Originally Posted by
rickair7777
If you read carefully I'm not dictating anything, just discussing some additional measures they *could* hypothetically take, and the costs and ramifications of doing that.
People advocating tougher medicals probably don't realize that's most likely going to start with an annual cardio stress test, which is somewhere on the uncomfortable to painful spectrum (if you're not a competitive endurance athlete), and will cost several hundred dollars. Fringe benefit: If you're going to have a cardio event, good chance it will happen on the stress test, so the AME can apply CPR and AED while the ambulance is on the way... as opposed to 2.5 hours out from Midway Island.
We don't seem to have a problem with sudden incap, so I don't see a need to change anything. The current issues in the news appear to be experience related, maybe aggravated by chronic fatigue from high ops tempo?
Many years ago - back even before my time - a Wing Commander at an overseas USAF base landed his F-4 and had a heart attack on the roll out. The WSO called a medical emergency when his front seater became unresponsive and got the aircraft taxied to the arm/dearm area where the fire/rescue/medical people extracted the pilot who couldn’t be successfully resuscitated. This occurred only two weeks after the man’s annual flight physical - which HAD included an ECG which - even in retrospect - had been totally normal.
Against the recommendations of some of the medical personnel and all of the statisticians a policy was implemented for all fighter pilots that an Exercise Treadmill Test be included in the annual flight physical for all currently flying fighter pilots and that all personnel showing an “abnormal” exercise treadmill test be referred to the aeromedical consult service, the USAFs central point for difficult problem cases. There those people would be further evaluated.
Those opposing the new policy cited as their reason something called Bayes Theorem or the Law of conditional probability. Not to get too didactic, what this means is that any medical test has a certain percentage of false positives and a certain number of false negatives and there generally isn’t an actual “normal” or “abnormal” except as defined by the desired sensitivity and specificity of the test. Generally speaking if you tweak the sensitivity up you get more false positives while if you tweak the sensitivity down you get fewer false negatives. And with specificity, it’s just the opposite. If you tweak the specificity up you get fewer false positives at the cost of more false negatives. But what really drives the predictive value is the actual frequency of the disease/illness /condition in the population being tested.
If I recall correctly (from a paper I wrote for squadron officer school years ago) the policy lasted about a year and a half and generated just over 200 referrals for further evaluations. All personnel over 35 (a minority in the actively flying fighter pilot community) needed to agree to a cardiac catheterization before they could be returned to flight status.
The program was abandoned after about 18 months and they reverted to the old rules because all but one of the “positive” treadmills in the group turned out to be false positives and that one true positive also had an abnormal resting ECG and would have been picked up under the previous criteria in any event. IIRC, some small number (a half dozen or so) fighter pilots were lost from flying because they refused the cardiac catheterization (which back in that era carried somewhere between a quarter and a half percent MORTALITY). I believe they were all allowed to go to two pilot cockpits though in tankers, transports, and bombers. Whether any ever got back into TACAIR I was never able to discover.
But anyone recommending tightening of medical standards really does need to understand Baye’s Theorem. Doing the “right” thing is not intuitive.
https://youtu.be/HaYbxQC61pw?si=QeQDCZbVeBL6Cz-9