and airmen was immense. dents at St. Vincent’s Hospital. Continued on page 11 from page 1 WAKE UP I hope you will agree that fatigue is Obviously, a similar set of circum- a safety risk factor and that it is very stances could have ended in disaster. important to do all we can to mitigate The aviation community is well aware the risk. I hope that you will also agree that fatigue can be a major safety issue. that untreated OSA is a fatigue risk, and The Federal Aviation Administration there are probably a significant number has drafted a notice of proposed rule- of undiagnosed pilots who should be making on pilot flight duty and rest. receiving treatment. It has been forwarded to the Depart- Therefore, we have added an OSA ment of Transportation for review and lecture to the AME seminar curricu- clearance, and I expect that it will be lum, and we have developed an OSA published for comment in the Federal brochure (see article, page 8). In the By Fred Tilton, MD Register later this year. coming months, we will be giving OSA R e se a rc h i s a l so bei n g done to ident i f y increased emphasis. These are some of what else can be done to combat fatigue help to mitigate one cause of fatigue in the other things you may see: and make flying even safer. our pilot population. We are developing • Enhanced guidance for pilots, em- These projects are very important, initiatives to improve our ability to ployers, and physicians regarding and I am sure that they will help to en- identify and assure appropriate follow- the identification and treatment of hance the safety of the national airspace up for airmen who are suffering from individuals at high risk. in the future. obstructive sleep apnea (OSA). • Modification of the AME Guide to However, I want to let you know that Obstructive sleep apnea risk varies add a BMI calculator and to include the Office of Aerospace Medicine is with respect to gender, age, and body questions regarding risk factors and/ working on a project that I believe will m a s s i nde x ( BM I ) . It i s more c om mon i n or a history of OSA. males, and the more obese an individual • Addition of a BMI calculator to Federal Air Surgeon’s is the more likely he or she is to suffer the Airman Medical Certification Medical Bulletin from OSA. The evidence is clear that Subsystem. Library of Congress ISSN 1545-1518 OSA is markedly under-diagnosed and • Screening requirements for pilots at Secretary of Transportation therefore left untreated. high risk of OSA. Ray LaHood The National Transportation Safety • Required treatment and follow-up FAA Administrator Board has also cited several incidents for individuals with OSA. J. Randolph Babbitt where fatigue and OSA were considered I believe these initiatives are very Federal Air Surgeon to be contributing factors in incidents. important. You can help by taking a Fred Tilton, MD A preliminary literature review revealed: couple of extra minutes to assess your • Some of the high-risk criteria for pilots’ OSA risk. Ask them if they snore Editor Michael E. Wayda OSA are: obesity; new onset hy- or if they experience day time sleepiness. pertension or hypertension that is If they answer yes or if they are hyper- The Federal Air Surgeon’s Medical Bul- uncontrolled, or that requires two tensive and have a high BMI, it is pos- letin is published quarterly for aviation medical examiners and others interested or more medications for control; sible that they are suffering from OSA. in aviation safety and aviation medicine. and type 2 diabetes. Talk to them about OSA and consider The Bulletin is prepared by the FAA’s Civil • Loud snoring is an indicator of OSA. recommending that they see a specialist Aerospace Medical Institute, with policy • It is fairly easy to screen for OSA. for further evaluation. guidance and support from the Office of • OSA causes fatigue and daytime If it turns out they have OSA and Aerospace Medicine. An Internet on-line sleepiness. receive proper treatment, they will most version of the Bulletin is available at: www. faa.gov/library/reports/medical/fasmb/ Analysis of the Civil Aerospace Medi- likely come back and thank you because cal Institute 2009 medical certification they will feel so much better. Authors may submit articles and photos database indicates that 0.39 percent of And, who knows? it is possible that for publication in the Bulletin directly to: over age-20 pilots have a diagnosis of these simple measures may help to prevent Editor, FASMB OSA. So, it appears that there are a the next accident. FAA Civil Aerospace Medical Institute AAM-400 significant number of pilots with un- Thanks for “listening,” and thanks P.O. Box 25082 recognized OSA because the prevalence again for all you do for us and your Oklahoma City, OK 73125 of OSA in the general population varies airmen. E-mail: [email protected] from 2.0 to 7.5 percent. —Fred 2 T h e F e d e r a l A i r Su r g e o n's M e d i c a l B u l l e t i n • Vol. 48, No. 3 • Policies Certification Update Bioaeronautical Sciences Research and Laboratory at the Civil Aerospace Information About Current Issues Unacceptable Medications Medical Institute, under the leadership of Dr. Dennis Canfield, is performing ince the most common error that research to see if they can determine an aviation medical examiner the most appropriate dosing interval. Smakes is placing an airman on In the meantime, we have changed a medication that is unacceptable, I this to five dosage intervals. In other thought I would spend the next several words, if the directions on the label say columns going over “policies” and spe- to take the medication every six hours, cific medications that are unacceptable the pilot should wait at least 30 hours to the FAA. after taking the last dose to fly. Those of you who have heard me Specific Medications speak at seminars know that when you By Warren S.