Shift length and on-duty rest patterns in rotor wing air medical programs

Abstract

Air medical teams provide around the clock critical care, risking performance-altering fatigue from circadian disruption and sleep deprivation. Safety is an essential issue in the air medical industry, but there is little data available on shift length and on-duty rest practices. We report on a survey concerning those practices and analyze relationships by program model (hospital-operated, vendor-operated, independent, or public safety), base location, flight volume, and job requirements. An anonymous survey was mailed to 182 AAMS-member rotor wing air medical programs in the United States who complete scene flights with a flight nurse. One hundred and twenty-nine programs (70.1%) returned surveys, all of which were used for data analysis. Results were analyzed with descriptive and non-parametric statistics. All pilots work shifts between 10 and 14 hours. For medical team members the shift distribution is ≤ 8 hours - 0.4%, 9-12 hours - 44.2%, 12-16 hours - 7.0%, 17-24 hours - 45%, > 24 hours - 3.5%. There is an independent association between shift length greater than 12 hours and each of flight volume per aircraft under 731 flights/year, program model other than hospital-operated, and non-hospital base (Fisher's exact test with Bonferroni correction, P < .01 for each). All pilots are allowed on-duty rest on both day and night shifts. On-duty rest is permitted for 67.4% of medical team members, 18.2% only at night and 49.2% at any time of day. The presence of any period of on-duty crew rest is significantly associated with non-hospital base, program model other than hospital-operated, and shift length exceeding 12 hours (Fisher's exact test with Bonferroni correction, P < .01 for each). The presence of a non-flight clinical assignment while on flight duty is associated with a prohibition against on-duty rest (Fisher's exact test with Bonferroni correction, P < .05). There are notable differences between on-duty work and rest patterns for pilots and medical team members. Medical team members generally work longer shifts than pilots, with shifts exceeding 12 hours as the most common staffing pattern. Medical team members also have less access to on-duty rest than do pilots. Hospital-operated programs are more likely to utilize shorter shifts and to prohibit on-duty rest for the medical teams, while vendor-operated, independent, or public safety programs are more likely to utilize longer shifts and to permit on-duty rest. As the industry works to mitigate the impact of fatigue on safe operations, variable practices based on job description and program style may be a consideration.