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Author Topic: Flying while mentally ill
Capn Eddie Ricketyback
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The AAL Flight Attendant story seems to have disappeared into a hole somewhere, as I haven't seen anything about it since a day or two after it happened. One part of the story I remember alleged that she was bipolar and hadn't taken her medication.

Having been away from the industry for more than a quarter century my memory may be faulty, but I was not aware that Flight Attendants were allowed to fly after being diagnosed with mental illness. If so, please don't tell me that is true for pilots as well.

Perhaps someone who has been in and around the airline biz more recently can enlighten us.

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PITbeast
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If a pilot regularly flew the great circle route both to the north and to the south, would not he (she or it) be bipolar?
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Subsonic Transport
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It has annoyed me for years and years at how AA can just make "things" disappear.

One was the crash of the 757 where I think the pilots/autopilot flew the plane into the hill side. I don't remember the details. But after about 1 day of news reporting, Pooof! Never heard about it again.

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Bob Ritchie
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Gents,

As the former aeromedical chairman at TWA I can attest to the fact that pilots with a history of "mental illness'???? whatever that is...can be recertified to fly: just as those with heart bypass, alcoholism and virtually every other imaginable physical/emotional/mental condition.

The FAA's prehistoric attitude toward medical certification went out with the 70's. Gee...rememember when the airlines reqired new hire pilots,such as ourselves,to have 20/20 uncorrected vision? Things have changed.

My heart goes out to this AA Flight Attendant who..."but for the grace of God there goes I."

The story disappeared from the media...because it was of no particular importance. And by the way...the 757 crash in south America was all over industry publications for years.

Bob

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R$
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The AA crash you are referring to occurred near Cali, Columbia. The information about what happened, and how to avoid what happened, was used for years in TWA's flight training.
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Rocky Dollarhide
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That was my other login.
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Capn Eddie Ricketyback
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quote:
Originally posted by Bob Ritchie:
As the former aeromedical chairman at TWA I can attest to the fact that pilots with a history of "mental illness'???? whatever that is...can be recertified to fly:

I asked you not to tell me that!

It's nice to know, though. Next time I'm asked at a cocktail party or somewhere if it's safe to fly, I'll share that reassuring information with the questioner.

"No particular importance," eh? I can think of several other reasons for the media ignoring that story and hoping it'll go away (which it probably will), all of which are more plausible than that one. It probably will go away, though, and she'll probably be back at work within a month and nobody will be the wiser, except a few officials who will be keeping their fingers crossed hoping that something worse doesn't happen before they retire.

I see that excuse being used a lot by people who defend the news media for ignoring offensive behavior by public figures with whom they are sympathetic and trumpeting less offensive behavior by those of whom they do not approve.

We live in iteresting times.

[ 03-17-2012, 06:24: Message edited by: Capn Eddie Ricketyback ]

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Bob Ritchie
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quote:
Originally posted by R$:
The AA crash you are referring to occurred near Cali, Columbia. The information about what happened, and how to avoid what happened, was used for years in TWA's flight training.

Flight history

At that time, Flight 965 mainly carried people returning to Colombia for the Christmas holiday, vacationers, and businesspeople.[5] A winter storm in the northeast United States caused the airline to delay the departure of the airliner for thirty minutes to allow for connecting passengers to board the flight, so Flight 965 pushed back from gate D33 in Miami at 5:14 pm, and then taxied to runway 27R, but seasonal congestion caused the Boeing 757 to take off two hours late.[6] Some other passengers booked on Flight 965 missed the flight due to missed connections.[1]

The cockpit crew consisted of Captain Nicholas Tafuri and First Officer Donald Williams. The cabin crew consisted of Purser Pedro Calle and Flight Attendants Magdalena Borrero, Rosa Cabrejo, Teresa Delgado, Gilberto Restrepo, and Margaret Villalobos.[6]

Cali's air traffic controllers had no functional radar to monitor the 757 as the pilots flew the approach using the area's radio navigation aids and the airport's instrument approach system. Cali's approach uses several radio beacons to guide pilots around the mountains and canyons that surround the city. The airplane's flight management system already had these beacons programmed in, and should have, in theory, told the pilots exactly where to turn, climb, and descend, all the way from Miami to the terminal in Cali.[citation needed]

Since the wind was calm, Cali's controllers asked the pilots if they wanted to fly a straight-in approach to runway 19 rather than coming around to runway 01. The pilots agreed, hoping to make up some time. The pilots then erroneously cleared the approach waypoints from their navigation computer. When the controller asked the pilots to check back in over Tuluá, north of Cali, it was no longer programmed into the computer, and so they had to pull out their maps to find it. In the meantime, they extended the aircraft's speed brakes to slow it down and expedite its descent.[4]

By the time they found Tuluá's coordinates, they had already passed over it. In response to this, they attempted to program the navigation computer for the next approach waypoint, Rozo. However, the Rozo NDB was identified as R on their charts. Colombia had duplicated the identifier for the Romeo NDB near Bogotá, and the computer's list of stored waypoints did not include the Rozo NDB as "R", but only under its full name "ROZO". In cases where a country allowed duplicate identifiers, it often listed them with the largest city first. By picking the first "R" from the list, the captain caused the autopilot to start flying a course to Bogotá, resulting in the airplane turning east in a wide semicircle. By the time the error was detected, the aircraft was in a valley running roughly north-south parallel to the one they should have been in. The pilots had put the aircraft on a collision course with a 3,000-meter (9,800 feet) mountain.[7] The air traffic controller believed that some of the requests of the pilots did not make sense, but did not know enough non-aviation English to convey this.[8]

[edit] Crash

Twelve seconds before the plane hit the mountain, the Ground Proximity Warning System activated, announcing an imminent terrain collision and sounding an alarm. The captain and first officer attempted to climb clear of the mountain, but the deployed speed brakes reduced the rate of climb and the aircraft hit the mountain near its summit. Research has shown that the aircraft would probably have cleared the terrain if the crew had immediately retracted the speed brakes when the GPWS alarm sounded.[4]

[edit] Aftermath

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Bob Ritchie
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quote:
Originally posted by Capn Eddie Ricketyback:
quote:
Originally posted by Bob Ritchie:
As the former aeromedical chairman at TWA I can attest to the fact that pilots with a history of "mental illness'???? whatever that is...can be recertified to fly:

I asked you not to tell me that!

