Fatigue Risk Management Systems Research Articles

A Guided Comparative Analysis of Fatigue Frameworks in Australasian Ambulance Services

Objective Paramedics work in a complex, unpredictable environment, subject to many external stressors including critically unwell patients, dangerous driving conditions, and prolonged shift work. Paramedic fatigue from these and other occupational demands is well documented. Ambulance services attempt to safeguard paramedics from fatigue using internal policies or procedures – a type of Fatigue Risk Management Systems (FRMSs). This study reviews ambulance service fatigue frameworks to understand the current situation in fatigue management in paramedicine, and to identify fatigue monitoring tools, strategies, and other components of these frameworks that are designed to protect personnel. Methods This study involved a qualitative document thematic content analysis. All eleven statutory ambulance services across Australia, New Zealand, and Papua New Guinea, represented by the Council of Ambulance Authorities, were contacted and invited to participate. Fatigue frameworks were collated and entered into NVivo where data extraction occurred through three a priori areas (fatigue, fatigue mitigation tools & fatigue management). Results Nine of the eleven ambulance services provided fatigue documentation, with one declining to participate, and one did not respond to invitations. Through thematic analysis and abstraction, seven themes were identified: fatigue definition, consequences of fatigue, sources of fatigue, signs and symptoms of fatigue, fatigue-related incidents, fatigue monitoring tools, and fatigue mitigation. There was also poor alignment between provided frameworks and established FRMSs components. Conclusion Our findings provide an initial insight into existing ambulance service fatigue frameworks across Australia, New Zealand, and Papua New Guinea. The many inconsistencies in frameworks between ambulance services highlight an opportunity to develop a more consistent, collaborative approach that follows evidence-based FRMSs guidelines.

Evaluating fatigue management regulations for flight crew in Australia using a new Fatigue Regulation Evaluation Framework (FREF)

Flight crew experience fatigue due to sleep loss, circadian desynchrony, early duty start times, long duty periods, high and low workloads, and unscheduled duties. As fatigue is considered a significant safety risk in the air transport industry, the primary approaches to managing fatigue are mandating prescriptive limits for work and rest periods or adopting performance-based fatigue risk management systems (FRMS). However, recent aviation incidents indicate that current regulations may not be adequate to manage the fatigue risk experienced by the flight crew. This study evaluates Australian flight crew fatigue management regulations using a new fatigue regulation evaluation framework (FREF) adapted from Jones et al. (2005). Results show that Australian regulations for flight crew include limits on flight duty period (FDP), off duty period, FDP start time, sleep requirements for flight crew before starting an FDP, high and low workloads, circadian rhythm disruptions, and fatigue awareness. However, there are regulation variations in addressing lengths of sectors and methods to report fatigue, which may need to be reviewed to manage fatigue better. Recommendations are made to consider incorporating these factors into fatigue regulations to ensure a safe air transport system.

Fatigue among anaesthesiologists in Europe: Findings from a joint EBA/NASC survey.

Anaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness. 1. This study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists. An online survey of specialist anaesthesiologists. The survey was sent to anaesthesiologists in 42 European countries by electronic mail. Responses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries. Work-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being. Work-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.

Fatigue risk management in aviation operations

Fatigue accounts for 15% to 20% of human-related accidents. The increasing annual demand for air transportation has raised concerns in this 24/7 activity, as the crew ends up working irregular hours to meet this demand. Current regulations limit crew working hours to minimize fatigue risks, but do not eliminate them. Scientific studies reveal multiple contributing factors leading to crew fatigue, dispelling the old paradigms that fatigue resulted solely from a linear accumulation of working hours. Based on the findings of these scientific studies, a new support tool is created and presented, with the primary goal of mitigating fatigue-related effects and enhancing crew alertness to operate at a satisfactory performance level. This work aims, through a literature review, to expose the risks associated with fatigue in aviation operations and introduce the fatigue risk management system as a competitive lever to achieve a balance between safety and productivity.

Fatigue amongst anaesthesiology and intensive care trainees in Europe: A matter of concern.

