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Safety Recommendation Details

Safety Recommendation A-09-134
Details
Synopsis: On September 27, 2008, about 2358 eastern daylight time, an Aerospatiale (Eurocopter) SA365N1, N92MD, call sign Trooper 2, registered to and operated by the MSP as a public medical evacuation (medevac) flight, impacted terrain about 3.2 miles north of the runway 19R threshold at Andrews Air Force Base (ADW), Camp Springs, Maryland, during an instrument landing system (ILS) approach. The commercial pilot, one flight paramedic, one field provider, and one of two automobile accident patients being transported were killed. The other patient being transported survived with serious injuries from the helicopter accident and was taken to a local hospital. The helicopter was substantially damaged when it collided with trees and terrain in Walker Mill Regional Park, District Heights, Maryland. The flight originated from a landing zone at Wade Elementary School, Waldorf, Maryland, about 2337, destined for Prince George's Hospital Center (PGH), Cheverly, Maryland. Night visual meteorological conditions prevailed for the departure; however, Trooper 2 encountered instrument meteorological conditions en route to the hospital and diverted to ADW. No flight plan was filed with the FAA, and none was required. The MSP System Communications Center (SYSCOM) was tracking the flight using global positioning system data transmitted with an experimental automatic dependent surveillance-broadcast (ADS-B) communications link.
Recommendation: TO THE MARYLAND STATE POLICE: Implement a program to screen and if necessary treat your pilots for obstructive sleep apnea.
Original recommendation transmittal letter: PDF
Overall Status: Closed--No Longer Applicable
Mode: Aviation
Location: District Heights, MD, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: MIA08MA203
Accident Reports: Crash During Approach to Landing of Maryland State Police Aerospatiale SA365N1, N92MD
Report #: AAR-09-07
Accident Date: 9/27/2008
Issue Date: 11/13/2009
Date Closed: 5/16/2016
Addressee(s) and Addressee Status: State of Maryland, State Police, Aviation Command (Closed--No Longer Applicable)
Keyword(s): Fatigue, Helicopter Emergency Medical Services (Public Operators)

Safety Recommendation History
From: NTSB
To: State of Maryland, State Police, Aviation Command
Date: 5/16/2016
Response: We are aware that, since 2011, all MSPAC pilots, flight paramedics, maintenance technicians and flight dispatchers have received (1) annual OSA training, (2) an OSA screening package, (3) instructions on how to obtain a clinical evaluation to rule out a diagnosis of OSA, and (4), for pilots diagnosed with OSA, information on how to petition the FAA for a “Special Issuance of Medical Certificate” under Title 14 Code of Federal Regulations Part 67 section 401. We previously commended you for taking these positive steps to raise awareness throughout your organization about this important safety issue, but also expressed concern with your decision not to require that MSPAC pilots complete the OSA screening package or submit to a clinical screening for OSA. As you are probably aware, however, the FAA has revised its guidance on identifying and treating OSA that Aviation Medical Examiners (AME) use when performing the recurrent medical examinations required for pilots to obtain and keep their medical certification. The new guidance, which became effective March 2, 2015, directs AMEs to screen for OSA using the guidelines of the American Academy of Sleep Medicine (AASM). Pilots identified as being at risk for OSA are issued a medical certificate and, shortly thereafter, receive a letter from the FAA’s Federal Air Surgeon requesting that an OSA evaluation be completed within 90 days. Any physician may perform the OSA evaluation; if he or she, using AASM guidelines, determines that a laboratory sleep study or home study is warranted, the pilot is required to undergo the study and initiate any treatment prescribed. Pilots diagnosed with OSA and undergoing treatment may send documentation of effective treatment to the FAA for consideration for a special issuance medical certificate. Because the FAA’s revised procedures directly address the intent of Safety Recommendation A 09 134, the recommendation is classified CLOSED—NO LONGER APPLICABLE.

