Proficient Pilot

Feeling faint

July 1, 2003

Retired TWA captain Barry Schiff has logged more than 26,000 flight hours.

A few months ago, my friend — let's call him Roger — boarded an airline flight on a business trip to the Northwest. He would have flown his Cessna 310, but the forecast discouraged flying there in an airplane incapable of contending with moderate structural icing. He instead settled back and relaxed as the Boeing 737 climbed through the lower flight levels. He soon began to munch on some almonds he had purchased at the airport gift shop.

Roger does not remember much after that except that he recalls having felt strangely dizzy. When he opened his eyes after what seemed like only seconds, he discovered two flight attendants and a female passenger huddling over him him. A blood-pressure cuff was wrapped around his left bicep and an oxygen mask covered his nose and mouth. He pulled the mask away and asked, "What in the [world] is going on?"

"You passed out for about five minutes, and your blood pressure was only ninety over sixty. What is it normally?" The inquiring passenger was a registered nurse.

"About one-twenty-five over eighty," he said as he felt himself climbing out of the mental morass. The pilot announced over the public-address system that the aircraft was going to make an unscheduled landing because of an ill passenger.

Roger was beginning to feel normal and it was difficult for him to comprehend that the announcement was about him.

"Hey, I don't need to land. I feel fine."

Minutes after the jetliner touched down at Sacramento, California, paramedics came on board and carted him off the aircraft, down the Jetway stairs, and into a waiting ambulance. He was taken to a nearby hospital where he underwent an exhaustive battery of tests. All were negative, and he was declared healthy.

The doctors advised my friend that he had apparently suffered a vasovagal syncope, a type of fainting spell. President George W. Bush had a similar experience while eating pretzels and watching television on January 14, 2002.

This was only the beginning of Roger's problems. His girlfriend became concerned that the same thing might happen while he was flying his own airplane. She would not fly with him unless another pilot was aboard.

In discussing this dilemma with other pilots, Roger discovered that he was not the only one with such a problem. Other wives and girlfriends, in these particular cases, were similarly concerned about the possibility of pilot incapacitation.

There is no way, of course, that one can assure a passenger that such a thing will not occur during a given flight even though the likelihood is hardly worth considering, or is it? After all, Roger passed out while airborne. What if the fainting spell had occurred while flying his Cessna? How many otherwise inexplicable accidents might have been caused by an incapacitating syncope that was undetectable during the autopsy that usually follows a fatal aircraft accident?

Roger's girlfriend suggested that she would be more willing to fly with him in a Cirrus. "After all," she reasoned, "if you were to faint, I could pull the handle, and we would float serenely to safety." This simplistic and expensive solution almost got Roger to consider flying his airplane to a distant airport. There he would visit Midnight Modifications and install a dummy handle on the ceiling of his Cessna along with a placard that would read, "Pull in Case of Emergency."

"There!" he would tell his girlfriend. "Now we have a parachute; you don't have to worry any more." But he was too honest to deceive her like that. (Can you imagine Roger actually passing out while en route and her pulling a handle that did nothing but come loose in her hand? He might not want to recover from the syncope considering the just compensation he would find awaiting him.)

Kidding aside, pilots — especially older ones — need to be compassionate about such apprehension from nonflyers. We owe it to our passengers to do everything possible to prevent such occurrences. One way is never to fly under the influence of medication whose side effects are not completely understood or anticipated. Some medications that are seemingly benign on the ground can have debilitating effects at altitude. Another is to avoid flying while fatigued, and some doctors even recommend not eating while serving as the sole pilot aboard an airplane.

If a pilot does begin to feel dizzy, he should immediately turn on the autopilot (if available), engage altitude hold, and lower his head as much as possible to maximize blood flow to the brain and possibly prevent passing out.

The three most common causes of fainting are 1) a vasovagal syncope (accompanied by a decrease in blood pressure and heart rate), 2) a change in heart rhythm, and 3) dehydration. Considering the availability of bottled water and the need to remain hydrated at altitude, there is no excuse for any pilot to suffer dehydration. A companion to water, of course, is something into which one can conveniently dispose of the by-product.

Your first-aid kit — every airplane should have one that is easily accessible in flight — should contain smelling salts, but I would hate to be the one to brief unsuspecting passengers about when they might have to use them.

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