Fatigue Characteristics and Perceptions in US Helicopter Air Ambulance Pilots

Helicopter air ambulance (HAA) operations involve shiftwork schedules that put personnel at an increased risk of fatigue. This survey study aimed to provide an updated benchmark for fatigue characteristics and perceptions within US HAA pilots. Pilots across the US HAA industry were invited to complete a survey related to their work and individual sleep-related preferences. Pilots completed the survey, including standardized questionnaires such as the Morningness-Eveningness Questionnaire, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index, during a larger field study. Our survey of 120 pilots across 21 operators revealed that poor self-reported sleep quality is an issue in more than half (53%) of the sample population. Most participants (71%) felt that fatigue was most prevalent on the return-to-base leg of a trip, and 69% felt that the number of flight requests was the greatest schedule-related contributor to fatigue. One-third of the pilots (34%) reported "nodding off" during a flight, and more than three-quarters (87%) said that their work performance had been affected by sleep inertia. The pilots provided suggestions as to how to mitigate fatigue risk through flight request limits, duty duration maximums, and sleep inertia protections. Overall, the results of this survey can be used to identify areas of fatigue risk to be addressed through operational policies and to highlight areas in need of further research.