It's nice to know, though. Next time I'm asked at a cocktail party or somewhere if it's safe to fly, I'll share that reassuring information with the questioner.

"No particular importance," eh? I can think of several other reasons for the media ignoring that story and hoping it'll go away (which it probably will), all of which are more plausible than that one. It probably will go away, though, and she'll probably be back at work within a month and nobody will be the wiser, except a few officials who will be keeping their fingers crossed hoping that something worse doesn't happen before they retire.

I see that excuse being used a lot by people who defend the news media for ignoring offensive behavior by public figures with whom they are sympathetic and trumpeting less offensive behavior by those of whom they do not approve.

We live in iteresting times.

Nothing happens...

....in the airline industry today that has not happened many times in the past. Discretion was once the rule: incidents were kept quiet and handled internally.

We did not always have dozens of 24/7 news programs and endless talking heads. Nor did every yahoo have video equipment and cell phones at their finger tips.

The public was blissfully ignorant.

With sincere confidence you can reassure the cocktail circuit that airline flying is incredibly safe....safer than it has ever been. The record speaks for itself.

Bob

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extwacaptain
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Yesterday, a member of this board posted a reply to this topic, in which he stated that military pilots have flown while intoxicated.....My request of this expert: Please provide a little information to substantiate this claim....Dates, names, and facts would be appreciated.

During my limited military time, never, ever was this observed......AFTER each mission the crew was met by the flight surgeon and a lovely young nurse and handed a shot of what-ever cheap whiskey was available. The challenge being to attempt to act like John Wayne and drink that thing without the embarrassment of throwing- up in front of the lovely lady.


To be honest, that post was removed and replaced without that comment included........However, in an effort to tell a true story about our combat/military pilots, it would be appreciated if those on this message board who are aware of the true story would share their thoughts on this subject.


That author's military flying record might also be of interest.





Randy Kramer

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Subsonic Transport
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quote:
Originally posted by Bob Ritchie:
quote:
Originally posted by R$:
The AA crash you are referring to occurred near Cali, Columbia. The information about what happened, and how to avoid what happened, was used for years in TWA's flight training.

Flight history

At that time, Flight 965 mainly carried people returning to Colombia for the Christmas holiday, vacationers, and businesspeople.[5] A winter storm in the northeast United States caused the airline to delay the departure of the airliner for thirty minutes to allow for connecting passengers to board the flight, so Flight 965 pushed back from gate D33 in Miami at 5:14 pm, and then taxied to runway 27R, but seasonal congestion caused the Boeing 757 to take off two hours late.[6] Some other passengers booked on Flight 965 missed the flight due to missed connections.[1]

The cockpit crew consisted of Captain Nicholas Tafuri and First Officer Donald Williams. The cabin crew consisted of Purser Pedro Calle and Flight Attendants Magdalena Borrero, Rosa Cabrejo, Teresa Delgado, Gilberto Restrepo, and Margaret Villalobos.[6]

Cali's air traffic controllers had no functional radar to monitor the 757 as the pilots flew the approach using the area's radio navigation aids and the airport's instrument approach system. Cali's approach uses several radio beacons to guide pilots around the mountains and canyons that surround the city. The airplane's flight management system already had these beacons programmed in, and should have, in theory, told the pilots exactly where to turn, climb, and descend, all the way from Miami to the terminal in Cali.[citation needed]

Since the wind was calm, Cali's controllers asked the pilots if they wanted to fly a straight-in approach to runway 19 rather than coming around to runway 01. The pilots agreed, hoping to make up some time. The pilots then erroneously cleared the approach waypoints from their navigation computer. When the controller asked the pilots to check back in over Tuluá, north of Cali, it was no longer programmed into the computer, and so they had to pull out their maps to find it. In the meantime, they extended the aircraft's speed brakes to slow it down and expedite its descent.[4]

By the time they found Tuluá's coordinates, they had already passed over it. In response to this, they attempted to program the navigation computer for the next approach waypoint, Rozo. However, the Rozo NDB was identified as R on their charts. Colombia had duplicated the identifier for the Romeo NDB near Bogotá, and the computer's list of stored waypoints did not include the Rozo NDB as "R", but only under its full name "ROZO". In cases where a country allowed duplicate identifiers, it often listed them with the largest city first. By picking the first "R" from the list, the captain caused the autopilot to start flying a course to Bogotá, resulting in the airplane turning east in a wide semicircle. By the time the error was detected, the aircraft was in a valley running roughly north-south parallel to the one they should have been in. The pilots had put the aircraft on a collision course with a 3,000-meter (9,800 feet) mountain.[7] The air traffic controller believed that some of the requests of the pilots did not make sense, but did not know enough non-aviation English to convey this.[8]

[edit] Crash

Twelve seconds before the plane hit the mountain, the Ground Proximity Warning System activated, announcing an imminent terrain collision and sounding an alarm. The captain and first officer attempted to climb clear of the mountain, but the deployed speed brakes reduced the rate of climb and the aircraft hit the mountain near its summit. Research has shown that the aircraft would probably have cleared the terrain if the crew had immediately retracted the speed brakes when the GPWS alarm sounded.[4]

[edit] Aftermath

Thanks for the extra details. I never did get to read anything except what the media wrote.
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Subsonic Transport
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quote:
Originally posted by extwacaptain:
Yesterday, a member of this board posted a reply to this topic, in which he stated that military pilots have flown while intoxicated.....My request of this expert: Please provide a little information to substantiate this claim....Dates, names, and facts would be appreciated.

During my limited military time, never, ever was this observed......AFTER each mission the crew was met by the flight surgeon and a lovely young nurse and handed a shot of what-ever cheap whiskey was available. The challenge being to attempt to act like John Wayne and drink that thing without the embarrassment of throwing- up in front of the lovely lady.


