“Miracle on the Hudson” … and the “Sully” movie

Ray Basri, MD, FACP on the day Miracle on Hudson with survivors

Ray Basri, MD, FACP on the day Miracle on Hudson with survivors

Ray Basri MD, FACP with Mayor Bloomberg in NYC after the plane crash, Miracle on Hudson

Ray Basri MD, FACP with Mayor Bloomberg in NYC after the plane crash, Miracle on Hudson

Sully, the movie is being released in a couple of weeks. I’m asked if I’m in it.
Short answer, no. Disappointed? A bit. So how did this big Hollywood movie with Tom Hanks and made by Clint Eastwood miss my role of a lifetime?

My guess is that they cut me in editing the film and I’m on some acetate lying in a dumpster. My version of the story is that I was there in fact and did make the reality version of “Miracle on the Hudson”.

For those that didn’t read my chapter in “Brace for Impact”, I did respond to the scene of the rescue being the first and only physician there. I did so after being broadsided by an NYPD truck and still limped over to help.

When I got there, the first passengers and crew were coming into the passenger ferry terminal on the West Side of Manhattan. I sent the injured stewardess to the hospital by ambulance and met the rest of the flight crew, Sully and Capt. Jeff Skiles before all the passengers were accounted for.

Not to miss my other job as a Senior Aviation Medical Examiner for the FAA, I called the regional flight surgeon and the Federal Air Surgeon to let them know that everyone was safe when they didn’t even know any plane was down in the Hudson.

But most “too good to be true” part was that 2 of my neighbors were passengers on the plane. Diane Higgins and her mother Lulu were the last passengers off the plane. They were my connection to the event more than anything.

So in the movie “Sully”, Diane Higgins is listed in the cast as being played by Valerie Mahaffey. There is a doctor listed in the cast as “Dr. Elizabeth Davis” being played by Anna Gunn. being played by Anna Gunn.

However, there is no “Dr. Elizabeth Davis” and I get no mention. I was hoping to have Brad Pitt take my part but they made it a woman. So there is a fictional doctor being played by an actress.

That’s my claim to Hollywood Legend and I’m sticking to it.
Should be a great flick. Hope you all see it on the big screen.

Aeromedical Certification after alcohol or drug infractions *****8500-8 Section 18.v.

FAA Medical Exam

FAA Medical Exam

Aviators are a special breed, often close to adventure and active socially. When they are not flying, they may be subject to indiscretion and bad choices. A few may be involved in an incident involving alcohol or drug abuse that becomes a police matter.These are very serious situations both for the individual’s health and well-being, family, and aviation certification. The FAA medical application Form 8500 screens for these two issues in item 18 V

if there have been any administrative proceedings, arrests or convictions.

Many times the infraction involves driving a motor vehicle after consuming alcohol.  While drug offenses are far less common, they clearly pose a very significant issue for medical certification. Pilots that use narcotics clearly cross a boundary of good judgment. A history of substance dependence is disqualifying and requires review by the Federal Air Surgeon.

The FAA routinely reviews every Medxpress application for alcohol offenses in every state department of motor vehicle databases. This is also true for all criminal arrest and convictions for drug related offenses.  Failure of the aviator to disclose these issues on the era medical certification examination also constitutes grounds for administrative and criminal proceedings for falsifying the application.

The FAA says that a single arrest or conviction for driving while intoxicated will not be grounds for denial.  However it will trigger the aviation medical examiner (AME) to defer if adequate documentation is not provided to the AME within 14 days of the examination.  Necessary documentation includes a number of criteria that must be met to reach the threshold for issuance by the AME.Often the next step will be a review by the Aeromedical Certification Division in Oklahoma City. The pilot will receive a letter from them within a couple of weeks asking for documentation as to the offense:

  • the legal proceedings such as court records and arrest reports
  • a detailed personal statement as to the history of alcohol use and any legal matters related to it
  • a complete copy of the driving record for the last 10 years in any state where the individual has held a motor vehicle license
  • a substance abuse evaluation by a psychologist, psychiatrist, or addiction specialist

The FAA has a protocol in assessing the severity of alcohol related motor vehicle offenses. The number of offenses is a crucial factor in the review.  Having more than one is an indicator of a pattern of abuse and disregard for the law.

The FAA has a worse view of individuals that refuse to cooperate with authorities to obtain a blood alcohol level. So simply refusing to take the test creates assumptions that are worse for gaining certification.

