Heart condition - Medical requirements for airline pilots

You probably heard about the 57 years old American Airlines pilot who tragically died yesterday while flying from Phoenix to Boston. What I found surprising is what his widow told the press:

I have no idea what the medical requirements for pilots say in detail, but I would have assumed that the rules are such that a pilot who (1) had a double bypass and (2) is 57 years old would absolutely have been precluded from flying a commercial airplane?!

It’s not quite that simple. And certainly the details differ in various countries.

For FAA regulating US airlines, here’s the basic list of disqualifying conditions: http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/general/decision/

But for most of those, there’s something called “special issuance” which means that after a pilot has had a disqualifying diagnosis, the prescribed treatment, and have been monitored for awhile to ensure the treatment is working, they can be issued a special medical certificate which permits them to go back to work. These usually have additional conditions for intrusive monitoring, sticking with a medication regimen, etc.

This is the guidance for special issuance for Coronary Heart Disease: http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/coronary/

Essentially the FAA treats pilots as just another part on the aircraft. Parts that have redundancy are required to have catastrophic failure rates below IIRC 1-in-a-million flight hours. Pats that do not have redundancy whose failure pretty well guarantees an accident (e.g. wing-to-fuselage-attachments) are required IIRC 1-in-100-million flight hours reliability.

The current medical standards achieve their statistical goal. Despite the occasional headline event. You’ll notice nobody other than the pilot himself was harmed by this event. The rest of the redundancy worked as designed.

Clearly if we are ever to move to single-pilot ops (management’s current Holy Grail of cost cutting) there would need to be a lot of rethinking of these standards, both special issuance and for intrusive screening of asymptomatic healthy pilots.

That makes sense. I wonder, though, if the airlines are considerate enough not to assign two elderly pilots with a documented history of serious medical problems to the same flight?

That used to be the case several decades ago, however, advancing medicine means that someone post-bypass may be much healthier than in the past. The other thing is that by not making a heart condition an instant and permanent disqualifier it is believe that this makes it more likely that pilots will seek treatment for medical conditions rather than attempting to hide them, which would definitely decrease safety overall.

Certainly, telling a pilot “you will only keep your license if you comply with the following conditions/treatment” will make compliance more likely given the level of monitoring that can be imposed on a pilot.

I will also mention that there was an incident in, if I recall correctly, the 1990’s with an under-30 pilot with no prior medical history of cardiovascular problems literally dropping dead in the center aisle of his airplane during a flight (he was coming back from the toilet at the time, again, IIRC). The airline was definitely Northwestern, I’m sure of that. Anyhow there is a non-zero risk of any pilot suddenly dying. It’s rare and unlikely, but it’s also why commercial airlines have at least TWO pilots on board. Stuff happens.

Even for a private pilot license post-bypass medical requirements and monitoring are quite stringent. For commercial pilots even more so. Sudden death of a pilot while in flight is extremely rare, even in those with a past medical history. It wouldn’t surprise me if at this point the rate of occurrence of death-while-in-flight for pilots with a history of cardiac issues and those without prior such history are pretty much the same. Would be interesting to look at the stats.

Yes, the media likes to breathlessly imply a fiery crash and mass death were only narrowly averted. In reality, the backup/safety/redundancy systems functioned as designed. In other words, the system worked just fine. The risk to the passengers was minimal in this context. That’s not to say the situation wasn’t serious, it certainly was, but they weren’t teetering on disaster here.

Actually, management’s current Holy Grail would be NO pilots, completely automated airplanes.

There is actually a regulation regarding that. I don’t recall the exact wording, but it’s something along the lines that if one pilot is over 60 the other has to be under that age.

Don’t know if they take into account whether both pilots have special issuance or other forms of waivers or not, but that might be a possibility for future consideration if this sort of thing becomes more common.

Historically in the US & Europe pilots had to retire at age 60. In the early 2000s the EU bumped that to 65. The US followed suit in IIRC 2007. Since then some European countries have increased the mandatory retirement age to 67. They are making rumbling noises about going to age 70.

Meantime in the US there are no above-the-table plans to change the age 65 rule. But we all suspect that somehow when push comes to shove and companies can’t recruit anyone to do the job in a few years the age will miraculously just change one day, probably to 68 or 70.

Right now only one pilot can be above age 60. There is no company-level tracking of medical history. If you have a medical certificate, special or otherwise, the FAA has said you’re healthy enough and that’s the end of it.

My bottom line: there are a lot of other things in aviation vastly more risky than the current state of pilot health. If indeed Congress keeps bumping the retirement age we’re probably going to need a more intrusive inspection regime for the very old. But meanwhile, this ain’t broke & doesn’t need fixing.