The recent German Wings suicide and mass murder disaster has created much repercussion within the field of medicine, not only psychiatry and aviation medicine. The tragedy highlights the need for significant change around the assessment of pilots’ health if we want to prevent such disasters from happening in the future, particularly as the world […]
The recent German Wings suicide and mass murder disaster has created much repercussion within the field of medicine, not only psychiatry and aviation medicine.
The tragedy highlights the need for significant change around the assessment of pilots’ health if we want to prevent such disasters from happening in the future, particularly as the world population grows, and the number of flights is constantly increasing.
At the same time, the incidence of mental illness is growing, and the threat of terrorism is on the rise.
This is no longer an issue just for doctors who are designated aviation medical examiners (DAMEs). All doctors have a part to play. But having just returned from a conference on the topic, convened by the Australasian Society of Aerospace Medicine conference, I can tell you it’s not going to be easy.
After listening to carefully chosen expert psychiatrists, I have mixed feelings. While I will be doing everything I can at my end to identify pilots at risk, it simply isn’t possible to be confident of detecting this type of problem during an aircrew medical.
The comprehensive pilot questionnaire, history, examination and assessment that forms the pilot medical is unlikely to reveal if they have plans to commit mass murder. Neither is a person with such plans likely to divulge them.
While depression and other psychiatric conditions are relatively easy to diagnose, treat and manage, it is not the depressed pilot we are looking to identify here.
As a rule, it is not people with depression who deliberately crash an aeroplane carrying hundreds of passengers. Instead, we are looking for particular kinds of personality disorders and derangements, which might be picked up more easily if information was shared between practitioners.
One solution might be to increase access to pilots’ medical histories between doctors.
If there was ready and shared access to information about previous visits to doctors, previous medical, social and psychiatric history, and other details about their lives, a pattern of behaviour might be detected that could warn us when something may be amiss.
This could then precipitate a doctor doing an aviation medical, or CASA, to ask more questions.
I understand that moves are underway to find a way of making all pilots’ past medical and other relevant histories available to doctors performing aviation medicals at the time of their assessment, but there is still a long way to go.
The argument is that every GP, whether they do aviation medicals or not, should be in a position to make an immediate phone call to CASA when doubt arises about a pilot’s state of mind.
Obviously, this raises a huge confidentiality issue, balancing the rights of the individual to confidentiality, and the public to be protected from potential harms.
Once alerted to a potential problem, CASA would then assess the situation, look at any other information they may have, and decide what action, if any, should be taken.
The pilot of the German Wings plane apparently had 15 unusual visits to a doctor in the 12 months prior to the suicide/murder. The final doctor was concerned and gave him a medical certificate, asking him not to fly, and to return in two days for review. The certificate was later found in the bin, after the plane had crashed.
A timely phone call to the relevant aviation authority in this type of scenario may prevent the deaths of hundreds of people.
As well, as GPs make sure we know what our patients do for a living, so we know which of them are in this profession.
Or, of course, we can just do nothing differently and say: “shit happens”.