...And The Predicament Of Medication

A QANTAS 767-338ER aircraft, registered VH-OGP, was recently operated on an international passenger flight from Auckland, New Zealand to Melbourne, Victoria with two pilots, seven cabin crew and 177 passengers. At the top of climb from Auckland, the captain advised the copilot that he intended to stand down in Melbourne due to his concerns about possible sinus problems and a feeling of being unwell.

At that point, the captain felt he was able to continue as a member of the flight crew. Shortly afterwards, the pilot's condition deteriorated appreciably and he left the flight deck to use the adjacent toilet. He subsequently sought assistance from cabin crew members who were in the forward galley at the time. He felt shaky and nauseous, and had pain in the back of his head and neck. A flight attendant administered oxygen and the captain was assessed as unfit for duty.

The copilot advised air traffic control of the situation, and requested medical assistance on arrival. An alert phase was declared. The aircraft was approximately midway through the flight near SASRO reporting point, located on the boundary between the Brisbane and Auckland Flight Information Regions. From top of descent until landing, a cabin crew member with flying experience remained on the flight deck in an observer seat, listening to air traffic control radio transmissions and monitoring the copilot for signs of incapacitation.

For the approach and landing, the captain was returned to the flight deck and his seat, seatbelt, and harness were adjusted such that he could not inadvertently interfere with the operation of the aircraft.

At Melbourne, an ambulance took the pilot to hospital for observation. His condition improved and tests proved inconclusive. However, no evidence was found of heart-related problems. The PIC later reported a history of stress-related difficulties, mostly related to unstructured situations such as the home environment, rather than the more structured work environment.

He had been receiving treatment for anxiety through a combination of a stress management program and prescribed medication. That was in the form of a selective serotonin reuptake inhibitor (SSRI). The pilot was also being treated for hypertension. On the day of the incident, he awoke at 0340 for a 0615 departure, and felt that his sleep that night had been disrupted.

Civil Aviation Safety Authority (CASA) medical staff were aware of, and were monitoring, the treatment of the pilot's medical condition. Part of that monitoring required his aircrew medical certificate to be reviewed and approved by CASA annually before renewal.

The CASA policy is to manage in-house the medical certification of some private and commercial pilots and air traffic controllers who are taking medication such as SSRIs. That approach differs from that of most other civil aviation regulatory authorities. The CASA approach is in line with that recommended by the Aerospace Medical Association (AsMA). For example, an AsMA position paper on Aeromedical Regulation of Aviators Using Selective Serotonin Reuptake Inhibitors for Depressive Disorders proposes that an aeromedical protocol be adopted by aviation certificatory and regulatory authorities to remove the alternative of absolute prohibitions against pilots flying while taking SSRIs.

The reasons that AsMA gave for this proposal included evidence that:

a. professional pilots may refuse SSRI medication and continue to fly without treatment appropriate for their medical condition to avoid being grounded;

b. a significant number of US professional pilots take SSRI medication while continuing to fly without informing the U.S. Federal Aviation Administration;

c. the use of SSRIs has little or no demonstrable detrimental effect on automobile, bus, and truck drivers.

The Australian Transport Safety Bureau (ATSB) said it was conceivable that the pilot's incapacitation was related to anxiety precipitated by a combination of factors including low blood pressure due to hypertension medication, fatigue and a head cold.