NEMSPA Fatigue and Sleep Management Survey Question 34 – Open Ended Responses

Conducted by

Survey Report Compiled by William Winn NEMSPA Administrative Assistant

November 2008

Introduction The following open-ended comments to the NEMSPA Fatigue and Sleep Management survey are presented separate from the other survey questions in order to to keep the file size and download times down to a reasonable time. Question 34. Please add any additional comments or suggestions you may have. Note that these comments may be eventually shared throughout the EMS industry. (To assist in assessing the 330 comments that follow, the table below groups the most numerous and (arguably) the most significant responses into six general categories.) Category

Comment Line Numbers

Pilot rest is a personal and professional responsibility Being able to sleep on shift is important to safety

2, 6, 33, 67, 83, 87, 88, 96, 101, 102, 104, 110, 112, 113, 114, 115, 129, 142, 144, 145, 175, 185, 186, 191, 223, 330 3, 7, 8, 12, 13, 15, 17, 18, 19, 24, 25, 26, 27, 28, 29, 30, 34, 38, 40, 41, 42, 43, 48, 52, 53, 54, 56, 57, 58, 59, 60, 62, 63, 69, 71, 73, 74, 76, 77, 78, 81, 82, 84, 85, 93, 95, 98, 99, 109, 118, 123, 124, 125, 126, 127, 128, 131, 134, 139, 143, 146, 152, 155, 156, 157, 160, 161, 168, 171, 172, 175, 177, 178, 181, 183, 189, 194, 195, 200, 213, 217, 221, 224, 226, 231, 238, 248, 258, 261, 275, 284, 289, 292, 294, 296, 319, 326 9, 52, 61, 70, 72, 80, 100, 182, 199, 239, 240, 242, 280, 294, 324

Shorter (3 or 4 ) sequences of night shifts are preferred Reaction to CAMTS proposal

Launch-time pressures Organizational/cultural

10, 12, 13, 14, 35, 51, 64, 72, 73, 89, 90, 91, 94, 99, 105, 107, 114, 117, 119, 120, 122, 125, 133, 134, 135, 136, 138, 147, 152, 158, 159, 162, 163, 164, 170, 171, 172, 173, 176, 177, 179, 181, 187, 191, 194, 196, 197, 209, 213, 214, 215, 216, 218, 219, 220, 232, 234, 235, 250, 259, 265, 267, 277, 283, 287, 296, 303, 309, 316 31, 35, 49, 55, 77, 120, 207, 212, 223, 268, 275, 285 32, 35, 56, 98, 100, 118, 161, 180, 209, 223, 274, 285, 330

1. Having been an EMS pilot for the past 20 years I have definately notice the effects of rest or the absense of it as being cumulative. Lack of rest has also just recently been shown to increase the risk of heart disease. 2. As a professional pilot "I AM RESPONSIBLE FOR BEING RESTED and FIT FOR DUTY" I don't need someone telling me how to do what I've done for 20 years. 3. Only solution is to allow/encourage/promote sleep whenever and as often as pilot feels the need. Sleep Inertia is not near the problem for me as fatigue/sleepiness, because I'm usually able to keep rested at work and at home. Except for busiest programs where several nights in a roll might be balls-to-wall, enough sleep opportunities occur to keep rested. Problem is, you can't regulate what a crew will do during time off. The possibility that sleep deprivation comes to work is always there. You have to allow opportunity for rest even during the day! Twelve (or even eight hours), why not rest if you feel the need, unless of course you're behind the stick. 4. I feel that coming to work rested and ready to stay awake all night if necessary is very important in this profession. I've known pilots who have second jobs during the day who have great trouble when they have a busy night shift. One, non job related, sleep problems have as I get older is getting back to my normal night time sleep after working nights. Being able to sleep all night and stay awake all day. Sometimes it takes almost my entire time off. 5. The killer that will likely never change is the fact shifts are 12 hours. 12 hour shifts are too long, with commute times and consecutive days rest is inadequate. 6. Can I stress personal responsibility again? Pushing uniform policy, such as when one can sleep, will not work because individuals operate differently. It isn't possible to force sleep, you can only help your staff manage their sleep needs. 7. Fatigue is an issue which needs to be addressed by the industry, both for pilots and Flight nurses/paramedics. Going from days to nights means that the first few nights the crew are not adapted to night shift and work at a diminished capacity, especially 2-5 am. Crews need to be able to sleep when assigned to night shifts. 8. I find sleep depervation to be a much greater issue than sleep inertia. My scheduled shift schedule is 2 days, 2 nights, 2 off, 2 days, 2 nights, 6 off. Change of duty: 6am & 6pm. That requires awaking at 4:30am for a day shift. At our program, all eight pilots work both base locations. Four pilots work the 16 day rotation described above. The other four work a modified 7/7 schedule. Two pilots work 3 days & 4 nights. The other 2 work 4 days & 3 nights so they match

up. We strive to limit the number of nights to a maximum of four, so as to mess with our biorhythms minimally. Occassionally, when working a greater string of nights (vacation relief, etc.) when we've had busy nights, my daytime sleep increases proportionately. On the flip-side when working a string of day shifts, I find myself going to bed earlier and earlier each successive nights. I've been an EMS pilot for 30 years. The first six years we had only two pilots and with the FAA exemption using retrosopective rest we typically worked 48hrs on, 48hrs off, 72hrs on, 48hrs off, 48hrs on, 72hrs off. The documented 8 hours of rest was far from quality. Occassionally, we had to ground the program for pilot rest as there was no relief pilot available. 9. I work a 6 on 6 off schedule, 3 days then three nights. I love it. I think it would be very difficult for me to work seven consecutive nights. I would be very fatiqued after 3 nights. With my normal shift, at most I feel a little fatiqued on my third night if I have been up the previous two. I then have 6 days of rest. If I get some sleep the first night, I find it easy to get through the other 2. I would not take a job with a 7/7 ( 7 days then 7 nights) schedule and I don't know why anyone would want to work one. 10. I have been in aviation for almost 40 years. My background includes military, with combat, Parts 91,135,& 121 flying. My combat flying netted me 900 hours+ of night time. I have flown Part 121 night freight in turbo jet aircraft. I flew Part 121 operations for a major airline for 20 years and flew many "Red Eyes". I started flying EMS helicopters in 1980 before going to the airlines. To say the least, I have quite a bit of night experience. I have seen these night and fatique surveys for the last 30 years, and the outcome is still the same- very little gets changed. We talk of getting our med crews involved helping to make sure obstacles are ovoided or checks are completed, but I have yet to see in an accident report identify the med crew as a causal factor. The long and short of it that most of these surveys are driven and concluded in favor of the coporation. CAMETS who preaches safety is now proposing that a rest period of twenty minutes is all that is necessary for EMS pilots during a night shift and that seperate quarters are not necessary. Thinking such as this is absolutely insane. These folks are beginning to believe eveything that they have wriiten about themselves. 11. I prefer the 7 day all day shift; week off; 7 day all night shift routine. I can acclimate to that better. 1st day off of night I do house chores and catch up on solid sleep. 12. Sleep is very important to the night operation, when pilots are able to sleep in

BEDS ,it keeps us the pilots alert , and will allow to perform duties to the best of our ablities, without this rest time the programs are just waitng for a accident to happen. with this said, CAMTS should never have control of the aviation side that the FEDS have given the part 135 operators control of. After conducting my own survey within our program, the nurses are saying the same thing, thay want us to sleep in beds for their own safety!!!They want us to sleep when possible in our own BEDS!!!! 13. The ability to have a quiet, private area for day or night rest, and to be able to grab naps when not flying to me is the single most important component to being alert and ready to fly - especially at night. I can not, for the life of me, figure out what CAMTS is thinking with this suggestion. With 19 years in this business, I believe I'm correct in saying you'll see many more fatigue related accidents if they prevail with this idea. 14. In my opinion, the CAMTS proposal is treading dangerously close to interfering with Operational Control. 15. Do not change a system that is working properly. Having a dedicated bed for the pilot to rest helps me stay well rested the entire shift while flying EMS. I am not able to rest in a recliner chair. The bases that I have worked that have this (duke lifeflight) I have felt much MORE TIRED the last half of the shift when compared to all the other bases that have beds. 16. Don't remove the ability for crews to rest comfortably. 17. I know it aggravates people that pilots may sleep while on duty, what's important is that a pilot who has the opportunity to nap when feeling fatigued is safer than one who is required to be awake even when there is nothing going on. I expect more flight turn downs due to fatigue or more fatigue induced errors on flights that are undertaken by a fatigued pilot who is afraid to say I'm too fatigued to fly. 18. There should be no limits on pilot's access to rest and sleep while on duty.The pilot should ensure he avails himself to an appropriate level of rest priorto reporting for duty.Note: I have over 40 years of helicopter flying experience,civil and military,with 20 plus years of accident free civil EMS experience. 19. We are trained to not take flights if we do not feel safe for any reason. If we follow in ernest our training. Taking away the pilots ability to rest when ever he or she sees fit would create an environment of no or limited night flying. The key is to eliminate the launch time pressure for late night flights and allow the pilot

to over come any sleep inertia. Some studies have shown a 20 min nap will revitalize you similar to a good nights rest without the sleep inertia. But multiple night shifts relying on naps in a chair or couch would be a recipe for disaster. 20. I do not agree with forcing a pilot to stay up at night. In fact, at my base, any crewmember can sleep at any time (day or night), and we encourage naps for the 24 hour duty standers. 21. Perhaps EMS pilots should only work 8 hour shifts. This might be tougher on the company, but better for the industry. 22. I know there is some talk about sleep inertia. Rather then have someone stay awake until the point of exhaustion and then get a flight, why not regulate that flights not take off for a minimum of 15 minutes after the initial call. Besides, how many accidents have occurred within this 15 or 20 minute window of sleep intertia? 23. A pilot must arrive for any shift as rested as possible. This is as important as fuel in the tank for a flight. 24. Sleep during the duty shift assists in reducing the fatigue accumulated during the seven day shift 25. for me, any sleep during my night shift helps me to function better 26. I worked at a program that had the "cat nap only" rule (Albany, NY) and We were not allowed to have a bed at all. We were working short handed and worked 3 days, 3 nights and 3 off(actually 2.5 off ) Fatigue went from accute to chronic, Tempers were continuously Flaring. There came a point where the pilots told management that we could no longer cover extra (vacant ) shifts. Once the bottom line was called into peril a bed arrived rapidly. As a relief pilot I go to many bases that are short handed, with pilots that are already in need of rest. I hopt that I do not ever experience that policy or see my any other EMS pilot go through that experience. 27. Dont think about taking the bed away from the job. It is not normal to work days then nights and be expected to perform 100%. I feel my present situation is adequete and does not need changed. 28. It doesn't matter if I'm working days or nights; if I'm fatigued it's nice to know that I have a seperate quiet place to lay down and take a nap. 29. I believe that it is important to have the option to sleep when not flying and a good room and bed to do it in when not flying. While I think sleep inertia is a

valid concern, I feel it is less of a concern than fatique in general. I fly fixed wing and there is generally a longer lead time before a flight in which to do planning etc, and work through the sleep inertia before the flight actually takes place. I think when working nights, fatigue becomes an issue more quickly than day shifts and it is important to sleep if you can when not flying. In my case, any sleep I can get at night while not flying is signifigant in combating fatigue during my week of night shifts. 30. I have been an EMS pilot for over 18 years. I have always had a bed to sleep in while on shift. I am much better rested and prepared for flight because I am allowed to sleep during my shifts. If I was not allowed to sleep during shifts I believe it would greatly degrade my ability to remain alert and safe. 31. If sleep inertia is a major problem, why not delay the launch by a mandatory five or ten minutes enabling the pilot to clear away the inertia? 32. The accident rate is not so much a result of sleep deprivation, or a disrupted circadium rythm as it is the disfunctional relationship between the medical community and the aviation community. The avation side is so eager to please the med side that in the end (in order to renew the contract) we let them do what ever they want (they have the money) , or we give them what ever they want (they want to help out the pilot in the cockpit ... read that as distraction)! Distraction and pressure, as a result of a "bad relationship" are the root of all the accidents in the industry. 33. The key element to pilot performance during a night shift is for each individual to determine a routine that works best for them. I strongly disagree with a "catch all" mandate that dictates what we should do during a shift to maintain alertness and acceptable performance levels. I believe I know best how my physiology works and what actions to take to ensure optimum performance in the cockpit. All pilots are regularly evaluated for judgement and performance by company check airmen, and on a dialy basis by the medical personnel we fly with. If we fail to exercise the appropriate ADM or flight performance, provisions already exist for appropriate action for additional training or to remove the pilot from the flight schedule. Universal sleep mandates are unwarranted, unenforceable, counterproductive, and in now way can replace the good judgement and ADM of the individual pilot. 34. In the opinion of this pilot removing our ability to sleep at work at night or during the day would be a knee jerk and a grasping at straws reaction to this years safety issues. Due to the imperfections of human beings and the dynamics and unpredictability of the flight and EMS environment this industry will never be

