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including knowing what healthy sleep is, and how to obtain it. Do you really understand how the circadian clock impacts your ability to take a nap during the day? Or do you understand the importance of taking a nap, or extended nap, dur- ing the day, especially when you are working a shift that night?

Knowing how cumulative sleep

debt impacts your cognitive abilities and how rap- idly that sleep debt can build during a series of night shifts can be a real “eye opener” (no pun intended).

Think you need caffeine? Do you

know how much caffeine you really do need, and when you should take it for maximum effective- ness? When you drink that Starbucks Grande on the way home from your night shift, do you have any idea how that will affect you? These are tip of the iceberg questions. Knowing the answers to these questions and many others that should be considered is critical to any pilot or flight crewmember who wants to control the effects of fatigue on his or her performance.


Although education about fatigue manage-

ment may seem to be low hanging fruit, it is only superficially considered in most air medical oper- ations. “Fatigue? We

conduct training on an

annual basis and there is always something thrown in on fatigue. What more could we possibly need?” Expressions like this seem commonplace in many programs. While fatigue and alertness “training” may be throughout

the industry,

occurring this

at scratches the surface of this complex issue.

average grade received by veteran EMS pilots at a well respected air medical program was a “less than favorable.” That’s a disturbing performance for a group that should be well schooled in a subject area that has such a dramatic impact on their everyday lives.

various levels

training often just The

previously mentioned NEMSPA survey revealed, in this writer’s opinion, numerous deficiencies in many pilots’ preparations for consecutive night shifts. Unacceptable cumulative sleep debt, diffi- culty sleeping during the day, and poor under- standing of how to mitigate the effects of fatigue are all indications that better education is needed. Not convinced? When given a simple quiz

covering basic subjects such as circadian rhythms, sleep debt, use of caffeine and sleep disorders, the


In air medical operations, a

lack of understanding and control of fatigue can be part of a recipe for disaster. The 1995 NTSB and NASA Ames Fatigue Symposium Proceedings concluded that comprehensive edu- cation is a fundamental element for any fatigue management effort. The pilots in the airline AMP described above scored at an ‘A’ level after edu- cation.

INSIGHTS FROM Z-COACH When NEMSPA began collaborating with

Dr. Rosekind on various fatigue related issues nearly two years ago, we were introduced to an online Alertness Management Program that is tai-

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