Avoiding Fatigue in the Air: Smarter Shift Planning for Air Ambulance Teams

Fatigue among air ambulance teams, particularly in helicopter emergency medical services (HEMS), poses serious safety and performance risks. Smarter shift planning and enhanced fatigue risk management are vital to maintain both crew well-being and mission effectiveness.

Understanding Fatigue and Its Impact

Fatigue diminishes psychomotor vigilance, increases self-reported tiredness, and negatively impacts decision-making and operational performance — all of which can compromise flight and patient safety.

The primary cause is insufficient, poor-quality sleep, often exacerbated by:

• Irregular scheduling
• Long shifts
• Night work
• Circadian rhythm disruption common in air ambulance operations

Key Strategies for Fatigue Mitigation

1. Adequate Sleep and Sleep Hygiene

The most effective defence against fatigue is ensuring sufficient, high-quality sleep — ideally 7–9 hours daily without interruptions.

Sleep hygiene training helps crew members develop routines for better sleep despite irregular schedules, including:

• Minimising caffeine and screen use before bedtime
• Creating sleep-conducive environments
• Understanding personal sleep needs

2. Predictive Fatigue Tools and Monitoring

Using predictive fatigue calculators during daily pre-flight safety briefings increases awareness of individual and team fatigue states.

This enables proactive rota decisions, reassignment of roles, or increased supervision where needed.

3. Shift Design and Rotation Policies

Extended 24-hour shifts within HEMS can allow more in-shift rest opportunities. However:

• Shift rotation must be carefully planned
• Adequate time off between shifts is crucial
• Night shifts should be rotated fairly and spaced out

4. Task Distribution and Logistical Adjustments

On return journeys or repositioning legs, it may be beneficial to:

• Shift driving duties from fatigued paramedics to less-fatigued team members (e.g., doctors)
• Adjust non-critical duties accordingly

5. Lifestyle and Organisational Support

Supporting crews beyond shift design includes:

• Encouraging healthy routines outside of work
• Fostering a culture of fatigue reporting without stigma
• Supporting fatigue mitigation through leadership and policy

Conclusions

Fatigue is an inevitable challenge for air ambulance teams, but smarter shift planning can significantly reduce the associated risks.

A combination of personal responsibility and systemic solutions is necessary to maintain optimal performance and ensure both crew well-being and patient safety.