100% accident free. But that doesent meen we dont try to be. I believe that regulating and mandating a pilots sleeping habits at work will trade 6 of one danger for two dozen of another. Chronic and acute fatique is more dangerous than sleep inertia period. 35. Sleeping while at the job site should be encouraged rather than colored with terms, being allowed to "Rest" rather than "Sleep". Stop playing games, people need to be able to sleep without qualification at the job site, they need to be able to get up and shake the cobwebs out before climbing into the aircraft, that goes for both the Flight Crew and the Medical Team. That means of course stop starting the stop watch when the flight is handed off, lift times are not so important as getting there. Certainly launching in a timely fashon is necessary but not causing circumstances where proper preflght planning is skipped or creating improper shortcuts, the "Kick the Skids and get Airborn" attitude is contributing to our accident rate and needs to be done away with. Also CATMS needs to be informed that if they keep meddling into new territory that doesn't need to be meddled with, that EMS companies are simply going to demonstrate that they meet those standards without CATMS being invited to inspect in the future. 36. I still haven't determined the most effective way to transition from day shift to night shift even after working in this profession for nearly 5 years. Currently, I just get a normal night's sleep the night before and try to catch a 1 hour nap prior to my first night shift. This seems to work fairly well but there is the potential to be awake for 22+ hours (in a 24 hour period) especially on a busy night. I feel that this is one of the most important issues to the overall safety of the aerial EMS profession. Thank you for your assistance. 37. I know this may not have anything to do with the study, there should be not night flight without NVGs. It's so much less stressfull. 38. Requiring a pilot to remain awake while on shift, regardless of the time of day, is a dangerous proposition. Mainly because most EMS pilots work both day and night shifts, usually in the same month and often in the same week and never really reset their circadian rythem clocks to a nocturnal schedule. As a result, the pilot who works all night will compensate for the lost sleep by catching up in the day or on the following night. Also, most pilots will not stay up all night during their off duty periods in order to acclimate themselves to night work periods. If not allowed to sleep as necessary when feeling fatigued, a pilot will, not may, but will enter a downward spiral of progressively less attentiveness and effectiveness in his/her job, i.e. flying the aircraft. If one argued that a

professional pilot will always report to work in a rested state and therefore should not require additional rest while on the job, I would refute that by asking if additional time off after a long night of flying is being offered for the proper recouperation of the affected pilot. If one were to argue that sleep inertia is a flight hazard that needs to be addressed, I would agree, but not by restricting the sleep of a pilot which will lead to both short term and long term fatigue. Better to take a few minutes to wake up and improve the safety of the operation than to stay awake and degrade the performance of the operator. 39. I find that this old farmer likes the night time for sleeping but know that all pilots are different. Some can sleep at a drop of a hat and some struggle closing down the "system" to allow good sleep when tired. Some can jump out of bed and seem to not be bothered with lag time when with others they need a few minutes to pull their thoughts together. I personally try not to sleep much at work as I want to be "with it" when the call comes in. But working a long series of night shifts will really tire me out as I don't or can't sleep during the day. If the sun is out, I can't sleep well during the day so being able to lay down for a short time at work really benefits me for readiness. I have been flying for 42 years and find I am needing more down time than I used to. 40. It is important to have a place to sleep during night shifts. It would be insane to try to stay awake all night if it was a slow flying night. If a call came in at the end of the shift you would be a zombie. 41. Trying to make someone stay awake all night long if they are not flying would be fine if they were permanatly on night shift and never worked days. But otherwise is a ignorant idea and will lead to more mishaps. 42. When the EMS program at my location was first conceived, the vendor (which provided the pilots and mechanics) proposed a no sleeping policy. After the customer/client conducted some elementary research in the subject, they demanded sleep areas. Begrudgingly, the vendor complied. It's not much--a bunk bed in a very small room for 2 pilots. Very tight quarters indeed. But better than sleeping in a chair. Some pilots end up sleeping on cots they bring in and go hide out in the classroom. Some of the guys snore so loud that no one else can sleep. Most have resorted to ear plugs. Some will sleep in small campers they drive to work. In any event, there should be more sensitivity to the needs of crew-resting pilots. 43. After spending 24 years flying reverse cycle in the military and working other jobs that required me to be up all night i find that allowing pilots to sleep and then wake up when flights dictate is much easier on the body and reduces

chronic fatigue, which builds up when individuals spend long periods on reverse cycle. My experience shows that keeping individuals up for a flight that might not even come fatigues individuals without cause. Personally I find myself more fatigued when I'm forced to staying up than when I'm allowed to sleep. 44. NVG's and random drug testing for flight crews NOW! 45. Like many people that work a night shift,knowing that I have to work a 12 hour night shift does not really change my routine during the day, unless I was awake much of the night in which case I do try to sleep as much as I can so as to function on my next shift. Like most people we all have additional responsibilites outside of the workplace and it is a difficult balance. 46. It's somwhat difficult to shift from a day to night shift in jsut 24 hours. The first night is the hardest as it's almost impossible to sleep during the day of the first night. 47. encourage pilots to set up a day sleep pattern, and keep it whether they sleep at work at night or not 48. I have more trouble going to days then nights. We will always need to have a place to lay down if needed, but shouldn't come to work expecting to sleep. How stupid, besides a fire fighter job, who else goes to work to sleep. 49. ability to wake from a sound sleep & safely be airborn in a matter of minutes is not realistic 50. Sleep adaptation is what I have experienced, prior to flying EMS.I was a very heavy sleeper. Doing this for 10 years my somnabulatory habits have adjusted accordingly to be ready to awake, when nessassary. I am able to restore 'lost sleep' on my 7 days off somewhat, Training my body to shut down from the previous work habitat mode 51. This CAMTS proposal is possibly one of the dumbest things I have heard. There is little to any proof that any US EMS accident has been caused by sleep inertia. There certainly is a causal role of fatigue related accidents though. There are also numerous published studies that have documented that being awake for more than 12 hours straight can have a significant impact on health. There is ample evidence to suggest persons working more than 12 hours with out sleep begin to have a level of impairment akin to drinking. Sleep inertia has been shown to be avoidable by limiting the length of a nap to less than 2 hours. Not to mention science shows us that EVERYONE is tired from 1am to 3am, no matter if they are fully rested or not - we are not meant to be functioning at a

high level of alertness during this period of the night. To apply one single study in such a weak and reckless correalation, and then attempt to say it is a safety issue is poor leadership to say the least. NASA has done numerous aviation related studies about fatigue. The FAA and NTSB have studies about fatigue. Flight Safety Foundation and numerous other ICAO authorities have studies about fatigue in aviation. How can we propose something like this without reviewing some of this literature? 52. Although I realize that sleeping while on shift posses some risk with sleep inertia, I believe the remedies of requireing pilots to stay awake throughout the night shift will lead to more fatique problems unless there is a drastic and costly change to pilots current scheduling. Human beings do not naturally sleep during the day time. Additional pilots may need to be added to facilitate shorter schedules with less time on and off. Most people can handle a short amount of time with sleep deprivation without a significant loss of performance. Keeping these night shifts to a shorter range as recommeded by Michelle North, 3 day, 3 night, 6 off was the savest scheduled she concluded from her studies, allowing pilot rest times at work with 2 hour max napings while on shift at night to prevent or minimize sleep inertia problems. The problem arrises from wake ups within deep REM sleep as I understand it. Solution, prevent deep REM while on duty. Three night shifts max, would limit chronic fatique. 53. Pilot's should be allowed to rest on night shifts. Their responsibility in no les than med crews who are expected to sleep on duty. 54. I have been in EMS aviation for over 25 years and have only had to turn down one flight due to fatigue, and this ocurred during a family crsis. I know that the possibility exist that I may have to stay awake and alert all night when working the night shift, so I prepare myself for it by resting and sleeping during the day. I accept this as part of my work requirment. I have experianced sleep inerita once or twice in my career, and took adquate precautions to overcome this. It is my opnion from all of these years, that requiring the pilot to stay awake would be detremental to our safty. If it was such a good idea why is it not imposed on other jobs similar to our own such as firefighter, ems workers, nurses and doctors? It is idiotic to consider imposing this restriction on us while promoting it in other industries where alertness is so critical. 55. During my work week I dedicate myself to getting enough sleep but I know my some of my coworkers don't. For myself and my crew I believe it is extremely important to get enough rest but the long duty hours, commuting, and working nights makes it difficult. The best thing we can do is to go slow and ensure we

are deliberate in our actions when it comes to work. Requesting agencies need to understand that sometimes we are much better off taking an extra five to ten mintues getting off the ground to improve our level of safety and to reduce risk. 56. Pilots are individuals that need to find what works for them, in the shift aspect of what they work. The availability to be able to rest without higher level management input (being frowned upon) is a great stress reliver for my base. Knowing that I can easily lay down for a few as time/job permits is a great benefit to my overall out look on the job and my performance at my job here at the hospital. 57. I think fatigue is the number one safety hazard in my corner of the industry (rotary wing pilot) and I suspect many of our fatal accidents have been caused in some way by some level of fatigue and sleep deprivation (just my opinion). 58. The opportunity to comfortably nap/sleep during the course of a 12-14 hr shift is a vital safety feature of the two EMS programs that I have served in over the past 18 years. Over and above the obvious benefits of a refreshing nap (siesta in many parts of the world) midway through the shift there are times when a pilot may come to work not feeling 100% up to the days work - first symptoms of illness not yet dibilitating; ordinary headache; effects of personal, not job related stress which can be mitigated by a pre-emtive nap while awaiting a flight request. 59. I do not believe having the crew stay awake the entire night shift is a wise idea. 60. Fatigue and the effects therof on flying are well documented. In the long term, we need better regulations for scheduling. For example, if a flight originates or terminates after midnight the 10 hour rest peiod before return to duty is inadequate. It might even be prudent to take the pilot off the schedule the next day if he has been awake all night.This will certainly involve econmic impact on the operators and will be opposed. But that is how the rest of the world schedules their pilots. In the short term, not permitting pilots to sleep during night shifts flies in the face of decades of research and should be summarily dismissed as a ludicrous idea,hatched by someone who has obviously no clue about aviation or flying and is probably flying a desk somewhere now. 61. I trained nights and night vision goggles for 3 years where I worked from 7pm to 3-4am. It is possible for one to get used to a consistent schedule of nights and work/sleep accordingly. In my current job though, completely reversing out for one week out of each month sounds dangerous to me. This whole discussion of sleep inertia is ill conceived and a knee jerk reaction to other problems affecting

our industry. Thanks for doing the survey. 62. We need to be able to sleep at night during a shift. 63. I feel that the night pilot should be able to sleep when on duty. 64. CAMMTs is constantly getting into areas that they don't need to be addressing. They have a real credibility issue with some of the programs that they "certified and with the accident rate as high as it is. They aren't doing anything for the industry. Just being self fullfilling. I truly feel they are just a get rich organization and that Air Methods should wash their hands of them. 65. I believe that the average person is unable to get real quality sleep during the day time which makes it important to have a sleeping area available for the pilot at night. I have 22 years of EMS flight experience with half of that being on night shifts. 66. I can't believe we're even discussing this. 67. Sleep and fatigue are the responsibility of each individual. Trying to make a policy to fit everyone is like trying to make everyone like vegetables. If someone is abusing a rule, policy or sound safety practice then address it with the individual do not try and make a one size fit all policy that doesn't fit properly. 68. A well rested Pilot is a safer Pilot. 69. Again I would reiterate that any attempt at regulating sleep while on the job will be a big mistake, unenforceable and cause many to leave the industry, me included. I wll be more at risk to have an aircraft incident / accident if forced to remain awake all night to thwart the effects of sleep inertia. 70. If a pilot is expected to remain awake through a night shift, finds himself alone with the medical crew sleeping, and none of the usual social or work interactions taking place, he is going to sleep, doze, or otherwise not remain totally awake. Without a comfortable resting surface, such as a bed or a recliner, the pilot is not going to get any worthwhile sleep, and may indeed have musculature problems. Additionally, he will find he has to get good sleep during the day, or suffer the effects of chronic fatigue. So if he has difficulty sleeping during the day, problems will arise. 71. I think it's important to try and get some sleep on night shifts if possible. I helps keep my brain in synch with my body and the rest of the world. 72. The suggestion to limit/remove our ability to sleep between flights reveals a lack

