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American Airlines Pilot Dies in Flight BOS-PHX

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American Airlines Pilot Dies in Flight BOS-PHX

Old 9th Oct 2015, 19:00
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The pilot, Michael Johnson's body was returned to Phoenix. Watch the video of his fellow employees at the airport.
Thanks for sharing this news item about Captain Johnston's final flight. I found the workplace tribute very tasteful and touching.

The dignity of the event was somewhat diminished by the generic shipping container.

American could have done better.
I know what you are saying but somehow I would be proud to take my last ride home in that plain cardboard box to such a warm reception from my colleagues at the airport.
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Old 9th Oct 2015, 19:15
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Allegedly, his widow told some newsie that he had a double by-pass operation in 2006. If all of this is true, I suspect the FAA's medical recertification process will be subject to review, at least for first class medical certificates.
Well, there's the question... Is a post-bypass-op pilot really a higher risk than a pilot with undetected or sudden-onset heart issues?
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Old 9th Oct 2015, 21:16
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Risk Factor

Originally Posted by er340790
Well, there's the question... Is a post-bypass-op pilot really a higher risk than a pilot with undetected or sudden-onset heart issues?
I don't think there have been enough cases to make a valid statistical determination.

The Captain of Continental Flight 61, apparently, had no prior indications.

http://www.nytimes.com/2009/06/19/ny...lane.html?_r=0
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Old 9th Oct 2015, 21:31
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Originally Posted by er340790
Well, there's the question... Is a post-bypass-op pilot really a higher risk than a pilot with undetected or sudden-onset heart issues?
No, but you do know who is post-bypass-opp and (per definition) do not know who has unknown issues. The former is, however, a far larger risk than the average pilot.
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Old 9th Oct 2015, 21:40
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Originally Posted by Airbubba
I know what you are saying but somehow I would be proud to take my last ride home in that plain cardboard box to such a warm reception from my colleagues at the airport.
That's all well and good and I wouldn't personally care if they brought my remains back in a plain black body bag or my ashes back in a beer mug. However, in my opinion, the persons responsible for the transport of Capt Johnston's mortal remains should have afforded him more respect, especially knowing full well the likely presence of his family, friends and colleagues awaiting his arrival in Phoenix. Not to mention the poor impression it gives the public from the video coverage.

JMHO
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Old 9th Oct 2015, 22:38
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No, but you do know who is post-bypass-opp and (per definition) do not know who has unknown issues. The former is, however, a far larger risk than the average pilot.
I had a heart attack when I was 42 - totally out of the blue. I was fit, non-smoker, exercised regularly, ate right, etc. Yet one of my cardiac arteries was completely blocked (when I told a physicians assistant who was a racing buddy about it, he was shocked - he said they call that particular blockage "the widow maker"). A little roto-rooter work and I was good as new - in fact a few years ago I did what's called a 'stress echo' and the cardiologist told me he could see no evidence I'd ever had a heart attack. I was incredibly lucky.
But here's the thing - now we know and keep an eye on it. I'd argue that I'm actually at lesser risk of sudden cardiac arrest than most people my age because we're actively monitoring the issue.


Unfortunately for the pilot in question, nothing is 100% - sometimes happens.
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Old 9th Oct 2015, 23:11
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Mortality data

The mortality data suggests a USA 50 year old male has about 1 chance in 200 dying in a year, whereas the data for a guy who had bypass surgery is about a chance in 50.

Although flying is increased stress (7000 foot cabin pressure is a factor) the chances while flying are still pretty low, but -- big but -- the chances of a death of a guy who had not have the operation is about 4 times less.

Google can help you refine these numbers but they are at least in the correct zip code if not on the right street.
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Old 10th Oct 2015, 01:04
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The Widowmaker Documentary

Preventive care vs stents or bypass surgery.

The Widowmaker Movie

Last edited by wanabee777; 10th Oct 2015 at 14:03.
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Old 10th Oct 2015, 02:11
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It's a side theme running through the thread, but I am slightly disturbed by the confidence displayed by some paramedical/nursing types in their ability to diagnose, resuscitate and provide care to the exclusion of involving an available physician on a flight.