There is a growing awareness of the effects of fatigue on trainee wellbeing and health. Trainees in anaesthesiology and intensive care work long hours, switching work schedules frequently with insufficient rest. This may have unwanted long-term effects on mental and physical health and emotional well being, resulting in burnout and affecting patient safety. The study aimed to evaluate the prevalence, severity, causes and effects of work-related fatigue in trainees in anaesthesiology and intensive care. Online survey of trainees in anaesthesiology and intensive care. A total of 31 countries within Europe were included in the survey. European anaesthesiology and intensive care trainees who responded to an invitation to take part by electronic mail or through social media. Responses from a 29-item online survey to assess the realities within European countries with regards to work-related fatigue. One thousand and two hundred trainees from 31 European countries answered the survey demonstrating that an alarming number of trainees were fatigued by their working patterns and night shifts. Trainees reported effects on personal well being, safe commuting and potential for clinical errors. Respondents described a lack of support from hospitals and management for recovery during and after night shifts. Fatigue among trainees in anaesthesiology and intensive care has a significant impact on their well being and potentially, on the incidence of clinical errors. Current measures from authorities and hospital management are not sufficient to prevent serious fatigue, and therefore a fatigue risk management system should be considered. Failure to address this issue might lead to a further decline in trainees' wellbeing, their capacity to work in the speciality in the future, and potentially increase patient care errors.

Pilot fatigue survey: A study of the mutual influence among fatigue factors in the "work" dimension.

Fatigue risk management for pilots has received increasing attention. The existing fatigue management systems have detailed descriptions of the factors and the mutual influences among the factors that affect the dimension of "sleep", which is one of the most important causes of fatigue. However, the analysis of the influencing factors of the "work" dimension of fatigue causes has not been very detailed or accurate, especially the exploration of the mutual influence among many fatigue-influencing factors in the "work" dimension. The purpose of this study was to explore the mutual influence among fatigue-influencing factors related to the "work" dimension in the analysis of pilot fatigue causes. This study designed a questionnaire on the dimension of "work" in the causes of pilot fatigue and collected a total of 270 feedback data points from international flight pilots. Based on the questionnaires and data, descriptive statistical analysis, exploratory factor analysis and confirmatory factor analysis were performed to explore the influencing factors and their mutual influences on the "work" dimension of pilot fatigue. There is a strong, mutual influence relationship among the fatigue causes of long-haul flight pilots - working status, working conditions and working schedules - in the dimension of "work". The workload only has a strong correlation with the working schedule, and the interaction relationships with the working status or working conditions are weak. This study analyses the mutual influence among the influencing factors of the "work" dimension of pilot fatigue, and we expect to provide empirical data for pilot fatigue risk management and to help improve fatigue risk management systems.

The next generation of fatigue prediction models: evaluating current trends in biomathematical modelling

Biomathematical models (BMMs) are parametric models that quantitatively predict fatigue and are routinely implemented in fatigue risk management systems in increasingly diverse workplaces. There have been consistent calls for an improved ‘next generation’ of BMMs that provide more accurate and targeted predictions of human fatigue. This article examines the core characteristics of next-generation advancements in BMMs, including tailoring with field data, individual-level parameter tuning and real-time fatigue prediction, extensions to account for additional factors that influence fatigue, and emerging nonparametric methodologies that may augment or provide alternatives to BMMs. Examination of past literature and quantitative examples suggests that there are notable challenges to advancing BMMs beyond their current applications. Adoption of multi-model frameworks, including quantitative joint modelling and machine-learning, was identified as crucial to next-generation models. We close with general recommendations for researchers, practitioners, and model developers, including focusing research efforts on understanding the cognitive dynamics underpinning fatigue-related vigilance decrements, applying emerging dynamic modelling methods to fatigue data from field settings, and improving the adoption of open scientific practices in fatigue research.

The duration of work-related fatigue as a criterion for assessing the workload and the cause of chronic diseases of workers