of knowledge of the realities we face on this job. I'm pretty sure the people suggesting this are not active EMS pilots. 73. In my opinion, taking away the ability to rest/sleep, when able, will NOT have the positive effect on performance that CAMS expects. Trying to adjust a circadium rythm for 4-7 shifts won't work, period--irregarless of the type schedule in effect. The inconsistancies of flights numbers (at night), compounded by the expectation of a pilot to avoid rest when not performing flight duties, will only worsen the fatigue issue. 74. I'll get VERY cranky if you take away my bed. 75. Work at Hospital based program. Hospital often expects pilots & med crew to switch between day & night shifts to cover schedule. This contributes much more to fatigue than ability to sleep on duty. 76. In my entire career, I have never had a problem with "sleep inertia." I have felt drowsy during the longer enroute legs if I have had no previous sleep in the night. In my experience being awakened after at least an hour of sleep is much better than flying all night with no sleep. 77. Any sleep is better than not sleeping! I just make that I'm awake and functioning normal before I start the aircraft. 78. I think it is a very bad idea to try and limit sleep for pilots during the night shift. I believe the problem you are trying to solve will only get worse. Every individual is different and a cookie cutter policy is doomed to failure. If a pilot struggles with wakefulness after sleep, that should be dealt with on an individual basis. Some people can take a catnap and spring into action quite effectively. 79. We have a system that works!!! So why are you trying to create a problem were there is none!!!!! Only bad things can come from this!!!! Please find something better to do with your time and leave this alone, it is one of the few things that dose not need to be fooled with!!! If you wish to get people killed keep this kind of stupity going!!!!!!!!!!!!!!! 80. I have worked a variety of shifts from 7 days on / 7 off / 7 nights, 5 days/5 nights/5 off, 3 days/4 nights/ 7 off. By far the schedule that I felt most rested (without fatigue) was the 3 days/ 4 nights / 7 off schedule. It has minimal impact on the normal circadian rhythm and does not require you to try to go "reverse cycle". 81. You would be doing a great disservice to us pilots by trying to do away with

sleeping. I'll sleep regardless. If I need it I'll do it. 82. I believe especially during evening shifts we should have a quiet space/room to sleep in if not flying during that shift. 83. get enough sleep before reporting for flight duty. 84. Being able to get some sleep during the night shift definitely helps overall alertness and safety. 85. I believe any measure to restrict pilot sleep on shift is an attempt to fix a problem that doesn't exist. In my experience, pilots who are allowed to rest on duty have fewer problems with fatigue. Looking at accident statistics in EMS will also correct the absured notion that crashes are happening because pilots are "getting too much sleep". 86. I am the exception and not the rule, when it comes to being able to sleep during the day and come to work rested. I sleep easily and can stay up all night with no problem. However, I have pilots whose family life and normal sleeping habits make it nearly impossible for them to sleep and get completely rested for a night shift. These pilots look forward to bad weather or peaceful nights, so that they can rest. I think that these pilots need to know that it's okay to NOT take a flight if they are too fatigued. I just don't know if their ego's will allow them to make that decision. Good luck tyring to regulate "rest". 87. Fatigue is a factor that i have experienced while flying for the military but normally flew missions 8 hours or more at a time. EMS flights are short in nature and i have not really noticed this "sleep inertia" after taking any form of a cat nap during a night shift. The PIC should be trusted to evaluate both their own personal condition and their aircrew's to determine if a flight should be conducted or not due to fatigue concerns. 88. I think that pilots should have the abillity to choose what works best for them. After all we have different needs to do the job safe. 89. I believe that prohibiting the EMS community from sleeping longer that twenty minutes at a time will significantly increase the already high accident rate for the EMS community. 90. Forcing pilots to stay awake or limited to short naps during night shifts is the stupidist thing I have ever heard and is out of line. I will leave EMS work if this is enforced. Every person is different and should do what works best or them regarding sleep cycles and performance of their duties. CAMTS is the biggest

industry shakedown scam I have ever seen and this is outside of their area of expertise. I will be leaving EMS at the first opportunity. Thanks for doing the survey and taking up the fight. 91. campts needs to stay out of the 135 side of the house. We can handle ourselves quite well without the knee jerking of a non aviator! 92. I feel that there will always be some concern for fatigue in our industry simply because of the shifting back and forth from days to night which will affect our bodies biorythms. We are simply more adapted to daytime activities. Maybe looking at some data already available from studies in other emergency service areas ( Fire, Ambulance, etc.) may be useful. 93. There should be no sleep restriction on a pilot on duty. 94. I feel that the CAMTS opinion on sleep inertia are unfounded. 95. All the pilots at my base concur that being able to sleep is critical to the safety of the program. 96. We are responsible to provide ourselves to the workplace rested and ready to work. To often this is not the case. I try to do this but evan rested, I perform better with a short nap during the shift. This has become more apparent as I've aged. The environment must continue to support these "power naps." 97. Many questions in this survey are worded in a way that presumes that we are fatigued. 98. Pilots fought for years to have a room with a bed in a quiet place. DO NOT TAKE THAT AWAY. If it comes to that I would suggest that pilots NO LONGER WORK NIGHTS!!!! They let Med crews work 24 or 48 hours straight. Operators tell pilots to exceed 14hr duty days because they are Part 91. Tighten the standards for med crews and follow Part 135 rest standards to improve the rest of crews. 99. Continue policies that provide the capability for the pilots to sleep when time permits and when appropriate. This keeps the pilots from stacking up hours of sleep deprivation over time. Have pilot quarters environmentally controlled and private. Separated pilot rooms. For this pilot, a 7 day-night schedule and 7 dayday schedule lets me get on the schedule and have more consistent sleep habits for the shift verses a split schedule. Do NOT have medical crew members wake the pilot after 20 minute "naps". The pilots are able to control their own need for shorter or longer sleep times when afforded the opportunity. The sleep need is different for each person and should not be dictated. Some pilots do not wake-

up very well from any sleep event. Those pilots are aware of their unique situation and do not sleep during their shift. You cannot dictate a one rule fits all, with the exception that pilots will have adequate sleep/rest before conducting flight duties. 100. Our medical counterparts have no work limitations and sometimes put in ridiculous hours. This mindset creates a mentality which says that sleep is no big deal and can be caught up with at some point post duty. I believe this has some influence on pilots as well. I've observed several programs that schedule pilots for 7 or more consecutive shifts on a routine basis. I believe this is hazardous and unnecessary in most cases. I am currently in a 7 on, 7 off schedule and fought it prior to it's implementation. I lost the argument. The concept of circadian cycle needs to be discussed and understood in our industry. It is unheard of to turn down a flight for fatigue, you just don't do it unless your looking to explain why everyone else can do it and you can't. There's no known way to instantly adjust one's sleep pattern but we can control fatigue caused by excessive consecutive shifts. Thanks for addressing this issue and showing leadership. 101. I have always held the belief that it is my personal responsibility as a professional to get the proper amount of uninterrupted rest as possible, prior to reporting to duty for a night shift. 102. I think the biggest problem with fatigue is individuals not being able to identify when it is affecting them, and the extent to which it endangers their performance. I believe all pilots must sleep well prior to any day or night shift. 103. I like most people do better if I work all night shifts or all day shifts. It seems to make my sleep more of a routine. 104. I don't count on coming to work for a night shift, and plan on sleeping throughout the night, I am adamant about getting some sleep prior to my night shift, as to avoid being up for possibly 24 hours straight. 105. This CAMTS witch hunt on sleep deprivation and sleep inertia smacks of an organization desperate to justify its existence. Unfortunately, only one of the 17 Board Members, NEMSPA, has the background and wherewithal to understand that the CAUSE of most night mishaps is a lack of visual cues. Secondary considerations such as weather, complacency, mechanical failures, and fatigue are CONTRIBUTING, not causal factors. After innumerable, prolonged overwater searches at night in the Coast Guard, I'm here to tell you that the circadian ebb at 0300 - 0500 is real... removing mattresses and enforcing

a 20 minute map limit is NOT the answer. If CAMTS wishes to actually improve the odds for single pilot night flying, they should lobby for NVGs, SPIFR capable aircraft regardless of program designation, more instrument training, and a less punitive stigma attached to inadvertant IMC. 106. Poor sleep efficiency and circadian disruption are KNOWN factors that adversely affect mental efficiency. Why are they rouitinely ignored in the industry? 107. I think the proposed CAMTS changes are ridiculous. Once again people who have nothing to do but sit in an office and make some stupid rule need to get out and actually do the job so they understand the difficulties. 108. I work closely with 22 other EMS pilots. We have one pilot that works as a spare pilot, days only because he can not rest during the days and feels his performance is to degraded to work at nights. Our management respects his decision and keeps him gainfully employed during the month. I think rest should be left up to each individual profesional pilot. 109.

Not allowing sleep during duty is stupid and will be ignored

110. Profesionalism during your off duty hours cannot be over stated. By being prepared to fly every minute of my assigned shift, I feel greatly enhances safety 111.

The privilage to nap at work is great when I'm on my 6th-7th shift

112. Don't rely on the ability to sleep at night while on duty. Show up to work rested, and use the priviledge to "keep the edge". 113. I feel as a professional ems pilot, that I need to get adequate rest during the day if I am to work a night shift. I have blackout drapes at home and run a fan for white noise so that I may sleep all day if needed while working nights. It has worked sucessfully for me for the 30 years I have flown ems. I feel any pilot flying ems should have the same dedication. 114. It's every EMS pilots responsibility to successfully prepare your daytime environment in order to achieve the maximum amount of rest as possible. We owe the medical crew and patient our best effort with this, it's a matter of integrity and professionalism. It's rediculous to think taking the bed away, or any other way of limiting the amount of sleep a pilot can get during a night shift, would or could, positively influence safety of flight. 115.

30 years EMS, Fire, Military Aviation and Civilian Medivac. Learn to

function after getting woke up or find another line of work. 116. I personally think that a 6/6 shift split between days/nights makes little sense. I think we should work 6 days/6 OFF/6 nights. Makes a lot more sense for sleep cycles. 117. Refer to previous statement concerning CAMTS in prior question. I feel very strong about this statement. 118. I wish to state emphatically that questions 5 and 6 are entirely flawed and the results will skew your study. Question 5 should have an answer available that says "it doesn't". Questions 6 should have an "NA" answer available. There are those who are able to fly in environments where they are not taxed to the point that they become fatigued. By the grace of the Almighty, I happen to work at one of those programs. With day sleep and the ability to sleep at worrk when the opportunity arises, I am able to remain rested. I have called in sick to work one time because I was too tired to fly. This was after a 4 or 5 night stretch of night shifts and I was unable to get any sleep that day due to circumstances beyond my control. 119. Taking the bed away, and/or restricting sleep at work on nightshift would be highly detrimental to safety, well-being, morale. 120. This is an addendum statement to my previous survey. The obvious point....does the mishap data demonstrate that we've crashed aircraft within 20 min of "waking-up"...I suspect it doesn't....so CAMTS position is moot. Furthermore, CAMTS bases their premise on the "10 min" launch criteria...the CCE's will tell you, such a requirement doesn't exist. Interesting that the more obvious recommendation would be to propose for the aircraft to launch within 30 min at night (if the aircrew needs to overcome "sleep inertia" (I still giggle over that term), if they were so concerned about safety, but that doesn't appear to be on the table. I'd also be curious if they're [CAMTS] recommending pulling the beds out of hospitals for the residents and hospital staff and keeping them to 12hr shifts before they treat or operate on someone...human performance is human performance. 121. I have found that even 1 hour of sleep helps keep me alert on nights that go for 12 or more hours. 122. I always get to take a nap before I start a night shift. If I need a quick power nap during the day, I take it and never feel groggy after waking up. I am a light sleeper and don't suffer from being groggy when the tones go off at night, I

must get a adrenaline rush or pop because I have never felt sleepy while flying at night. The flights are too short for that. I did feel sleepy while in the Coast Guard during 6 hour searches at night but never during my EMS career (8 years). I think taking the abillity to sleep at night away from the pilot is very stuipid. Talk to the crews and see if when they are looking at the night pilot falling asleep in the chair at 2 am and see if they want to go fly with him. 123. I feel that I perform better for those early morning flights after a few hours of sleep rather than staying up all night and then flying. 124. The ability to grab a short nap, or full night sleep while on shift (if needed) enhances my ability to perform at my peak performance! 125. Most EMS pilots work so few consecutive night shifts that it is impractical to attempt to acclimate away from a normal circadian rhythm. Thus, any sleep/rest that can be obtained during the night shift is essential to minimizing fatigue while at the controls. Daytime naps help, but cannot replace a full night's rest. The solution is to work as few nights in a row as possible, and sleep, nap, or rest whenever possible, in whatever fashion minimizes fatigue. The suggestion by CAMTS that we not sleep at all to "remain alert" is assinine, and effectively guarantees that pilots will fly in an exhausted state whenever they are on a night shift. Daytime rest is hard to attain when you're used to sleeping at night, and it makes no sense to try to "reverse cycle" oneself for the relatively small number of consecutive night shifts that most of us work. I work four nights in a row (about my limit), sleeping/resting whenever possible to insure alertness when I'm flying -- I find that sleep inertia is not a problem for me, because I don't sleep that soundly while on shift, and the adrenalin jolt of the phone call and mission assignment is more than enough to fully wake me up quickly. 126. Company provided sleeping quarters, including a bed in a private room, are the best measures to address fatigue/ safety related concerns. Allow the individual pilot to decide whether or not to sleep while on duty. This serves everyone's best interest. 127. I feel that being able to relax or sleep in between flights keeps my crew and myself much safer than trying to fly when tired. 128. My sleep habits on duty seem to be either 20 min nap periods or approximately 2 hour rest periods. I tend to rest when workload permits and my body says it's time. Fatigue sets in after a particularly busy night and the pace slows down. The drive home is sometimes the most dangerous part of the job.

