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Investigation of In-flight Medical Incapacitations and Impairments

Investigation of In-flight Medical Incapacitations and Impairments. Chuck DeJohn, D.O., M.P.H. FAA Civil Aerospace Medical Institute. Incapacitation Event. A300 14 CFR 121 San Juan, Puerto Rico to Miami, FL July 12, 1996. Incapacitation Event. Approach/landing

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Investigation of In-flight Medical Incapacitations and Impairments

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  1. Investigation of In-flight Medical Incapacitations and Impairments Chuck DeJohn, D.O., M.P.H. FAA Civil Aerospace Medical Institute

  2. Incapacitation Event • A300 • 14 CFR 121 • San Juan, Puerto Rico to Miami, FL • July 12, 1996

  3. Incapacitation Event • Approach/landing • Visual meteorological conditions • 2 flight crew, 7 flight attendants, 240 passengers • No accident • No injuries or fatalities

  4. Incapacitation Event • Captain did not ask for landing gear • Approach flown at higher than normal airspeed

  5. Incapacitation Event • Reverse thrust used longer than normal • Captain applied full power on taxiway

  6. Incapacitation Event • Captain again applied full throttle • Captain incoherent • FO shut down engines and called for assistance • FO reduced power to idle

  7. Medical History • 55 year old Caucasian male • Well controlled in atrial fibrillation since his early 40s • Digoxin, propranolol and aspirin.

  8. FAA Medical History • FAA pathology codes • 463: PVCs • 464: atrial fibrillation • 465: bradycardia • 469: irregular beats

  9. Medical History • May 31, 1995 (approximately) • Pilot discontinued medications • Felt that he was experiencing side effects

  10. Medical History • December 28, 1995 Private physicians evaluation for certification • Stable • Asymptomatic • Pulse 60 to 90 • Blood pressure 140/90 • Atrial fibrillation with varied ventricular response and occasional PVCs • Controlled on digoxin, propranolol, and aspirin

  11. Medical History • January 29, 1996FAA Physical for medical certification • Significant medical history • No abnormal physical findings • First-class certificate issued • July 12, 1996 Incapacitation

  12. Hospital Admission • July 12, 1996Incapacitation • July 12, 1996 Hospital admission diagnosis • Atrial fibrillation with rapid ventricular response • Secondary focal cerebral embolization • Transient aphasia • Transient hypertension

  13. Hospital CourseJuly 12 through 20, 1996 • Anti-coagulated with Heparin then Coumadin. • Thallium stress test: normal. • CT scan: evolving left temporoparietal infarction. • Neurological evaluation: Embolic left hemispheric cerebral ischemia with subtle aphasia.

  14. Hospital Discharge July 20, 1996 • Discharge Diagnosis • Posterior temporoparietal infarction secondary to chronic atrial fibrillation • Secondary dysarthria, resolved • Mitral regurgitation • Discharged on digoxin, warfarin, and metoprolol.

  15. Clinical Follow-up • March 12, 1997 Neurological Consult • Recommended brain CT scan • Recommended 1 year rather than 2 year waiting period since event was embolic rather than atherosclerotic • March 26, 1997 CT scan • Negative for space occupying lesion

  16. Epilogue • July 23, 1997 Neurological consult • Neurologically intact without contraindications that would preclude certification • July 24, 1997 Myocardial perfusion scan • Normal without evidence of infarct or ischemia

  17. Epilogue(Continued) • August 8, 1997 Cardiovascular consult • No significant CAD or other structural heart disease • A-V response to atrial fibrillation well controlled • Tolerates arrhythmia well • Qualified for flight status

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