Introduction. The developers of fatigue risk management systems in the workplace note that there is no universal definition and a consistent way to measure workload, and that scientists have not sufficiently studied the relationship between workload and fatigue. The study aims to analyze the impact of the workload, estimated by the duration of the state of production-related fatigue of workers, on their subjective health and the risk of chronic diseases. Materials and methods. The study involved employees in three areas of employment: healthcare (697 employees), industry (751), education (687). Experts have determined four indicators of the risk of violation of the subjective health of employees during the year: the presence of chronic fatigue syndrome (Rcfs), deterioration of employee health during the year (Rdh), long-term illnesses during the year (Rli), fatigue accumulation during the year (Rfa). We have analyzed the diseases detected during periodic medical examination. The researchers have calculated the HFweek indicator - the duration of the fatigue state - "hours of fatigue per working week": HFweek (hour) = PRN (hour) × Kdf × Kff, where: PRN (hour) is the actual duration of the working week; Kdf and Kff are coefficients that take into account the degree and frequency of fatigue. We also have calculated the relative risk (RR). Results. The researchers have found that with more than 25 hours per week in 108 sample groups of workers in 25 cases, RR exceeded the control level by more than 5 times; in 44 comparison groups by 2.1-5 times and in 35 groups by 1.1-2.0 times. With a HFweek of more than 25 hours, there is an annual accumulation of fatigue (Rfa), similar in workers of all spheres of employment. At HFweek>15 hours, the RR of chronic diseases of the musculoskeletal, respiratory, nervous systems and skin was in the range of 1.31-1.83. The RR of diseases of the genitourinary system (women) and endocrine system increased by 1.13 times; diseases of hypertension, diseases of the digestive system, visual system RR÷1,05-1,07. Conclusion. The HFweek indicator is the physiological equivalent of the professional workload of employees in various fields of employment. With HFweek>25 hours, there is a sharp increase in health risks.

Fatigue Risk Management Systems Diagnostic Tool: Validation of an Organizational Assessment Tool for Shift Work Organizations

BackgroundThis study aimed to determine and define the elements of an Fatigue Risk Management System (FRMS) diagnostic tool to assist an organization in systematically assessing its level of implementation of an FRMS. MethodsA modified Delphi process was used involving 16 participants with expertise in sleep science, chronobiology, and fatigue risk management within occupational settings. The study was undertaken in two stages 1) review of elements and definitions; 2) review of statements for each element. Each stage involved an iterative process, and a consensus rule of ≥ 60% was applied to arrive at a final list of elements, definitions, and statements. ResultsStage 1: a review of elements (n = 12) and definitions resulted in a final list of 14 elements and definitions with a consensus of ≥ 60% achieved after 2 Delphi rounds. Stage 2: a review of statements (n = 131) resulted in a final list of 119 statements with a consensus of ≥ 60% achieved after 2 Delphi rounds. ConclusionThe final FRMS diagnostic tool will enable an organization to systematically assess the level of implementation of their current FRMS and identify gaps and opportunities to reduce risk.

비행 임무에 따른 조종사 스트레스 차이에 대한 연구

This study is a study to analyze the stress difference of pilots according to the category of aircraft. According to previous studies, pilot stress is affected by several factors such as flight time, fatigue regulation, and operating environment, and it is known that stress also affects cardiac variability. In this paper, we analyzed that there is a difference in stress according to the operating environment through airline pilots and pilots of educational institutions, and then tested the difference in stress between airplane pilots and helicopter pilots. This study differs in that it is a study that has almost no empirical research on pilot fatigue and stress considering the role of flight crew members and operational conditions for each mission. If we expand and verify the sample of the results for the stress difference in the future, it will be a great contribution to practical aviation safety research in connection with the fatigue risk management system in the future.

Work schedule and seasonal influences on sleep and fatigue in helicopter and fixed-wing aircraft operations in extreme environments

Sleep and fatigue were investigated in aviation search and rescue, firefighting, emergency medical services and offshore transfer operations in 210 participants, for 21 days each, across 17 datasets in seven countries. Sleep data were collected using wrist-worn actigraphs and sleep diaries. Sustained attention was assessed using a 5-min Psychomotor Vigilance Task (PVT). Duty information was provided from corporate IT systems. Despite the number of 24 h operations, most work occurred during daytime hours, and most sleep occurred at night. There were seasonal changes in work and sleep patterns, with naps used to augment total sleep time. The proportion of sleep occurring during duty varied from zero to 30%. Differences in PVT response times were trivial to small. Legislation that defines flight, duty time and minimum rest limits assume that sleep is not obtained during duty periods, apart from some napping under Fatigue Risk Management Systems (FRMS). However, especially in cases where the aviation service requires waiting for tasks (e.g. search and rescue, emergency medical response), this assumption may not always hold. FRMS should accommodate different modes of working that safely facilitate sleep during duty time where appropriate.