Another key issue is a blood alcohol level at the time of the arrest. Usually a driver suspected of driving while impaired will be given a field sobriety test or breathalyzer.  The next step is a blood specimen which is the gold standard.  In most states the threshold for impairment is 0.08 mg/dL of alcohol.

The FAA looks at a blood alcohol level greater than 0.16 mg/dL as indicating a more severe alcohol problem. The FAA views this threshold of double the legal limit more closely for three reasons.

  • First, it indicates that the aviator was operating a motor vehicle with enough alcohol to show a significant impairment in judgment.
  • Second, that driver probably had some degree of chronic alcoholism such that their level of comfort driving was a practiced behavior.
  • Third, this would indicate that the arrest was somewhat random and there were other times that the individual thought they could drive while impaired.

So the blood-alcohol threshold of 0.16 mg/dL will open the FAA investigation to a more thorough review of the potential for chronic alcohol abuse. The in-depth review of legal and medical records and a new psychological profile will be necessary for the recertification.

When I review the medical application with a new DWI offense, I try to counsel the aviator that they need to be cooperative and proactive. They will need to provide the necessary documentation and immediately begin to put together that package of reports and legal forms.

As with other medical issues, the FAA needs to do a thorough review before recertification. However as I said before, a high blood alcohol level indicates a more chronic pattern of abuse or that there is a disregard for the safety of others.

The FAA can also mandate that a pilot go to a recognized expert in the field that they will designate. These examinations are quite comprehensive and go beyond the issue of alcohol use. They are truly global psychological evaluations that encompass underlying motivation, personality, and cognitive function.

Commercial airline pilots can ask their employers and unions to access dedicated counseling and assistance programs. Aviators with alcohol related issues also have programs in the FAA has its own HIMS program.

Obstructive Sleep Apnea (OSA) – Pilot – FAA Medical Exam

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Pilots are concerned about a new medical standard for Obstructive Sleep Apnea (OSA) by the Obstructive Sleep Apnea (OSA). The concern is that pilots with a serious weight problem will be adversely affected in their recertification. I would like to present my perspective as a senior AME. My thoughts are my own and not necessarily shared by the powers that be.

Obstructive sleep apnea may cause functional impairment for safe aircraft operations. OSA literally means that someone stops breathing during sleep or effectively loses the ability to oxygenate the blood stream. This is because the upper airway is partially or completely blocked during sleep. Therefore the chest muscles and diaphragm must work much harder to open the airway and maintain respiration.

Sometimes a spouse or significant other will notice that during sleep an individual has difficulty maintaining normal respiration or, in fact, there are long pauses between breaths. Patient will come to the office with this clear witnessed account of sleep apnea and we request that a sleep study be done.  This involves going to a sleep lab and spending the night while being monitored.

However doctors also should be looking for symptoms of daytime sleepiness, excessive fatigue, non-restorative sleep, difficulty concentrating, forgetfulness, snoring, and inability to stay awake during common activities during the day.

Overwhelmingly the patients at risk for this are not aware of the condition. Therefore, prospective screening is the best way to diagnose and manage patients with OSA.  There are estimated to be more than 12 million people in the United States at this time with sleep apnea. More than half of those individuals are overweight. It tends to occur in middle-age man and older woman.  The risk factors for obstructive sleep apnea include obesity, thick or large next, and smokers.

The FAA’s concerned that OSHA will result in impaired pilot performance. The FAA has published the Guidelines indicating that mild to moderate obstructive sleep apnea can show performance degradation equivalent to 0.06 to  0.08% blood alcohol levels which is the measure of legal intoxication in most states.  There’s also the increasing risk of hypertension and atherosclerosis with the resulting increasing the risk of heart attack and stroke.  In fact 30 to 50% of patients with heart disease and 60% of patients suffering strokes are found to have obstructive sleep apnea.

The FAA medical guidelines indicate that OSA is present in almost all obese individuals with a body mass index over 40 and the next circumference greater than 17 inches.  Untreated obstructive sleep apnea is a disqualifying condition for airmen and air traffic control specialists.

The next steps in the process will be for the pilot to have a BMI and neck circumference measured during the medical examination. Those airman with high BMI above 40 and neck circumference greater than 17 will be asked to undergo specialized evaluation by a sleep disorder specialist.

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Duration of FAA Pilot medical certificates

Many pilots ask if we could recap the duration for their medical certificates. and the frequency for the EKG for the first class airmen.