To be honest, that post was removed and replaced without that comment included........However, in an effort to tell a true story about our combat/military pilots, it would be appreciated if those on this message board who are aware of the true story would share their thoughts on this subject.


That author's military flying record might also be of interest.





Randy Kramer

I have read many personal stories of WWII bomber pilots. One book about B-17 crews and another about B-25J crews out of the Philippeans. Each crew received one shot of whiskey upon return.

Wasn't there a story, maybe true or maybe not, about a KC-135 crew out of HNL that was on leave, been drinking, then ordered to take the 135 back to the West Coast and overflew the coast? I have no details to back that up.

[ 03-19-2012, 07:55: Message edited by: Subsonic Transport ]

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Bob Ritchie
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quote:
Originally posted by extwacaptain:
Yesterday, a member of this board posted a reply to this topic, in which he stated that military pilots have flown while intoxicated.....My request of this expert: Please provide a little information to substantiate this claim....Dates, names, and facts would be appreciated.

During my limited military time, never, ever was this observed......AFTER each mission the crew was met by the flight surgeon and a lovely young nurse and handed a shot of what-ever cheap whiskey was available. The challenge being to attempt to act like John Wayne and drink that thing without the embarrassment of throwing- up in front of the lovely lady.


To be honest, that post was removed and replaced without that comment included........However, in an effort to tell a true story about our combat/military pilots, it would be appreciated if those on this message board who are aware of the true story would share their thoughts on this subject.


That author's military flying record might also be of interest.





Randy Kramer

Randy,

Over the years I noticed that you deleted many, many, of your posts a day or so later after either rethinking your statements or more often after having been unable to successfully initiate desired responses. About two years ago I started downloading them and keeping them for future reference.

Like you...after further thought...I deleted the posting that you referenced and replaced it with a far more simple response. Not because there was any error or misstatement. Rather because sometimes I have a tendency to overstate my case; when fewer words would suffice. In the instance referenced....that was my judgement.

Many times I served as an airline crew member in which one or more of the pilots were intoxicated and/or terribly hung over. Gratefully years later several of those individuals came under the care of OZA/TWA aeromedical, recovered from their alcoholism and completed their careers.

As for military pilots flying intoxicated: what I really said was that some Military/Airline pilots had flown intoxicated. To suggest otherwise, simply because one did not observe such is either naive or a case of denial.

I could give you names by the dozen of former Military pilots who will confess to having flown while intoxicated....including missions in Mach 2 fighters.

As an Aero Medical committee member at TWA for 10 years and it's chairman for 3 I handled the cases of many such individuals. The former TWA STL, NYC and LAX chief pilots, during my tenure, were/are intimately aware of such happenings,the individuals involved and our efforts to facilitate their recovery. We worked hand in hand to help those pilots through intervention, recovery and reinstatment to their careers.

Slowly the military is coming out of the dark ages and have begun to help their alcoholic pilots as well.

Over 20 years ago Diane Sawyer did a special report on her show called HARDCOPY. I was part of that program along with several other military and airline pilots. During the interview there was acknowledgement by both former military and civilian pilots of having flown intoxicated.

As stated by one of them...."Scores of times, had I been pulled out of the cockpit and given a breathalizer test....I WOULD HAVE FLUNKED"! Vietnam era pilots acknowledged having flown combat missions intoxicated.

I doubt that anyone is going to admit on this forum of such experiences. But deep in the files and memories of many persons are evidence of all that I have stated.

Thank God that we have come to an age where personal demons can be dealt with and health restored without losing one's career. Nice to be able to come out of the closet.

May God be with the AA FA whose life overcame her in such a public and unfortunate venue.

Bob

[ 03-19-2012, 08:59: Message edited by: Bob Ritchie ]

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dave carr
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Many times I served as an airline crew member in which one or more of the pilots were intoxicated and/or terribly hung over.


Bob

I read your posting containing the above quote with some interest. As always you make valid points and I can't really argue with the probability that there have been flights operated while pilots have been under the influence. Like you, I have known many very fine individuals that have struggled with drinking and have been helped greatly by the intervention of fine ALPA volunteers such as yourself.

With that said, are you really saying that on many flights you operated as one of a three member crew with the other two pilots being intoxicated (drunk?)and/or terribly hung over? For you it must have been a tough decision to operate in such an environment

Fortunately I was never placed in that situation. I flew with some real hard chargers that really enjoyed their layovers and weren't shy about partaking and they may have had real drinking problems. However in total honesty I can state that in my 37 year involvement as an airline pilot I never flew with a crewmember obviously under the influence or hung over to the extent that I recognized erratic or unsafe behavior. The hard drinkers I worked with seemed to keep the effects of their drinking out of the cockpit.

You still miss flying airliners? Twelve years retired and I still miss it!!! Hope all is well with you------Dave Carr

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Bob Ritchie
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Dave,

My statements are correct. Perhaps there is a clue for you in the old notion of... "Playplaces and Playmates." Different persons swim in different circles. Thus their experiences differ.

Remember when the TWA DC-9 KCI based crews were known as FOUR ON THE FLOOR? Different experience than TWA as a whole.

Also please consider that Chief Pilots and ALPA volunters are sort of like drain pipes. The issues of thousands of pilots end up in their laps.

Although the problem children are/were a tiny minority: when one is dealing with thousands,it is easy to imagine that over a period of 10 years one would become aware of many score extraordinary circumstance.

Drug/alcohol testing: Herpes and Aids changed the nature of airline social behavior dramatically The behavior observed during the last 20 years of my career was totally different from the first 15. Also the crewmembers during the last half of my career, were probably 15 years older on average than in the early 70s and 80s.

Yes I miss flying those big shiny airliners a bit. However I would not want to have continued my career since 2007. I have enjoyed an additional 5 years of excellent health and freedom from the constraints of a career.

