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Fatigue Management

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Claude Preitner Senior Medical Officer Civil Aviation Authority Why talk about fatigue management What is fatigue Effect of fatigue Physiology of sleep Management ... – PowerPoint PPT presentation

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Title: Fatigue Management


1
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2
Fatigue Management
  • Claude Preitner
  • Senior Medical Officer
  • Civil Aviation Authority

3
Fatigue Management
  • Why talk about fatigue management
  • What is fatigue
  • Effect of fatigue
  • Physiology of sleep
  • Management of fatigue

4
Charles A. Lindbergh
  • The nose is down, the wing low, the plane is
    diving and turning. I've been asleep with open
    eyes... I kick left rudder and pull the stick
    back... My eyes jump to the altimeter...I'm at
    1600 feet. The turn-indicator leans over the left
    - the airspeed drops - the ball rolls quickly to
    the side...My plane is getting out of control!

5
Fatigue Kills !
  • 1993 DC8 _at_ Guantanamo Bay
  • 1994 Air Algerie 737 _at_ Coventry
  • 1997 Korean Air 747 _at_ Guam
  • 1999 American Airlines MD82 _at_ Little Rock
  • 2001 Crossair BAe 146 _at_ Zurich
  • 2002 Challenger 604 _at_ Birmingham
  • 2004 MK Airlines 747 _at_ Halifax
  • 2004 Corporate Bae Jetstream 31 _at_ Kirkville
  • 2004 Med Air Lear 35a _at_ San Bernardino
  • 2005 Loganaira BN Islander _at_ Machrihanish

6
NTSB
  • The effects of fatigue are particularly
    prevalent when all these three factors
    overlap...
  • The crew had
  • limited sleep in the previous 48 hours
  • been awake more than 19 hours during both day and
    night periods
  • to be at a high level of alertness during a
    period of time (3-5 PM) associated with
    sleepiness.

7
What is fatigue
  • Inability to function at ones optimum level,
    because physical and mental exertion exceeds
    existing capacity (P. Gander)
  • Multifactorial
  • Work duration and intensity (time on task
    fatigue)
  • Inadequate recovery sleep, which has cumulative
    and dose dependant effects
  • Working at inappropriate times in the circadian
    cycle

8
Measurering fatigue
  • No biochemical markers for fatigue, no
    breathanalyzer, no blood component
  • Electrical registration of
  • heart activity (ECG)
  • brain activity (EEG)
  • eye movement (EOG)
  • body core temperature
  • measurement of blood- and urine content of
    enzymes and hormones

9
Wegmann, Institute of Aerospace Medicine,
Germany, 1995
  • ECG showed increased parasympathetic regulatory
    trend, most pronounced during return flight
  • (indication for drowsiness)
  • EEG showed signs of increased sleepiness, most
    pronounced during return flight
  • Microsleeps (sleep-periods of more than 8 sec
    duration) were found in pilots 5 times /hour in
    average during the last part of the return flight

10
Medical Evidence
  • Overtime ? higher injury rate
  • gt12 h per day ? 37 increase
  • gt60 h /week ? 23 increase(Dembe A al, Occup
    Environ Med 200562588-595)
  • Safety and productivity reduced at night
  • Bhopal, Three Mile Island, Chernobyl, Exxon
    Valdez all at night !
  • Junior doctors 70 more than 50 h/week, 13
    more than 70 h per week. 42 clinical error in
    past 6 months.

11
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12
Factors influencing fatigue
  • Sleep loss, i.e lt 8 h per day
  • Continuous hours awake
  • 17 h awake 0.05 alcohol
  • 22 h awake 0.08 alcohol legal limit
  • 24 h awake 0.10 alcohol
  • Sleep quality sleep apnoea, micturition, pain,
    infant crying etc.
  • Circadian cycle upset jet lag night duty

13
Fatigue and flying
  • Lack of patience / snappy
  • More forgetful
  • Instrument cross check breaks down
  • Reduced Situational Awareness
  • Slows reaction time
  • Reduced G tolerance
  • Micro-sleeps

14
Fatigue Kills
  • Guantanamo
  • 18 h on duty, 9 hours flying
  • Stalled aircraft
  • Lear Jet
  • Vectoring after take off
  • ATC ignored warning of terrain
  • 8h shift, 7.5 h pause with no sleep, new shift
  • Challenger
  • Both fatigued
  • Ice on airframe
  • Little Rock
  • Landing in thunderstorm
  • Failed to arm spoilers

15
Sleep Phisiology
  • 7 9 h of actual sleep / night
  • Sleep loss is cumulative
  • Sleep loss and sleepiness can degrade essentially
    every aspect of human performance NASA

16
Sleep Cycle
17
Factors Affecting Sleepiness
  • Prior sleep
  • Prior wakefulness / stress
  • Alcohol / coffee / tea /coca
  • Environmental/work conditions
  • Medications
  • Age
  • Circadian phase

18
According to NASA
  • "Sleep loss and sleepiness can decrease physical,
    psychomotor, and mental performance, and negative
    mood can increase and positive mood can decrease"
  • It can lead to a reduced safety margin and
    increased potential for operational incidents and
    accidents."

