Frakes Michael A, Kelly John G
LIFE STAR/Hartford Hospital, Hartford, CT 06102-5037, USA.
Air Med J. 2004 Nov-Dec;23(6):34-9. doi: 10.1016/j.amj.2004.08.027.
Air medical teams provide around-the-clock critical care, a pattern at risk of inducing performance-altering fatigue from circadian disruption and sleep deprivation. Safety is an essential issue in the air medical industry, but little data are available on shift length and on-duty rest practices. We report the results of a survey concerning those practices and analyze the relationships to crew duty practices by program model (hospital-operated, vendor-operated, independent, or public safety), base location, flight volume, and job requirements.
A survey was mailed to 182 Association of Air Medical Services-member rotor-wing air medical programs in the United States that complete scene flights with a flight nurse. One-hundred-twenty-nine programs (70.9%) returned anonymous surveys, all of which were used for data analysis. Results were analyzed with descriptive and nonparametric statistics.
All pilots work shifts between 10 and 14 hours. For medical team members the shift distribution is: </= 8 hours, 0.4%; 9 to 12 hours, 44.2%; 12 to 16 hours, 7.0%; 17 to 24 hours, 45%; > 24 hours, 3.5%. An independent association exists between shift length greater than 12 hours and each of the following: flight volume per-aircraft under 731 flights/year, program model other than hospital operated, and nonhospital 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 nonhospital 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 nonflight clinical assignment while on flight duty is associated with a prohibition against on-duty rest (Fisher's exact test with Bonferroni correction, P < .05).
Notable differences arose between on-duty work and rest patterns for pilots and medical team members. Medical team members generally work longer shifts than pilots do, 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. Traditional hospital-operated programs are more likely to use shorter shifts and prohibit on-duty rest for the medical teams, whereas vendor-operated, independent, or public safety programs are more likely to use longer shifts and permit on-duty rest. As the industry works toward a unified approach to mitigating the impact of fatigue on safe operation, variable practices based on job description and program style may be a factor.
空中医疗团队提供全天候的重症护理，这种模式存在因昼夜节律紊乱和睡眠剥夺而导致影响工作表现的疲劳风险。安全是空中医疗行业的一个重要问题，但关于轮班时长和值班休息做法的数据却很少。我们报告了一项关于这些做法的调查结果，并按项目模式（医院运营、供应商运营、独立或公共安全）、基地位置、飞行量和工作要求分析了与机组人员值班做法的关系。
向美国182个空中医疗服务协会成员的旋翼机空中医疗项目邮寄了一份调查问卷，这些项目配备飞行护士并完成现场飞行任务。129个项目（70.9%）返回了匿名调查问卷，所有问卷均用于数据分析。结果采用描述性和非参数统计方法进行分析。
所有飞行员的轮班时长在10至14小时之间。对于医疗团队成员，轮班时长分布如下：≤8小时，0.4%；9至12小时，44.2%；12至16小时，7.0%；17至24小时，45%；>24小时，3.5%。轮班时长超过12小时与以下各项均存在独立关联：每架飞机每年飞行量低于731次、非医院运营的项目模式以及非医院基地（采用Bonferroni校正的Fisher精确检验，每项P<0.01）。所有飞行员在白班和夜班都允许值班休息。67.4%的医疗团队成员被允许值班休息：18.2%仅在夜间，49.2%在一天中的任何时间。任何时段的值班机组人员休息与非医院基地、非医院运营的项目模式以及轮班时长超过12小时均显著相关（采用Bonferroni校正的Fisher精确检验，每项P<0.01）。飞行值班期间存在非飞行临床任务与禁止值班休息相关（采用Bonferroni校正的Fisher精确检验，P<0.05）。
飞行员和医疗团队成员在值班工作和休息模式上存在显著差异。医疗团队成员的轮班通常比飞行员更长，轮班超过12小时是最常见的人员配置模式。医疗团队成员获得值班休息的机会也比飞行员少。传统的医院运营项目更有可能采用较短的轮班并禁止医疗团队值班休息，而供应商运营、独立或公共安全项目更有可能采用较长的轮班并允许值班休息。随着该行业努力采取统一方法来减轻疲劳对安全运营的影响，基于工作描述和项目类型的不同做法可能是一个因素。