Mindfulness and burnout among Chinese civil pilots: Mediation through fatigue and proactive coping

We explored the possibility of a relationship between mindfulness and burnout among Chinese civil pilots, and investigated the mediating effects of fatigue and proactive coping in this relationship. Participants were 319 civil pilots employed by China Southern Airlines, who completed a survey. Structural equation modeling was used to test the hypothesized parallel mediation model. Results show that the direct effect of mindfulness on burnout was not significant, but mindfulness had an important preventative effect on burnout. Furthermore, fatigue and proactive coping completely mediated the effect of mindfulness on burnout. Consequently, our findings corroborate the predictive role of fatigue and proactive coping in mediating the indirect effect that mindfulness exerted on burnout. Theoretical implications and practical recommendations for pilots' mindfulness training practice and fatigue risk management systems are discussed.

Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management.

To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts. FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools. A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders. Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive. This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.

Psychophysiological coherence training to moderate air traffic controllers' fatigue on rotating roster.

The nature of the current rotating roster, providing 24-h air traffic services over five irregular shifts, leads to accumulated fatigue which impairs air traffic controllers' cognitive function and task performance. It is imperative to develop an effective fatigue risk management system to improve aviation safety based upon scientific approaches. Two empirical studies were conducted to address this issue. Study 1 investigated the mixed effect of circadian rhythm disorders and resource depletion on controllers' accumulated fatigue. Then, study 2 proposed a potential biofeedback solution of quick coherence technique which can mitigate air traffic controllers' (ATCOs') fatigue while on controller working position and improve ATCOs' mental/physical health. The current two-studies demonstrated a scientific approach to fatigue analysis and fatigue risk mitigation in the air traffic services domain. This research offers insights into the fluctuation of ATCO fatigue levels and the influence of a numbers of factors related to circadian rhythm and resource depletion impact on fatigue levels on study 1; and provides psychophysiological coherence training to increase ATCOs' fatigue resilience to mitigate negative impacts of fatigue on study 2. Based on these two studies, the authors recommended that an extra short break for air traffic controllers to permit practicing the quick coherence breathing technique for 5 min at the sixth working hour could substantially recharge cognitive resources and increase fatigue resilience. Application: Present studies highlight an effective fatigue intervention based on objective biofeedback to moderate controllers' accumulated fatigue as a result of rotating shift work. Accordingly, air navigation services providers and regulators can develop fatigue risk management systems based on scientific approaches to improve aviation safety and air traffic controller's wellbeing.

Comprehensive Assessment of Fatigue and Stress Research on Collegiate Aviation Pilots in the United States

Recently, there has been a reemergence of fatigue research within the collegiate aviation environment. Nevertheless, the collegiate aviation flight training environment has not been researched as much when compared to military and airline operations creating an opportunity for examination. University students are unique in the sense that they are tasked with academic tasks such as studying, participating in student organizations, social activities, and are often employed part-time within and outside of the academic environment. The workload experienced by students may cause errors, incidents, accidents, poor academic performance, repeat flight and simulator lessons as well as undesirable health metrics. This work aims to gather data on college students in an attempt to bolster Fatigue Risk Management System (FRMS) concepts. The proposed implementation of psychological Fatigue Indicators identifies critical and significant risks related to the current Fatigue Risk Management System, especially in atypical periods when the aviation industry is experiencing substantial disruptions and psychological fatigue is prevalent. The purpose of this proceeding is to communicate recent research methodologies, results, and practical implications as well as ongoing studies.

Quantifying the effects of sleep loss: relative effect sizes of the psychomotor vigilance test, multiple sleep latency test, and maintenance of wakefulness test.

The psychomotor vigilance test (PVT) is a widely-used, minimally invasive, inexpensive, portable, and easy to administer behavioral measure of vigilance that is sensitive to sleep loss. We conducted analyses to determine the relative sensitivity of the PVT vs. the multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT) during acute total sleep deprivation (TSD) and multiple days of sleep restriction (SR) in studies of healthy adults. Twenty-four studies met the criteria for inclusion. Since sleepiness countermeasures were administered in some of these studies, the relative sensitivity of the three measures to these interventions was also assessed. The difference in weighted effect size (eta-squared) was computed for each pair of sleepiness measures based on available raw test data (such as average PVT reaction time). Analyses revealed that the sleep measures were differentially sensitive to various types of sleep loss over time, with MSLT and MWT more sensitive to TSD than the PVT. However, sensitivity to SR was comparable for all three measures. The PVT and MSLT were found to be differentially sensitive to the administration of sleepiness countermeasures (drugs, sleep loss, etc.), but PVT and MWT were found to be comparably sensitive to these interventions. These findings suggest the potential utility of the PVT as a component of next-generation fatigue risk management systems.

