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Old 24th Dec 2014, 18:18
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Medications

I had that same cocktail 2 weeks ago during a routine colonoscopy. Administered through IV at 9am, procedure took about 30 min or so. After my wife drove me home pretty much slept all day and through the night. Next morning still tired and groggy but able to get around, but ate very little. At 48 hours still tired but ravenously hungry, and at 56 hours felt normal.

If he had a similar procedure and followed all the orders, it's very possible he hadn't eaten much in 3 days, and had been "fully cleansed" as the doctors are fond of saying.
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Old 24th Dec 2014, 18:25
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You are so so kind! Thanking you very much on behalf of the captain!
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Old 25th Dec 2014, 12:29
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Now the medications are interesting.

Fentanyl is an analgesic. Its a synthetic opioid and is very useful in both acute and chronic pain. It should most certainly have been declared to his supervisors that he was prescribed it.

Midazolam is interesting too. Its quite strong, even in mild doses, and in combination with fentanyl would be quite disabling, although 45 hours is well beyond the half life of the drugs, even combined.

I'm presuming the "stress test" relates to a cardiac test? Its a wonder he didnt fall asleep on the treadmill.
Medications
I had that same cocktail 2 weeks ago during a routine colonoscopy. Administered through IV at 9am, procedure took about 30 min or so. After my wife drove me home pretty much slept all day and through the night. Next morning still tired and groggy but able to get around, but ate very little. At 48 hours still tired but ravenously hungry, and at 56 hours felt normal.

If he had a similar procedure and followed all the orders, it's very possible he hadn't eaten much in 3 days, and had been "fully cleansed" as the doctors are fond of saying.
Fentanyl is an opioid most commonly used for severe pain in terminal cancer patients, when morphine alone isn't effective anymore. Our Swedish medical agency also recommends using fentanyl when there is severe chronic pain due to other circumstances, when morphine is not enough.

Fentanyl is about 150 times stronger than morphine. It depresses the CNS and one common side effect is reduced breathing/breathing difficulties. When used to treat chronic pain it is administered through via skin patches although cancer patients may get it as pills for oral consumption. It is of course extremely dangerous to operate any kind of machinery when using this drug. It does not say if the pilot had a patch or a pill - pills usually clears faster than patches that are designed to deposit a certain amount over time.

Fentanyl is also extremely dangerous to combine with sedative drugs since they interact to make the overall effect stronger in both medications.

Midazolam is a very strong sedative, a member of the bensodiazepine family. This is, in Sweden, only used as anaesthetic in hospitals due to its complicated and potent sedation effects and because it is very easy to overdose. Just as Fentanyl it depresses CNS and can result in breathing depression or the heart just stopping beating.

Both these substances are working via enzyme CYP3A4, which explains why the side effects become more severe when combining them.

So, the story about the pilot using these two substances in combination because of some cardiac test is just not plausible. For use of these two in combination you would have either an extremely irresponsible physician that prescribes substances at a whim, a pronounced substance abuse or some sort of invasive surgery followed (or caused) by extreme pain.

I find it confusing that FG claims it was a stress test that was conducted since Fentanyl+Midazolam can have detrimental effects on breathing capability AND heart function, with heart faliure as the ultimate life threatening condition. Either you have very strange procedures on that side of the pond or someone has got things mixed up.

As I said. I am confuddled by this.

I am not very surprised that the Capt reported for duty though. Due to the CNS depression you're not capable of thinking correctly even though you truly believe you are perfectly fine.

I had one such experience when I thought I was perfectly OK after surgery involving some huge amounts of sedatives. It wasn't until later I realised that I was totally whacked and I was glad my surroundings didn't listen to my declarations of fitness and instead strapped me in the back seat of the car. In hindsight I am sure I wouldn't even have gotten out of the parking lot at the hospital without wrecking the car, running over some pedestrians and ending up in a bicycle parking lot...
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Old 25th Dec 2014, 16:47
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Medication 2

Fentanyl / Midazolam for colonoscopy sedation is pretty common here in the US according to the Dr. who did mine, especially on the West Coast. Propofol, which used to be the drug of choice, is falling into disuse because it requires the presence of an anesthesiologist. Under the FM sedation I was never fully out, I don't think, although in the recovery room (about 90 min) I dozed off. Immediately after the procedure I doubt I could have stood up.

I can't find any reference to the F/M mix being used during a cardiac "stress test". Something about the story doesn't quite add up in my mind, but I'm not a Dr.
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Old 25th Dec 2014, 19:13
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did I miss something about meds? I don't see anything about meds anywhere but in the last few posts

is the captain accused of using meds?

please straighten us out!
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Old 25th Dec 2014, 20:54
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See post 80 in this thread. From FAA report.