129. I feel that a pilot for his safety and the safety of the crew should be responsible and mature enough to get the proper rest that puts him in a position to be safe and alert for each and every shift that he or she works. If he or she cannot perform at this level then maybe a career change is in order. When you report to work you can not hope to have a quiet night, but must be prepared to have a night where you flly all night 130. Physical fitness palys a large part in ones ability to deal with fatigue and stress. A moderate level of fitness can delay the onset of both. The ability to conduct cardio and strength training during duty hours (30-45 minutes out of a 12-hour shift) would be beneficial. A base having a home gym and an elliptical trainer or treadmill would provide crews the ability to achieve and/or maintain a higher fitness level. Lets face it, we spend a considerable time "sitting around" even when performing work (computer training or studying). Other than washing or servicing the aircraft, unless we are on a flight we're sitting and waiting. That's the nature of the job. A little physical training during the shift (day or night) would not fatigue an individual, it would have just the opposite affect by increasing alertness and allowing a better sleep when off-shift. I have done this in the military and it worked very well. 131. any policy that restricts the pilot to sleep during a shift is not tolerable. any rest during a shift can only help the duty pilot 132. My flight performance has never decreased due to sleeping while on shift. 133. Even if the sleep area is gone I will find a way to sleep on the night shift. Taking away the bed and telling me to stay up all night will create a negative atmosphere. One of the most ignorant ideas I've ever heard. 134. Without significant manning changes, the need to effectively schedule EMS helicopter pilots makes shift flexibility extremely important. The ability to switch from nights to days and back is critical. Sleeping as much as practicable during a night shift allows the pilot to maintain a more flexible schedule. My belief is that the sleep inertia problem is not best solved by removing the potential to attain a restful sleep on any given night. This concern is best dealt with by maintaining good physical fitness, nutrition, and careful practices when waking late at night, ie; take that extra minute or so to do a proper walkaround, grab a snack that you can pop in your mouth as you go out the door, preferably wholegrain or veggie. 135.

I believe it would be foolish to prevent crewmembers from getting sleep

at work if possible. Our current scheduled work week (4 days, 3 nights) would not be possible as it would be virtually impossible for most people to switch to a night schedule in a 24 hour period. If a policy of "no sleeping" at work was implemented it would force crewmembers to spend two days prior to starting nights to get onto the "night shift". 136. I'm assuming that this is some knee jerk reaction to the recent rash of HEMS mishaps. I was a school trained Safety Officer and Mishap investigator. I've seen far too many times, supervisors making baseless changes and implementing initiatives which have no foundation to increase safety after a mishap....they're just "feel good" initiatives. I would categorize this "sleep inertia" as one of these baseless "feel good" initiatives. If you want to make an impact, I would recommend the two following suggestions which I believe would have a dramatic impact upon safety (for the positive) in our profession: 1. Standardize the aircraft cockpits withing the respective companies. In the span of 1.5 weeks, I flew 3 different AS-350s. Our base aircraft, a spare and then did a workover at another base. All were B2s...but the differences were dramatic in the cockpit layout and configuration. This can reduce pilot situational awareness (e.g....instead of the pilot normally spending 90% attention outside cockpit and 10% inside...in an unfamiliar cockpit...he might now spend 30-40% inside and 6070%...and thus miss wires, towers...etc. 2. No MORE NIGHT SCENE CALLS TO UNSURVEYED LANDING SITES. What I mean by this is no more landing on highways, roads or unfamiliar areas at night....we didn't do this in the military during peactime....too great a risk. Wires and hazards, to the most vigilant pilot are invisible. For night operations, force counties and municipalities to double and triple pre-designated LZs this will ensure landing sites free of dramatic hazards. Strategically located throughout counties....then after an MVA...drive the patient to a pre-designated LZ for loading and subsequent transport. 137. Despite the science behind "sleep inertia" it is still better to try and get a "cat nap" during duty. (day or night) Recognizing the affects of sleep inertia and taking it slow when necessary are vital elements in pre-flight planning and prep. Thanks! 138. CAMTS seems to be focusing on a subject that doesn’t need to be addressed. It is oblivious that CAMTS is a medical run organization with little to no Aviation input. There is a greater chance of harm to patients from Nurses and Paramedics that work 24 hour shifts after working 24 hours at their other Hospital or EMS jobs. We turn down more flights due to medical crewmember fatigue than we do weather or pilots fatigue.

139. The ability to sleep or nap at night is a positive benefit and increases both overall long term alertness and health, as well as positive attitude towards being on duty for the night shift. 140. Some guys come in to sleep. You have to be able to be awake and able to safely fly the entire shift because occasionally you will be up all night flying, doing maint or other reasons. 141. I keep myself on a predictable pattern of sleep as much as possible so as to not disrupt circadian rhythm. We don't fly much at night. 142. Being at the base for 12 hours on a 'slow' day or night shift results in boredom/lethargy that, in my experience, can be easily countered with a nap. During a busy shift with no time to nap, I find that I tend to be more alert than on the slow days when I haven't taken a nap to pass the time. I do make it a point to ensure that I am well rested for both day and night shifts and do not 'plan' to be able to rest while on shift. 143. Most of the time I am honestly trying to rest during the day if I am on night shift that night. Sometimes, however, it is difficult to sleep during the day, even if I have been up much of the night before. In those cases (which aren't typical) I think that it is important to be able to sleep in between flights. Otherwise, the fatigue factor would greatly overshadow the sleep inertia factor in my opinion. 144. I think ensuring that a pilot is ready for duty is a personal decision. I take it upon myself to ensure that I am as ready as possible for each shift, day or night. I also think a straight 7 on 7 off, 7 day 7 night shift is the best shift schedule to accomodate proper rest cycles. It worked in the military and it's working for me now flying EMS. 145. I think it is important for each person (Pilot, Nurse and Paramedic) to understand their own circadian rhythm. This will allow them the ability to make good decisions on preparing for Night Shift work by getting the prerequisite sleep required for them to function at an optimal level. 146. Being fully rested is very important to this industry and getting sleep or rest during the shift is just as important 147. Our program flies as much if not more during the night shift as they do during the day shift so sleeping on duty is rare, though welcome. I think this entire subject (sleep inertia) is B.S. for those of us who work shift work regulary. I generally sleep with one ear open listening for the next call, assuming I get to lay

down at all. If I do get some sleep I am that much better prepared and alert for when I do get a call. It seems to me that this study refered to didn't evaluate those of us that do this kind of work week in and week out. I don't think that restricting or limiting crew rest will do anything towards enhancing safety. 148. 14 years of Special Operations service has conditioned me to sleep when I’m tired and be totally functional when I wake-up. I am an extremely light sleeper and do not think I have ever suffered from Sleep Inertia, regardless of the activities or inactivity of the day/night or duration of my sleep. Studies show that after a brief nap productivity is increased. There are also numerous studies conducted by the military which reinforce this. 149.

this survey would be better if it were anonymous.

150. Survey questions are not that well designed. Remember, we all have a life we are trying to live! The job is a means for this life. The important thing is that you need to be sufficiently rested prior to duty, so you can keep going all night. And when you do, the next day is used for resting, assuming you come back for concecutive night-shifts. If I get some "bonus rest" during the night, I can get up and do yard work or whatever your hobby might be. I think it is important to NOT have comittments you can't change during your period of nightshifts. If you have a second job or other plans you can't change, you will soon end up with sleep deprivation and cronic fatigue that will definately affect your performance. Education and self dicipline are key factors here. Restricting rest periods during shifts is not a good solution. In some cases it might be necessary to restrict outside employment that takes place in between the typical 12 hour flight shifts. What some people seem to not understand is that the comittment of a outside job is much differrent then performing work that can be taylored based on your level of rest at any given time. In addition, different flight programs have significantly different flight "patterns". It is routine for me to fly all night. Some programs have a typical weather pattern that precludes much flying after 1-2 in the morning on a normal basis. 151. Additional comment on question #33. If the night time weather is forcast to be below minimums it sometimes affects my daytime sleep habits. 152. I work a 7-on/7-off shift. Each on-week I work 3 day shifts followed by 4 night shifts. I always assume that I could be flying all night long, and therefore take a nap during the day prior to my night shifts. However, my biological clock cannot simply switch to daytime sleeping during these four days, and therefore I am unable to sleep more than 2-3 hours during the day unless I actually do fly more the night before. When that happens, I ensure that I get more sleep during

the day to make up the deficit. However, I typically am able to sleep 6 hours during a night shift, making my 2-3 hour nap adequate. Sleep inertial has not been a serious problem on duty. I recognize it when driving to work early in the morning, but the adrenaline factor when getting toned-out for a flight (we get toned-out for every type of call) seems to cut right through the inertia. It's usually on the return leg home that I feel the most fatigued. And the level of this fatigue seems directly related to the amount of sleep I was able to obtain (bank) before the flight (a combination of my nap and night sleep before the flight). For example, worse-case scenario would be to get toned-out for a longer flight right about when I was getting ready to go to sleep for the night (11pm-midnight, typically). I would be returning to base around 3-4 in the morning with no prior night sleep. Fatigue would probably be a factor. That would contrast with going to sleep at, say, 11pm and getting toned-out at 2 am. In my experience, I would be less fatiqued during the flight in the latter case. Forcing myself to try to stay awake all night would be disasterous, fatigue-wise, to me. Sleep inertial _is_ a problem, but in my opinion a relatively small one compared to the state my body would be in were I forced to stay awake all night. There is no way that for the eight days out of the month I fly nights I can convince my body to sleep all day and stay awake all night. This is completely unrealistic. Studies have shown that it takes weeks, if not months, for the human body to reverse its natural circadian rhythm. They have also found that the best thing to do if when that's not possible is to try to bank as much sleep as possible. I have found this to be true in my experience. 153. This survey contends at 1st that we are sleep deprived and grogy when waking up. Not true. 154. Personally I find that the transition shift from days to nights is the most dificult night shift. I feel the transition in and of itself induces some level of fatigue. 155. In EMS and there is no guarantee that a pilot would have any chance to sleep and therefore should be ready to fly all night if asked, however that does not preclude the benfit of "down time" and a nap to maintain alertness. A bunk room affords a pilot a quiet area to either catch a nap or decompress after a long or taxing flight. The sleep that one gets while on shift generally is not as deep as the sleep one gets when they know that they will not be inturupted but even short naps can benefit ones mental state and focus. 156. Sleep inertia may have a little validity but it ABSOLUTELY PALES IN COMPARISON TO DOING THIS JOB WITHOUT THE ABILITY TO SLEEP. YOU WOULD

HAVE FLYING ZOMBIES IN THE AIR IF SLEEP WERE NOT ALLOWED DURING THE SHIFT. 157. I appreciate the fact that beds/rest areas are available for the EMS pilot...there have been studies that have shown that napping at the workplace is especially effective for workers who need to maintain a high degree of alertness, attention to detail, and who must make quick decisions...in this respect, allowing the EMS pilot to sleep in the evening in a comfortable, sleep inducing environment helps with the circadian sleep cycle theory..... 158. Those that work the night shifts must prepare by getting sufficient rest during the day; enough that would provide them with little or no alertness problems if they were to be flying all night. The notion that more restrictions are placed on this industy by CAMTS or any other organization instead of company training, education or other non-legislative means to affect a change is bordering on ridiculous. 159. This proposal is obviously a knee jerk reaction by people who don't really understand what problem they are trying to solve. If they want to increase the accident rate then by all means force people to sleep in uncomfortable environments because everyone knows people are going to sleep regardless of some idiotic "20 minute rule". This is an issue in which I would not hesitate to participate in a strike. Otherwise, I will turn down any flight request that comes in after 2 AM. 160. I know I have a bed and a recliner at work to nap in if needed. I do not count on getting rest because we are normally a very busy program. I make every effort to sleep during the day when I work nights, just as I try to sleep at night when I am working the day shift. Although I do not use the sleeping quarters every night, I do appreciate using it when necessary. By the way, my wife appreciates my being rested before flights so I can be safe and come home and I am sure our insurance company does also. 161. Allow pilot to sleep. Consistant schedules, minimize relocations of crew. I think the real danger is in not allowing pilots to sleep. As bad as sleep inertia is, numerous scientific studies have shown sleep deprivation is worse than drinking alchole. EMS industry tends to be "cheap", and would not pay night differential. To be done properly, pilots should be hired for a night shift only. As it stands now, pilots rotate between day and night and can't "adjust' to any schedule. Availability of caffeine, e.g. coffee, soda's etc.

162.

CAMTs should stay in the hospital and out of the cockpit.

