The Unsafe Pilot / Driver:
We don’t even grasp the threat!
(c) Dr. Rajas Deshpande
Imagine someone without consciousness / awareness of self / self control handling a gun around you or driving a truck / train or flying an airplane with you in it.
The recent claim about a pilot “deliberately” downing his plane with many others will make most Neurologists / Psychiatrists recall the horror every time they advise a patient “Not to Drive” and the patient flatly refuses, quoting reasons like “His / Her income is dependent upon driving, It is only a short distance, etc.” or just smile away diplomatically, meaning “I don’t care, I will still drive”.There was a recent tragedy in an Indian metropolis where a bus driver went on a spree that killed many.
Is it possible that the pilot was conscious, could move, but not in control of his / her actions? Yes, there are some types of epilepsy where this may happen (e.g. Complex partial seizures). There is a condition in a slightly elder age group called “Transient Global Amnesia” where the patient is fully conscious, behaves apparently normally, but has no memory of an entire time period lasting few minutes to hours, during which they may drive, perform routine tasks etc. It is debatable whether a “correct and determined sequence of actions” is possible during such “seizures” or TGA, but this is not unknown. Also, some drugs may cause abnormal behavior “Pushing the patient” over their edge of normalcy. While depression may cause harm to self / others, it is rare for that level of depression to suddenly emerge / be unnoticed. There are usually clues in talk / behavior about such intentions, weeks / months prior to such action.
There are Medical conditions incompatible with driving / Flying / Adventure sports / Swimming and in general be in charge of public safety. These include epilepsy, any episodes of recurrent unconsciousness due to any cause, patients who have had large strokes in brain, patients who have had open brain surgeries, heart diseases with abnormal rhythms or clots that can precipitate unconsciousness, uncontrolled blood pressure (that can lead to bleeding in the brain), medicines that can cause abnormal behavior or can precipitate convulsions, few psychiatric conditions etc. Some infections in brain also cause sudden abnormal / violent behavior. Most of the medicines used for treatment of epilepsy, anxiety / psychiatric conditions/ allergies/ muscle relaxation etc are notorious in causing drowsiness.Many of these conditions are beyond recognition of even general practitioners or specialists untrained in these diseases. There are hundreds of people with poor physical self control (like balance disorders, Parkinson’s disease, stiffness or weakness in hands or legs, impaired vision / visual fields, daytime somnolence etc.). Imagine the threat to kids / pedestrians/ small vehicles with a delay in breaking!!
While some educated / socially responsible patients agree and stop driving, most just laugh away the instruction. It is terrible to imagine how many pilots/drivers / gun holders out there on the road may be a risk to public life. Besides alcohol consumption and withdrawal, some other factors also increase the chances of unconsciousness / convulsions, like lack of sleep (most truckers drive at night in India), fasting, severe stress, fever, some over the counter medicines like cough syrups etc.
While one can understand and sympathize with the need of poverty-struck class to have to work for survival, the risk this causes to general public is unacceptable. Hundreds of accidents kill thousands of people on the roads, everyday, and it is high time we think about this.
What can be done?
In most countries, including India, patients with seizures are permanently banned from driving / piloting. In some countries, a certain seizure free period is compulsory before the licence can be reinstated. However in India this is not at all implemented, as the doctors are not authorised to retain the driving licence of the patient at the first hint of risk. This is a standard procedure in all developed world, and this is usually done with caution as many patients protest and some get violent too. It is very difficult given the Indian society which not uncommonly beats up even the traffic police for stopping them and calls political / senior police official / judicial reinforcements to suspend / transfer anyone who interferes with their free / drunken driving. However, the doctors must have forms / hotline numbers where they can at least report potentially dangerous drivers.
It will be interesting to know how many driving licences were rejected in India quoting seizure disorder / alcoholism, or psychiatric conditions/ disability: the prevalence of seizures is one in every one thousand population!
Most airlines take a normal EEG (electroencephalogram: which records electrical activity of the brain) test as an evidence against epilepsy. However this is an elementary test and a normal EEG does not rule out epilepsy. Only qualified Neurologists / epileptologists or psychiatrists can identify some types of seizures.
While it is impractical for a driving / pilot licence applicant to visit many specialists, the criteria of basic medical evaluation can be definitely upgraded, and the screening doctors trained better in identification of potential risks.
The educated and socially responsible (is this not a compulsory duty of a citizen?) should voluntarily refrain from driving if they have these conditions, and resume only when their doctor allows them.
Let us spread the word for our own good.
(c) Rajas Deshpande