title: Sleep and sleepiness of pilots operating long-range airplane emergency medical missions.
abstract: BACKGROUND
  Airplane emergency medical services (AEMS) operators use fixed-wing airplanes to undertake rapid response, round-the-clock medical transport missions. This paper explores the structure of long-range, multileg AEMS missions and the sleep and sleepiness of the pilots who work them.
  
  
  METHODS
  During nine long-range AEMS missions, pilots kept a sleep and sleepiness logbook and wore a wrist activity monitor to evaluate the timing of sleep/wake.
  
  
  RESULTS
  Missions had a mean duration of 20 h 00 min ± 2 h 39 min, involved two to four flight legs, and were crewed by three or four pilots who rotated between operating and sleeping in curtained-off bunks. The pilots obtained a mean of 15 h 26 min ± 4 h 51 min and 7 h 54 min ± 1 h 33 min of sleep in the 48 h and 24 h prior to checking in for duty, respectively. During missions, a mean of 3 h 33 min ± 1 h 46 min of sleep was taken, usually across two in-flight sleep periods. Karolinska Sleepiness Scores (KSS) at top of climb and top of descent were typically less than 5 ('neither alert nor sleepy'). A small number of individual higher KSS scores were recorded on the longest missions and on flights between 02:00 and 06:00.
  
  
  CONCLUSIONS
  These findings suggest that despite the long duration, timing, and multileg nature of AEMS missions, it is possible via careful design and management to operate these missions with appropriate levels of pilot alertness.
authors.affiliation: Rega/Swiss-Air Ambulance, Rega Center, Zurich Airport, Zurich, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Amann
authors.forename: Alex
authors.initials: A
authors.lastname: Holmes
authors.forename: John
authors.initials: J
authors.lastname: Caldwell
authors.forename: Cassie
authors.initials: C
authors.lastname: Hilditch
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D017732:Air Ambulances; D001359:Aviation; D002940:Circadian Rhythm / Q000502:physiology; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000503:physiopathology*; D013557:Switzerland; D014940:Work Schedule Tolerance / Q000502:physiology