HIMS David Bryman, D.O Senior International Aviation Medical Examiner FAA, Transport Canada, Australia, New Zealand, EASA/Europe

Transcription

1 HIMS An Occupational Substance Abuse Treatment Program AOMA 2016 David Bryman, D.O Senior International Aviation Medical Examiner FAA, Transport Canada, Australia, New Zealand, EASA/Europe Headlines Idea is to try to avoid headlines and allow pilots a safety net to identify themselves to safely enter a treatment program 1

2 Former Alaska Airlines Pilot Charged With Flying While Drunk Drunk' Florida pilot arrested after crashing his Cessna plane into airport shed with young son onboard 2

3 America West pilots convicted of being drunk in cockpit The Germanwings co-pilot suspected of deliberately crashing his plane into the Alps had disclosed an earlier bout of depression, Lufthansa has said. 3

4 Evolving Duties of the HIMS Independent Medical Sponsor HIMS program for Professional Airline pilots Non-Industry Program- other pilots -nonairline, commercial, private Depression- Pilots treated with medication-ssri Evaluation for DUI S My Practice 90 + pilots- HIMS and Non-Industry ETOH, cocaine, Meth, Marijuana, Heroin Professional and private pilots DUI evaluations- almost weekly SSRI/Depression 4

5 HIMS program Substance abuse treatment program for commercial pilots Cooperative effort between pilot, AME, Union, Airline, FAA to save careers and enhance safety Role of the AME/IMS Evaluate the quality of an airman s Recovery Program and make a recommendation to the F.A.A. regarding the Special Issuance of his or her F.A.A. Medical Certificate. 5

6 Types of Evaluations Initial application and examination for an F.A.A. Special Issuance Medical Certificate monitoring for continuation of Special Issuance Non-industry pilot Private pilot monitoring DUI Evaluation Depression AME Responsibilities # 1 Responsibility is to the public- Safety Pilot Advocate-Be sure that the pilots recovery program is of high quality Airline Advocate Responsible to the FAA 6

7 Pilot Responsibilities Attend all required meetings-log attendance Stay abstinent from Alcohol and drugs Keep AME informed-letters, lab, sponsor Why do Pilots want to be in the HIMS Program? They get a second chance to keep their job Excellent support for recovery - Sponsor, Airline support, Financial support, Excellent in-patient and out-patient treatment centers, AME support, FAA support, Psychiatry and Psychology support, Peer support, Family support 7

8 HIMS Program Pilot identifies (or is identified) that there is a problem, has an intervention Given option to participate in program-optional (usually alternate option is to be fired) Admitted to in-patient or out-patient treatment program AME must decide if quality of program is acceptable After discharge pilot will see AME ASAP 1 st visit in my office is usually within a week of discharge from treatment center Managing a HIMS case Several ways to do this AME/IMS is the treating physician-all styles are different One physician may see diabetics every 3 months and another doc might prefer more frequent visits for management Both are correct as long as good outcome 8

9 Managing a HIMS case Pilot goes to rehab and is discharged Pilot sees IMS the following week for 1 st visit I see pilot monthly in my office Monitor pilot with random ETOH/Drug screens Decide when the pilot is ready to see FAA Psychiatrist and Neuropsycholgist Managing a Case Pilot attends 90/90 AA meetings Pilot attends relapse prevention - attends weekly and AME receives a monthly letter Airline monitor sends monthly letters to AME Peer pilot monitor sends monthly letters to AME Initial evaluation and write letter to FAA when AME feels the pilot is ready Pilot gets his/her medical back AME see pilot every 1-2 months Medical done every 6 months-issued by AME under a special issuance. 9

10 1 st Visit Review all documents with the airman H&P, complete lab work-repeat in future as medically indicated Sign HIMS registration forms and agreement for random screens Stress to pilot that this program is their responsibility. They are responsible for all paperwork Checklist/Protocol Complete hospital records, ambulance transfer records, ED records, in patient or out patient treatment records, Psych evals( this way there are no surprises)-usually a lot of paperwork to review-some cases very complicated-bill appropriately for your time List of charges, dates and states where they occurred and all convictions previously undeclared to FAA Enroll in Aftercare program and continue weekly Continue AA meetings for 90/90 Birds meetings weekly (BOAF) See AME monthly, until medical is returned 10

11 Protocol continued After medical is returned see AME every other month ( some, I continue monthly) Complete all medical evaluations that were recommended (neuro, ortho ) Aftercare reports monthly- include statements about frequency of participation, quality of progress, and whether or not pilot is abstinent as well as pilots progress. I DO NOT ALLOW FORM LETTERS OR SAME COMPUTER LETTERS WITH DIFFERENT DATE After return to work, reports every 3 month for duration of monitoring Protocol Psychiatric evaluation when AME feels pilot is ready Comprehensive neuropsychology evaluation with CogScreen and other testing Both Reports and the IMS/AME must support the Pilot in return to flight status I have one office person put randoms in the computer- Patient is set up at a local lab, most are on SobeLink Many pilots get ethyl glucoronide and UA drug screens Airline representative usually chief pilot will write a letter monthly for record. Peer monitor also writes a monthly letter 11

