by Dr. John Beasley, MD
Professor Emeritus and Clinical Professor, Department of Family Medicine
University of Wisconsin – Madison
June 18, 2009: “A Continental Airlines Boeing 777 with 247 passengers traveling from Brussels landed safely in New Jersey on Thursday after the pilot died of an apparent heart attack during the flight.” (MSNBC)
After I do all that poking and prodding for your medical certification, the FAA would like me to say: “This pilot isn’t going to drop dead.”
However, that’s not easy – or even possible – to do. All we can do is predict probability, high or low. I may die while writing this article, but the chances are pretty good that not only will I finish it, but I’ll also live long enough to be referred to as “spry” and annoy my grandkids. It’s all a matter of probabilities.
What tends to kill people suddenly is heart disease or strokes, or possibly the rupture of an aneurysm somewhere in the body. These events are all related to vascular disease, in particular atherosclerosis caused by a buildup of cholesterol in the arteries.
To some extent, we can predict the risk of major events. While there are some genetic effects, most risks are related to lifestyle and age. Generally speaking, not smoking, getting reasonable exercise and good medical management for diabetes, high blood pressure and bad cholesterol levels can reduce the risk of sudden death by 30 to 50% – but not eliminate it. One calculator (pretty rough, I must admit) is at: http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof.
The mechanism of death with heart disease is usually a disturbance in the heart rhythm caused by an area of the heart not getting enough blood (ischemia). This is most often due to a small plaque of early arthrosclerosis breaking open inside a coronary artery and causing a clot, which cuts off blood flow to the tissue downstream. About 50% of heart attacks come from plaques, which are small enough that they are not at all easy to detect – even by stress testing or other methods. This is why (along with the large number of false-positives in stress testing) that the FAA has not – thankfully! – required routine stress testing for pilots.
This is also why aspirin is recommended for folks at moderate to high risk. It doesn’t really “thin” the blood, but does reduce the likelihood of a blood clot if a plaque does break open. However, aspirin also increases the risk of hemorrhage. It’s all a matter of higher or lower risks.
Interestingly, a problem that is bigger than that of sudden death is that of “subtle incapacitation.” Many years ago a friend of mine was flying a DC-9 as first officer when Orlando approach called out: “FastAire 123, turn left 090.” The captain who was flying the plane, didn’t respond – he just kept looking straight ahead.
Approach said again: “FastAire, left to 090.” Again, no response. My friend called out “My airplane,” and completed the flight uneventfully. Upon deplaning, the captain seemed OK. It turned out the problem was alcohol withdrawal. The captain got a free ride back home in seat 38E. Had this been a tight approach to minima, the outcome could have been different.
So how can we ensure that a pilot won’t die suddenly? We can’t. We just have to make the risk as low as possible. And if you are flying with another pilot as pilot in command, you want to be sure that he or she is on top of things and that there is no evidence of even subtle problems in performing pilot duties.
And of course you, as a pilot, have an obligation to look at your own risk factors and reduce them as much as possible. I suggest you review the FAA’s I’M SAFE criteria.
Illness: Do I have any symptoms?
Medication: Have I been taking prescription or over-the-counter drugs?
Stress: Am I under psychological pressure from the job? Worried about financial matters, health problems or family discord?
Alcohol: Have I been drinking within 8 hours? Within 24 hours?
Fatigue: Am I tired and not adequately rested?
Eating: Am I adequately nourished?
In addition, I would add the importance of addressing any significant risk factors to your health – lack of exercise being one of the main ones. I won’t even mention smoking; nobody is stupid enough to do that these days if they value their health.
All of this doesn’t guarantee you won’t have a problem, but it’s a good starting point and reduces the risk.
The Doctor’s Thought for the Day: “You should always follow your doctor’s advice. That won’t guarantee you’ll live longer, but it may seem a lot longer!”