Quote:
* but did not enter take-off V-speeds or a “flex temperature” into the MCDU

* When the captain advanced the throttles for takeoff, a warning chime sounded and a screen displayed “ENG THR LEVERS NOT SET; SET TOGA”; The captain responded that “the power is set”, adding that he had advanced the throttles to the flex position.

* The FAA’s report also notes that the captain reported for duty that day 45h after taking midazolam, a sedating drug, and fentanyl, a narcotic; He took the medications for a stress test performed on 11 March, but did not notify US Airways


Astounding.
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Old 25th Dec 2014, 21:08
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glendalegoon

A few pages ago someone posted a link to FlightGlobal:

Pilots played role in US Airways 1702 crash: FAA - 12/12/2014 - Flight Global

Snippet1 (about the accident):
The documents say that, prior to take-off, captain John Powell noticed the aircraft’s primary flight display wrongly indicated 27R as the departure runway.Co-pilot Lynda Fleming then correctly inputted 27L into the multifunction control display unit, but did not enter take-off V-speeds or a “flex temperature”, which allows the aircraft to take-off at lower-than-maximum thrust. The computer needed those values to calculate takeoff power, and required their re-entry after a runway change.
“The crew failed to accomplish this step and so the aircraft had no data available to compute and perform a flex take-off or display speeds,” say the FAA documents.
As a result, when the captain advanced the throttles for takeoff, a warning chime sounded and a screen displayed “ENG THR LEVERS NOT SET; SET TOGA”, an instruction to set the throttles to take-off/go-around” power.
The copilot, who had 4,784h in A320s, read the first part of this message aloud, but not the instruction to increase power, the report says. The captain, who had 4,457h of A320 time, responded that “the power is set”, adding that he had advanced the throttles to the flex position.
Meanwhile, the aircraft accelerated along runway 27L into a 19kt headwind.
When it reached 80kt, an audible warning sounded “retard, retard, retard”, instructing the pilots to idle the throttles, the FAA report says. The first officer told the captain she had never heard that warning during take-off. “We’ll get that straight when we get airborne,” the captain responded.
The documents give varying indications of how high the aircraft climbed; one inspector says 20ft, another 70ft. Regardless, shortly after take-off the captain aborted.

Snippet2 (regarding medication):
The FAA’s report also notes that the captain reported for duty that day 45h after taking two prescription medications: midazolam, a sedating drug, and fentanyl, a narcotic used as part of medical procedures.
He took the medications for a stress test performed on 11 March, but did not notify US Airways, says the FAA. It notes that pilots should not fly, after taking the last dose of such medications, for a period equal to five times the medications’ half-life. That period was 60 hours for the captain, the FAA says.
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Old 25th Dec 2014, 22:47
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MrSnuggles, thank you very much for explaining that to me. WHEN someone posts a link to another article, at least put the important points in the thread as some of us don't go to links we have never heard of like: FLIGHT GLOBAL.

AviationWeek, I've heard of but these others...hmm.

AS TO THE MEDS. Anyone remember the L1011 crash in windshear/microburst many years ago. The captain was said to have been taking some sort of medicine that might impair judgement.

ALL OF US as pilots must police ourselves in terms of use of meds, herbs, nutritional supplements and the like.

And when in doubt, sit it out. EVEN if it changes your vacation plans ets.


Although I will say that when a bad tire becomes airborne the shaking can get worse, not better!

And I will say, without auto throttles, you just push the throttles forward and off you go. All the other monkey motion is just to save money somewhere.

oh well and thanks again Mrsnuggles.
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Old 26th Dec 2014, 00:17
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Oh, don't mention it glendalegoon. Happy to help!

I was under the impression that Flight Global was fairly known in the airline industry, considering Mr Learmount being a writer in the paper and on the blog-kinda-thingamajog they have got going on. Whatever the personal opinion about Mr. L, he is often featured in reports from aircraft accident sites. At least in Sweden.

Anyway, back on topic:

And when in doubt, sit it out. EVEN if it changes your vacation plans ets.
This is very easy to say, but as I myself experienced, when you deal with drugs that depress CNS your line of thinking becomes distorted. This does not happen to everyone, and I can not speak for the Capt of this flight, but the general trend is that your ability to assess a situation is severely impaired to the point that you truly and honestly believe you are fit for any fight.

Someone sensitive to this drug combination might thus have felt perfectly fine and fit to fly/drive a car/operate heavy equipment/perform advanced surgery/whathaveyou while in reality the judgement is out the window and rational reasoning is nowhere to be found. To just "sit around when in doubt" does not apply during these circumstances. This combination of drugs makes some people unable to doubt. For them, me included, there is no doubt about skills needed to perform a certain task. And when you have no doubts, you really need a very assertive environment to stop you from making very very bad decisions.
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Old 26th Dec 2014, 01:31
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mrsnuggles


Anytime I go to the doctor, other than my aviation medical examiner, I mention to the doctor that I am a pilot and ask if the med/procedure will affect my judgement. I will often pursue it further mentioning that even though our plane is pressurized, 8000' is still pretty high.


