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Human Intervention Motivation Study

Captain Chris Storbeck

Former ALPA National HIMS Chairman

with

Lynn Hankes, MD, FASAM

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Disclosures

I have no relevant financial relationships

with proprietary entities producing health

care goods or services related to the content

of this presentation.

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Qualifications?

• Delta Air Lines Captain, transoceanic,

B767ER

• USAF instructor and fighter pilot (T-37, F-

4E & G)

• 13 years as Delta HIMS Chairman, 4 years

as National HIMS Chairman

• HIMS graduate and recovering alcoholic

(25 years sober)

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Before HIMS

• Do airline pilots suffer from alcoholism?

• If so, is it possible to identify, treat, and

safely return them to the cockpit?

• Could the program survive the anticipated

negative public reaction?

• Pre-HIMS FAA medical policy lists

alcoholism as a disqualifying Dx, with no

exemptions granted.

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The Beginning

• Dr. Richard Masters approached the ALPA

Board of Directors (BOD) about the problem

of alcoholism in the pilot group.

• Following some information gathering, the

BOD approved the development of a program

in 1972.

• Captains Rod Gilstrap and Gil Chase assisted

Dr. Masters in the development of HIMS.

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Fundamental Assumptions

• Alcoholism is a primary treatable disease

characterized by chronicity and relapse.

• Early identification and treatment is

possible - and it works.

• Total abstinence is essential to successful

rehabilitation.

• Intensity of job motivation will yield a

higher recovery rate for airline pilots.

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1974-1980

• Period of original National Institute on

Alcohol Abuse and Alcoholism (NIAAA)

grant to HIMS

• 375 petitions to FAA – 305 granted

• All legacy carriers, except one, establish

rehabilitation structures using the “HIMS

Model”

• “HIMS Model” – not standardized

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1980’s - Expansion

• Pilot Leadership – Capt. Dick Stone

• 15 new programs started

• Federal Grant support sporadic

• Gradual expansion of aftercare/monitoring

• 900 pilots successfully treated and returned to

work

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1990’s – Medical Model

• 1991 – Fargo incident

• 1992 – DOT random testing begins

• Increasing FAA guidance – Dr. Pakull

• Dr. Audie Davis becomes Program Manager

• 1500 pilots certified

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2000 – 2010

Doctors in Charge

• HIMS Model increasingly defined by medical

standards

• Aviation Medical Examiner/ Independent

Medical Sponsor (AME/IMS) role expanded

• Alcoholism + other Chemical Dependency

• Increased influence of “P&P”

• 1700 pilots recertified

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2010 – Present

Back to the Future

• Reinvigorating role of recovering pilots and

management

• Reemphasizing HIMS TEAM approach

• Expanding HIMS to include general aviation

• “Best Practices” Model

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HIMS Structure

• Chairman – First Officer Corey Slone

• Program Manager – Dr. Quay Snyder

• FAA Contracting Officer’s Technical

Representative – Dr. Nicholas Lomangino

• Advisory Board – Industry-wide composition

• Pilot Reps., Physicians, Airline Managers,

FAA

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Functions of HIMS Staff

• Educate industry representatives in HIMS

model

• Refine and improve HIMS model

• Advisory support to established and new

HIMS programs

• Industry-wide information and referral

resource for pilots/families

• www.himsprogram.com

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HIMS Accomplishments

• Approx. 5,000 pilots successfully identified,

treated and returned to flying under close

supervision

• One-time relapse rate of 15-20%

• Long-term success rate of 88-90%

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HIMS “Penetration?”

• Major U.S. carrier – 12,000 pilots

• Number of pilots in, or previously

participants of HIMS - 220

• “Penetration” – 1.8%

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HIMS Elements

• Identification

• Assessment

• Treatment

• Psychological and Psychiatric Eval (P&P)

• Medical Recertification

• Monitoring

Identification • DOT Positive

• DUI charges: 1 per 1000 pilots per year

• Missed appointments

• Heavy use of sick leave and/or last minute

sick-outs

• Irregular pilot proficiency

• Isolation

• Volatile personality/erratic behavior

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Assessments

• Client selected or FAA directed based on

circumstances

• Must address FAA standards

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Treatment

• 28 day residential treatment is recommended

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• Assess mental functioning including intelligence, attention, memory, language, and personality.

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Psychiatric Evaluation

• Make and/or Confirm Clinical Diagnosis

• Rule out Disqualifying psychiatric condition(s)

• Assess Quality of Recovery / Prognosis/ Relapse Risk

• Assess Fitness-For-Duty

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Medical Recertification

• Independent Medical Sponsor is a HIMS

trained AME (Aviation Medical Examiner)

• Collates treatment, P&P, and other records

• Conducts a physical evaluation

• Evaluates all factors related to the pilot’s

fitness-for-duty

• Recommends medical special issuance to FAA

Day 1 Intervention,

Requested Help

Day 2-4 Evaluation

Minimum 28 days Residential treatment

Widely variable Intensive outpatient

or individual therapy

as needed

Allow 3 - 4 weeks Psychological and

Psychiatric Exam

1 - 2 weeks Collect and

review records

Concurrent Identify peer

and company

monitor

7 - 14 days

FAA exam

case to FAA

30 - 60 days

Case at FAA

FAS

7 days

Case at

OKC

SI certificate ≅ 6 months

HIMS Certification Flow Sheet

> 30 days to 90 days Aftercare/relapse prevention/

AA with sponsor well

established

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Monitoring

• Monitoring normally lasts 3 – 5 years

• Special Issuance Authorization will require weekly group

therapy and continuous abstinence

• Abstinence testing is normally left to the AME but may be

supplemented by company testing

• Program requirements vary by airline but will likely include:

Monthly meetings with company supervisors

Monthly meetings with peers

AA / NA meetings

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Address Risk of Relapse

• Watch for high risk behavior – not following program

requirements, HALT, repetitive anger, etc.

• Structure monitoring to address risk

More support early in sobriety

Rigorous random testing taking advantage of look-back

• If relapse is suspected – remove from duty, communicate to

monitoring team, conduct an investigation, and determine

appropriate treatment

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Additional Considerations

• The program requires continuous education

• A team approach is best

• Good communication between team members

is imperative

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HIMS Relapse Statistics

• 5% - Folklore

• 8% - Our “best rate” HIMS programs

• 12.2% - Database ( but caveats )

• 15% - Estimated overall rate

• 15-20% - Probable true overall rate

Other Relapse Rates

• 8% - “Best rate” Physician Health Programs

• 15-20% - Overall PHP rate

• 10-30% - Other “professionals” programs

• 45-60% - General public

Data Comparison PHP

60% - random testing

20% - worksite monitor

20% - other

HIMS

22% - random testing

9% - worksite monitor

29% - self-report

11% - other

29% - DUI’s

Breakdown by Primary Drug

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Website

Questions?