163. I've been doing this for 12 years, If they take away my bed I'll do something else. even if I only get one hour of sleep at work it helps me to fly safely. 164. The issue of sleep inertia has been around for many years. As you state in the beginning of your survey the are many varied opinions. As far as I know there is no evidence to date that sleep inertia has been a factor in any of the recent HEMS accidents. There is alot more research needed before anyone, especially CAMTS, can say that this is a factor in any HEMS accident. 165. Question 5 & 6 assumes I let fatigue affect me. You should have a not affect selection. Bad questions. 166. Cant sleep during night shifts? May be time to find a day job. Good luck finding pilots willing to work EMS. 167. The only "fatigue" I have felt in EMS flying has been from having duty for several days more during a month than usual. This is regardless of how much flying I am doing; it is just the length of a duty hitch longer than eight or nine days being a drag on the system. It actually seems to be worse when there is less or no flying. 168. I strongly support the ability to sleep during shifts. I thought that the industry had put this issue "to bed." as a result of previous studies that proved the importance of sleep vs accidents. Thank you for this survey, I hope it forwards the industry to a safer standard. 169. Never push personal limits(know your limits); take naps often; if able to recognize that you are making numerous, small mistakes, that's a sign that you need to take your self out of service; listen to your crew about what they see in your behavior and performance. 170. I have read the CAMTS proposal and strongly disagree with its substance and premise. 171. It takes 4 or 5 nights of being up most of the night for me to be totally "Reversed out". I am absolutely positive that getting to sleep during the night shift even if it is only a short nap keeps me more alert than if I stayed up all night. I've been doing medical evacuation for 12 years now in the military and in the civilian and I don't know of anyone that would prefer to stay up all night. I would guess that this issue was brought up by someone other than pilots that

actually do this job. 172. Having the ability to sleep at night and also nap during the day is 100% beneficial to the safety of a flight program. A program where the medical crew is required to work in the ER or on the floor between flights is a hazard. It degrades the safety of the entire crew because they are tired. It also degrades crew coordination, which in the area of Night Vision Goggles has a significant impact on performance. In my program, we tend to take naps during the day at slow times so everyone is rested and functioning together properly as much as possible. Looking at the accident histories, very few are in the beginning of the flight. Most occur on the return trip home as the adrenaline wears off. Fatigue is an issue. Not allowing crewmembers to sleep, or severely restricting the conditions that allow them to get proper rest (ie no beds) is detrimental. There are many Military studies supporting the fact that rest and proper sleeping conditions enhances safety. Please contact me if I can do anything to assist in stopping this totally inappropriate standard from even being considered. Any rational person that has ever performed as a flight crewmember knows that rest and sleep are necessary to allow the crew to function as close to 100% as possible. This suggestion to restrict rest and limit resources has no basis in fact and is repeatedly indicated as counter-productive to a safe operating environment. 173. I believe that this issue is something CAMTS needs to keep out of. The power of a "safety nap", even during the day shift, cannot be overstated! Each and every person is different in their sleep patterns. Additionally, each base/site situation is different. One size fits all won't work in this case. Some people just can't seem to wake up fully even if they have been awake all night! Let the crewmembers rest whenever they need to. Just imagine the accidents/incidents if no one was allowed to sleep. 174. My napping technique continues at home. As flight activity increases the percentage of sleep at home increases naturally. I let the job requirements dictate the where/when I sleep. There is no way for me to answer one of you're previous questions properly. There is nothing interrupting my daytime sleep 25% of the time. That isn't an option in the question. 175. As a professional pilot I know what is expected of me as far as coming to work ready to be awake and working an entire 12 hour shift if need be. Not only does my Medical staff have expectations of me being ready and rested for work more importantly my wife and kids want me to be as safe as possible at work. I think that having a bed in seperate quarters, and having no restrictions as to

how I use it, can help prevent more fatigue later on in the week of my shift. 176. The proposal to keep pilots awake at night in the interest of safety is counterproductive and totally absurb. This proposal does nothing to resolve a lot of accidents which we all know are night weather related. Why not do something which could possibly solve that problem like raising the night weather minimums to a level that would keep one out of trouble. 177. I feel any rule that would prevent rest, or sleep/relaxing during the night would adversely impact the normally body functions and safety would be compromised. A little rest is better than none. I thought this issue was addressed by military safety studies in the 80’ that concluded that sleep or rest during slow periods were more productive and enhanced safety than “saying awake” 178. As EMS pilots, particularly single pilot operations, we need to have the best possible rest quarters available to take a nap or to sleep at night to be the most prepared for all eventualities of our job. This includes an environment that is air conditioned or heated, as applicable, to a comfortable level. I just finished a 24 year career in the Coast Guard and these tenants were preached and practiced and allowed us to safely execute flights in all weather conditions during the day or night. I have found that my current EMS program has successfully achieved this environment and comfort level. Having a bed to nap or sleep as well as a comfortable lounge area is paramount to continued flight safety. Another helpful feature that my current program employs is to have the flight planning tools in the sleeping quarters room with the pilot - this is an improvement from my Coast Guard experience. 179. The idea that requiring a pilot to limit their sleep on a night shift to 20 minute cat naps is detrimental to safety. If a pilot is coming to a night shift so tired that they can not perform their job, this is an individual problem, not a collective one. Most pilots, myself included, show up for work at night prepared to fly the whole night through. When I am allowed to sleep, which we are at my program, I go to sleep earlier than I would while at home, and this allows me to get as much sleep as possible before getting wakened to do a flight. When I have been up all night, the 0400 flights are more difficult than when I have slept from 2200 till 0400 and then been requested. Even 2 to 3 hours of good sleep refreshes me and allows me to function at a high level. I am actually more awake after 2 -3 hours of night sleep than I am after a 2 - 3 hour nap in the afternoon before coming to work. Humans are daytime creatures and to try to force us to become night time creatures, on a limited basis, is unrealistic and unsafe.

180. Our base has only had three pilots out of a possible four for the last year. We have been working eight on, four off during this time. All of us are relatively young and have been able to maintain a good level of safety despite this schedule. However, as the year progressed, we did not necessarily see a decrease in awareness, but rather in increase in our tendency to become annoyed with relatively small issues. As fixed-wing pilots who have flown extensively in our home area, we understand the importance of making sure we are alert when flying in an around the surrounding terrain. I have stressed to my pilots that I will support them if they call in sick on any shift feel like they cannot safely complete a shift safely. I have made it a safe environment for them to do so and they have taken me up on that offer several times. I believe it is important for the pilots to view each patient flight as if they were flying one of their own loved ones. If they would not want a pilot in their condition transport their spouse, sibling, parent, etc in the condition that they are in, I tell them to turn down the flight or call crew rest before a flight is assigned to them. 181. My understanding that the reason for this survey is in response to a nurse with CAMTS wanting to do away with sleeping or napping by EMS crews, by removing beds and lounge chairs ect. I feel this would be a huge mistake! and lead to an increase in possible accidents due to sleep deprivation. Reverse cycle shifts are difficult to adjust to, by not being given the option to sleep I am concerned that some people will not be able to function at peak performance. In discussing this with other team members we feel this is a policy that if implemented would lead to an increase in accidents in the aero EMS industry. Doing this job safely last time I checked was our # 1 priority and just because a nurse with camts probably wants to get their masters or PHD or is irritated because the base they work at does not allow sleeping and has come up with a stupid idea that they want to make mandatory, without any input from the industry is just plain reckless! If this is the direction that camts is going in, then my recommendation to my employer is that we need to seriously look at dropping out of camts as a program and use common sense in how we approach problems, rather than going off with halfcocked ideas. We are an EMS organization just like fire fighters and ambulance drivers who are allowed to sleep during their shifts. People need to understand their limitations when it comes to sleep and work. Some are able to function by cat napping or getting fewer hours of sleep, others require a full 8 hours of sleep. Some people just don't function well at night regardless of how much sleep they get. People need to understand those limitations and take appropriate actions. Camts meeds to take a hard look at its self and decide if it wants to help the industry or just become another bureaucracy that hinders the safety of the profession with red

tape and the loss of common sense. By adopting policy's without discussion and input from the people most affected by them. 182. A split 7 shift schedule (4D/3N) is by far superior to straight 7D or 7N shift work. The 24 hour period provides for internal battery recharge of the human body. This opinion comes from working all the different combinations. 183. I, for one, have difficulty sleeping during the day. Removing the bed from my quarters will not improve that situation; it will only make the fatigue issue worse. 184.

never plan on sleeping on night shift!!!!!!

185. Don't report for duty expecting to be able to sleep. I always go to work expecting to fly during my shift. My job flying is the most important thing. I recover during my days off. I take care of myself and don't report for work if I don't feel well or if I am too tired to safely do my job. 186. I think every pilot should take the responsibility of insuring that they get the proper amount of rest before reporting to duty. Hoping you don't get a night flight is no excuse to push the sleep deprivation envelope. 187. CAMTS should make the same proposal to fire departments across the nation and see how that goes over. 188. Sleep inertia was an issue when I was a new EMS pilot. Now, I sleep so lightly that I rarely experience this, however, I find I need more than eight hours of EMS sleep per day. ie. several hours sleeping soundly at home after a shift. 189. Pilots' should always be afforded the opportunity te sleep.rest during a shift. Too much attention will be focused on sleep intertia if we let it happen. Sleep inertia affects every pilot differently. Allowing sleep during shifts keeps us safer than tired pilots pusing fatique. Just look at the trucking industry for comparison. 190. From question 33. If I did not fly the night before I will sometimes have a much shorter nap and active day. I always give my body the opportunity to sleep as much as it needs the morning after a night shift. If I flew a lot, I sleep a lot. Bad scenario is "I need to get things done today". It's important to treat the days when on night shift as rest first, then use extra time as able before working that night. 191. Sleep requirements vary from person to person. Trying to find a blanket cure or fix for fatigue will be impossible. As aviation professionals, it is our

responsibility to know our own needs and limitations for attaining the rest we require to do our duties safely. I take great pride in the pilot I am and the dedication of performing my duties safely. To have someone other than the FAA try and impose a requirement on how I perform those duties is absurd. Hopefully what the FAA already has in place will be sufficient. 192. in preparing for a night shift I always plan that I will have to fly all night and ensure that I have plenty of day rest. Cat naps at night ensure that I am well rested for the flight and any follow-on flights for the night. 193. Pilots need to night shift seriously and not "expect" to sleep on shift. The day should be for rest only, not extracurricular activities. 194. taking beds away and requiring us to be up all night is stupid and unsafe. see you in the GOM if that happens. 195. I feel it is much better to sleep when you can and deal with the short term effects than to stay up and continue to get more tired as the night goes on. 196. Allowing non-aviators to dictate aviation policy -- including rest periods and rest areas -- is patently stupid! 197. There is a greater chance of me turning down a flight at night due to fatigue if I am required to stay awake during a night shift, than if I am allowed to sleep until a request comes in. 198. No real comments other than I do what I need to do to ensure that I am in the best state possible for my night shifts... 199. I have found the best work cycle to be a split cycle, either 3 days then a 24 hour break and 4 nights or 4 days then 3 nights. That 24 hour break sure helps. Also, if you are flying a lot during the night portion, you only do it for 3 or 4 nights before you are done. That is a lot better than 7 straight nights! 200. Sleep inertia is a temporary condition. If I begin a flight after being awakened from a deep sleep. I quickly overcome any grogginess and can complete the flight with a sharp mind. Fatigue is something that continues to effect a person's performance for a longer time. If I am fatigued when I begin a flight I will probably be fatigued throughout the flight and be susceptable to all the negative effects of that fatigue. I would think that the effects of fatigue are very similar to the effects of sleep inertia except that you don't quickly overcome fatigue. 201.