The humanitarian flying that I do gives me a great sense of purpose. Between that and our Maule I still fly about 350 hours per year. Also to my great delight I an getting checked out in a DC-3 next week and will be flying it in the future. Cannot wait. It has been a life long dream of mine.

So...let me take a 767 on a transcon once every 6 months...and life would be perfect.

Take care,

Bob

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Charlie Jennings
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I don't check this forum everyday but checked in today and I have found this topic interesting and I'd like to offer a little historical fact dredged from my 8 year Air Force career.

In the early 1960's my outfit flew B-47's from Mountain Home, Idaho to Guam (non-stop with two refuelings), westbound about 17+30 flight time.

The B-47 was operated by a crew of three with our only means of navigation over the pacific being celestial (stars at night and sun LOP's in the day time. There was no place to stand erect in the B-47 so we sat in our seats wearing those uncomfortable helmets, monitoring the HF radio the entire trip (except when taking on LOTS of fuel two times from KC-135's and fooling around with the sextant).

In order for us to "perk-up" for approach and landing at destination we were issued little white pills by the Flight Surgeon with instructions to take one if we REALLY got tired en-route and one about 30 minutes from our ETA. I was never told what they were but they sure made us "perky".

Upon arrival, as we exited the aircraft, a staff Officer would meet and greet us (no pretty nurse in sight) with the bottle of whiskey, mentioned earlier in this thread.

The booze was in a quart bottle and the black and white fancy printed label, complete with logo, indicated the contents was "Old Overholt" and on the bottom of the label was clearly printed "Property Of The U.S. Government".

After the little white pills and a belt of that "arrival tonic" we tumbled into bed and slept like babies for a long time.

Just Another War Story from an old guy!

Charlie

P.S. Did I mention that Guam is a very small island in a very large ocean and navigators had to find it in the daytime with only LOP's from the sun......... But they always did!

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extwacaptain
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GREAT story, Captain Jennings....and appreciated.

During one of a couple of furloughs from our airline, it was my good fortune to do a little over the Pacific flying with Flying Tigers..Yes, some of those islands were somewhat less than large. Kwajalein seems to come to mind as we flew DC-4s from the San Francisco area, island hopping, to and from Tokyo. Nothing heroic, just slow and as you mentioned, lots of lines of position taken to determine our position in relation to a destination only slightly larger than a small airport.

It would be my guess that those little pills the Doc was handing out were related to an over the counter product available at that time called “No Doze”.

In any event, your story is most interesting and enjoyed. Hopefully you will share others.........

Sorry there wasn’t a good looking nurse in attendance when you landed. But, you know....maybe those nurses in Italy weren’t REALLY that good-looking. We’d been away a long time. [Big Grin]

Thank you for your service to our country, Captain Jennings..and for your contributions to help save TWA.

Respectfully,


Randy Kramer

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Bob Ritchie
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Amphetamines.... a common diet drug back in the 1970s.

B-2 Crews fly 40+ hour missions from Whitman AFB in Missouri to Afghanistan and back.

Good to hear from you again Charlie. We live just down the road from one another.

Bob

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Bob Ritchie
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Some military services recognized the potential of psychostimulants to combat fatigue and boredom. The greatest use of the drug reportedly occurred during World War II by German, Japanese, and English troops.7 Although American troops reportedly did not have access to the drugs, studies were initiated in the late 1940s and 1950s to determine the military significance. The results among healthy subjects were remarkably consistent: in numerous studies using normal, nonfatigued human volunteers—including some military personnel—amphetamine improved performance by about 5 percent on most mental tasks. Reaction time and hand--eye coordination were most significantly improved. Similarly, amphetamine administration restored mental performance of sleep--deprived subjects to nondeprived levels.8 Additionally, almost all studies found improvement in physical strength and endurance.9 In conjunction with other drugs, amphetamine proved very effective for treating motion and space sickness, allowing missions to continue that would otherwise have been terminated.10 None of the experiments showed a decrease in mental or physical performance of normal subjects taking amphetamine.

Although amphetamine possibly was available during the Korean conflict, the Air Force did not sanction its use until 1960. At that time, Strategic Air Command (SAC) approved limited use of amphetamine, and Tactical Air Command (TAC) followed in 1962. The first widespread use by US military aircrews probably took place during the Vietnam War. Although written documentation is almost entirely absent, interviews with Air Force and Army pilots who used amphetamine during this time give us a picture of a drug that permitted an extended duty day as well as increased vigilance during flight operations.

Side effects described by these pilots include feelings of nervousness, loss of appetite, and inability to sleep. Master Warrant Officer Lance McElhiney, a 20--year--old Cobra gunship pilot in Vietnam, states that some kind of “upper” was available like candy; he reports essentially no control over the dose or frequency of use.11 Col Paco Geisler, USAF, Retired, used amphetamine as an F--4 pilot during the Vietnam War and later as an F--15 squadron commander during Operation Just Cause. He notes that “the difference in the two situations was amazing. I don't know if the difference is dose or drug formulation or what. But there were no noticeable side effects during Just Cause; we just felt wide awake. But there was none of the nervousness—no feeling `wired' like I remember in Vietnam.”12 Medically controlled use of prescription--quality, small doses almost assuredly accounts for the difference that Colonel Geisler reports.

The policies concerning stimulants ultimately evolved into Air Force Regulation (AFR) 161--33/TAC Supplement 1. TAC sanctioned the use of amphetamine because single--seat pilots are particularly susceptible to the effects of boredom and fatigue during deployments overseas and during extended combat air patrols. Maj David Caskey, an Air Force F--15 pilot, reported using “go” pills routinely when flying from the United States to Germany, Japan, or Thailand. He recounted that some pilots refused to take them, saying they didn't need them; however, he pointed out that one time, an entire flight diverted to a base in England because some pilots simply couldn't stay awake en route to their destination in Germany.13

note: It appears that the Air Force officially ended the use of such drugs in 1991.