While many EMTs are very slick with prehospital management, it is important to recognise the boundary of your skills, competence and expertise.

The trouble with the world is that the ignorant are cocksure and the intelligent are full of doubt.

Bertrand Russell


I was formally an 'EMT' and at that time I thought I was pretty clever as I could follow ALS algorithms exactly, bash in the emergency drugs at the right time, push the button on the defib, do lots of vital signs, do what I had been taught, and manage pretty much any presentation with great confidence at the prehospital level. I knew what to do and could tell other people what they should do as well.

I am now a surgical doctor (and have done general/emergency residency previously) and in retrospect I had no idea just how superficial my understanding, diagnostic acumen and treatment abilities were when I was doing 'EMT' things.

I predominantly do surgical things only now, but still manage acutely unwell patients on the ward when they crash. And I am still privy to a variety of junior staff (with qualification not dissimilar to mine when I was an EMT) managing emergencies, and witness them telling others what to do, with great confidence, except now I know that much of what is touted with confidence is plain unhelpful or even dangerous.

Of course you will find physicians who are very stale with their skills of emergency management, resus and the like. Everyone has stories of an elderly physician doing something silly in a resus. I might say that the reverse is frequently true as well. And out of date physicians will hopefully defer to the initial stabilisation that can be offered by EMTs/ some nurses and the like, and offer their skills at diagnosis and management as appropriate.

But it is staggeringly arrogant for EMT/nursing staff to presume, sight unseen, that their knowledge and skill resuscitating patients is superior to physicians - and that the latter shouldn't even be consulted. And the patient may well be the victim.

Be careful! As a private pilot (for fun) I wouldn't presume I have the skills of a airline pilot. And as an EMT you might just find that an experienced physician rather exceeds your ability to manage any one of the potential fatal complications of an inflight cardiac emergency.
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Old 10th Oct 2015, 02:57
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Alchemy: it's not arrogance. I do believe I did rank the right kind of MD at the top of the list of who you want there. Nevertheless even with that stipulation the great equalizer is that all you have on the aircraft is O2, maybe some airway management tools (maybe not), and an AED. When there is no pulse and no respiration due to a cardiac disease process what extra is an MD going to bring to the party except the ability to pronounce and save everyone a bit of trouble? There's no access for med's, no med's, no 12 lead, no pacing, etc., etc. I suppose you could get crazy with an EpiPen somehow. But pretty much if CPR and the AED don't do the trick the party is over.
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Old 10th Oct 2015, 03:11
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Originally Posted by aa777888
Alchemy: it's not arrogance. I do believe I did rank the right kind of MD at the top of the list of who you want there. Nevertheless even with that stipulation the great equalizer is that all you have on the aircraft is O2, maybe some airway management tools (maybe not), and an AED. When there is no pulse and no respiration due to a cardiac disease process what extra is an MD going to bring to the party except the ability to pronounce and save everyone a bit of trouble? There's no access for med's, no med's, no 12 lead, no pacing, etc., etc. I suppose you could get crazy with an EpiPen somehow. But pretty much if CPR and the AED don't do the trick the party is over.
Not the case with my US LCC. At my outfit we carry 1-2 EMKs with very short rectification intervals on the MEL; they have quite the laundry list of specialized drugs, and an inner and outer compartment whereby the inner compartment may only be opened by an MD or DO (or flight attendant/emt/RN when authorized by Medlink). I'd be willing to bet something very similar is onboard most major worldwide carriers at this point, perhaps even required by CFRs.
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Old 10th Oct 2015, 03:28
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With respect, you are illustrating my point. It's arrogant because you assume you know what others can contribute, and that you can make this judgement as an EMT. Your illustration of management is very 'stuff' focussed, which is what my focus was when I was an EMT, and your list of things you believe the MD can do betrays the fact that this is not your training.

