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J Am Acad Psychiatry Law. 2019 Nov 21. pii: JAAPL.003889-20. doi: 10.29158/JAAPL.003889-20. [Epub ahead of print]

Psychiatry and Fitness to Fly After Germanwings.

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Dr. Pinsky is Adjunct Clinical Assistant Professor, University of Michigan School of Dentistry, Ann Arbor, Michigan, and Chairman, Pilot Assistance Network, ALPA Master Executive Council, Atlanta, Georgia. Dr. Guina is Chief Medical Officer, Easterseals Michigan, Pontiac, Michigan; Clinical Associate Professor, Wright State University, Boonshoft School of Medicine, Department of Psychiatry, Dayton, Ohio; and Public & Community Psychiatry Fellow, Wayne State University School of Medicine, Department of Psychiatry, Detroit, Michigan. Dr. Berry is Federal Air Surgeon and Dr. Chesanow is Chief Psychiatrist, Federal Aviation Administration, Office of Aerospace Medicine, Washington, DC. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.


In March 2015, a co-pilot flying Germanwings Flight 9525 deliberately pointed his airplane into a descent, killing himself, five other crew members, and 144 passengers. Subsequent investigation and review teams examined the incident and considered potential lessons to maximize air safety. In this article, aviation industry clinical leaders, including the U.S. Federal Air Surgeon and Chief Psychiatrist from the Federal Aviation Administration (FAA), along with a professional pilot and collaborating forensic psychiatrists, discuss suicide-by-plane, evolving themes related to public safety responsibilities for psychiatrists treating pilots, and forensic trends in pilot evaluation for medical certification from an aerospace psychiatric perspective. We explore how psychiatric aspects of pilot fitness and aviation safety are examined across perspectives, including unsafe acts, preconditions, organizational factors, and unsafe supervision. We explore practices for civilian pilots and offer information related to military pilot fitness. Lessons from Germanwings are presented, as is the need for increased support for pilots who might be concerned about revealing mental health challenges for fear of loss of medical certification and pilot employment. The Air Line Pilots Association Pilot Assistance Network is highlighted as one example of pilots supporting pilots to increase airway safety.


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