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One major airline,

struggling with


fatigue on domestic routes, made the decision to take a proactive approach and test a novel pro- gram designed to mitigate the impact of fatigue on their flight crews.

The results of this study, con-

ducted and published by Dr. Rosekind and asso- ciates, showed unequivocally that a well designed, scientifically based Alertness Management Program (AMP) can significantly improve per- formance for flight crews. The AMP designed by the Rosekind group

and used in this study covered four major areas 1. Education. A 3.5 hour interactive CD

was provided to each of the 29 pilots involved in the study with emphasis on sleep and circadian basics, and fatigue in the aviation environment.

boost to performance when fatigued, there seems to be no question that the core requirement to staying alert is to simply obtain adequate, healthy sleep. As

stated by Dr. Rosekind in his white

paper prepared for NEMSPA, titled Managing Fatigue in EMS Flight Operations: Challenges and Opportunities, “It is an absolute: sleep loss will reduce alertness and performance . . . the most important factor to promote performance, alertness, and safety is optimal sleep.” The airline’s AMP accomplished its objec-

tive of mitigating the effects of fatigue in three major ways:

1) schedule improvements, 2) edu-

cation and 3) strategies for optimal sleep and alertness. In air medical transport there is a need, in some cases, for a more enlightened approach to


2. Alertness Strategies. This module

provided information about 10 different strategies and their use as preventive and operational fatigue countermeasures.

The use of caffeine, strategic

napping and enhanced sleep techniques were dis- cussed in this module. 3. Healthy Sleep. This module provid-

ed an introduction to six specific sleep disorders, including sleep apnea, and provided information about their diagnosis and treatment. 4. Schedule. An innovative schedule was

designed which had minimal affect on current crew staffing, while reducing consecutive night shifts, maximizing night sleep and observing estab- lished duty limits. Without getting into the fine details of the

study, it is enough to say that pilots who partici- pated in the AMP showed performance increas- es across most aspects of the flight regime of any- where from 10% to 45%, as measured by the standard Psychomotor Vigilance Task (PVT) test, which essentially measures vigilance and sustained attention. So how do you obtain such a dramat- ic increase in performance? A significant outcome for participating pilots was their ability to sleep more during their trip schedules.

The result was

an average sleep debt of 1.7 hours per day for pilots in the standard condition and only 0.2 hours per day for pilots in the intervention condition (participating in the AMP.) While alertness strategies, such as taking caffeine at the right time and in the right amount, can provide a temporary

scheduling. The NEMSPA survey referenced

earlier showed that roughly 53% of the EMS pilot bases work three-day shifts, followed by three night shifts, and followed by about six days off. A little more than 37% work seven days shifts fol- lowed by seven days off, followed by seven night shifts. A major difference in these two schedules is obviously the number of consecutive night shifts required, with the longer number of night shifts presenting a potential for increased cumulative sleep debt – something pilots and managers should certainly be

aware of.

Intermountain Life Flight in Salt Lake City is focused primarily on what performance degrada- tions may occur in an air medical environment as the night shift count increases from three to seven. The results of this study, and others, have the potential to change how we look at crew sched- uling in air medical transport.

EDUCATION IS KEY Unlike our counterparts in Germany, who do

not conduct air medical transports at night, we will likely never “close down shop” when the sun goes down. A twenty-four hour response structure and the crew duty schedules that go with it are here to stay, and we need to do the best we can to adjust to the demands, and the risks, inherent in our environment. Certainly, one of the first steps in controlling

the effects of fatigue is to understand fatigue, 39

An ongoing study at

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