Get extra lift from AOPA. Start your free membership trial today! Click here

Fly Well: ‘IMSAFE, Harry Hotspur!’

Let’s not lose any more team members

Preflight health checks such as IMSAFE (illness, medication, stress, alcohol, fatigue, eating) are eminently sensible and a legal obligation. Sadly, lack of pilot diligence leads many to die prematurely. Hopefully, this narrative involving an ancient English nobleman, soccer, and cardiac concerns will help you change behaviors. But behavioral change requires changing beliefs—and I hope I can make a believer of you.

My favorite team is Tottenham Hotspur—the mighty Spurs—a football team named for the Tottenham area of London, and Sir Henry Percy, a nobleman whose nickname was “Harry Hotspur.” He led rebellions against King Henry IV, died in battle, was immortalized by Shakespeare, and his descendants owned land where the Spurs first did battle. They play football, the kind that uses a ball and feet—soccer to Americans. They compete in the beautiful game with passion, with heart. And recently heart issues have affected the Spurs.

In March 2012, an opposing team member, Fabrice Muamba, collapsed on the field mid-game. The massive crowd was eerily silent as medics surrounded him. Players were weeping; clearly this was serious. Eventually Muamba was evacuated, obviously in a critical state; he had suffered cardiac arrest and was kept alive by chest compressions and oxygen for 78 minutes. He later, miraculously, recovered fully and at 30, is now coaching another team. In April 2017, Ugo Ehiogu, an English footballer and the Spurs’ beloved under-23 team coach, collapsed and died from cardiac arrest on the training field. On October 27, 2018, the day of his sixty-first birthday, Glenn Hoddle—a famous and gifted former player and manager—suffered a major heart attack and cardiac arrest in a TV studio. Thankfully, Hoddle also recovered.

So what is happening here? Three fit athletes, nonsmokers, and all with great medical services at their fingertips. Similar tragedies strike American athletes, one every three days—probably for the same reason.

Of the hundreds of thousands of sudden cardiac arrests (SCA) every year, we usually imagine an older person—and that is largely correct—but SCA in fit young people is not uncommon. If SCA is not rapidly addressed with resuscitation, sudden cardiac death (SCD) ensues in mere minutes. Among athletes, the leading cause of SCA is hypertrophic cardiomyopathy, a thickening of heart muscle. More common in athletes of African descent (Muamba and Ehiogu both were of African heritage), a history of fainting when exposed to a surprise or during exercise, or shortness of breath and chest pain when active, should be taken very seriously and provoke a detailed cardiac evaluation. So, all of you weekend warriors, because you are super-fit does not mean you are free of risk.

Second, family history is critical—Hoddle had another family member who had suffered a myocardial infarction (heart attack). That increases the likelihood of an event—and as the first symptom of a heart attack is inadvertently purchasing six feet of undesirable real estate, get a check up.

Pilots are reminded repeatedly and train how to react in an emergency: Aviate, navigate, communicate. Fly the airplane. I have the same repetitive message and will continue until people stop dying needlessly. If you want to keep flying (and living), take steps to minimize risk. Review your diet and weight, and take steps to get healthy; eating less in general and cutting out sugar is a great start. And take steps—10,000 a day is a good start, because regular exercise keeps the grim reaper at bay. Look at stress factors in your life, we know that being relaxed, having love and company in your life, and a pet to stroke are good for cardiac and mental health.

Check your blood pressure regularly and know your numbers. Similarly, have a battery of blood tests annually to look for abnormalities with blood fats. Consider taking more detailed steps to evaluate your SCD risk—I have written about this before. One can have a heart CT scan or angiogram, but you need to discuss that with your doctor. I chose to have the heart scan, but you should investigate what is right for you.

The FAA takes a history of cardiac disease seriously, much to the consternation of our readers, but the agency does this to protect pilots and those who fly with them. Avoiding disease beats having to deal with the FAA.

Finally, please talk to your work colleagues and encourage people to learn CPR—ensure there is an automatic defibrillator nearby, and learn how to use it. Saving a life could be in your future. Or you may have to say a big thank you to someone who saved you.

American pilots may not like my kind of football, but you are on my team, fellow aviators, and I don’t want to lose any more team members.

Email [email protected]

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

Related Articles