[ 03-21-2012, 11:57: Message edited by: Bob Ritchie ]

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Capn Eddie Ricketyback
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I found it somewhat interesting that the article from which a previous post was quoted extensively was advocating, by 3 doctors, rescinding the 1991 Air Force ban on amphetamines (If you'd like to read the original article you may find it here).

Now since I made the original post, I hope I may be allowed a personal privilege to stray even further from the subject: Apparently others have different opinions about this, but I think it's a good idea to avoid copying & pasting large blocks of text from other people's work into forums, especially without giving credit to the original authors.

While the 1997 article from which such text was posted most likely wouldn't be cause for legal action, it seems to me to be basic good manners to credit your sources. In extreme cases this may be regarded as copyright infringement, and according to numerous sources, including this one,
quote:
It is considered "acceptable use" from a copyright perspective to quote limited parts of the content and then invite someone to visit the original version of the content themselves (using a link).
Regardless of the legal ramifications, IMO credit should be given where credit is due.
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Bob Ritchie
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Stimulant Use in Extended Flight Operations
LT COL RHONDA CORNUM, USA
DR. JOHN CALDWELL
LT COL KORY CORNUM, USAF

PSYCHOSTIMULANTS, particularly amphetamine, became available in America for clinical use in 1937, and since then have been widely prescribed. More recently, their beneficial effects have been overshadowed by the recognition of a significant abuse potential. Nevertheless, the military services, particularly the Air Force, have recognized the value of psychostimulants under certain conditions. Use of amphetamine, at the direction of the unit commander and under the supervision of the flight surgeon, has been sanctioned by some components of the Air Force since 1960 and by the tactical air forces until 1991. In March 1991, following successful completion of Operation Desert Storm, the chief of staff of the Air Force sent a message terminating the policy of allowing in--flight medications, including amphetamines, by Air Force personnel.

This article briefly outlines the historical development, mechanism of action, and effects of amphetamine on normal personnel. It then discusses the value of these agents in military operations, the safety record, and the concerns that may have been the impetus for banning their use. Finally, it concludes that, in light of their value to mission accomplishment—especially in the absence of demonstrable negative effects—the ban on amphetamines should be rescinded.


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In light of their value to mission accomplishment—especially in the absence of demonstrable negative effects—the ban on ampethetamines should be rescinded.


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Amphetamine is one member of a family of synthetic drugs, similar in chemical structure to the neurotransmitters adrenalin and noradrenalin. Amphetamine is known to enhance the release of naturally occurring neurotransmitters that affect central nervous system neurons (i.e., the brain) and that are involved with peripheral neurotransmission (such as nervous control of muscular contractions). Amphetamine in particular was noted for its striking “central effect”—that of enhanced alertness, with relatively minor physiological effects on blood pressure, heart rate, or gastric motility.1

Amphetamine became commercially available for prescription in 1937. Able to decrease appetite markedly in almost all species, it rapidly found favor as a treatment for a number of conditions, including obesity and narcolepsy.2 Other conditions that occasionally improve with amphetamine usage include hyperactivity in children, depression, and some types of parkinsonism.3 By 1938, amphetamine was a very commonly prescribed medication.4 It was considered very safe and was widely used for a variety of physical and mental disorders. However, within a short time, physicians determined that amphetamine's ability to suppress appetite decreases markedly with continued usage, requiring higher and higher doses to maintain the same effect on food intake. Overdose (usually greater than one hundred milligrams) can cause mood changes.5 They also noted other undesirable side effects that occur with chronic, increasing use, including insomnia, psychosis, euphoria, and paranoia. Additionally, when high doses of amphetamine are ingested, inhaled, or injected, significant mood--altering effects occur, which explains why amphetamine became a drug of choice to abuse in the 1960s and 1970s.6 These undesirable traits led to the strict control of amphetamine drugs, as is the case today.

Some military services recognized the potential of psychostimulants to combat fatigue and boredom. The greatest use of the drug reportedly occurred during World War II by German, Japanese, and English troops.7 Although American troops reportedly did not have access to the drugs, studies were initiated in the late 1940s and 1950s to determine the military significance. The results among healthy subjects were remarkably consistent: in numerous studies using normal, nonfatigued human volunteers—including some military personnel—amphetamine improved performance by about 5 percent on most mental tasks. Reaction time and hand--eye coordination were most significantly improved. Similarly, amphetamine administration restored mental performance of sleep--deprived subjects to nondeprived levels.8 Additionally, almost all studies found improvement in physical strength and endurance.9 In conjunction with other drugs, amphetamine proved very effective for treating motion and space sickness, allowing missions to continue that would otherwise have been terminated.10 None of the experiments showed a decrease in mental or physical performance of normal subjects taking amphetamine.

Although amphetamine possibly was available during the Korean conflict, the Air Force did not sanction its use until 1960. At that time, Strategic Air Command (SAC) approved limited use of amphetamine, and Tactical Air Command (TAC) followed in 1962. The first widespread use by US military aircrews probably took place during the Vietnam War. Although written documentation is almost entirely absent, interviews with Air Force and Army pilots who used amphetamine during this time give us a picture of a drug that permitted an extended duty day as well as increased vigilance during flight operations.

Side effects described by these pilots include feelings of nervousness, loss of appetite, and inability to sleep. Master Warrant Officer Lance McElhiney, a 20--year--old Cobra gunship pilot in Vietnam, states that some kind of “upper” was available like candy; he reports essentially no control over the dose or frequency of use.11 Col Paco Geisler, USAF, Retired, used amphetamine as an F--4 pilot during the Vietnam War and later as an F--15 squadron commander during Operation Just Cause. He notes that “the difference in the two situations was amazing. I don't know if the difference is dose or drug formulation or what. But there were no noticeable side effects during Just Cause; we just felt wide awake. But there was none of the nervousness—no feeling `wired' like I remember in Vietnam.”12 Medically controlled use of prescription--quality, small doses almost assuredly accounts for the difference that Colonel Geisler reports.