MANY airline Ops manuals give specific examples and so does the A.I.M. in terms of meds and other things like scuba diving and blood donating.
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Old 26th Dec 2014, 02:50
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It's been my experience that many doctors don't have a clue that a prescription they write might put a pilot on the "deny" list for a medical certificate. I don't think it's their fault for not knowing, but for some reason the information isn't communicated to them. For pilots that means you have to watch out for yourself.
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Old 26th Dec 2014, 03:45
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I really doubt the procedure was a "stress test". Rather, it was some sort of minor surgical procedure like a colonoscopy. For you younger guys, allow me to describe the delights of this experience, it is routine in the US upon reaching age 50.

The day before, you are instructed to eat no food and drink only clear liquids. Then at about 6pm the evening before you drink over a liter of a foul tasting solution they give you. About 90 minutes after that you have an explosive diarrhea attack lasting 2 to 3 hours.

The next morning at about 4, you drink another liter of the ambrosia and repeat the process, until whatever you pass is clear. When you arrive at the Hospital you are already dehydrated and worn out. They place an IV, check your vitals, and if all is good they roll you in for the viewing.

Within seconds of being dosed with the sedatives you are pretty much out of it, although in my case still barely conscious. It only takes about 30 min after that unless they find polyps, in which case they are removed for biopsy. In my case there were none.

After that they monitor you in the recovery room for about 90 min until your wife shows up to take you home.

The next day you feel ok, they tell you to eat but in my case I just wasn't hungry. The following day I woke up feeling like I had run a marathon and had a huge appetite. 8 hours later (56 hours after the procedure and 80 hours after the fasting began) I felt pretty normal.

Toward the end, I don't think I was experiencing the effects of the drugs; I was just dehydrated and starved. For me, I would not attempt any high performance activity before five days after the fasting starts.
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Old 26th Dec 2014, 06:37
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Meds or simply a physically taxing procedure?

@gerago:

I don't fly anymore but I've found that doctors rarely ask what kinds of activities you might be involved in before admistering drugs or performing minor surgeries. In my recent procedure, I would have no idea what the guy used to sedate me unless I had specifically asked. I also never really considered, nor was I informed, that I would be going for almost 3 days undernourished and dehydrated.

Additionally, almost any invasive medical procedure, even a dental filling, can be physically taxing to the point that the patient might not be aware of its effects on performance. Perhaps the focus shouldn't be so much on the drugs themselves, but on the trauma and stress of climbing Mt. Everest.
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Old 26th Dec 2014, 20:51
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I have searched the NTSB home page for an accident/incident docket about this event but came up with zilch. Googling led me to two *.mp3 files on the FAA website.

Can someone please help me find the report(s?) Flight Global refers to in the article or are they still confidential due to investigation blabla?
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Old 26th Dec 2014, 22:42
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Me too Mr. Snuggles:

The article begins with "But newly-obtained documents trace the accident to failures made by the pilots during taxiing, and reveal the tyre blew after the captain aborted the take-off just after the aircraft became airborne.

"The FAA and National Transportation Safety Board (NTSB) declined to comment on the new information, citing the NTSB's ongoing investigations. American Airlines and the Allied Pilots Association, which represents US Airways pilots, declined to comment due to participation in the investigation."

Obtained from whom? We're they leaked to someone? I'm beginning to doubt the accuracy of the story.
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Old 7th Jan 2015, 03:19
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Obtained from whom? We're they leaked to someone? I'm beginning to doubt the accuracy of the story.
From the horse's mouth, can't blame this one on the summer intern:

NTSB Press Release

National Transportation Safety Board Office of Public Affairs

FAA Mistakenly Released a Draft Internal Report During NTSB Investigation

1/6/2015

The NTSB has found that the Federal Aviation Administration mistakenly released investigative information, an error that violated NTSB regulations and party process in our investigation of a March 13, 2014, airplane accident in Philadelphia.

The accident, involving a US Airways passenger jet, is currently under investigation by the NTSB. Recently, the FAA, which is a party to the investigation, mistakenly released preliminary information about the accident under the Freedom of Information Act.

The NTSB depends upon full participation and technical assistance by the parties in our accident investigations – in this case, the FAA, the airline, and the pilots’ association -- in order to ensure that our investigations are objective, rigorous, and complete. Allowing any party to release investigative information without approval may enable that party to influence the public perception of the investigation, and undercut the fairness of the process.

Accordingly, we require that any release of information related to an ongoing accident investigation be coordinated and approved by the NTSB prior to its release. When the investigation is complete, these restrictions no longer apply. Because this investigation is not yet complete, the FAA was required, but failed, to notify and seek the necessary approval from the NTSB prior to releasing their draft report.

