Fatigue in Air Medical Clinicians Undertaking High-acuity Patient Transports

Abstract

Background. Fatigue is likely to be a significant issue for air medical transport clinicians due to the challenging nature of their work, but there is little published evidence for this. Objective. To prospectively assess the levels and patterns of fatigue in air medical transport teams and determine whether specific mission factors influenced clinician fatigue. Methods. Physicians and flight nurses from two intensive care interhospital transport teams routinely completed fatigue report forms before and after patient transport missions over a 4-month period. Data collected included subjective ratings of fatigue (Samn-Perelli and visual analog scale), mission difficulty and performance. Multivariate hierarchical logistic and linear models were used to evaluate the influence of various mission characteristics on post-mission fatigue. Results. Clinicians returned 403 fully complete fatigue report forms at an estimated overall return rate of 73%. Fatigue increased significantly over the course of missions, and on 1 of every 12 fatigue reports returned clinicians reported severe post-mission fatigue (that is, levels of 6 or 7 on the Samn-Perelli scale). Factors that impacted significantly on clinician fatigue were the pre-mission fatigue level of the clinician, night work, mission duration, and mission difficulty. Poorer self-rated performance was significantly associated with higher levels of fatigue (r = -0.4, 95% CI -0.5 to -0.3), and for the 6-month period leading up to the study clinicians reported a total of 22 occasions on which they should have declined a mission due to fatigue. Conclusions. These results suggest that clinicians undertaking interhospital transports of even moderate duration experience high levels of fatigue on a relatively frequent basis. In the unique and challenging environment of air medical transport, prior fatigue, long or difficult missions, and the disadvantageous effect of night work on normal circadian rhythms are a combination where there are minimal safety margins for clinicians' performance capacity. Fatigue prevention or fatigue resistance measures could positively affect air medical clinicians in this context.

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study

“…It is also possible that self-ratings are more accurate at the extremes, such as when performance is significantly degraded [ 36 ]. Further examination of ‘self-rating’ is warranted in light of the fact that critical care air ambulance clinicians are particularly vulnerable to factors like fatigue [ 37 ], and risk management systems generally rely on clinicians ‘self-identifying’ if their performance is compromised [ 38 ].…”

Shiftwork, functional bowel symptoms, and the microbiome

“…There are about 15 million Americans working full-time on evening, night, or rotating shifts, or other irregular employer-arranged schedules; 4.7% on evening shifts, 3.2% on night shifts, 3.1% on irregular schedules, and 2.5% on rotating shifts ( United States Department of Labor Bureau of Labor Statistics, 2005 ). Night shift work is associated with increased mortality, higher risk of cardiovascular disease, cancer, diabetes, hypertension, chronic fatigue, sleep problems and higher body weight ( Gu et al, 2015 ; Jia et al, 2013 ; Myers et al, 2015 ; Pan et al, 2011 ; Rajaratnam et al, 2011 ; Vyas et al, 2012 ). Night and rotating shift workers also report a higher prevalence of Irritable Bowel Syndrome (IBS), abdominal pain, constipation and diarrhea than do day shift workers ( Caruso, Lusk & Gillespie, 2004 ; Knutsson & Boggild, 2010 ; Nojkov et al, 2010 ; Wells, Roth & Chande, 2012 ).…”

Looking back to inform the future: a review of published paramedicine research

“… For this category 23 out of 25 articles could be retrieved and analyzed. Of the 10 articles in the Fatigue theme, there was a diverse set of topics with one article each on air ambulance crew fatigue [ 211 ], biomathematical models [ 212 ], caffeine [ 213 ], data collection instruments [ 214 ], fatigue training [ 215 ], inter-shift recovery [ 216 ], napping [ 217 ], shift pattern [ 218 ], task load [ 219 ], and sleep and safety [ 220 ]. Of the seven articles in the psychological wellness theme, three were focused on critical incidents [ 221 – 223 ], and one each on inclusivity (LGBTQ2) [ 224 ], mental health matters [ 225 ], rural paramedicine [ 226 ], and the “national EMS memorial” [ 227 ].…”