From: NTSB
To: State of Maryland, State Police, Aviation Command
Date: 11/7/2011
Response: The NTSB commends MSPAC for its efforts to develop a departmental policy mandating annual OSA training for all pilots, flight paramedics, maintenance technicians and flight dispatchers. We note that MSPAC also plans to provide these employees with (1) an OSA screening package, (2) instructions on how to obtain a clinical evaluation to rule out a diagnosis of OSA, and (3), for pilots diagnosed with OSA, information on how to petition the FAA for a “Special Issuance of Medical Certificate” under Title 14 CFR § 67.401. We believe that this information would be helpful to pilots; however, we are concerned that the same screening will not be required for MSPAC pilots. In addition, we believe that, if a diagnosis of OSA is confirmed, MSPAC should ensure a pilot complies with the treatment prescribed while he or she is on active flight status. Mr. DeRuggiero indicated that MSPAC cannot mandate that its pilots complete the questionnaires and submit to clinical screening for OSA because such screening is not currently required by the FAA. As MSPAC operates under the “public use” exclusion, we are not aware of any regulation that would prohibit MSPAC from instituting such a requirement without the implementation of a similar mandate by the FAA. Additionally, even if MSPAC were operating as a Part 135 carrier, it could require OSA screening and treatment without the approval of the FAA. We point out that a recommendation similar to Safety Recommendation A-09-134 was issued to all U.S. rail transit agencies, and the majority of these agencies have successfully implemented OSA programs that require training, screening, and treatment, even in the absence of a Federal mandate. We continue to believe that undiagnosed and untreated OSA among pilots presents an unacceptable risk to safety. Therefore, we urge MSPAC to reconsider its position on this matter. Because of the positive steps already taken to address this recommendation, pending MSPAC’s implementation of a program that mandates not only training but also OSA screening and, if necessary, treatment for its pilots, Safety Recommendation A-09-134 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Maryland, State Police, Aviation Command
To: NTSB
Date: 8/4/2011
Response: CC# 201100302: - From Michael W. DeRuggiero, Trooper First Class, Safety Management Officer, Aviation Command: In an effort address NTSB recommendation A-09-134, the MSPAC has partnered with the University of Maryland Sleep Disorder Center (UMSDC), located in Baltimore, Maryland. The MSPAC, in conjunction with the Dr. Steven Scharf, the Director of the UMSDC, is in the process of developing a departmental policy that will mandate the following: - All pilots, flight paramedics, maintenance technicians and flight dispatchers receive Obstructive Sleep Apnea (OSA) training on an annual basis. After satisfactorily completing the mandated OSA training, all pilots, flight paramedics, maintenance technicians and flight dispatchers will receive: - An OSA “screening package” to assist each employee in accessing their individual risk of having OSA. - Instructions on how to obtain a clinical evaluation to rule out a diagnosis of OSA - For pilots diagnosed with OSA, information on how to petition the FAA for a “Special Issuance of Medical Certificate” under Title 14 CFR § 67.401. The mandatory annual OSA training will be delivered as an on-line training program. The training will include recognition of the symptoms and detrimental health effects of OSA and the available treatment options for those diagnosed with OSA. After receiving the mandated OSA training, all pilots, flight paramedics, maintenance technicians and flight dispatchers will be provided with an OSA “screening package”. The OSA screening package will include the “Stop-Bang” and the “Berlin” questionnaires, as well as the “Epworth Sleepiness Scale” to help each employee access their individual “risk” of having undiagnosed OSA. Completion the questionnaires contained within the OSA screening package will not be mandated by the MSPA. However, all pilots, flight paramedics, maintenance technicians and flight dispatchers will be encouraged to utilize the OSA screening tools provided and to receive the appropriate clinical evaluation if they believe they are at risk of having undiagnosed OSA, based on the information obtained from completing the OSA screening questionnaires. Instructions on how to obtain a clinical evaluation for OSA at the UMSDC will also be part of the OSA screening package. If a MSPAC pilot, flight paramedic, maintenance technician or flight dispatcher believes that he or she may be at risk of having undiagnosed OSA, or another sleep disorder, the employee can voluntarily (and anonymously) schedule a clinical