  1. First Class Medical Certificate: A first class medical certificate is valid for the remainder of the month of issue; plus

o    6 calendar months for operations requiring a first class medical certificate if the airman is age 40 or over on or before the date of the examination, or

o    12-calendar months for operations requiring a first-class medical certificate if the airman has not reached age 40 on or before the date of examination, or

o    12 calendar months for operations requiring a second class medical certificate, or

o    24 calendar months for operations requiring a third class medical certificate if the airman is age 40 or over on or before the date of the examination, or

o    60 calendar months for operations requiring a third class medical certificate if the airman has not reached age 40 on or before the date of examination. *

EKG is first done on the first medical exam after the airman’s 35th birthday.

The next EKG is done on the first medical exam after the airman’s 40th birthday.

After that one EKG is done every 12 months.

Please note that having the EKG in proper sequence with the medical is vital to maintaining the first class certificate.

After 12 months, an airman who does not have a current EKG will lose the first class certificate as it reverts to a Second class automatically.

    2. Second Class Medical Certificate: A second class medical certificate is valid for the remainder of the month of issue; plus

o    12 calendar months for operations requiring a second class medical certificate, or

o    24 calendar months for operations requiring a third class medical certificate, if the airman is age 40 or over on or before the date of the examination, or

o    60 calendar months for operations requiring a third class medical certificate if the airman has not reached age 40 on or before the date of examination. *

     3. Third Class Medical Certificate: A third-class medical certificate is valid for the remainder of the month of issue; plus

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6th Annual International Aviation Medical Examiner Seminar – presenting cutting Edge Technology

Cool gadgets in Aviation! Check out the latest: X2 Biosystem (TBA) and Heart Rate & Pulse Oximeter Monitor – Cutting Edge Technology.

Once every 2 years, the FAA sponsors a medical education program in Europe for Senior Aviation Medical Examiners.  It is a terrific opportunity to learn directly from the top FAA medical leadership.  This year traveling to Munich from Oklahoma City and the FAA medical headquarters were 3 senior staff.  We learned about the new EKG transmission standards, CACI and special issuance rules, and discussed the future of aviation medicine with our colleagues from all parts of the world.

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Captain Sully Sullenberger and the Miracle on the Hudson

I turned on the radio and caught the first mention of a plane down in the Hudson. Not just a plane, but a commercial airliner in the river just a half mile away.

By Ray Basri, MD, FACP

I began my morning running a couple of stress tests and then settled into the office seeing patients. That afternoon I drove to Manhattan to pick up some medical equipment on the eastside. When I got back in my car, I turned on the radio and I tuned into one of my presets, WCBS News Radio 880 and caught the first mention of a plane down in the Hudson. Not just a plane, but a commercial airliner in the river just a half-mile away.

Every firefighter would say, “Wow, I’m on it.” I called in to Orange County fire control. I turned on my red lights and drove west cross town to the New York Water Ferry terminal at 38th Street. As I drove there, I had thoughts of 9/11, especially when I got to the West Side Highway going south. I wondered what the rescue would entail. I considered possible injuries during landing such as blunt trauma, deceleration injuries, near drowning, and hypothermia. The weather was in the 20s and moderate wind. The Hudson River was 42 degrees. That would give those in the water only a few minutes to be pulled out.

Thomas Jefferson once said, “I’m a great believer in luck, and I find the harder I work the more I have of it.

I believe in luck and opportunity. Coincidence brought this physician into the fire service 27 years ago. It stuck with me and I with it. I work at my office most days practicing internal medicine and cardiology. I work about 50 miles northwest of Manhattan in Orange County. I am a deputy county fire coordinator and do medical exams for the Federal Aviation Administration in the office. I spend a lot of time with firefighters and pilots. They share a lot in common. Most will be there in a tough time doing everything possible for anyone else. They also are brighter, well-trained, and experienced in handling difficult situations, and even spend endless hours going through simulations of near-death scenarios.

Just my kind of people.

I parked on the West Side Highway and made my way past three security check points into the terminal. It looks like an airport lounge perhaps 120 feet long and 40 feet wide with high ceilings. It is modern with glass along the riverside but no views of the water due to the gangways. When I first got inside, I noticed it was sort of quiet. No shouting, screaming, or panic. That was the first sign that it was good news.

I found the EMS Lieutenant in charge, checked in, and offered my help. He said all the passengers in the area had been triaged and tagged green, with the exception of one with orthopedic injuries tagged yellow. EMS transported this passenger within a few minutes.