It is difficult to define rest without sleep or sleep without rest. I am

personally a night person and some times sleep as often during the day portion of my shifts as the night portion. I have suffered the effects of sleep inertia, but that has occured about 3 time in the last 11 years. 202. Mandatory minimum time off between night and day shifts, and a minimum amount of nights or days in a row would help me to prevent fatigue. 203. I realize there are abuses of sleep due to extra jobs. More with medical crews than pilots. As noted, any sleep a pilot can get on duty is good. 204. circadian rhythm plays a role. Some of US are night people. I personally am one of them. I sleep better during the day and prefer to work nights. WE should be given a choice if possible on what shift to work without concern that we are trying to get over on everyone else by having our days off. Some of your questions are invalid (left unanswered) because they will skew the data since you assume we have flown fatigued etc. Also, some EMS bases fly 14 days (7 days followed by 7 nights). Nothing is anonymous. NO NAME if you want the truth! Pilot with a PhD (Biomechanics and Human physiology) 205. In my opinion, sleep inertia and fatigue are not responsible for the accidents EMS is experiencing. I believe it is night conditions, scene landings and marginal weather. 206. I think the night shift should be limited on the amount of flights each crew conducts. 207. People should not wake up at day and especially night and expect to be in the air in 5-10 minutes that is dangerous 208. This is not a problem. it seems to be the cause of the month. I have seen no incidents or accidents where fatigue has been an issue 209. I do not believe sleeping during night shift work is detrimental to flight safety at all. It is my belief that the most significant issues with night flight are the lack of NVG use industry wide and internal (personal) and sometimes external (company, management, or medical personnel) pressure to accept flights in marginal weather conditions. Also, IFR currency and practice is of paramount importance to night flight proficiency, confidence and safety of flight in areas of weather volatility. Due to cost constraints, most companies will not promote or supply IFR training and practice for VFR programs. The use of helicopter simulators (VFR and IFR) would be a major and positive impact on helicopter night flight operations. Training redundancy, particularly for IFR and inadvertent IMC skills, are the only way to effectively reduce the horrific accident

rate of the last few years in this industry. In addition, I also believe everyone is different, some pilots do better staying awake while on duty, while some do better with sleeping or napping between flights while on duty. That goes for both day and night shift. Question: How do you regulate those differences? If it is mandated that no sleeping be allowed on duty then those that do perform better when sleeping is allowed are now compromised by regulation. The potential risk factor to flight safety goes up for those individuals. 210. I consume a sleep inducing diet during the night shift and concentrate on REST. 211. As I stated before, changing my sleep cycle from day to night then back again would degrade my performance more than staying with a night sleep cycle. Studies have shown that you cannot change your sleep cycle with in one week time. Trying to change my sleep cycle from week to week would be more difficult for m me than just staying with a night sleep cycle. If I did not feel rested or alert enough for flying then I would turn down that flight. I would not take that risk knowing that I am not able to fly safely. This type of work is like no other type of work I have ever done before flying EMS. In other words this is not like a manufacturing production type of job. If I worked 2nd or 3rd shift in production, and I have before, then I would set my sleep cycle for that schedule. EMS is not that type of duty. If I was flying just about all night every night then I would be able to modify my sleep cycle to meet the need of the duty. I hope this information helps the study for the purpose that NEMSPA needs. Thanks 212. circadian rhythms associated with night shifts have a huge influence on alertness at 4 AM in addition to sleeping during the day. In 39 years I have never found a "perfect" solution to night shifts. Awake some nights, napping some nights is problematic for EMS pilot shifts. Extend launch times at night to deal with sleep inertia. 213. My first priority is to show up at work rested. My experience has been that the best way to do this, without having to make a complete day-to-night sleeping schedule shift every two weeks, is to get as much as I can at work on night shift, then make up the rest by an extended nap at home. As I stated before, the CAMTS proposal to have pilots get almost all their sleep while off duty, necessitating a complete shift back and forth from day to night sleeping, would play havoc with a pilot's circadian rhythms, and would cause fatiguerelated problems that make sleep inertia look insignificant. 214. sleep inertia is a moderate concern as oppossed to the chronic fatigue generated by multiple nights in a row of working a 10-20 nap cycle to prevent

sleep inertia. 215. Please ensure that non aviation personell do not control or attempt to control the pilot's sleeping habits. The FAA and my company handle that well. 216. CAMTS is crazy. Have we brought the FAA & IHST into this. I know they can't regulate, but maybe they can influence these bureaucrats who haven't recently done a series of night shifts. What [are they] citing as [their] evidence??? 217. Knowing that I may be called to fly at any time, I sleep lightly at work. While resting at home, knowing that I won't be disturbed, I sleep more heavily and feel the affects of sleep interia when I awake. Quality of sleep is different at work and at home. I rarely fall into a "deep" sleep at work. Pilots who have long driving distances and are working successive days, will take advantage of having a sleep room available to them. Their other option is to get a hotel room at their own expense, or risk the fatigue associated with driving to and from work. Our mechanics have taken advantage of the sleep room after getting called in the middle of the night to perform unscheduled maintenance. On more than one occasion, I've stayed at our base, rather than drive home and back, due to severe weather considerations such as blizzards and fog. I thought that the safer choice. Finally, this sleep interia seems to be related to Deep sleep. As I mentioned earlier and with speaking to other pilots, the quality of sleep on the job is different than that at home, so I'm not sure if I ever get into a deep sleep very often. Finally, maybe CAMTS should apply the same standard to the medical crews who often come in tired and are found sacked out in their office or in the hangar. 218. CAAMTS does not and cannot regulate any sleep patterns or sleep areas. They can make suggestions but cannot enforce them because they are not a regulating body such as the FAA. The FAA states that there must be proper rest facilities for pilots. Even though they do not state that there is a "rest requirement" for sleeping, it would be foolish for anyone to abide by these rediculous CAAMTS recommendations. If a pilot is tired, they are the only ones who can say if they need a nap or a long term sleep. CAAMTS is not a regulatiing body and cannot enforce any sleep regulations. Doing so would jeapordize not only the pilots personel safety habits but would also give them the perceived power that they can try to regulate areas that do not pertain to their "jurisdiction". CAAMTS does have some good recommendations but they are not a regulating body and no matter what they may suggest, they have no final say in the outcome, unless you just HAVE to be associated with an organization that

already has too much power over flight operatons becuase you want their sticker on your aircraft. I would rather see individual flight programs survey their own people and come up with their own recommendations. There should never be an outside force trying to persuade or convince any group or individual that they know how much sleep someone else needs. That just isn't intelligent. 219. Our program owner has stated that they will drop CAMTS accreditation if the proposal to remove beds is adopted. I heartily support this position as for CAMTS to state that it is better to not sleep flies in the face of REAL experience. 220. The CAMTS suggestion that 10 - 20 minute naps is better then a few hours of sleep is wrong. 221. I've worked other night jobs that do not allow for naps during duty time. I've found that between 0300 and 0500 I almost always hit the "wall" when I've been required to be up all night. During my EMS night shifts, I've found that I'm more alert during these critical hours if allowed to nap during work hours. 222. I did not feel the effects of rotating shifts, or length of shifts were explored enough in this survey. 223. I believe I have the responsiblity to be adaquately rested to be able to safely perform my pilot duties. With rare exceptions, I don't count on getting rest at night, and try to get at least 7-8 hours rest in every 24 hour period. I will occasionally make exceptions if it is obvious that we won't have the weather to fly overnight, but I am careful about taking this gamble. Regardless of all the above, I strongly believe that response times should be increased for night flights. Night missions are the most hazardous HEMS missions and we should do all we can to increase the safety factor for these flights. Unfortunately, the philosophy from our customer management is we should just stay awake all night because "I am not paying you to sleep." I believe that in a large number of programs there are often (maybe the majority of time) nights when there are long periods with out a flight if any flights at all. To expect the pilot to just sit up and stay awake all night is not only not logical, It may be just replacing the risk of sleep inertia with fatigue due to not resting when able. 224. I think that it is necessary to be able to sleep as much as necessary during a shift when not flying or performing a needed task . 225. My worst time for fatique is night shifts between 0300 and 0600 especially if I had little sleep the day before and I was busy most of the night. 226.

Long lifespan at this job in my opinion requires the ability to sleep at

night. My body is used to sleeping at night so when it get dark outside for a while my body likes to sleep. If I need to I can wake up quickly and be alert by the time I get to the aircraft to fly. I would be very opposed to a job that alternates between night and day shifts without the ability to sleep while not required for flight duty during the shift. 227. Remember the airline industry is looking into Safety Naps, "cat naps" during flight with two pilots. The military allows it now on some flights now. 228.

The most tiring time to fly is from 0200 to 0300 on until sunrise.

229. I do believe that EMS pilots all try to relax as much as possible when not flying so we can be sharp as possible when we are called upon to go. 230. I think that a small number of pilots do not have the self discipline for this job. They will put their personal business before the job. Not only that; but they will come to work and share this with the med crews, "I was out mowing the hay on my farm all day" or "I hung dry wall in three rooms of my rental house today" These bad apples ruin it for the rest of us who take crew rest; and the rest of this job seriously. I am ex-military, and I find the retired military to be the worst culprits. They treat this job as a "hobby". 231. Everybody is different in the amount of sleep needed. Being able to sleep on duty can ensure that a crewmember is well rested for the flight. 232. Requiring pilots to stay awake for an entire night shift, regardless if they have flights or not, is insanity. I can't believe it is even being considered by, supposedly, intelligent people. 233. If you even think you are "warding off" a cold or flu-like sickness, please don't come to work. If you don't have sick days, or PTO, maybe someone can trade a day with you, or whatever. Flying when you're sick is dangerous, and will get you sent home quickly at my base. Nothing is more important than your family. Be around for them. 234. Restricting a pilot from sleeping during a night shift would be counter produjctive and would adversely affect safety. Cat naps are of no use in my opinion, and only make me feel more fatigued. 235. CAMTS is barking up the wrong tree on their proposed "nap only" plan for pilots and 12 Hr duty day for Medcrew. Our company already looks the other way on the 24 Hr max shift for Medcrew if it means the base will be OOS. If we aren't flying, we'll be "resting" regardless of what CAMTS says. Work smarter

(SAFER), not harder! 236. The ability to get into a set pattern of 7 staight nights getting a nap during the day and a couple of hours rest most nights. Makes a very easy to handle set of night shifts. 237. I sleep randomly when I want to without restriction. I feel good all the time. I've had occasions of multiple back-to-back flights that have kept me out for nine hours straight. Allowing for random rest keeps me ready for unforeseen situations such as this. 238. My drive is 2 hours round trip, duty time with briefings and such is about 13 hours, eat/say hi to the kids 2 hours, an hour to get ready before shift, that leaves six hours if sleep continuosly the rest of the time. NOT GONNA HAPPEN, that means i'm flying around on 5 or 6 hours of sleep for seven days in a row if I don't get any sleep at work. That's ok at walmart but probably not a good idea with our accident rate. My two cents. 239. I definately try to get as much sleep as I can during the day. I always plan on working all night. This is a difficult schedule for me to stick with for a long period of time. I think that our bodies are programmed to sleep at night and I know that can be overcome but on a 7 day off schedule you are not going to stay to that schedule of sleeping during the day and being awake all night. It would be much healthier to stay on that schedule for months at a time but we don't allow ourselves to do that. Another option would be to only do a couple of night shifts like 3 days and then 3 nights so that you get enough rest, are alert for your night shifts but then it doesn't catch up to you and be physically draining like if you were to do multiple nights in a row even with adequate daytime rest. 240. this is the bussiest ems program in the country. we work 2 on 2 off 3 on 2 off 2 on 3 off. we change from days to nights only after a 3 day/night off shift.we have little or none of the problems referenced to cause this survey. i've been at this program 21+ years 241. The rest time acquired during a night shift is imperative to my ability to remain alert and feel somewhat rested when switching from regular shifts to reverse cycle shifts as I do every other week hitch. 242. Split shifts seem to be the best. We work a 3 day.4 night or 4 day, 3 night with 7 off. Problem is that there are always OT shifts during your time off and those shifts alway seem to be tacked on either end of the off stretch. Pilot rooms are usually the smallest room available which usually means you are resting or

sleeping with a computer buzzing two feet from the bed, and about a dozen blinking charger lights. Seperation of sleep quarters and office would do wonders. 243. General physical fitness greatly improves your ability to sleep both day and night. Get into a program that helps you do some excercise on a regluar basis. 244. Promote self awareness and readiness to climb into the cockpit. We are individuals that have varied needs for both rest and sleep. Sugestions yes, mandates, no. 245. Is NEMSPA a safety oriented organization? This is ludicrous in an industry such as this. If you are not actively engaged in flight at 2am, are we to deduce that the cure to fatigue would be to stand at attention and wait for a call? Are we going to hire a sleep monitor for quarters to come and kick us if our eyes close for more than 20 minutes? How long between 20 minute periods? If there is a tendency for Can't we find other studies that make sense for our industry? 246. I will always sleep before reporting for a night shift. Usually, after my first night shift, regardless of the sleep I got on shift, I will sleep at least 5 to 6 hours, usually more, at home before reporting for duty, so that I am well rested and ready for my shift. I try not to allow fatigue to even become a factor in my duties. 247. I'm just one of those people that can't sleep well during the day, no matter whether I'm up flying all night or not. The most I sleep during the day is 3-4 hours max. It's amazing what adrenaline can do to a persons body. 248. I notice a significant improvement in alertness and endurance while flying during the critical "DARK" hours of 0100 thru 0500 if I have had at least 1 hour of sleeping rest prior to that flight. 249. I have been flying for 41 years and have over 18,000 hours. My number one reason for having "close calls" is from flying sick or tired. I learned my lesson from my own "close calls" and will never fly sick or tired again, regardless of the urgency. If I am sick or tired I will call in sick or turn down the flight. The number one lesson I can pass on to younger, less experianced pilots is to understand that they can and should turn down a flight if they do not feel rested.. 250. I don't drop in to a sound sleep when on duty. Knowing that the tones could go off keeps me in a light sleep. The ability to "rest my eyes" is crucial. If I

were a night shift only pilot, then I would adjust my schedule. I don't think regulating whether I can or cannot sleep should be done. 251. I think pilots with families at home and their schedules will have a harder time finding that good , quiet rest time compared to pilots with no at home families and their schedules. 252. Pilots should make every attempt to report to work rested. Don't plan on being able to sleep during the night but, if possible, sleep if you can. I do feel sleep inertia if I wake up from a sound sleep, but it seems to wear off in 10 to 15 minutes. During that time I just slow down and follow appropriate procedures. That is not the time to try to rush yourself. Dealing with it for a few minutes is much easier and than dealing with the feeling of total fatigue. 253.

