Green Chile Chapter 691
of the Experimental Aircraft Association

Education and support for general aviation

Pilot Incapacitation

By Will Fox

My Dad got his pilot’s license in a 1958 Cessna 172. I was 12 years old at the time and was really excited about it. After a few “interesting” cross country flights with the family, Dad informed me that he was going to teach me to be able to land the plane in an emergency should anything happen to him. Evidently Mom had refused the offer. So began a series of flights where Dad, who was very experienced, in my mind, with more than 100 hours of flight time, taught me how to fly an airplane. My training was very simple. All I needed to know was that pitch was airspeed and power was altitude. As far as landing the airplane went, all I had to do was maintain 80 mph, fly down close to the runway, and chop the power, easy peasy. We didn’t actually practice the chopping the power and landing part, but I did learn how to fly around without stalling the airplane and make an approach to a runway. According to Dad, Mom would do the navigating and handle the radio so all I had to do was the flying. This was all very exciting to me and I can remember day dreaming about landing the plane and saving the day. We never discussed how I would get Dad out of the pilot seat and me into it, but I figured I could just crawl over the back of the seat and sit in his lap. That way if he somehow recovered he could take the controls back and land the airplane. In my youthful day dreams, Dad didn’t recover until after I had landed the plane and saved the day. This was followed by the FAA giving me a pilot’s license for this outstanding accomplishment. Fortunately for everyone involved, Dad never needed me as a backup:-)

Pilot incapacitation is something we rarely think about when flying light aircraft. There is no training for it in a normal pilot curriculum nor is it in the Airman Certification Standards, and it is never covered in a Flight Review, so is it really a big deal? Probably not for younger pilots, but as you might imagine, it becomes more of a factor as you get older. In-flight incapacitation means the pilot is not able to perform his or her duties and must be replaced by another pilot. There is also in-flight impairment, where a pilot is able to continue to do some of their duties, but I will focus on in-flight incapacitation here. Incapacitation may result from a number of problems, such as cardiac or cerebrovascular events, neurological problems, gastrointestinal problems, kidney stones, seizures, loss of
consciousness, etc.

In-flight incapacitation occurs at a rate of around 0.045 incidents per 100,000 hours for pilots in their 40s. The rate can be up to 5 times higher for pilots in their 60s, according to one study I read, or about 0.23 times per 100,000 hours. In 2018 General Aviation (GA) accumulated 25,500,000 flight hours. If we apply the in-flight incapacitation numbers for commercial pilots to the flight hours for GA, we get something like 12-60 incidents per year in the US. Is this a reasonable estimate? Let’s see.

As far as accidents go with regard to in-flight incapacitation, they are very rare on commercial flights because most commercial flights have two pilots on board. However the same can not be said about most private pilot operations, because they are usually flown by a single pilot, and incapacitation is almost assuredly going to lead to an accident. A quick search of the NTSB accident data base for accidents connected to pilot incapacitation over the last 10 years comes up with 108 accidents or about 11 accidents per year. This is close to the lower bound of the previous estimate made using the in-flight incapacitation rates above, so I think I’m in the ball park.

Is in-flight pilot incapacitation a serious problem? I don’t think it is the most serious problem pilots face. Poor decision making ranks much higher on the list, but that doesn’t mean we should ignore the problem. Can we do anything to reduce the accidents that result from it? I think so. Pilots are generally pretty good about monitoring their health and only flying when they feel well. However, as a pilot gets older it is even more important to do so. Sudden incapacitation is more prevalent as you age. Yearly visits to your doctor for a good medical exam if you are over 60 is a good idea. If you fly with your family you might consider having your spouse or another family member take a Pinch Hitter course, where they will be taught to fly and land the plane in an emergency. Something else to consider is to use shoulder harnesses that limit their extension to prevent an incapacitated pilot from slumping forward on the controls. Consider flying an aircraft that has a ballistic recovery system in it. These systems are effective at saving lives in multiple scenarios besides pilot incapacitation. Affordable autopilots are coming out with the capability to automatically level the aircraft with the push of a button (the Blue Button) and that can assist not only a pilot but also a passenger with flying the plane in an emergency. Garmin has recently come out with an autopilot that that will automatically land an aircraft with a push of a button. It is currently aimed at higher end GA aircraft but I suspect it will become available for lighter aircraft in the not too distant future.

I’m reminded of another story. Many years ago I was taking a friend’s young son for his first flight in a light aircraft. I went through the runup checklist with him, and before we taxied on to the runway I asked him if he had any questions. He looked at me and asked “What do I do if you faint?”. I didn’t really have a good answer for him, so I said, “Just keep shaking me until I wake up.” There are much better answers to that question available today.