The policies concerning stimulants ultimately evolved into Air Force Regulation (AFR) 161--33/TAC Supplement 1. TAC sanctioned the use of amphetamine because single--seat pilots are particularly susceptible to the effects of boredom and fatigue during deployments overseas and during extended combat air patrols. Maj David Caskey, an Air Force F--15 pilot, reported using “go” pills routinely when flying from the United States to Germany, Japan, or Thailand. He recounted that some pilots refused to take them, saying they didn't need them; however, he pointed out that one time, an entire flight diverted to a base in England because some pilots simply couldn't stay awake en route to their destination in Germany.13


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There is no evidence that aviators attempt to abuse amphetamine if the medication is occasionally made available.


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There is no evidence that aviators attempt to abuse amphetamine if the medication is occasionally made available. And there is virtually no similarity between the effects of high dosages or chronic amphetamine abuse among addicts and occasional, low--dose administration of the same drug to military pilots involved in extended operations.14 First, military aircrews are a well--screened, intelligent, motivated, and mentally healthy population. A remarkably low incidence of any sort of addictive behavior or other mental pathology occurs in this population. Second, the medication is administered on a case--by--case basis by a flight surgeon working closely with the pilots and under the direction of the squadron commander. The commander or flight surgeon would likely note unusual personality traits, increased drug--seeking behavior, weight loss, or any other indication of maladaptation on the part of the pilots. Third, because the source of the medication is a physician and military pharmacy, the pilot is not exposed to the drug counterculture that he or she would encounter by obtaining the drugs illegally. Thus, there is no increased availability of amphetamine (or any other drug) for excess or recreational use.

Determining the effect of amphetamine use on safety is not possible because of a lack of applicable reports. Aeromedical after--action reports of Operations Desert Shield/ Desert Storm, however, attempted to quantify amphetamine use.15 Data from anonymous questionnaires found that, of the pilots who responded, 65 percent of them used amphetamine during the deployment to theater, and 57 percent used it at least once during the air war. No one reported adverse side effects, and over 60 percent of the pilots who used the drug said it was “essential” to mission accomplishment.

Of the Class A mishaps occurring during Desert Shield/Desert Storm, several were partially attributed to pilot fatigue, and no pilots were using amphetamine at the time of any mishap. Additionally, there have been no accidents, during training or actual deployment to a theater, in which amphetamine use by the aircrew was either reported or found to be a factor during the accident investigation. Last, there have to date been no medical disqualifications for drug use among aircrews who had previously received amphetamine operationally. Thus, although one cannot prove an improvement in safety, one can say with some degree of certainty that there has been no negative effect.


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Using drugs to enhance performance in sports may be “immoral,” but war is not a sporting event.


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Recent laboratory studies comparing dextroamphetamine with placebos in terms of their effect on maintaining performance and alertness in fatigued military pilots have demonstrated clear benefits, confirming earlier results in nonpilot volunteers.16 Helicopter pilots who received placebos and then flew a simulator from 0100 to 1700 hours after a single night of sleep deprivation displayed significant, progressive deterioration of flight--control skills that would have threatened both safety and mission accomplishment. The problems encountered were especially severe in the morning hours (0300–1000). Even after a slight improvement in the afternoon (due to circadian rhythm), control accuracy did not recover to normal prefatigue levels. When these pilots received amphetamine on a different sleep--deprived night, decrements in performance did not occur. In fact, low--dose amphetamine eliminated the early morning deteriorations in flight skills and maintained performance at prefatigue level for the remainder of the day.

If psychostimulants improve performance effectively and safely, why is there still resistance to their use—and why did the policy change in 1991? The answer seems to be informational, emotional, and political. Most policy makers are ignorant of the facts concerning the effects of limited, low--dose administration of amphetamine on normal personnel. Some people are concerned that crew members might abuse the drug and thus become psychologically or physically addicted or tolerant. Others are concerned about commander abuse—that instead of allowing reasonable crew rest and endurance policies, commanders might rely on stimulants to get superhuman effort out of their subordinates.

These concerns, though deserving of thought, go against the preponderance of evidence collected to date. As noted above, we have not been able to identify a single disqualification for amphetamine use by Air Force aircrews. Although “command abuse” evidently was a problem in World War II and possibly Vietnam, we believe that strict regulations and vastly improved training of our commanders will continue to prevent abuse—just as we have faith that other problems from the Vietnam era will not recur. There is no evidence of command abuse during recent deployments or during operations in Libya, Grenada, Panama, or the Persian Gulf.

The two other potential concerns are less logical but probably more compelling. First, some people harbor an ill--defined feeling that performance enhancement by chemical means is “immoral,” a sentiment evident in myriad regulations prohibiting drug use by athletes, although such use would indeed enhance performance. The second reason is clearly political: military leaders are understandably concerned about misinformation that could be engendered by press accounts of pilot use of amphetamines. In light of the current efforts in drug control, some parties might accuse the Air Force of imposing a double standard.

These are realistic concerns, but they do not justify prohibiting the use of centrally acting stimulants in the military. Using drugs to enhance performance in sports may be “immoral,” but war is not a sporting event. Success in combat is not a question of fairness but of power; our weapons and training are designed to maximize combat power. We do not seek to equalize each side's chance of success prior to initiating contact (as we do in sports), but we do seek to obtain every advantage for our forces. However, this does not mean that we should rely upon amphetamine indiscriminately to create a performance edge on every day of combat operations. As with most things in life, we should consider costs and benefits prior to taking specific actions in various situations.

Although properly administered doses of amphetamine can alleviate significant problems in very demanding circumstances (e.g., they can sustain the performance of heavily fatigued, sleep--deprived personnel in combat), an indiscriminate, daily reliance on amphetamine may quickly create more negative than positive effects. Routine administration of stimulants under “normal” circumstances may create problems of drug tolerance, addiction, and various forms of abuse—not to mention physiological changes (in terms of sleep disruption and other side effects) that would ultimately render personnel less effective. However, if amphetamine administration is well controlled and restricted to those short-- to moderate--term circumstances requiring severely fatigued personnel to perform continuously, the medication may make the difference between a mission completed safely and effectively, and one that ends in disaster.