19
Circadian Rhythm
20
Circadian Rhythm or Internal Circadian Clock
Circa about and dies day
  • Body functions follow a pattern through the day
    and night, fluctuating over app. 25 h (free run)
  • Hormones
  • Alertness
  • Heart rate
  • Body temperature
  • Bowel function
  • Body responds to zeitgebers (e.g. light)
  • Moving to a new light/dark schedule
  • (e.g. shift work or time zone change)
  • can create desynchronization

21
Circadian Rhythm - Efficiency
22
Asleep at the wheel car accidents
The distribution, by time of day, of 6,052
vehicular accidents that were judged by
investigators to be fatigue related.
From Pack et al. (1995)
23
Circadian Rhythm Disruption
  • Shift work
  • Jet Lag

24
Jet Lag
  • Crossing multiple time zones changes the
    zeitgebers
  • The bodys normal circadian rhythms are disrupted
  • Different physiological functions are out of step
    with each other

25
Circadian Adaptation
  • The internal clock cannot adapt immediately to a
    new time or to a duty/rest schedule change
  • The more time zone you cross, the longer it takes
  • Faster adaptation with westward flights because
    biological clock is longer than 24 hours
  • Faster adaptation when duty days progressively
    begin later each day

26
Factors Affecting Circadian Adaptation
  • Different people adapt at different rates
  • Evening-people adapt faster than
    morning-people
  • Ability to adapt decreases with age

27
Fatigues affect on operations
Circadian Rhythms
Sleep loss
Fatigue
Effects of fatigue in aviation operations
28
Fatigue Management SystemAlertness Management
Strategies
29
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30
ICAO
  • Fatigue management SARPS, in Annexe 6 - operation
    of aircraft - Part 1 - International Air
    Transport Aeroplanes
  • Current proposal for amendment by the Fatigue
    Risk Management Task Force (FRMSTF)
  • FAA
  • Fatigue management on most wanted list
  • Regulating flight duty time limit is not enough

31
Local legislation
  • SARPS Implementation via local (NZ) legislation
  • Part 141 requirement for operators to have a
    fatigue management system as part or SMS ?

32
Prescriptive Flight/Duty Limits
  • Address
  • Duration of work (time on task fatigue)
  • Duration of rest
  • Do not generally address
  • Workload
  • Circadian rhythms disruption
  • Sleep opportunities
  • Schedules
  • Life away from work
  • Safety risks associated with fatigued crewmembers

33
Do you have a fatigue management policy in your
operations that is endorsed by top management
?What about students ?
34
Big Problem
  • Expert consensus is that fatigue is
  • the largest identifiable
  • and preventable
  • cause of accidents in transport operations
  • (Åkerstedt, Carolinska University Hospital,
    Sweden)

35
Fatigue Risk Management System FRMS
  • An integral part of SMS designed to limit the
    degradation of alertness of the crew due to
    fatigue.
  • Science-based process and flexible.
  • Increase safety by reducing errors, incidents and
    accidents caused by low levels of alert.

36
What Can Be Done About It?
Training / Education Students !!
37
Example of Policy
  • Encourage reporting of fatigue
  • Allow withdraw from duty
  • Nap permitted lt45 (middle to long haul)
  • Shift work rotate forward i.e Morning evening,
    night
  • Code of conduct foroff duty rest
  • Students
  • Instructors

38
Alertness Management Strategies
  • Preventive strategies
  • Used before duty and on layovers to reduce
    adverse effects of fatigue, sleep loss, and
    circadian disruption (scheduling)
  • Operational strategies
  • Used in-flight to maintain alertness and
    performance

39
Preventive Strategies
  • Begin a trip /a shift as rested as possible
  • At home Layovers
  • Maximize sleep 1-2 days before departing on trip
  • Strategic napping can be very effective
  • 45 minutes or less, if just before duty

40
Preventive Strategies
  • Alcohol consumption can have major disruptive
    effects on sleep quality
  • Exercise regularly, but avoid just before
    bedtime
  • Avoid TV or thrillers before bedtime
  • If you cant fall asleep in 30 minutes, get up
    and engage in some relaxing activity
  • Dont just lay in bed and be frustrated

41
Operational Strategies
  • Strategic caffeine consumption
  • Best not to constantly drink caffeine before,
    during and after duty
  • Use it to best increase alertness
  • Dont use it when already alert (start of duty or
    after a nap)
  • Avoid caffeine near bedtime
  • Sensible nutrition and stay hydrated

42
Summary
  • A fatigued pilot has nothing to do in cockpit
  • A pilot will at best declare himself unfit
    for duty due to fatigue one day too late
  • A pilot should be nearly as alert for duty on the
    last day as on the first
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