Drugs, lines, machines, things - mostly unhelpful. Actually you can improvise just about anything that is likely to be useful, and 'stuff' rarely makes much difference. The only exception is the AED if you are lucky enough to have a shockable rhythm.

That's why it's worth consulting the physician on the plane. How do you know it is an MI? How do you know it's not one of the many masquerades? And since the pilot wasn't feeling well for a while before he (presumably) arrested, how do you know what the actual causative factor was likely to be, and that the timely involvement of a physician wouldn't have been helpful? Do you really think no-one on the plane had GTN, aspirin? Or that I couldn't fix a tamponade, a tension or an airway with what is available? Despite the fact that I'm not the 'right kind of MD'

The pilot in question may well have done just the same had he keeled over in the Mayo clinic waiting room as in his cockpit. But that's unknown.

Edit: And I agree with aewanabe. Last time I had a look there was a kit with quite a few good things in it (though missing some logical things too!)
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Old 10th Oct 2015, 03:48
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An in-flight announcement was made that the pilot was sick.

That doctor in 1F is a Professor of Medicine at the UMass Medical School and Associate Chief of Medicine at St. Vincent Hospital

He witnessed what happened, spoke to the Flight Attendant after the plane landed, and has publicly credited the FA for her performance.

Good enough for me.
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Old 10th Oct 2015, 11:32
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Derfred ; Gosh. I was not aware that the reason for carrying TWO pilots was because one may die. Er, couldn't they BOTH die ? I always thought that the development from single to multi crew ops was because ONE pilot was unable to reach all of the controls from his/her seat. I do not have any issue with the SYSTEM that has just been demonstrated to work. My disappointment is that a dear colleague with a history of heart problems is finally deemed fit to fly public transport aircraft but then suffers a fatal attack. Gosh !

As for the AME with a disclaimer on his website ! Cripes, you couldn't make this stuff up. Lawyer yuckspeak for making all events of no direct guilt. I was once offered an aircraft that was in "general" good health but had a history of fluid leak onto the APU lines causing oily smells in the cabin (no, honestly). The APU was declared unserviceable. I walked away. Heard that the aircraft, later, diverted with strong undetectable oily smells in the cabin. I managed a wry smile from the safety of my pub.

Time for the Medics to take a hard review of the SYSTEM. The system I refer to is one where pilots, with long history of above average health monitoring and required to demonstrate above average levels of medical fitness get through the screening process only to the suffer fatality.

My ageing motor is due for MOT. Long history of age related problems. I bet it passes the MOT. Will I be surprised if the wheels fall off ? Not really. But it will have ticked all the boxes and the Mechanic has every right to smugly assert that he did his job, all requirements met and.....................oooops, sorry, the odd one slips through the net .

Some very muddled thinking going on, mainly from those with a corner to defend.
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Old 10th Oct 2015, 12:10
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Not the case with my US LCC. At my outfit we carry 1-2 EMKs with very short rectification intervals on the MEL; they have quite the laundry list of specialized drugs, and an inner and outer compartment whereby the inner compartment may only be opened by an MD or DO (or flight attendant/emt/RN when authorized by Medlink). I'd be willing to bet something very similar is onboard most major worldwide carriers at this point, perhaps even required by CFRs.
Good to know! Wasn't the case on the U.S. domestic air carriers I volunteered on (if you'll pardon the pun )

Alchemy: ah, but you are one of the right kind of doctors. While you are focusing on my ranking you are forgetting that I ranked you highest. I still stand by my ranking, based on first hand experience, understanding there are always exceptions, of course.

