FATIGUE: A STEALTHY KILLER MY 2 CENTS
By Randy Mains
Have you ever been so tired flying at night or early morning that, thinking back on it, you could not remember the takeoff? As an air medical pilot in the early days in Houston and San Diego, I can raise my hand and say, “I have.” Why was that? The answer: fatigue.
The International Civil Aviation Organization’s definition of fatigue is “a physiological state of reduced mental or physical performance capability resulting from sleep loss or extended wakefulness, circadian phase, or workload (mental and/or physical activity) that can impair a crew member’s alertness and ability to safely operate an aircraft or to perform safety-related duties.”
An article posted online by Aerossurance aviation consultants on Sept. 26, 2020 titled “Fatal Fatigue: U.S. Night Air Ambulance Helicopter Loss of Control – In-flight Accident (Air Methods AS350B2 N127LN, Wisconsin)” describes how a pilot and two medical personnel were killed in a crash. The helicopter, operating as Ascension Spirit Air, was on a night repositioning flight after two inter-hospital patient transfer flights with a refueling stop. The U.S. National Transportation Safety Board (NTSB) issued a simple probable cause: the pilot’s loss of helicopter control as a result of fatigue during cruise flight at night.
Fatigue is a big issue in our nation’s airlines, especially following the Colgan Air crash on Feb. 12, 2009. The aircraft involved was a Bombardier Q400 turboprop that entered an aerodynamic stall perpetrated by the pilot and crashed into a house in Clarence Center, New York, killing all 45 passengers and four crew members on board as well as a person on the ground.
The NTSB found the probable cause to be the pilots’ inappropriate response to the stall warnings during a stall they inadvertently caused and then mishandled during their attempted recovery. Fatigue was noted to be a contributing factor in the crash. Families of the accident victims lobbied the U.S. Congress to enact more stringent duty-time requirements for regional carriers to avoid similar accidents related to pilot fatigue.
I had the opportunity to attend the American Airlines training academy and sit in on several CRM training courses. Crew fatigue was front-and-center in each presentation I attended. I was surprised to learn that the airline takes crew fatigue so seriously that it pays its crew members $1,000 not to come to work if they are tired or fatigued.
Research has shown that loss of sleep can be as detrimental as alcohol to judgment and reaction time. In a study published in the (British) BMJ Group publication “Occupational and Environmental Medicine,” researchers in Australia and New Zealand reported that sleep deprivation can have some of the same hazardous effects as being drunk. They wrote, “People who drive after being awake for 17 to 19 hours performed worse than those with a blood alcohol level of .05 percent.”
In addition, their findings demonstrated that getting less than six hours of sleep a night can affect coordination, reaction time, and judgment, creating “a very serious risk.” If one goes 24 hours without sleep, their judgment and reaction time are similar to being legally drunk.
Sleep research has shown that a person’s circadian rhythm (the 24-hour internal clock in our brain that regulates cycles of alertness and sleepiness by responding to light changes in our environment, sometimes referred to as one’s “body clock”) is at its lowest ebb at 4-6 a.m. This fact is something you should be aware of when you take that early-morning flight. My early- morning flight combined with lack of rest most likely explains why I could not remember the takeoff on that San Diego moonless night in 1980 while being required to work 48-hour shifts at UCSD Medical Center.
Another contributing factor to my state of fatigue? We were required to lift off within five minutes, day or night. Each morning following a night shift, the medical director would check the time cards in the dispatch center to see if we were off within that five- minute window. If not, he would ask us why.
Things have changed dramatically since then, but that’s just how it was in the early days of helicopter EMS when we were striving to prove the helicopter air ambulance concept. It’s one of several reasons I wrote my first book entitled “The Golden Hour.” It was my way to shine a spotlight on the fatigue problem to anyone who would listen, in my personal effort to hopefully enact change. The change I was hoping for, but never saw in my six years as a HEMS pilot, was to work 12-hour shifts like our six flight nurses did. I would often argue that if a doctor, nurse or paramedic is dog-tired they possibly could make a mistake and kill a patient. On the other hand, if the pilot is dog-tired he could kill everyone on board, which might include a patient.
On those late-night/early-morning flights, more often than not the flight nurse on duty would hand me a cup of coffee as we boarded the elevator taking us up to the helipad. I guess when
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Nov/Dec 2021
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