The NTSB has shared its strong concern about this matter with the FAA. As a result, the FAA is reviewing this case to see how the disclosure of information occurred and will review its policies and procedures to ensure that information from accident investigations is properly protected.
FAA Mistakenly Released a Draft Internal Report During NTSB Investigation
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Old 26th Feb 2016, 21:23
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Pilot Error Blamed for 2014 Botched US Airways Takeoff, NTSB Says - ABC News

Full Narrative NTSB
http://www.ntsb.gov/_layouts/ntsb.av...14MA081&akey=1

Full Docket
Accident ID DCA14MA081 Mode Aviation occurred on March 13, 2014 in Philadelphia, PA United States Last Modified on February 26, 2016 13:02 Public Released on November 19, 2015 08:11 Total 32 document items

Summary:
http://www.ntsb.gov/_layouts/ntsb.av...20140314X21725

... Collectively, the events before rotation (the incorrect runway programmed in the FMC, the "thrust not set" ECAM message during the takeoff roll, the RETARD alert, and the lack of required V-speeds callouts) should have prompted the flight crew not to proceed with the takeoff roll. The flight crewmembers exhibited a self-induced pressure to continue the takeoff rather than taking the time to ensure the airplane was properly configured. Further, the captain initiated a rejected takeoff after the airplane's speed was beyond V1 and the nosewheel was off the runway when he should have been committed to the takeoff. The flight crewmembers' performance was indicative of poor crew resource management in that they failed to assess their situation when an error was discovered, to request a delayed takeoff, to communicate effectively, and to follow SOPs. Specifically, the captain's decision to abort the takeoff after rotation, the flight crew's failure to verify the correct departure runway before gate departure, and the captain's failure to move the thrust levers to the TO/GA detent in response to the ECAM message were all contrary to the operator's SOPs.

Member Weener filed a statement, concurring in part and dissenting in part, that can be found in the public docket for this accident. Chairman Hart, Vice Chairman Dinh-Zarr, and Member Sumwalt joined the statement.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:

the captain's decision to reject the takeoff after the airplane had rotated. Contributing to the accident was the flight crew's failure to follow standard operating procedures by not verifying that the airplane's flight management computer was properly configured for takeoff and the captain's failure to perform the correct action in response to the electronic centralized aircraft monitoring alert.

Last edited by alph2z; 26th Feb 2016 at 22:15.
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Old 26th Feb 2016, 23:34
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Member Weener filed a statement, concurring in part and dissenting in part, that can be found in the public docket for this accident. Chairman Hart, Vice Chairman Dinh-Zarr, and Member Sumwalt joined the statement.
Weener's dissent seems to be that the 'RETARD, RETARD' message was so distracting that it affected subsequent decision making including the decision to reject the takeoff after lift off. He says the 'insistent nature of the alert affected the crew and drew their attention during this critical decision-making period':

Dissenting Opinion

I'd kinda hope that if the plane was loudly yelling 'RETARD' on the takeoff roll it would draw the attention of the crew.
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Old 27th Feb 2016, 06:35
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More on this dissent:

Party Submission - Allied Pilots Association

Document 1 Human Performance Group Chairman's Factual Report Filing Date November 19, 2015 11 page(s) of Image (PDF or TIFF) 0 Photos
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Old 27th Feb 2016, 10:14
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According to Airbus, from below, "... the aircraft is declared in landing phase whereas it is taking off."

By the way, the below link is to Document 28 although "it" (ie some computer software) has apparently declared it as Document 1

From Document 28, page 11, in the NTSB docket:

Party Submission - Airbus

Document 1 Human Performance Group Chairman's Factual Report Filing Date November 19, 2015 11 page(s) of Image (PDF or TIFF) 0 Photos

6.2 If thrust levers are not set for take-off

The condition 1st ENG TO PWR is not set when thrust levers are not advanced sufficiently to reach the take-off position corresponding to FMS thrust configuration, i.e.:
•Thrust levers below FLX detent if a FLX TO TEMP has been entered,
•Thrust levers below TOGA detent if no FLX TO TEMP has been entered.

As the aircraft accelerates during the take-off run, FWC does not compute flight phase 3 but stays in phase 2 in absence of corresponding thrust condition (1st ENG TO PWR not met). When aircraft reaches 80kt, FWC computes flight phase 8 on the basis of the 3 conditions:
•GROUND
•NO ENG TO PWR
•SPEED > 80kt.

Accordingly, the aircraft is declared in landing phase whereas it is taking off.

6.3 Audio-alert RETARD during take-off

Audio-alert “RETARD” has been designed in order to remind the pilot to retard the thrust levers for landing.

Last edited by airman1900; 27th Feb 2016 at 14:03.
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