A Case for Critical Incident Response Programs in Business Aviation

 - August 2, 2013, 1:45 AM
Mimi Tompkins, a 767-300ER first officer with Hawaiian Airlines

“From tragedy we draw knowledge to improve safety for all.” That’s the NTSB mission. And that’s what Kevin Armstrong, trainer at Aircare Assistance, and Mimi Tompkins, a 767-300ER first officer with Hawaiian Airlines, wanted to talk about at the NBAA Flight Attendants and Technicians Conference.

OSHA defines a critical incident as an extremely powerful event that causes strong emotional reaction. It can interfere with one’s ability to function, either at the scene of the incident or later on. If the interference is later, people are said to have post-traumatic stress disorder (PTSD). Armstrong has been on a mission this year to disseminate information about critical incident response programs (CIRP) to business aviation in the wake of Aircare Solution Group’s announcement that it is offering a CIRP to the corporate aviation community at no charge.

The value of CIRP in the aftermath of aviation accidents is well known. Moreover, any incident that causes terror can create the stress that induces PTSD. Airline personnel have had access to CIRP since the mid-1990s, thanks in large part to Tompkins, whose struggle with PTSD after piloting Aloha Airlines Flight 243 (the 737 that suffered an explosive decompression and lost 18 feet of its upper forward fuselage in 1988) inspired her to advocate for a formal program for airline crew through ALPA. (See box item.)

Early Intervention, Peer Intervention, Key

Aviation needs CIRP, and you don’t have to listen to Armstrong and Tompkins to find proof. ALPA aeromedical statistics catalogued over 17 years show that 82 percent of airline pilots with untreated PTSD after an accident leave the industry within four years.

Tompkins readily admits that she wishes she’d had the benefit of early intervention from a CIRP. “The real value of peer support is that most people are more comfortable discussing their feelings with someone who knows their situation,” she said. That trained peer support is the fulcrum of any effective CIRP.

The CIRP developed by ALPA was derived from the work of Dr. Jeffrey Mitchell, Ph.D., founder of the International Critical Incident Stress Foundation (ICISF) and inventor of a process for critical incident response that is used with firefighters, paramedics and those who deal with trauma regularly.

Hundreds of ALPA peer response volunteers have been trained since 1994 to conduct CIRP interventions, known as debriefings and defusings. A debriefing is a structured group discussion some days after the event, designed to allow participants to sort through their reactions to the trauma. A defusing is a shortened version of a debriefing that usually takes place within eight hours of a traumatic event. After a debriefing, peer support volunteers follow up with crewmembers to provide additional support and assess their recovery for six months.

Today Tompkins helps lead CIRP and critical incident stress management teams at Hawaiian Airlines; she is a member of the ICISF and a certified ICISF instructor. She also serves as a consultant to the Mayday Foundation and the NTSB’s Transportation Disaster Assistance Office.

It was clear to see, as she interacted with the flight attendants and technicians in the audience, taking questions, that she is as passionate as Armstrong about CIRP, and its ability to give aircrew involved in traumatic accidents or incidents a chance to have their professional lives back.


A Harrowing Flight Leaves Scars

Some 10 minutes into Aloha Airlines Flight 243 from Hilo, Hawaii, on April 28, 1988, an 18-foot section of the 737’s upper fuselage sheared off after an explosive decompression at 24,000 feet. Mimi Tompkins, in the right seat, was flying the airplane at the time of the structural failure. Captain Robert Schornstheimer assumed control of the aircraft, and the two pilots were able to land the aircraft safely in Maui, but one flight attendant was lost, and 89 passengers were injured.

Mimi Tompkins later upgraded to Boeing 737 captain, but all was not well. She had issues with night terrors stemming from the egress after landing, which was anything but trouble-free. In daydreams she’d see the disaster over and over. Sleeplessness progressed to memory lapses and physical symptoms over time. “I’m the kind of person who doesn’t like to admit something’s bothering me,” she confessed, trying to ignore the problem. “But I was sick a lot, and I missed work.”

Then she landed a flight in Honolulu and saw the broken airframe of United 811, a Boeing 747-100 that lost a cargo door and part of the fuselage over the Pacific Ocean. It was a little less than a year since her accident and her reaction was visceral. “I knew in that moment that I needed help,” she said.

Tompkins contacted ALPA’s aeromedical advisor, then Dr. Donald Hudson, a former U.S. Air Force flight surgeon board-certified in both aerospace medicine and psychiatry. Hudson diagnosed and then helped Tompkins recover from a classic case of first-responder type PTSD.

In recovery, Tompkins became involved with ALPA’s Air Safety Committee, and she participated on a task force that developed the pilot assistance program in place today.