Special Feature
the financial consequence of lower pro‐ ductivity due to a reduced attention span, poor decision making, loss of memory and overall loss of motivation is certainly cause for alarm and would make any fiscally responsible manager take note, the direct impact to safety is even more frightening. While poor decision‐making in an office environ‐ ment may result in the careless pur‐ chase of a sub‐standard photocopier, poor decision‐making in a helicopter cockpit can many times be lethal. Of particular interest in the Rosekind study was the report that shift workers report a significant decrement in their productivity as compared to their “9‐ to‐5” counterparts. This is cause for particular concern for air medical flight crews, who routinely operate in the nocturnal environment. One of the sig‐ nificant factors affecting alertness in any person is sleep debt, defined as the difference between how much sleep you personally require to be alert and attentive and how much sleep you actually obtain. For example, if you normally require eight hours of sleep and received only seven last night, you are running a sleep debt of one hour. Unfortunately, sleep debt will continue to build (over a week that one hour/night builds into a 7 hr sleep debt) until you compensate with a longer, deeper sleep period. This cumulative sleep debt phenomenon can wreak havoc with EMS flight crews. A recent National EMS Pilots Association (NEMSPA) survey conducted among nearly 700 EMS pilots revealed that many would have a significant cumula‐ tive sleep debt by the end of a seven
38 EMS PRO Magazine
night series of shifts, which could easily exceed five to ten hours. The resulting degradation in performance, in some cases, can be equivalent to being legal‐ ly drunk. More than 8 in 10 of those surveyed revealed that fatigue had affected their flight performance.
Alertness Management Program (AMP)
It should be no surprise that combin‐ ing shift work with a high stress avia‐ tion environment could increase opera‐ tional risk during night operations to an unacceptable level. So what do we do? One major airline, struggling with pilot fatigue on domestic routes, made the decision to take a proactive approach and test a novel program designed to mitigate the impact of fatigue on their flight crews. The results of this study, conducted and published by Dr. Rosekind and associ‐ ates, showed unequivocally that a well designed, scientifically based Alertness Management Program (AMP) can sig‐ nificantly improve performance 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 environ‐ ment. 2. Alertness Strategies. This module provided information about 10 differ‐ ent strategies and their use as preven‐ tive and operational fatigue counter‐
measures. The use of caffeine, strate‐ gic napping and enhanced sleep tech‐ niques were discussed in this module. 3. Healthy Sleep. This module pro‐ vided 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 reduc‐ ing consecutive night shifts, maximiz‐ ing 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 participated in the AMP showed performance increases across most aspects of the flight regime of anywhere from 10% to 45%, as mea‐ sured by the standard Psychomotor Vigilance Task (PVT) test, which essen‐ tially measures vigilance and sustained attention. So how do you obtain such a dramatic 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 condi‐ tion and only 0.2 hours per day for pilots in the intervention condition (participating in the AMP.) While alert‐ ness strategies, such as taking caffeine at the right time and in the right amount, can provide a temporary 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
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52