Special Feature
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 per‐ formance.
Although education
study at Intermountain Life Flight in Salt Lake City is focused primarily on what performance degradations 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 schedul‐ ing in air medical transport.
Education is Key
Unlike our counterparts in Germany, who do not conduct air medical trans‐ ports 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, 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, during the day, especially when you are work‐ ing a shift that night? Knowing how cumulative sleep debt impacts your cognitive abilities and how rapidly that sleep debt can build during a series of night shifts can be a real “eye opener” (no pun intended). Think you need caf‐ feine? Do you know how much caf‐ feine 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
40 EMS PRO Magazine
about fatigue management may seem to be low hanging fruit, it is only super‐ ficially considered in most air medical operations. “Fatigue? We conduct train‐ ing on an annual basis and there is always something thrown in on fatigue. What more could we possibly need?” Expressions like this seem common‐ place in many programs. While fatigue and alertness “training” may be occur‐ ring at various levels throughout the industry, this training often just scratch‐ es the surface of this complex issue. The previously mentioned NEMSPA sur‐ vey revealed, in this writer’s opinion, numerous deficiencies in many pilots’ preparations for consecutive night shifts. Unacceptable cumulative sleep debt, difficulty sleeping during the day, and poor understanding of how to miti‐ gate the effects of fatigue are all indica‐ tions that better education is needed. Not convinced? When given a simple quiz covering basic subjects such as cir‐ cadian rhythms, sleep debt, use of caf‐ feine and sleep disorders, the 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 sub‐ ject area that has such a dramatic impact on their everyday lives. In air medical operations, a lack of under‐ standing and control of fatigue can be part of a recipe for disaster. The 1995 NTSB and NASA Ames Fatigue Symposium Proceedings concluded that comprehensive education is a fun‐ damental element for any fatigue man‐ agement effort. The pilots in the airline AMP described above scored at an ‘A’ level after education.
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 tailored to the needs and requirements of the individual. This comprehensive AMP, called Z‐Coach, was developed by Alertness Solutions, of Cupertino, California, as an excellent method for providing awareness and understand‐ ing of various aspects of fatigue along with alertness management tech‐ niques to help each individual deter‐ mine his or her own particular sleep and fatigue‐related needs and require‐ ments.
The instruction takes each partici‐ pant through successive stages of edu‐ cation, training and understanding, using an Olympic model of bronze, sil‐ ver and gold levels. In fact, one of the first groups to use Z‐Coach was the U.S. Olympic Team bound for Beijing in 2008 (Z‐Coach is the “official sleep pro‐ gram of the U.S. Olympic Team for 2008/2010/2012”). The program pro‐ vides greater insight of the circadian clock and how it affects your ability to sleep during the day, as well as how it can make it very difficult to remain alert during certain parts of the night. It provides an understanding of accu‐ mulated sleep debt, not only in general terms, but in specific terms of how much sleep debt you personally build up during successive nights of shift work. A caffeine calculator will tell you how much caffeine you personally need to stay awake, and will provide guidance on when you should, and should not, take that caffeine. The importance of naps and a scientifically based strategy for incorporating naps into your daily routine is also part of the instruction. This is just a small sam‐ ple of the information and personal‐ ized strategies and tools provided by Z‐ Coach. The Z‐Coach program is now avail‐ able to air medical team members and ambulance personnel through NEMSPA. Qualifying individuals and programs that enroll through the NEMSPA website (
www.nemspa.org)
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