In combat, pilots unquestionably are responsible for accomplishing the mission. The issue in this case becomes whether they fall asleep at the controls or whether they avoid disaster by using a drug that enables them to stay awake, maintain vigilance, and safely complete the mission.


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Unfortunately, the elimination of amphetamine use has put aircrews at increased actual risk for the sake of eliminating theoretical risk.


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Military leaders are justified in their concern about public reaction to disclosure of the military's use of performance--enhancing drugs. The answer may lie in classifying our involvement to avoid media exploitation, educating our leaders and public concerning the unique military value of these medications, or employing some combination of these or other approaches. Unfortunately, the elimination of amphetamine use has put aircrews at increased actual risk for the sake of eliminating theoretical risk—a decision that does not pass the test of common sense and therefore should be changed.

Notes

1. E. H. Ellinwood and S. Cohen, eds., Current Concepts on Amphetamine Abuse (Rockville, Md.: National Institute of Mental Health, 1970), 238.

2. P. Rosenberg, “Clinical Uses of Benzedrine Sulfate (Amphetamine) in Obesity,” The Medical World 57 (1939): 646–59; S. C. Harris, A. C. Ivey, and L. M. Searle, “The Mechanism of Amphetamine--Induced Loss of Weight: A Consideration of the Theory of Hunger and Appetite,” Journal of the American Medical Association 134 (1947): 1468–75; and M. Prinzmental and W. Bloomberg, “The Use of Benzedrine for the Treatment of Narcolepsy,” Journal of the American Medical Association 105 (1935): 2951–3054.

3. R. S. Goodhart, ed., Modern Drug Encyclopedia and Therapeutic Index, 9th ed. (New York: Raven Press, 1975).

4. Rosenberg.

5. W. O. Evans and R. P. Smith, “Some Effects of Morphine and Amphetamine on Intellectual Functioning and Mood,” Psychopharmacologia 6 (1964): 49–56.

6. J. C. Kramer, V. S. Fischman, and D. C. Littlefield, “Amphetamine Abuse: Patterns and Effects of High Doses Taken Intravenously,” Journal of the American Medical Association 201 (1967): 305–9; and D. S. Bell, “Comparison of Amphetamine Psychosis and Schizophrenia,” British Journal of Psychiatry 3 (1965): 701–7.

7. L. Grinspoon, “Drug Dependence: Non--Narcotic Agents,” in A. H. Freedman, H. I. Kaplan, and B. Saddock, eds., Comprehensive Textbook in Psychiatry (Baltimore: Williams and Wilkinson Co., 1975), 1317–31.

8. B. Weiss and V. G. Laties, “Enhancement of Human Performance by Caffeine and the Amphetamines,” Pharmacological Review 14 (1962): 1–36; H. F. Adler et al., “Effects of Various Drugs on Psychomotor Performance at Ground Level and Simulated Altitudes of 18,000 Feet in a Low Pressure Chamber,” Journal of Aviation Medicine 21 (1950): 221–36; G. T. Hauty and R. B. Payne, “Mitigation of Work Decrement,” Journal of Experimental Psychology 49 (1955): 60–67; R. H. Seashore and A. C. Ivey, “Effects of Analeptic Drugs in Relieving Fatigue,” Psychological Monographs 67 (1953): 1–16; and D. P. Cuthbertson and J. A. Knox, “The Effects of Analeptics on the Fatigued Subject,” Journal of Physiology 106 (1947): 42–58.

9. G. M. Smith and H. K. Beecher, “Amphetamine Sulfate and Athletic Performance, I. Objective Effects,” Journal of the American Medical Association 170 (1959): 542–57; and B. Weiss, “Enhancement of Performance by Amphetamine--Like Drugs,” in F. Sjoqvist and M. Tottie, eds., Abuse of Central Stimulants (New York: Raven Press, 1969), 31–60.

10. A. Leger, P. Sandor, and M. Kerguelen, “Motion Sickness and Psychomotor Performance—Effects of Scopolamine and Dextroamphetamine,” Aviation Medicine Quarterly 2 (1989): 121–28; and R. S. Kennedy et al., “Differential Effects of Scopolamine and Amphetamine on Microcomputer--Based Performance Tests,” Aviation, Space and Environmental Medicine 61 (1990): 615–21.

11. Personal communication.

12. Personal communication.

13. Personal communication.

14. J. Cole, “Clinical Uses of the Amphetamines,” in Ellinwood and Cohen, 163–68.

15. “Desert Shield, Desert Storm: Aerospace Medicine Consolidated After--Action Report,” in Proceedings of After--Action Conference, 20–22 May 1991; K. Cornum, “Extended Air Combat Operations: F--15s over Iraq,” Aviation, Space and Environmental Medicine, May 1994; K. Cornum, R. Cornum, and W. Storm, “Use of Psychostimulants in Extended Flight Operations: A Desert Shield Experience,” in Advisory Group for Aerospace Research and Development Conference Proceedings 579, Neurological Limitations of Aircraft Operations: Human Performance Implications (Papers presented at the Aerospace Medical Panel Symposium, Köln, Germany, 1995), 371–74; and K. Cornum, “Eagles over Iraq: A Desert Storm Experience” (Paper presented at Seventh Annual Workshop on Space Operation Applications and Research [SOAR], Houston, Tex., August 1993).

16. J. A. Caldwell et al., “Sustaining Helicopter Pilot Performance with Dexedrine during Periods of Sleep Deprivation,” Aviation, Space and Environmental Medicine 66, no. 10 (1995): 930–37; and J. Caldwell et al., Sustaining Female UH--60 Helicopter Performance with Dexedrine during Sustained Operations: A Simulator Study, US Army Aeromedical Research Laboratory Report no. 95–27 (Fort Rucker, Ala.: USAARL, July 1995).


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Learning is by no means something we are supposed to do only from the ages of 5 to 21, in buildings called schools, but rather that it is a lifelong process, the proper conduct of which is not only absolutely necessary for the physical survival of individuals but for the survival of entire species.

