Sunday, April 24, 2016

U.S. Coast Guard: Keeping an eye on the eyes in the sky

Capt. Jose Sanchez of Coast Guard Air Station Humboldt Bay aboard a flight with Crater Lake in the background.

One Humboldt County doctor has an advantage over his colleagues in encouraging his patients to comply with their plans of care: Dr. Jose Sanchez can pull rank.

The U.S. Coast Guard captain has the authority, but he never needs to use that approach. The people entering his office might have to salute him, but they’re still his patients.

“Part of it is trust, and part of it is also their sense of ownership and their willingness to disclose,” Sanchez said. “We have a very good system. If an individual is under duress, they will speak up. If I need to be involved, I will be more than involved.”

In addition to the other care Sanchez provides the more than 200 men and women assigned to Coast Guard Air Station Humboldt Bay, he also performs aviation medical exams, which go far beyond the physicals needed for school sports or summer camps.

The comprehensive exams cover vision, hearing and vital signs, and can include blood work, an electrocardiogram and urinalysis. The examiners discuss health issues and medications, and review previous surgeries and doctor visits.

The Federal Aviation Administration requires pilots to be examined periodically depending on the type of flying they do.

“Aviation is very unforgiving,” Sanchez said. “The consequences are very significant in the realms of flying. We are not designed to fly.”

On Thursday, PenAir began service to California Redwood Coast-Humboldt County Airport, bringing an additional six flights per day in and out of the McKinleyville facility. Officials have touted the importance of having a second carrier serving the region, providing options to Humboldt County residents traveling out of the area.

At the helm of each of those flights is a captain and first officer who are regularly screened to determine their fitness to fly. Captains undergo the exams once every six months, and first officers once per year.

The process can be stressful for pilots because their flying privileges depend on staying physically fit.

Capt. Zennon McNeill, the pilot who commandeered the first PenAir flights in and out of the Arcata/Eureka Airport on Thursday, said the FAA requirements are a great motivator for him to stay healthy.

Even the scheduling of the exams is important, which must occur within a specific calendar month. A pilot’s availability beyond that month is void until the exam is completed and the certification filed.

Alexander Kluge, a first officer with Skywest, the other carrier serving Humboldt County, said he tries to schedule his aviation medical exams early in the month so he has time to correct any issue that might arise.

“Your work depends on these exams, so you’re always a little concerned,” Kluge said Thursday, waiting at Portland International Airport.

Matt Macri, director of operations for PenAir, said all air carriers maintain an ongoing oversight of their pilots’ physical and training requirements, which includes classroom and simulator-based continuing education. Airline officials carefully monitor every requirement for all of their pilots to ensure they are at peak performance before step into the cockpit, Macri said.

In Humboldt County, the FAA’s list of approved aviation medical examiners includes Dr. Melvin Selinger of Humboldt Pulmonologists in Arcata. Selinger said he does about 60 such exams per year for general aviation pilots who fly mainly as a hobby.

Military regulations differ from the rules the FAA uses for commercial and amateur pilots. In addition to the 18 pilots assigned to Coast Guard Air Station Humboldt Bay, Sanchez regularly screens the 68 air crew members. Being able to care for a patient population in such shape has its benefits, Sanchez admits.

“They are required to maintain a skill set of resiliency and physical stamina. They rescue people in places no one else wants to go,” Sanchez said. “They’re the tip of the spear, in my opinion.”

Rarely will a member of the Coast Guard lose the ability to engage in search-and-rescue operations because of a failed exam with a flight surgeon. More often, a pilot or air crew member might become temporarily ill or suffer some other injury rendering them unfit to fly.

Like athletes who push their bodies to the extremes, Coast Guard pilots can engage in activities that involve speed, height and a high level of physical exertion. Injuries happen, including torn anterior cruciate ligaments, or ACLs, a major piece of connective tissue in the knee. Football players, such as Adrian Peterson of the Minnesota Vikings, have made ACL injuries part of the sports lexicon. A torn ACL can happen during sudden stops, jumping or changes in direction. Coast Guard pilots are not immune to ACL tears, some of which can take a year to recover from fully.

“The question becomes: Is that a condition that’s going allow the individual to get back to full duties, in other words, to their status preinjury,” Sanchez said. “In aviation, if the individuals have the potential to get back to normal, we will aggressively deal with it. We might put them in an administrative hold called a temporary limited duty.”

Having a pilot on temporary limited duty can cause a strain so the unit could get a replacement to keep the team at full strength.

Sanchez’s assessments examine the physical and mental soundness of the pilots and flight crews. Trust comes to the forefront when his patients suffer from stress, anxiety or other issue regarding their mental well-being.

For those conditions, Sanchez relies on the trust he’s developed and the commitment the men and women have to disclose what’s bothering them to ensure safety. The intensity of search-and-rescue missions require pilots and members of the flight crews to have drive, determination, dedication and energy — physically and mentally.

Sanchez remembers one crew member who complained of an inability to concentrate and feelings of anxiety before he was able to determine the patient was suffering panic attacks.

“It took a while. It took a couple of months before he was able to finally disclose what was happening,” Sanchez said. “Once he disclosed that it was happening at random, we were able to address it and explore his options.”

In that case, the crew member accepted the determination he would not be allowed to fly, and he was able to continue his career as a Coast Guard officer in other ways.

“He felt OK not flying,” Sanchez said. “One of his biggest concerns was being involved in a potential mishap or making a mistake and having to deal with that for the rest of his life.”

From the beginning of their training, Coast Guard personnel involved in search-and-rescue missions are taught to minimize risks and watch out for themselves and the other members of the team, Sanchez said.

“We’re always stressing the safety of flight, first and foremost,” he said. “We look at the execution of the mission, then decide whether they’re good to go.”

Even a cold that causes nasal congestion and plugged ears can temporarily render a pilot unfit to fly.

The need for certain medications can automatically disqualify someone from flight, but others depend on degree. Waivers can be attained for some conditions, such as high blood pressure, but the issue can become more serious depending on the number of medications involved. If more than on drug is needed to keep a patient’s blood pressure at a safe level, the potential side effects of the medications could lead to lightheadedness or dizziness.

“It depends on the limitations for performing one’s duties. That’s when we use a combination of the art of medicine, science and the individual’s commitment to wellness,” he said.

Original article can be found here:

No comments: