Commercial Pilot Continues to Fly Despite Limb Loss

On a Sunday evening in late July 2014, Tom Koziel was helping his father mount fenders on his truck for a road trip his dad was taking the following morning. It was late and the two were hurrying to finish so the tractor-trailer would be ready to go. Koziel was switching between welding and using a hand-held grinder. He was operating the grinder when the blade shattered and nearly severed his left hand. Koziel remembers it felt as though the wind had been knocked out of him. For a moment, he didn't know what to think. "I let out a big yell," says Koziel, who was 35 years old at the time, and a commercial pilot with International Jet Aviation Services, Centennial, Colorado. "My first thought was, ‘There goes my job,'" says Koziel, who had flown commercially since 2007. Father and son didn't wait for an ambulance; they drove immediately to Sky Ridge Medical Center, roughly a 15-mile drive from their home. There were no physicians on-site that evening, so on-call physicians had to be notified, and Koziel says he had to wait four hours before he was taken into surgery. Surgeons were unable to successfully reattach the arteries in his hand, and by Wednesday of that week, Koziel was told nothing else could be done there to save his hand. During the three days at Sky Ridge, he developed compartment syndrome, a painful condition that stops oxygen and nutrients from reaching the muscle and nerve cells. Koziel was transferred to Presbyterian St Luke's Medical Center in Denver, which specializes in limb preservation. "Surgeons there were great," he says. They were initially able to save his hand. After a month in the hospital, including a week in the ICU, and more than a half-dozen surgeries, he was optimistic he wouldn't lose his hand. "Things were looking great," he says. The lack of blood flow to his hand, however, had caused irreversible damage, and Koziel ultimately had a transradial amputation that September. Roadmap to Recovery Tom Passero, CP, met Koziel soon after his amputation, while he was still in post-traumatic shock and unaware of the possibilities for recovery. "At this early stage of a traumatically injured person's recovery, they primarily need information and perspective on what, in fact, is possible and what the roadmap to that recovery looks like," says Passero, founder and clinical advisor of Handspring, Middletown, New York. What best serves a patient in this stage of the recovery continuum is to understand and manage realistic expectations, to determine what tasks are important to him or her at home and at work, Passero says. "In Tom's case, his hope was very clearly to be able to return to his profession as a commercial pilot," he says. "Taking that marker as a primary target from a prosthetic perspective, we needed to understand the tasks he would be required to perform in the pilot's and co-pilot's seats to operate the aircraft." Cockpit Appointment Koziel may have been charting unfamiliar territory as his rehabilitation process was about to begin, but he was certain of one thing: He did not want a body-powered device. "The hook was not appealing to me at all," he says. So, what better way for Passero and his team at Handspring to gain the best assessment of Koziel than to schedule his next appointment in the cockpit of his company's commercial jet? Koziel took the pilot's seat and showed his medical team what controls he had to manipulate during taxiing, takeoff, in flight, and landing. Passero's team had brought all the commercially available transradial devices, as well as a tool to power them to open and close to determine how they would fit into the task. "In this way we examined the geometry of the fingers and thumb, the space available at full opening of the transradial device, as well as the ability to touch all of the buttons, switches, and throttles as Tom demonstrated his responsibilities in each seat," Passero says. After that first appointment, Passero says he was "100 percent convinced" that two elements were in place for Koziel to achieve his goal to fly again: the technology could, when properly fitted, perform all of the critical grasping patterns, and "more importantly, Tom had the fire in his belly to push himself to master it, to push through the difficulty in the process." Best Hand for the Job Koziel tried several hands, but it was the i-Limb Quantum by Össur that ultimately proved to be the best fit for the job. "Although the Michelangelo was and remains faster in terms of ranging from open to close, the i-Limb has more versatility in terms of the available grasping patterns," Passero says. "It had a wider opening at full open, which made it easier to grasp the important control in the cockpit that he needed to get his hand on." Stepping-stones It wasn't his pilot's license Koziel says he feared losing after his amputation, but keeping his medical certificate. "As a pilot, even a private pilot, you are required to hold a medical certificate," he says. "If you can no longer hold a medical or lose it for some health issue or medical reason you can no longer fly. Without a medical, your pilot's license isn't valid." A friend from his former job recommended calling Rudy Kiffor, who owned and operated Air Training Support (ATS), Centennial, Colorado. Kiffor agreed immediately to hire Koziel. "I went through the ground school there again for the Beech 1900D, then became a ground instructor, then a simulator instructor while I was working on getting my medical back," Koziel says. "ATS' 1900D simulator is the same sim I took my medical flight test in." To keep his medical certificate, Koziel had to obtain a Statement of Demonstrated Ability, or SODA, which is granted by the Federal Aviation Administration, if the pilot's disqualifying condition is nonprogressive and the pilot can demonstrate he or she can do the job safely. Once he obtained it, he continued to work at ATS. He applied at Frontier Airlines in January 2017 and started training that April. There's a big difference, however, in flying the Beech 1900D, a 19-passenger plane with a jet engine that spins a propeller, and an Airbus, a big jet airliner—aside from the size, the switches, throttles, and starting procedures all are different. "The Airbus is very automated and for any pilot jumping from the 1900 to an Airbus is a big learning curve in itself," Koziel says. "I knew I'd have to use my prosthesis to control most of the controls on the center pedestal. "I very excited and nervous. I wanted [the job] very badly." Koziel's training at Frontier Airlines included eight simulator sessions, after which he was hired as a first officer. He had hoped to become a captain by December 2020, but the pandemic has pushed everything back. The Art of Listening Koziel says one of his biggest worries was being able to do his job as a pilot safely. "I didn't want pilots to watch over me just because I had a fake hand," he says. Also, Koziel was still new to the Airbus and didn't feel comfortable flying it yet. "My worry was the throttles and pulling the reverses on landing. Because I can't feel with my fake hand, I worried about a throttle split and not hitting the detent on takeoff." (A detent is a device used to mechanically resist or arrest the rotation of a wheel, axle, or spindle.) Koziel says he has trained himself to listen for the click sound the throttle makes when it's at the flex detent to make sure he has positioned both throttles in the right place. "So I always listen for two clicks," he says. "Similarly, on landing you are looking down the runway. I feared on landing pulling one reverser and not the other. I've also gotten good on landing, pulling the throttles to idle and listening for the click sound when pulling the reverse levers up without looking." Koziel did have one issue with the device when flying: His prosthesis had the tendency to fall off when he would pull back on the yoke of the plane. "Slippage was one of the biggest problems I had," he says. Zach Harvey, CPO, Creative Technology Orthotic & Prosthetic Solutions, Denver, Koziel's current prosthetist, was able to help with that issue. "We incorporated a rolled silicone liner that went halfway up his upper arm, and suction suspension," Harvey says. "It has proved to be a very good design." Koziel's position is unique because he relies on his prosthesis to do his job, says Harvey, who gave him an extra charger for the device so he's always prepared. Koziel also keeps a backup hand with him. "I've made certain to educate Tom on how the parts of the arm go together just in case a repair is needed and he's on the go," Harvey says. Not an Easy Road Koziel admits losing his hand has been difficult, and his journey from injury to commercial flying remains a challenge. When it came time to leave the hospital after his amputation, he didn't want to go. "I felt safe and comfortable there," he remembers. He still struggles some with wearing his prosthesis; he seldom wears a short-sleeve shirt and often uses his pilot's blazer to cover his hand when he walks through an airport. But Passero always had confidence in Koziel's abilities. "Tom was determined, and no amount of clinical skill of mine or our team can substitute for that factor in the equation that adds up to a full recovery," Passero says. "He was also benefitted by a supportive family and employer, but regardless, he's the one who made this happen." "I'd describe Tom's motivation to overcome adversity as inspirational," Harvey says. He has put Koziel in touch with a patient who has arm paralysis and wants to be a pilot. "The introduction really gave that patient confidence to complete flight school," Harvey says. Betta Ferrendelli can be contacted at betta@opedge.com.

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