title: Off-duty preparation for overnight work in rotor wing air medical programs.
abstract: BACKGROUND
  Air medical teams provide around-the-clock critical care, risking performance-altering fatigue from circadian disruption and sleep deprivation. Although safety is an essential issue in the air medical industry, there is little understanding of off-duty preparation for overnight shifts.
  
  
  METHODS
  An anonymous survey was distributed to pilots and medical team members at participating programs with variable program, staffing, and shift models. Eighty responses from crewmembers working 12-hour night shifts (12N) were analyzed with appropriate t-tests and nonparametric tests.
  
  
  RESULTS
  12N crewmembers sleep significantly less in off-duty periods than before night shifts: 7.3 +/- 1.2 hours versus 4.8 +/- 1.9 hours (P < 0.01). Preshift sleep does not differ between crewmembers permitted on-duty rest and those for whom it is prohibited. 34.1% of 12N crewmembers permitted on-duty rest say they report to work planning to sleep. The minimum preshift sleep reported by 12N crewmembers before any shift in the past month averaged 2.4 +/- 2.3 hours, with 36.3% having worked overnight in the past month with no sleep before their shift On-duty rest permission was not a significant factor. Fifty-five percent of 12N crewmembers report outside employment (OE) in addition to their flight position. 12N crewmembers with OE averaged significantly less preshift sleep than those without OE: 4.4 +/- 2.1 hours versus 5.3 +/- 1.6 hours (P < 0.05). 54.5% of 12N crewmembers with OE described reporting to a flight shift within 8 hours of leaving their other job at least once within the past month. OE was more common when the flight program permitted on-duty rest (P < 0.01).
  
  
  CONCLUSIONS
  Air medical team members report for 12N shifts with a significant sleep debt that does not differ between crewmembers permitted on-duty rest and those with on-duty rest prohibitions. More than half of flight team members surveyed have OE and many report for flight duty within 8 hours of leaving their other job. 12N shift crewmembers are at a particularly high risk for the consequences of fatigue. This is an important consideration as the industry develops on-duty rest guidelines to optimize safe operations.
authors.affiliation: LIFE STAR/Hartford Hospital, Hartford, CT 06102-5037, USA. mfrakes@harthosp.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Frakes
authors.forename: John G
authors.initials: JG
authors.lastname: Kelly
mesh_terms: D017732:Air Ambulances / Q000458:organization & administration*; D003625:Data Collection; D005221:Fatigue; D006801:Humans; D012890:Sleep; D014481:United States; D014940:Work Schedule Tolerance / Q000502:physiology*