evaluation at the UMSDC to confirm or rule out the presence of OSA. If, after a clinical evaluation, a diagnosis of OSA (or the presence of another sleep disorder) is confirmed by a physician, it will be the responsibility of MSPAC pilot, flight paramedic, maintenance technician or flight dispatcher to maintain compliance with the OSA treatment prescribed. All MSPAC pilots diagnosis with OSA (or the presence of another sleep disorder) will be expected remove themselves from “active flight duty” in compliance with 14 CFR 61.53(1), maintain compliance with the OSA treatment prescribed and receive a “Special Issuance of Medical Certificate” from the FAA under Title 14 CFR § 67.401, prior to returning to active flight status for the MSPAC. MSPAC Comments: Under Title 14 CFR 67, a diagnosis of OSA is considered a disqualifying physical deficiency for all FAA certificated pilots. While OSA is a disqualifying medical condition, OSA screening is not required by the FAA for the issuance of any Airman Medical Certificate issued under Title 14 CFR 67. Even though the MSPAC currently conducts all flight operations under the applicable statutory provisions of 49 USC 40125 as a “public aircraft” operator, all pilots employed by the MSPAC are required to be FAA certificated commercial pilots and to hold and maintain a valid Second-Class Airman Medical Certificate issued by the FAA under Title 14 CFR 67. Considering that the FAA Second-Class Airman Medical Certification process does not require that a certificated pilot submit to an OSA screening, the Director of the Maryland State Police Human Resource Section has ruled that the MSPAC cannot mandate that the certificated pilots within their employ submit to OSA screening as a condition of their continued employment or to maintain an “active flight” status within the organization. However, the MSPAC can mandate that its pilots, and other employees assigned to job functions that could have a direct impact on flight safety, receive OSA training on an annual basis to educate them on the adverse health effects of having untreated OSA. Once the OSA training has been completed, the MSPAC can provide each pilot, as well as other employees assigned to job functions that could have a direct impact on flight safety, with the aforementioned OSA screening package designed to assist each individual in voluntarily assessing their individual risk of having OSA. However, the MSPAC cannot mandate that pilots within its employ (or any prospective pilot applicants) complete the questionnaires and/or submit to a clinical screening for OSA. As should be evident in MSPAC’s proposal to address NTSB recommendation A-09-134, it is the hope of the MSPAC that once all pilots within its employ are educated on the signs and symptoms of OSA, the detrimental health effects of OSA, and the treatment options available to treat OSA, that they will voluntarily and conscientiously complete the OSA screening tools provided and seek a clinical evaluation, if warranted. However, at this time, the MSPAC cannot mandate that current or prospective MSPAC pilots submit to OSA screening without the FAA making the appropriate changes in the Second-Class Airman Certification requirements outlined in Title 14 CFR 67, as previously recommend by the NTSB. On August 17, 2009, as a result of an incident that occurred on February 13, 2008 where both the captain and first officer fell asleep during a flight and over flew their destination, the NTSB made the following recommendations to the FAA: - Modify the application for airman medical certificate to elicit specific information about any previous diagnosis of obstructive sleep apnea and about the presence of specific risk factors for that disorder.” (A-09-61) - Implement a program to identify pilots at high risk for obstructive sleep apnea and require that those pilots provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (A-09-62) As you know, the FAA’s responses to the above recommendations were classified “Open - Unacceptable Response” by the NTSB and both recommendations were subsequently placed on the NTSB’s “most wanted” list. If the FAA decides to embrace the above recommendation(s) and change 14 CFR 67 as appropriate, the MSPAC’s proposal for addressing NTSB recommendation A-09-134 will become a moot point. Until that time, the MSPAC believes that its proposal described here within is a good faith effort to meet NTSB recommendation A-09-134. Attached to this document you will find the following: - A draft of the policy design to specifically address NTSB recommendation A-09-164. - The Epworth Sleepiness Scale, Berlin and STOP-Bang Questionnaires to be used in the OSA screening package. Once completed, a copy of the mandated OSA training program will also be provided. We will keep you informed of our progress on this safety recommendation.