—Steve Allen


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Contributors

Lt Col Rhonda Cornum (BS and PhD, Cornell University; MD, Uniformed Services University) is a urologic surgery resident at Brook Army Medical Center, San Antonio, Texas. She was an operational flight surgeon with the 2/229 Attack Helicopter Battalion during Operations Desert Shield and Desert Storm, and a staff scientist in the Crew Life Support Branch at the US Army Aeromedical Research Laboratory, Fort Rucker, Alabama. Her research interests include factors affecting success in aviation training, integration of advanced visual displays, and transfusion therapy in shock and trauma. Colonel Cornum is a graduate of Air Command and Staff College.

Dr. John Caldwell (BS, Troy State University; MS, University of South Alabama; PhD, University of Southern Mississippi) is an experimental psychologist in the Aircrew Health and Performance Division of the US Army Aeromedical Research Laboratory, Fort Rucker, Alabama. For the past 10 years, he has been conducting laboratory, simulator, and in-flight research into the effects of pharmacological compounds, stress, and fatigue on the performance of military aviators.

Lt Col Kory Cornum (USAFA; MD, Uniformed Services University) is currently an orthopaedic surgery resident at Wilford Hall Medical Center, San Antonio, Texas. He was the flight surgeon for the 33d Fighter Wing during Operations Just Cause, Desert Shield, and Desert Storm, and during multiple overseas deployments. Subsequently, he served as a staff scientist at the Armstrong Laboratory at Brooks AFB, Texas. His research interests include effects of fatigue, circadian dysrhythmias, and pharmacological compounds on pilot performance. Colonel Cornum is a graduate of Squadron Officer School.


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Disclaimer

The conclusions and opinions expressed in this document are those of the author cultivated in the freedom of expression, academic environment of Air University. They do not reflect the official position of the U.S. Government, Department of Defense, the United States Air Force or the Air University.


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Bob Ritchie
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In case it was overlooked the above posting is.....


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Dick Nicklas
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"First, military aircrews are a well--screened, intelligent, motivated, and mentally healthy population", as quoted from the previous post.

Well maybe I travelled in different circles but that might be assuming an awful lot. In 1956 I was stationed in Bermuda and occupied mainly with enjoying myself and only occasionally, when pushed, with serving the U.S. Navy.

One evening, one of my fellow flying officers was out carousing with the surgeon of Nautilus, which was at the time tied up at the pier at the Naval Station.

One thing led to another and my buddy traded a bottle of Crown Royal for a bottle of benzedrine "bennies" tablets. The doc needed a bottle of liquor to take back to his quarters aboard ship that evening to help him sleep. Tsk,tsk.

We managed to go through the whole bottle of pills in the next few months. They were consumed mainly while on liberty in Panama, Jax or Norfolk but also when driving back to the NS in the wee hours and under the influence.

They seemed to work great but so much for the "adequate" supervision.

Fortunately, I think I've grown up a lot since then but I must add it's been very recently that I've done so.

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DC9
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Anybody ever hear of other incidents like the JetBlue incident yesterday?
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Capn Eddie Ricketyback
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quote:
Originally posted by DC9:
Anybody ever hear of other incidents like the JetBlue incident yesterday?

The closest thing I can remember is this truly horrific incident in 1994, where an off-duty Fed Ex pilot attempted to hijack and crash a DC-10.

BTW, this looks like a pretty good description of what happened on the JetBlue flight.

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Jeff I.
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Bob Herbst was quoted in today's NY Times re: the Jet Blue incident. It was a brief quote but basically Bob expressed surprise that this type of incident hasn't happened more frequently given the financial and scheduling stresses on pilots in today's industry.
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Irish
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quote:
Originally posted by DC9:
Anybody ever hear of other incidents like the JetBlue incident yesterday?

If attempted pilot suicide is on topic, oh, yeah! Who knows what the ultimate outcome would have been had the captain not left the cockpit.

In 1997, a SilkAir Boeing 737-700 crashed into the Musi River in Indonesia, killing 104 people. Investigators concluded that the most probable cause of this accident was deliberate, controlled flight into terrain by the captain who -- in an effort to confuse future investigation into the accident -- allegedly pulled cockpit voice recorder and flight recorder circuit breakers while returning from a visit to the rest room. If this scenario is true, then the captain's actions constitute premeditated murder. Apparently, the captain had recently been demoted from instructor and many other pilots who had flown with him had informally complained of his non-standard operation. Therefore, there was some evidence of aberrant behavior by this pilot prior to this accident that may have been a clue as to his state of mind.

In 1994, a Royal Air Maroc ATR-42-300 jet plunged into the ground ten minutes after takeoff from Agadir killing all 44 people on board. Investigators concluded that the captain had deliberately steered the plane into the ground. (The Moroccan Pilots Association disputes this claim.)

In 1982, a Japan Airlines (JAL) DC-8 crashed into Tokyo Bay while on approach to Haneda Airport in Japan, killing 24 and injuring 141. The captain allegedly pushed the nose down prematurely and pulled the inboard engines into reverse while on approach to the airport. Despite attempts by the first officer and flight engineer to rectify the perilous flight path, the captain was successful in his efforts to terminate the flight prematurely. After exhaustive investigation of this accident, the captain was placed into a psychiatric institution. Sources at JAL who knew this captain personally informed accident investigators that it was general knowledge the captain's behavior had been erratic before the accident. After the accident, there were accusations that JAL's management had been aware of the captain's mental instability but had failed to relieve him of flight duty. However, Japanese authorities ultimately concluded that both of these accusations were unfounded.

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Bob Ritchie
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Don't forget EgyptAir....B-767 plunged into the ocean by the FO.

Pilots are human. They suffer from every ailment common to mankind.

Bob Ritchie

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Dick Nicklas
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[QUOTE]Originally posted by Bob Ritchie:
[QB] Don't forget EgyptAir....B-767 plunged into the ocean by the FO.

Pilots are human. They suffer from every ailment common to mankind.*

*With the possible exception, some might say, of humility.

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