At any rate, the best thing to do is to get all the medical skill on the aircraft together and work as a team, thereby benefiting from everyone's knowledge and skill. That's what happened all 3 times I volunteered.
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Old 10th Oct 2015, 12:11
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Alchemy,
You are 100% correct. I've been a front line paramedic for the last 16 years in numerous roles including training and aeromedical emergency (helicopter/fixed wing). It never ceases to amaze me that others in my profession are so arrogant as to ignore the higher qualified and experienced. It's only been getting worse over the last few years, they leave training school with incredible attitudes and it's just embarrassing. A good medical professional recognises their limitations.
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Old 10th Oct 2015, 13:53
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Alchemy 101
Thank you, they are the points I wanted to make but lacked the vocabulary and verbal dexterity at the time. Well, I have just had major surgery, and am damn glad I had a surgeon performing it and not a paramedic or an ER nurse!
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Old 10th Oct 2015, 16:33
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Originally Posted by anjowa
The mortality data suggests a USA 50 year old male has about 1 chance in 200 dying in a year, whereas the data for a guy who had bypass surgery is about a chance in 50.

Although flying is increased stress (7000 foot cabin pressure is a factor) the chances while flying are still pretty low, but -- big but -- the chances of a death of a guy who had not have the operation is about 4 times less.
Please remember this golden rule when talking about statistics: Correlation does not equal causation. I might be able to show that bad weather in China means it's more likely for a plane crash to happen in North America. Does that mean a thunderstorm with hail in Shanghai should have you changing your tickets... most people would probably think not... but the causative relationship you just suggested is similar to that. In fact, which factor affect which is a whole nother field study in statistics that get above my level of math in a hurry. Google Dickey-Fuller test and you will see what I mean.



Originally Posted by slowjet
Time for the Medics to take a hard review of the SYSTEM. The system I refer to is one where pilots, with long history of above average health monitoring and required to demonstrate above average levels of medical fitness get through the screening process only to the suffer fatality.
I think this boils down to the everyday practical safety versus ultimate safety trade offs. Could we save thousands of auto fatalities just by halving the speed limit? Probably, yes....
Is it practical? No...most of us would be strongly against this.


Can you ground every pilot that show any medical indication and possibly save some lives? It might help... (but even that is somewhat arguable since personal health related double incapacitation hasn't happened in recent history). BUT, what are the practical implications? Much shorter career lengths and higher labor costs from that... etc, etc.

Not much gain, but at a very high cost.
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Old 10th Oct 2015, 16:53
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At any rate, the best thing to do is,to get all the medical skill on the aircraft together and work as a team
This would be my first concern during any airborne emergency. Being one of the slightly staler varieties of medics, I'm sure an EMT or an A&E nurse would be a lot more current and slick with the ALS algorithms. However, I am convinced the knowledge I and any other fully qualified medical practitioner have, would come in useful, especially with regards to considering differential diagnoses and further treatment.

Flapassym, if the powers that be have their say, it won't be long until your surgery might be done by someone not medically qualified... In some places and depending on what procedure is being done, this is already happening... Apparently my colleagues and I are far too expensive to be employed to do what we are actually trained to do...
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Old 11th Oct 2015, 15:00
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Aware that this is well off topic.

I was one of the first to suggest as an ex-paramedic that an experienced ER nurse could potentially have been as capable as a Doctor, in response to someone saying that someone's earlier post saying similar was the most stupid they'd ever read.

I made the point of saying that obviously common sense would be to use whatever help and expertise is available. Nowhere has anyone said I think that a Doctor should be ignored.

It is true though that an experienced Paramedic or ER nurse could be more capable at the specific skill of resuscitation than a Doctor working in an unrelated field who last resuscitated someone twenty years ago.

A Doctor with recent experience would of course be more qualified and capable, although to some extent hampered by the equipment/drugs available on board. Realistically in a simple resuscitation situation, its unlikely that he'd be able to do anything more than any other qualified ALS provider. But he'd still have superior knowledge.

I simply made the point in reply to someone saying that it was stupid that the nurse could do as much as a doctor. Thats completely possible, it depends on their respective experience/currency.

To make the point that you're glad a surgeon carried out your surgery rather than a nurse is silly. We're talking about the specific skill of resuscitation. The advanced life support course is identical taken by Nurses, Paramedics or Doctors.

Again, common sense is to use whatever experience is available.
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