Every Pilot should should try to sleep on his or her night shift

254. I think fatigue mitigation not sleep inertia is a larger problem. I think nearly 20 years of studies and dozens of transportation safety experts have agreed with that notion. I would like to know whether it is anectodal informatin or evidence based decisions that have casued the concens with sleep inertia. 255. Proper diet and maintaining your body in the best physical or at least a good physical condition will greatly help. Self discipline and ensuring you get the adequately required amount of rest for your idividual body composition will help prevent fatigue in most cases, not all but most. Don't try to maintain a day job while working your night job. If a second job is needed then schedule that job during your off days. 256. Having done Medevac in the Army for 8 years and civilian EMS for 15 years I have discovered that it is extremely important for me to get at least some sleep prior to a night shift, but not enough to go into REMS. 257. I try to sleep during the day before starting a night shift. I never know what the night shift will be like. But having the ability to get a couple of hours of sleep is a good safety valve and allows me to be more rested for the remainder of the night. We have three aircraft on all night within a short distance of each other so if we fly a significant amount we can call our crew off duty for the rest of the evening. Our dispatch will automatically begin to shift flights to other crews if we fly more than about three hours or three flights. If we are needed however (no other crews available) they will give us a flight and ask us if we feel good enough to take it. If not we can cancel without repercussions. If we made a reasonable salary we would not have to have a second income.

258. Our company schedules four weeks of nights, then four weeks of days...typically. We also work M,Tu...Fri, Sat, Sun, then alternate the next week working We, Thu. When working nights it's difficult to switch over to a night schedule because on your days off you go back to a day schedule to accomodate family demands. So getting rest at work, while on a night shift helps to reduce the amount of sleep deprivation you would otherwise experience. The sleep I get at work is not usually a deep sleep that is hard to wake from. Rather it is light where I wake up often due to other radio traffic and ambient noise. It's important to prepare for a night shift as much as possible, getting rest, but we need to be realistic about how much rest an individual is getting when adjusting from days to nights and after several days off. The pilot's must ultimately manage their condition and determine whether they are safe to fly or not. 259. We can’t do much to change our circadian rhythms—not unless we gradually shift to a completely night schedule (like the military does when preparing for extended night operations). This shift takes about 3 weeks to fully take affect which is unrealistic considering that pilots will most likely not adopt a night schedule on their week off. That being said, it is important to get rest (when able) during the low point of your circadian rhythm. I would submit, that even if you’ve rested well during the day (which is important), your ability to remain alert during the low part of the night (after 0200) is seriously degraded. I believe that sleep inertia is much less of a factor than acute fatigue. Furthermore, sleep and fatigue issues are not just a factor during the night. Fatigue issues can be experienced during the day—especially with high temperatures and after multiple long flights. Throw some food into the mix and now you have an insulin response in the afternoon which can make you extremely susceptible to the effects of fatigue. An afternoon “powernap” (only about 15-20 minutes) is an amazing way to recharge. I’ve yet to nod off on an EMS flight, but the times I nodded off in the military were all mid-afternoon flights—task UNDER-saturation (not enough going on to get you on edge). Flying in a mountainous environment, it’s a little harder to get complacent at night and nod off b/c it is a much higher workload. I hope they don’t take away beds, recliners, or rest areas as I believe these promote safety. If they do, I’ll just go out and sleep in the aircraft anyway—I mastered that art in the military! 260. I sleep during the day "in case" I have to fly all night. It happens. I have in the past had difficulty staying awake, and don't take chances with night shift anymore. 261. Foremost, in my experience it seems that it is most detrimental (alertness declines quickly and fatigue sets in more quickly) when I try to force myself to

stay awake, whether it be during day or night shift. The need for sleep can result from the body's sleep cycle, or it can be induced by a long or stressful flight or a series of flights. Caffeine or willpower can delay the onset of decreased alertness and sometimes that is necessary regardless of preventative measures. But I try to minimize those occurances, as the inevitable "crash" will require a longer and deeper sleep period. Also, the effects are cumulative: repeated periods of "forced alertness" take longer to recover from, sometimes requiring two or three days. I feel it is essential to be able to sleep when your body requires it. The effects of sleep inertia (when responding to a flight request) are minimal; plus, your body is transitioning to a state of reduced alertness to a state of hightened alertness (again, adrenalin greatly reduces this time period). The alternative is staying awake and thus trying to stave off fatigue... your body requires some amount of sleep, and in forcing yourself to stay awake, you are constantly fighting that transition from a state of increased alertness to a state of lowered alertness. I feel this is very dangerous and should never be required of any crewmember. Unfortunately, our medical crewmembers have a 'no sleep' policy because they work for the hospital and they still work shifts on the ambulances as well. In becoming aircrewmembers, they have quickly realized how draining even a single flight can be - especially in the summertime. The combination of hightened concentration, stress, and altitude (in addition to self-imposed stresses) during flight affect the body in a way that cannot be fully appreciated by people who do not experience it. As with pilots, the work of medical crews is of a critical nature and mistakes can cost lives. Thus, I feel that the medical crews, at least while assigned to aircrew duty, should not fall under the "no sleep" policy. 262. I feel that an exercise and proper diet program or wellness program could help in the ems community. 263. Maintain a good exercise program to remain physically fit. Eat a good breakfast as it is the most important meal of the day. Don't worry, fly happy. 264. In my opinion fatigue is directly related to how busy your program is. I am most likely to feel fatigued after multiple nights of after midnight flights. This is a rare occurence at my base. 265. With all the issues we currently have in EMS the fact the we are even having a discussion about removing the bed for pilots use is ridiculous!!! 266. Waking up to do shift change in the morning is often the worst thing for getting good continous sleep.

267. Significant issues will immediately arise if EMS operators restrict pilots from sleeping during shifts. Crewmembers will sleep anyway. Why set anyone in this industry up for failure? 268. Almost all EMS services have a time established for the time it should take from accepting the mission to take off. These times are only goals but they are looked at regularly by the bosses. The time set as a goal for a night flight should be at least twice the time set for day flights and require pilots to slow down during night flights. This would help to reduce mistakes. At our service we also tell our customers to put us on standby when it sounds like their initial call meets protocol. This allows the crew to get up and wake up and now they are ready if needed. 269. I have worked community base and hospital base programs I have found that medical crews while they might be wish they could sleep while on shift like knowing their pilot is well rested. I also have have met fellow pilots that have outside work that keeps them from coming to work well rested. Which at onetime I could understand because most pilots had to work two jobs to make ends meet. Since pay has made some significant improvements over the past three years I think we have gotten to the point that Pilots should be encourage to work only one job. I think it is important and studies have proven that a short nap can be very benifical to combat fatigue. I think at the very least a lounge chair with a quite area to take a short nap is a very positive thing. Pilots should always come to work expecting to work the full 12 hours of their shift and they should thus make sure they are well rested prior to their shift. It is part of being a professional pilot. 270. I believe that having a good place to rest/sleep between flights and flight related duties during both day or night shifts is very important to enhancing safety for EMS flight operations. 271.

It's good for me to have a place at work for periodic rest breaks.

272. As I get older, I have a harder time switching from days to nights. We normally are scheduled to work a 7/7 schedule, but we are short of pilots and sometimes work a 10 day schedule. I schedule pilots for "All Days or Nights" so the sleep cycle isn't changed. When working nights, I myself, if I'm tired will take a "safety nap". I have never had a problem getting up if we get a call. Sometimes during the day I can get 4 to 5 hours opf good sleep. Sometimes I'll sleep for 2 hours, wake up for a while, then go lay back down again for a couple of hours. In the Army when going on reverse cycle we were told by safety and others that it takes 1 day to accomodate for each time zone change. If I'm working on a night

shift during a normal 7/7 hitch, a couple of days before I go on nights, I would stay awake longer at night so I could adjust to the night schedule. There is no easy answer. When I work at night, I do have things to get done during the day. One other thing. I hear some people say that if you don't have a patient you can come back Part 91 and you don't have to worry about the 14 hours duty day. (This is not in my company, but others.) Your body doesn't care. 14 hours of duty is 14 hours. If I had to, I would call it a day if I was tired. 273. There should not be restrictions on allowing crew to rest to be alert for a call at night. to me that is more dangerous than forcing a pilot to stay up late. 274. My company considers a drive of less than 90 miles to any base as rest time[part of the 10 hour rest requirement], leaving 6-7 hours at home between shifts. 275. Presently, I'm allowed to take safety naps whenever, and I'm provided a bed for night shifts. If this were not allowed, I would be very concerned about the effects of fatigue on my performance, to the point of looking elsewhere for employment. Fatigue can be a problem anytime, day or night. If a pilot is too tired to fly, they shouldn't. If they're just somewhat fatigued, pilots just need to be cognizant of the effects of fatigue on their performance, and develop good habit patterns. When they recognize they have some level of fatigue, they need to remember to complete their tasks with more thought than they would when they are fully alert (eg. take more time to check the weather, read the checklists more thoroughly, make a second scan of switch settings prior to engaging the start switch, etc.). Any companies out there that are still pushing "off times within # minutes" need to stop, unless they want to bear the costs of replacing an engine that was hot-started, or even worse, replacing a lost aircraft and crew. 276. Although there are no "right" answers for fatigue and sleep deprivation while flying night shifts, I feel the effects can be mitigated with proper planning, diet, exercise and rest (when available). It is an individual responsibility to ensure you report to work able to do your job, and if not to ground yourself if you feel unsafe or too tired. 277. Look, if you take away the bed in the pilot room you're going to find the pilot sleeping on the couch or in a recliner. Heck, I might even bring an aero bed to work if you get rid of the bed in the pilot room. On the days I work the night shift I anticipate flying so I don't come to work completly tired expecting to sleep all night long. When I do get a call in the middle of the night, I turn on the lights, splash some water in my face, and drink some juice or eat a jolly rancher. The instant sugar helps me wake up. Then I go outside and methodically walk around

the helicopter and double check my self with the checklist so I don't forget something. This works for me, and may not work for everybody else. 278. I HATE going from day shift to night shift in just one day. I would prefer to have a 4 or 5 day on with all one shift and then several days off before coming back for a different shift. But, there's problems with that kind of schedule too. Good, quality sleep is deep, un-interupted sleep. One of the hardest things is to finish a flight at 3:30 or 4:00 am and then have to get up in 2 hours to brief the oncoming pilot when I can easily write it all down for them to read when they walk in the door and let me try and sleep for several continuous hours. It's IMPOSSIBLE to go from a day shift to a night shift in 24 hours and expect the pilot to perform at 100% for an entire night shift. 279.

Sometimes all I need is a quick 15-20 min nap to feel refreshed.

280. we need to abandon the 7/7 or other long work schedules. Since we are creatures of the day, we never really "adapt" to working nights, unless we always work and live on a night schedule. I think that working 7/7 during the days only adds to the fatigue factor. To mitigate fatigue, day and night, we need to work a schedule with shorter numbers of days and nights and more frequent days off. I know helicopter pilots are won't not to change; they always say they like their 7 days off, but I never actually get 7 off because of mandatory OT, meetings, training, etc. 281. 282. Has anyone ever looked at the relationship between accidents and number of shifts on duty? 283. There are "recommendations" by CAMTES to remove the pilots bed, I would like to know how many "pilots" are invovled working with CAMTES to come to these conclusion. There is talk amoung pilots that if the beds are removed, they feel this is an infringment, and this could induce pilots to want a union if they don't have one, or if they have a union, they will argue to have certain ammenities in their contract i.e. "a bed". So, this can have some ramifications that are not yet known. Also, when it comes to sleeping during the day at home, don't forget that, during the summer, kids can be home all day while the wife is at work, so getting sleep for these folks can be difficult, and needs to be seriously looked at. 284. An private secluded and dedicated sleeping area with a comfortable bed, heated and airconditioned in a low noise area is a must for routinely adequate

rest. A personal evaluation of my fitness to fly for EACH flight is a must. I don't cancel often but I do cancel when I find my self tired. 285. Company response times need to be a "target" and NOT mandatory (Generally speaking) Our company pilots are always put under the microscope concerning response times. THIS NEEDS TO STOP ! Our type of flying is VERY risky (Single pilot, single engine,turbine, at night in the weather and in mountainous terrain) Fatigue remains the number one killer in EMS fatalities. Companies MUST recognize this and not scruntinize pilots for taking time off when fatigued. Companies must also be PROactive in hiring new applicants rather than sitting around doing nothing while the current pilots are overworked. They should focus on pilot rest rather than keeping an airplane in service to pad their account balances and check books. 286. If the sleeping/quiet area for pilots are taken away, I would look for a other flying job (Not HEMS) where I get a better paycheck 287.

