Take Precautions… Don’t Become Victim To Incapacitation

by Dr. Bill Blank, MD
Published in Midwest Flyer – August/September 2018 issue

I am certainly no expert on the subject of “pilot incapacitation,” but it is a topic deserving of our attention.

Obviously, if you are flying, my short advice would be to land as soon as possible if you detect the onset of a problem. But let’s delve a little deeper into the subject.

Pilot incapacitation falls into two categories: pilot incapacitation caused by a malfunction of the airplane, and pilot incapacitation caused by health issues.

Incapacitation can be caused by an airplane malfunction, such as sudden decompression, a broken windshield, or fire and smoke in the cockpit. In these cases, the solution is to know and execute the emergency procedures for the malfunction prior to the onset of becoming incapacitated.

The second type of incapacitation is related to pilot health issues. Here, we would be thinking about gastro-intestinal problems, such as nausea, vomiting, diarrhea and weakness; cardiac problems from chest pain, all the way to unconsciousness; and neurologic problems. Remember, falling asleep in the cockpit is incapacitating if no one can wake you up. Sleep apnea can be a cause.

A major consideration of pilot incapacitation is whether it is a one or two-pilot flight. The airlines, and many corporations, have a two-pilot crew and each pilot is fully qualified to fly the aircraft. The airlines have specific training for this situation. What about single-pilot operations? Here, we could be talking about flying anything from a Piper Cub to a King Air or Cessna Citation.

The good news is, pilot incapacitation is relatively rare, but good statistics are hard to find. In the airline world, several cases occur every year. In general aviation, the incidence is hard to evaluate because unless there is a fatality, or the pilot winds up in the hospital, no one will probably know about it. In many cases, the pilot just goes home and recovers.

The most common cause of pilot incapacitation is gastro-intestinal difficulties, followed by cardiac and neurologic problems. What do you do if you are a single pilot and you think you may be becoming incapacitated?

I recently read an interview with the late Bob Hoover, pilot extraordinaire, that relates to many situations that may confront pilots from time to time when flying. Bob emphasized that it was important to think ahead about potential problems, have a plan, and practice it. He, of course, was talking about flight and airshow emergencies, but the same applies with pilot incapacitation.

Fighters are frequently flown single pilot. An option these pilots have is to eject. General aviation pilots with the exception of Cirrus aircraft pilots have no similar option. If you frequently have the same passenger, you could teach that person the rudiments of landings. AOPA has a Pinch-Hitter Course with this goal in mind.

I have talked to several pilots about pilot incapacitation, all professional and also some former military pilots. The consensus is to take immediate action! This is especially important, if you are flying as a single pilot. If you are not feeling well and think you are becoming incapacitated, don’t delay… take action while you can! This will depend on your aircraft’s capabilities. Turn towards an open area and engage the autopilot if you have one. Once you have done this, you can assess how incapacitated you are or will become.

Do you have time to declare an emergency? If it is a gastrointestinal problem, you will probably be able to muddle through to a successful outcome, whether that is to land at the nearest airport, or make an emergency off-field landing somewhere.

Is there anything you can do to decrease the likelihood of becoming a victim? Yes! The first thing is a healthy lifestyle. Exercise moderately, eat healthy, watch your weight, drink moderately, if at all, and DON ‘T SMOKE. Equally important, if you don’t feel well or suspect some sort of problem, don’t fly, regardless of the desire or pressure to get somewhere. This is even more important, if you are no longer young. A fair percentage of people who become incapacitated in flight had symptoms before takeoff.

Do you have any idea what your airplane would do if you took your hands and feet off of the controls? You might want to try it and see. Obviously, recover immediately if necessary. Otherwise, you may wish to ride it out for a while. Some aircraft with good stability will fly more or less level for quite some time. Other aircraft will go into a spiral dive fairly quickly.

I don’t have an answer for all of these scenarios. I hope none of us will ever have to face this situation. Good planning and a lot of luck may save the day. Happy flying!

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Blank holds an Airline Transport Pilot Certificate and has 5300 hours. He is a Certified Instrument Flight Instructor (CFII), and has given over 1200 hours of aerobatic instruction. In addition, Blank was an airshow performer through the 2014 season, and held a Statement of Aerobatic Competency (SAC) since 1987.

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