With the continued uptick in EMS accidents over the last few years, there is greater scrutiny on the pilots than ever before. A majority of EMS fatal accidents occur at night. Obviously, it is harder to see at night, but another factor is that pilots don’t always come to work fully rested. EMS has never been a time building job. It has rightfully earned the name “Earn Money Sleeping.” Given that you might fly only a few flights during your night hitch, it can become very easy to fall into the trap of not worrying about whether you get a good day’s rest. Hey, the lawn needs mowing and a storm front is forecast tonight so I’ll just stay up and do chores, you think.
Generally we can get some sleep at work, if not a full night’s rest. There is one reason you should not count on this. First off, you might not get to sleep at work as planned. There was one day I will never forget. The pilot on the opposite shift didn’t like nights so we almost always switched and I worked close to a full year solely on nights. I had a pretty good system that worked for me. If I didn’t sleep at work, I would come home and take a two-hour nap. I would then go back to bed after lunch for another four hours. On this particular day, my two small kids and wife were sick and I decided to stay up and help her. I felt the odds of my getting some sleep at work were good so I chose to stay up. Yes, I believed in my responsibility to be rested for work, but the weather guessers were calling for unflyable weather, so I gambled.
We received a flight request the second I walked in the hangar. No problem yet; I had only been up since 9:00 a.m. and there was time to sleep when we got back to base. After completing the first trip we get toned for a neo-natal. The weather guessers were wrong and the line of thunderstorms weren’t showing up until late morning, darn it. I was really counting on unflyable weather. After completing the neo natal, we get zapped for a scene call at 4:00 a.m. At this point, I should have just said I was sick and gone home. I was spent. Instead, I power chugged two more caffeine-laden Mountain Dews and hoped the adrenaline of landing in an obstacle-rich environment would keep me alert.
When I was landing back at the base, I realized I had been up for 21 straight hours. I was shaky while driving home and ran a stop sign I didn’t notice due to my fatigue-impaired state. I was a zombie. I can only imagine how well I would have reacted to any form of emergency that required quick and timely action. I then realized how stupid I was for choosing not to sleep the day prior. Sometimes good judgment comes about through poor judgment. This was one of those times.
Next, remember the med crews can see it in your eyes when you come to work tired. They may not have a clue about aviation, but they aren’t stupid people and can recognize when you haven’t slept all day. Let’s not violate their trust in us by risking their lives, along with ours, when we aren’t up to par.
No matter how conscientious you are about getting sleep during the day, the human body is not meant to sleep with the sun shining. Sometimes you just can’t sleep. If you don’t get a good night’s rest, then call in sick. It really is the only answer. According to the FAA, after 13 hours of duty the aviation accident rate is four times the regular rate. Humans make more mistakes the longer they are up. There is no getting around that fact.
How do we solve fatigue as a factor in helicopter, and particularly, EMS accidents? First, we need to recognize that some schedules are just not conducive to proper rest. A few programs are running split day/night schedules. For example: three day shifts followed by three night shifts. After getting up at 5:00 a.m. for three straight days it is brutal trying to sleep prior to the first night shift. Not just brutal, almost impossible due a little thing called the circadian rhythm.
Lastly, pilots need to realize the effects fatigue has on their ability to perform flying duties. Studies show that staying awake for 18 hours and driving produces the same effect as being legally drunk behind the wheel. The greater the sleep deprivation, the closer the correlation to higher levels of intoxication. If you are impaired due to fatigue, the professional course of action is to not fly.