Safety Climate Assessment: The Implementation of Psychological Fatigue Indicators in Airline Fatigue Risk Management Systems

In commercial aviation, safety is of paramount importance and an indispensable prerequisite for building extensive, dependable air transportation networks. Several aspects affect airline safety, from training to operations and organizational conditions. The critical importance of aircrew fatigue has long been identified; in 2016, nearly 20% of all accidents under investigation by the US NTSB had it listed as one of the probable causes or contributing factors. This study aims to evaluate the utility of adding psychological fatigue elements to the fatigue self-report and survey tools currently used by airlines. Research goals include identifying psychological fatigue markers in airline fatigue survey forms, analyzing these instruments to determine their sensitivity in identifying fatigue that is not exclusively attributed to physiological factors, and investigating potential improvements of these instruments for use in commercial aviation. The authors examined the effect of psychological and physiological fatigue factors on the aviation industry's overall state and dynamics, especially given the consequences of the recent pandemic. Analysis indicates that incorporating psychological items to existing fatigue reporting and survey instruments significantly changes the measured fatigue levels, suggesting that measuring physiological fatigue alone may not be sufficient to accurately determine overall fatigue levels. The proposed implementation of psychological Fatigue Indicators identifies critical and significant risks related to the current Fatigue Risk Management System, especially in atypical periods when the aviation industry is experiencing substantial disruptions and psychological fatigue is prevalent.

Development of a Tool for Hospital Nurses' Fatigue Self-Management That Can Be Used for Organizational Management.

The purpose of this research is to develop a tool for fatigue self-management for hospital nurses. It is based on a nursing fatigue management education program that we have developed by utilizing the airline industry's Fatigue Risk Management System (FRMS). More specifically, this research aims to develop a tool to check fatigue and sleep conditions, deepen the knowledge about fatigue management, devise a measure to avoid the risk of fatigue, and continuously conduct evaluation.

How effective are Fatigue Risk Management Systems (FRMS)? A review

ObjectiveFatigue Risk Management Systems (FRMS) are a data-driven set of management practices for identifying and managing fatigue-related safety risks. This approach also considers sleep and work time, and is based on ongoing risk assessment and monitoring. This narrative review addresses the effectiveness of FRMS, as well as barriers and enablers in the implementation of FRMS. Furthermore, this review draws on the literature to provide evidence-based policy guidance regarding FRMS implementation. MethodsSeven databases were drawn on to identify relevant peer-reviewed literature. Relevant grey literature was also reviewed based on the authors’ experience in the area. In total, 2129 records were screened based on the search strategy, with 231 included in the final review. ResultsFew studies provide an evidence-base for the effectiveness of FRMS as a whole. However, FRMS components (e.g., bio-mathematical models, self-report measures, performance monitoring) have improved key safety and fatigue metrics. This suggests FRMS as a whole are likely to have positive safety outcomes. Key enablers of successful implementation of FRMS include organisational and worker commitment, workplace culture, and training. ConclusionsWhile FRMS are likely to be effective, in organisations where safety cultures are insufficiently mature and resources are less available, these systems may be challenging to implement successfully. We propose regulatory bodies consider a hybrid model of FRMS, where organisations could choose to align with tight hours of work (compliance) controls. Alternatively, where organisational flexibility is desired, a risk-based approach to fatigue management could be implemented.

The human factors of mineworker fatigue: An overview on prevalence, mitigation, and what's next.

Though mining remains a vital shiftwork industry for U.S. commerce, problems of continued prevalence of mineworker fatigue and its mitigation persist. Publications and reports on fatigue in mining appear to be rich and diverse, yet variable and remote, much like the industry itself. The authors engaged in a brief nonexhaustive overview of the literature on sleep and fatigue among mineworking populations. This overview covers: potential sources of fatigue unique to mine work (e.g., monotonous and disengaging Work Tasks, underground environments and light exposure, remote work operations); evaluation of mitigation strategies for mineworker fatigue or working hours (e.g., shift-scheduling and training); and areas for future research and practice (e.g., fatigue risk management systems in mining, mineworker sleep and fatigue surveillance, lighting interventions, and automation). Fatigue continues to be a critical challenge for the mining industry. While research on the problems and solutions of mineworker fatigue has been limited to date, the future of fatigue research in mining can expand these findings by exploring the origins, nature, and outcomes of fatigue using advancements in lighting, automation, and fatigue risk management.