The impact of fatigue in air medical and other types of operations: a review of fatigue facts and potential countermeasures.

Because of its effects on productivity and safety, fatigue is receiving increasing attention in a variety of settings, including aviation. Fatigue-related problems cost America an estimated $18 billion a year in terms of lost productivity, and fatigue-related drowsiness on the highways contributes to more than 1500 fatalities, 100,000 crashes, and 76,000 injuries annually. Furthermore, evidence is mounting that pilot and aircrew fatigue has been a causative factor in several aviation mishaps. Although substantial research has been conducted on the nature of fatigue and the effectiveness of various countermeasures, much of the relevant information may not be reaching those who need it most. The importance of obtaining adequate daily sleep and the efficacy of proper work/rest schedules, strategic napping, rest breaks, circadian-entrainment interventions, and other techniques should be emphasized in air medical training programs along with the more standard courses aimed at maintaining crew skills and improving flight safety. Once the facts are known, the aircrew's ability to control fatigue will enhance the productivity and safety of air ambulance operations.