Types of Incapacitation Incapacitation generally falls into one of two groups:
1) Subtle or Incomplete • Skills or judgment may be lost with little or no outward sign.
• The victim may not respond to stimulus, may make illogical decisions, or may appear to be manipulating controls in an ineffective or hazardous manner.
• Failure to respond normally to two consecutive challenges or one significant warning (“You’re 100 feet below decision height”) should trigger action.
• Symptoms may be evident only in moments of high stress or workload. • The victim’s condition may lead to more dramatic or complete incapacitation.
• Subtle incapacitation is most commonly caused by hypoxia, hypoglycemia, extreme fatigue, alcohol, drugs or other toxic substances. Neurological problems, such as stroke, may also be a cause.
2) Obvious or Complete • The first indication of illness may be loss of consciousness, seizures, severe pain or paralysis. • Onset may be sudden. • The victim may interfere with aircraft controls, by (for example): • Gripping controls during a seizure; • Slumping forward on the controls, or • Behaving in a violent or aggressive manner, • The victim’s condition may deteriorate rapidly and appear to be in distress.
Heart attack or stroke are the most common causes of complete incapacitation. Warning signs include pallor, sweating, nausea, comment on heartburn, etc. The victim may deny the severity of the problem.
Solutions The key to early recognition of crew incapacitation is the regular use of Crew Resource Management concepts during flight. Correct use of both the aircraft pressurization system and, if necessary, emergency oxygen will both prevent hypoxia and protect the crew from the effects of smoke and fumes. Therapeutic oxygen can also alleviate the condition of a crew member suffering a medical condition. Staggering crew meal times and ensuring that each pilot eats different meals both prior to and during flight, will reduce the chance of both pilots becoming incapacitated due to food poisoning.
Crewmembers must be careful of the food and drink they consume, particularly in remote areas or where there are poor facilities. Two pilots flying together should never eat the same food, and preferably should not eat at the same time.
Heart problems and fainting are the main causes of serious incapacitation. Complaints of chest pain (often confused with indigestion), weakness, palpitation or nausea should be taken seriously. Pallor, unusual sweating, repeated yawning or shortness of breath should all trigger suspicion.
PILOT INCAPACITATION
What can you do when the pilot is incapacitated? You are on a routine flight and want to check on the ETA to your destination. When you ask, you get no answer from the pilot. Maybe they are busy with ATC or focused on something else? You repeat the question and still get no response. The aircraft is in a slow banking turn and there is no response when you now tap the pilot on the shoulder. Are you prepared for what can happen next?
Incapacitation of a crewmember is defined as “any condition which affects the health of a crewmember during the performance of duties which renders him or her incapable of performing the assigned duties.” Incapacitation is a real safety hazard and occurs more frequently than many other emergencies in routine aviation.
21 Emergency Evacuations
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