The thought started slowly that this was a miracle. Everyone alive and safe, but then I considered that there may be others still not on shore. I asked about that and was told it looked like everyone made it out okay. Major sigh of relief. I called the FAA regional office at JFK Airport and spoke with my boss, Regional Flight Surgeon Dr. Harriet Lester. She patched the call into the Federal Air Surgeon’s office in Washington, D.C. I reported that all was well on the scene.

I looked around the room and saw most of the passengers sitting quietly by themselves, most in their own clothes and some wrapped in sheets or turnout coats. Coffee was being distributed, and their hands were shaking. Most looked straight ahead, absorbed in thought. A few groups of two or three passengers spoke softly about the landing. One told me that touching down in the Hudson had been as gentle as any runway landing. I didn’t see many cell phones. When I asked why, everyone said they have already made the important calls. While some New Yorkers would call everyone in that situation, the reality is that it was a quiet time.

There were several head counts done. There were many detectives, some FBI, and emergency management doing interviews of all the passengers. The flight crew was a bit off to the side by the windows. They were smiling and confident. They said it was the only successful water landing of a commercial airliner ever and they had done it. The captain, Chesley B. Sullenberger, III, was standing away from the passengers quietly accepting congratulations. His uniform was as impeccably pressed as if he was boarding his flight. He was soft spoken and gracious. Later, I spoke with Mayor Bloomberg, who is an accomplished fixed wing and rotary pilot. He spoke glowingly of the pilot and first officer’s skill to bring the plane in safely.

Everyone had been in the water up to at least their shins. Some passengers were soaked, and they got out of their clothes and into sheets, then blankets. One young man was in his best suit, tie set just right, and I went over and said to him that he looked just like he was going to an interview. He laughed and said he did just before getting on the plane. His name is Richard Jamison and he finished his internship interview early so he could take an earlier flight home. I told him I would be delighted to call the program director on his behalf so that this was not his first and last visit to NYC. I told him about the possibility some passengers may develop post-traumatic stress disorder (PTSD). I had read some research recommending giving those at risk beta-blocker blood pressure medication soon after their experience. Some studies showed that this lessens the severity of PTSD later by diminishing the mind’s initial reaction to the stress. I kidded around that this would be a good place to test the theory. We spoke for a while and he seemed to relax. Would his life change after this? He said he would let me know.

Now there were another two passengers with luck and coincidence that afternoon. While I was working with the injured passenger, I heard, “Dr. Basri, is that you?” from behind me. I turned around and it was Diane Higgins and her mother, Lucille. I doubt either of us could believe a friend and patient could meet their doctor like this. Fortunately, they were safe and sound. Diane and her husband, John, live in Goshen, as I do, and John is a former fire commissioner, as well. None of us could get over the little hometown reunion. Diane was worried that her elderly mother may have been injured, so I gave her a thorough exam. Lucille was fine but a bit cold so I got her shoes and socks off and wrapped her feet in a blanket. We will be telling this story at the firehouse for many years to come. We thought no one back home would believe the coincidence, so we took photos. Sometimes, truth is stranger than fiction. Just good luck all the way around.

 

Dr. Basri is a senior aviation medical examiner who practices internal medicine and cardiology inNew York. He is also a volunteer firefighter with the Excelsior Hook and Ladder Company in Middletown, N.Y, and deputy Orange County fire coordinator. In addition to his private practice, Dr. Basri is an attending physician at Orange Regional Medical Center, consulting staff at The Valley Hospital in Ridgewood, N.J., and a Clinical Assistant Professor of Medicine at New York Medical College.

“Obstructive Sleep Apnea”

“F

 

rom: Raymond Basri”

“To: Civil Aviation Medical Associations”

I basically agree with your remarks.

I would like to offer these additional issues:

1. Using the BMI to defer pilots is going to affect the livelihood of some individuals. There should be at least one year of education and promotion of weight-loss programs.

2. Taking away medical certification without correlating to symptoms of obstructive sleep apnea is not medically sound. OSA cannot be diagnosed and penalties imposed without clinical correlation.

Where are the questions to go along with the differential diagnosis?

Why can’t we as senior AME’s order the sleep study, review the results and if normal approve certification?

3. Chronic obstructive pulmonary disease and hypoxia as well as coronary artery disease are far more significant conditions that are not being addressed currently. We do not ask the basic questions such as smoking history or coronary risk factors such as family history.

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