Always report for night shift knowing I can function all night if possible.

288. I feel that being able to sleep at night during shift is a safety enhancer. Too many pilots, including myself would push themselves (on minimum sleep) during our few nights shifts per week and try to make it up on the week off. This would degrade the safety we now have. I feel it is those pilots that become overly fatiqued that suffer from the affects of sleep inertia. Not allowing pilots to sleep on shift will not increase safety, in fact I think it will degrade and cause decreased safety because of fatique. 289. not allowing rest to a pilot i feel will make night flights harder, we all know that med crews are supposed to be up to have eyes out to help but they sleep all the time, and if the pilots are tired then we will start to have problems and more mishaps will happen. Please review sleep studies down by both the FAA and NASA. 290. Have some form of approved sleep aid for pilots when going from day-tonights to help in the transition. 291. We don't typically have the ability to completely adapt to a night schedule in this business. It is imperative that good sleep conditions be provided for night shift personnel; pilots and medical crew. 292.

Dual pilots are used only on the overnight shift - 7pm to 7am

293.

Even if I could totally transition to a full night shift sleeping pattern, I still

think extreme caution is required for all night flights. It needs to be taken more seriously in the industry. I don't know the answer industry-wide, but the current flippant attitude about night flying is unacceptable and people will continue to kill themselves and others. As I tell my wife, "there are a lot of guys out there with bigger balls than me; they just don't seem to be concerned about flying at night." I fly at night with ANVIS 9 googles and take extreme caution on all flights. 294. If it were mandatory to stay awake for my night shift, my fatigue level would increase substantially. Getting a short nap or naps during the shift (2-4 hours) helps me out tremedously. I have trouble getting a full 8 hours sleep during the day. About the best I can get is 6 hours. At home I use earplugs and a sleep mask and it helps quite a bit. I think the best solution for me would be to shorten the amount of night shifts worked in a row. 295. its important for a pilot to be able to take a nap whenever he can durning a shift. call it a power nap or whatever you want but the bottom line on it is its a "SAFETY NAP"!! its important and that it is free of noise and disruptions! NAP=SAFETY!!! 296. I never come to work with the expectation of sleeping. However, when on the night schedule it is always nice to get a 2 to 3 hour safety nap when I get a chance. For me, it is much easier to take a nap, wake up, and fly, than it is to try to stay up all night. I always try to stay up until 2am while on the night shift. But, if I have not been flying or do not expect to fly, I will go ahead and try to sleep some. I think it is much easier to fly multiple back to back to back flights and stay up all night flying and busy, than to sit all night and wait for your first flight at 4am. On those nights where I do not fly until after being on duty for 10 hours, and the first flight request comes in at 4am, I am much more fit to fly when I have had a nap, than had I just sat around trying to stay awake. It is very difficult for me to sleep during the day time. There is always something to keep me awake during the day; kids/family, garbage trucks, delivery trucks, landscapers and yard workers, neighbors with motorcycles, and people in general just living their lives because they are working a normal day schedule. I try to sleep as much as possible during the day, but it only works out to about 4 or 5 hours at most. Sometimes it is nice to have the luxury of lying down for a few hours just to make sure that I am rested for the next flight. I know that CAMTS is behind this issue and is trying to make an issue of overcoming sleep inertia. To me, that is total bullcrap and is a prime example of medical personnel directly interferring with aviation. Too many studies have shown that getting a short nap in between flights is beneficial to safety. For me, I know that it works! If they force this issue through, I will quit the EMS industry and go elsewhere.

There are too many other ways to improve safety, but taking away the ability to sleep or nap should not even be a consideration!! 297. I would mandate, twin engine, modern aircraft with nvg's, weather radar, glass cockpit and autopilot for any program operating at night. All single engine VFR aircraft would be restricted to day/vfr flight only. 298. My [medical] crew is not allowed to sleep on duty and may work up to 24 hours at another job before reporting for work. I'm generaly not tired, they are!!! 299. I believe the most important thing everyone needs to remember is that sleep is important to preform you job safely. Working a night shift does not mean I can play all day and catch up at work tonight. There are people that depend on you to make sound decisions and they cannot be made without proper rest. I would not work for an ems operator that did not allow me to sleep when I was able to. Lengthy studies have been made that prove that power naps work. We are paid for our decision making ability. If someone is flying and weather is a concern they need to make the right choice. If you are fatigued you also need to make the right choice, the safe choice. We all have families at home, and I expect to fly my shift and get myself and my crew home safely to see our families. 300. I wouldn't have to have a second job and all the responsibilities that comes with it if EMS would pay decent wages. 301. Requiring Pilots to remain awake all night would be a bad decision. (Safety First) 302. I think that this study is a reasonable step. However, I would be hesitant to blame this on the accident rates. I would also encourage a similar survey be taken of the flight crews. My reasoning is that they should be integrated in CRM training and alert enough to assist the pilot in collision avoidance and be in tune to the flight parameters that affect their safety, i.e. takeoff's, landings, cruise flight under marginal conditions (when patient load allows). I have personally witnessed crews performing 24 hour shifts up to 5 days of 24's with extreme fatigue. Not only are they a danger to the flight crew, but to themselves, and the patients they provide care to. The denial of a sleep room or provisions for such is denial of a problem that isn't going to change with the removal of such. Crews or pilots will find a way to take a nap - if needed. That is the reality of it. If you want more alert crews, switch to 8 hour shifts and limit their activities

prior to reporting to work. 303. I think it's a bad idea for CAMTS to consider eliminating sleep areas in favor of "rest areas" as a blanket policy. Each individual in different with regard to their sleep patterns. If I worked a job where I had things to do all night, then I would have no problem staying up. To be forced to stay awake in the event you get a flight would make me consider leaving EMS. I KNOW that I would be much more fatigued if I were forced to stay awake and pace the halls waiting for a flight because my body has a very natural rhythem and I would literally be a walking zombie under such circumstances! 304. I feel fatigue is greatly underestimated in EMS mishaps. Our 12 hour shifts can be very long and when working OT can affect our rest for many days and nights after. Manning should be increased but won't due to the monetary constraints and ability to find dedicated pilots to fill in part time. In a recent event at our program, fatigue wasn't called into the mix of reasons despite being a pilot short at the base for over 2 months and one pilot taking minimum extra duty shifts. This issue needs to be addressed. 305. I base my sleep habits on how much sleep I have had in a 24 hour period regardless of day or night. . .If I had to stay up all night working then I'll sleep during the day, however if I was able to sleep I might take a nap or if i have things to do then I'll stay awake all day. I find that the ability to have a "sleep" area is greatly beneficial with this job since we are on call even when we are on duty, and the ability to take a nap/rest/sleep when it's convenient for us is greatly beneficial, our rest/sleep time being dictated to us would greatly demish our ability to get the required rest, especially since everyone is different with regards to thier needs. 306. Sleep is most important. You can't always get what you would like. Please do not remove what sleep I can get. Each person is quite different on this, a good pilot pilot will work his or her sleep around to get the best they can but they need a place at work where they can do this. Also we are every short pilots and I am doing about three to four work overs a month to help keep programs open. This plays hell with my sleep. 307. Do not alternate day and night shifts. Dedicated day pilot and dedicated night pilot for the year. 308. I used to work a 3 days, 3 off, 3 nights, 3 off schedule and found that because I never had enough time to fully recover, I became chronically fatigued.

For me the extended time off (greater than 5 days) helped me recover. 309. I understand that CAMTS is proposing to not allow pilots to sleep during their shifts. I think that is unsafe, and therefore stupid. 310. Circadian disruption and poor sleep mentally impair you as much as alcohol or drugs. You wouldn't "drive drunk" because of impaired judgment and coordination... 311. If I am not allowed to sleep or nap during my shifts I will leave this line of work. 312. I have worked nearly every combination of day/night shifts. The best by far is 6 on, 6 off. The 6 on is 3 day shifts followed by 3 night shifts. You get a 24 hr break after day 3 before starting the 3 night shifts. Also, never, never work more than 10 consecutive shifts in a row. To me, that ought to be an FAA rule. 313. It would be nice to know what the motive is in this survey? Rumors say that sleep during the night may be restricted? Are we going to have to stay awake while the med crews sleep and make more than we are? I wouldn't be surprised if this measure goes through. And yes, being good soldiers we will abide by it. 314.

One should ALWAYS sleep to prepare to fly all night, keep Murphy at bay.

315. I attempt to get proper rest before shift. However circadian rythym favors daytime lifestye. I find a nap on night shift, when available, is beneficial in fighting fatigue and beneficial for safe operations. Any movement to prohibit sleep to "reduce fatigue" is counter productive for safe operations. 316. Gather additional data from military sources on this subject. There is a significant amount of research on this very subject, and you would be foolish to ignore it and support CAMTS desire to remove the beds from the bases. 317. FAR's need to be amended along the lines of airline regulations abroad. If a flight is initiated or terminated after midnight, the rest period should be longer before returning to duty. Ten hour rest period does not cater for disturbed circadian rhythyms and poor quality of rest during the day.A couple of late night flights or all nighters and you have a sleep deprived pilot. A supervisor should be able to pull him off the line and put somebody else in.This, of course , requires more pilots per base and active supervisory control. Not going to happen in the US.Especially not in the EMS sector. 318.

The idea that staying awake all night is safer than sleeping is one of the

most ridiculous things I have ever heard. A non-pilot has no place is saying what we should or should not do. 319. Not allowing me to sleep at night disrupts my normal daily rhythms, even 1-3 hours of night sleep will keep me on rhythm for the day, I cant seem to sleep enough during the day to make up for the lost night sleep, I dont get "rest" I need sleeping during the day 320. I consider this to be one of the most important issues in EMS. I have witnessed too many pilots pushing the limits of fatigue because they do not respect their rest period- many of them believe that they can go fly even after they have gone more than 24 hours without sleep. Sleep inertia scares the poop out of me, and it hits me hard every once in a while. If there is a method for combatting sleep inertia, I would sure like to know what it is! 321. Pilots are typically able to handle day nigh rotations. Medical crew have additional duties that OFTEN interfere with their responsibilities in HEMS 322.

I don't work my part time job when I'm scheduled to work nights

323. I got to work prepared to fly all shift regardless of the time of day or night. As a professional, it is my job to ensure that I am rested and ready. I owe that to myself, my crew, the passengers, and my family. 324. I would like to see a set shift for pilots. Either days or nights. As much as I like having 7 days off after a 7 day or night week on, I think 7 nights is a little rough. I have worked a 3 days off 24 hours and 3 nights then 5 off. It was a nice schedule but some months you never had a weekend off. Lots of plus's and minus's with all schedules. 325. I think that each individual needs to be aware of their personal limitations regarding the ability to get effective rest while on duty and their ability to wake up quickly and remain allert. It can be difficult even during a day shift with a good night of rest prior to stay at the higest level of performance. Multiple flights, heat, or boredom can all have an effect during a 12 hour shift. 326. It is important for a pilot's longevity in the EMS business to be able to sleep, in a bed, during the night when able. This has been key for me to maintaining a mostly normal circadian rythem. It also enables me to transition quite well back and forth from Day Duty to Night Duty. 327. There is no way a pilot can adapt to a night shift in a few days or even weeks. Therefore it is up to the pilot to ensure he is rested prior to duty.

Regarding sleep inertia. It is also the pilot's responsibility to recognize its presence and ensure he is fully awake before accepting a flight. This is an area where AMRM could really have a positive affect. It is also an area that should be highlighted during pilot/crew training, staff meetings, and nightly shift change briefings. 328. I think pilots have more of a challenge than most medical personnel when it comes to fatigue and sleep given their constant schedule rotation from days to nights. Most medical teams that work a 12 hour shift work either a day shift or night shift and rarely rotate back and forth like pilots do to maintain currency and a degree of competency for night operations. Given this constant rotation most pilots go their entire carriers with an out of phase circadian rhythm of one degree or another. Another point worth mentioning is the effect that fatigued medical team members are having on safety when combined with the past several years of air medical resource management (AMRM) implementation. Air medical pilots currently flying single pilot operations, especially new ones coming into the industry, have become much more reliant, due to AMRM, on medical team members to help with the overall workload of flights and help in the decision making process. Having fatigued medical team members on board has increased the work load of many pilots above that which one would consider normal for single pilot operations. Whether it is the medical team member that has been working a 24 hour shift or one that just left a 12 hour job and reports to flight duty for a consecutive 12 hour shift, medical team members who are fatigued create just as much if not more of a safety hazard than fatigued pilots. I think that both groups should have the same standards for crew duty and rest and that both be afforded the ability to take a power nap while on shift when needed. 329. most difficult sleep day is first day before first night shift... fly one night, no flight one night makes regular shift difficult 330. The keys to adequate rest is professionalism, self-discipline, and support from organizational policies, all of which must be implemented at the level of the organization and the individual pilot. You can't effectively control those influences by means of legislation outside of each flight provider organization.