12 Special Issuance Washington reviews the case and issues AME continues to monitor, sees the pilot every other month and does random drug or alcohol screens Reports from Airline and aftercare are kept on chart Pilot will see Psychiatrist yearly The pilot may be released from monitoring if Psychiatrist agrees after 3-5 years and AME writes to FAA if he/she agrees with release. If not, the AME may extend monitoring as long as necessary 12

13 Time line for acquiring Special Issuance Medical Certificate-I downplay this so the pilot avoids anxiety of watching the calendar. Other Cases 13

14 3 rd class certificate holders The total count of accidents in 2005 involving airman with a third class medical certificate was 771. Subject code 4000 physical impairment-25 accidents National Transportation Safety Board (NTSB) Medically Related Accident Query 2005 Medically Related Accidents by Airmen with Third Class Medical Certificates Data as of June 26, 2006 Flight Conduct Code: Part 91: General Aviation Subject Person Code: 4000 Subject Person: Pilot in Command NTSB Report Number Event Type Subject Code Subject Cause/Factor DEN06CA021 Accident Physical Impairment Factor NYC05LA106 Accident Physical Impairment Factor ATL05FA082 Accident Impairment (Drugs) Factor NYC05FA140 Accident Impairment (Drugs) Factor NYC05FA Impairment (Drugs) Factor SEA05FA090 Accident Incapacitation (Carbon Monoxide) Cause LAX05LA073 Accident Fatigue (Conditions Conductive to Pilot Fatigue) Factor 14

15 NTSB Accidents Involving 3rd Class Medical Certificate Pilots (Causal Code Limited) March 29, 2007 Category Subject C or F? 1 PILOT FATIGUE (CONDITIONS CONDUCIVE TO PILOT FATIGUE) FACTOR 2 PILOT FATIGUE (LACK OF SLEEP) FACTOR 3 PILOT FATIGUE (LACK OF SLEEP) FACTOR 4 PILOT IMPAIRMENT (ALCOHOL) CAUSE 5 PILOT IMPAIRMENT (ALCOHOL) 6 PILOT IMPAIRMENT (ALCOHOL) FACTOR 7 PILOT IMPAIRMENT (DRUGS) FACTOR 8 STUDENT IMPAIRMENT (DRUGS) FACTOR 9 PILOT IMPAIRMENT (DRUGS) FACTOR 10 PILOT IMPAIRMENT (DRUGS) FACTOR 11 PILOT IMPAIRMENT (DRUGS) FACTOR 12 PILOT IMPAIRMENT (DRUGS) FACTOR 13 STUDENT IMPAIRMENT (DRUGS) FACTOR 14 PILOT INCAPACITATION (CARDIOVASCULAR) CAUSE 15 PILOT INCAPACITATION (CARDIOVASCULAR) CAUSE 16 PILOT OTHER PSYCHOLOGICAL CONDITION FACTOR 17 PILOT PHYSICAL IMPAIRMENT FACTOR 18 PILOT PHYSICAL IMPAIRMENT FACTOR 19 PILOT PHYSICAL IMPAIRMENT (STROKE) CAUSE 20 STUDENT PSYCHOLOGICAL CONDITION FACTOR 21 PILOT PSYCHOLOGICAL CONDITION 22 PILOT USE OF INAPPROPRIATE MEDICATION/DRUG 23 PILOT USE OF INAPPROPRIATE MEDICATION/DRUG 24 STUDENT USE OF INAPPROPRIATE MEDICATION/DRUG FACTOR 25 PILOT USE OF INAPPROPRIATE MEDICATION/DRUG FACTOR Medical causes of crashes for GA Fatigue- 12% Cardiovascular- 12% Psych-12% Unknown physical complaints -8% Drugs and alcohol (illegal and prescription)-56% 15

16 Private pilots or Non-Industry Program Complicated cases that would normally make the FAA nervous, or dependency Multiple DUI s DUI >0.20 Helicopter pilot with HX cocaine, IV drug abuse, Alcohol abuse Alcoholic with multiple DUI s, Test Pilot Suggested protocol for special cases Similar to HIMS Monthly visits with AME Random drug or alcohol, or monthly lab Visit yearly with HIMS Psychologist (or Psychiatrist) Birds meetings regularly AA meetings-3x/week and log Monthly letter from their sponsor attesting to their sobriety Same evaluation with Psychiatrist and Neuropsychologist 16

17 Depression Has been stable on same dose of approved SSRI for over 6 months Has never been treated with more than one medication at a time to control symptoms Has had no hospitalizations or suicide attempts, PTSD, social phobia, agoraphobia, psychosis, or Treatment with ECT He has support for return to work from his psychologist, neuropsychologist, and aviation psychiatrist. Questions? 17

18 Questions? 18