Saturday, December 27, 2014

Feedback on Sleeping on Duty...from our friend Josh

Dan, i couldn't agree with this post more. I say this having worked in both arenas. 7 years in a busy level I trauma center ED and in the flight arena. And I can say this, working a long 3+ hour flight at night with a sick pt. is just as tiring as a 12 ED shift. However, there are a few things to consider when comparing the two. First, i 
think that the "powers that be" fail to recognize what i call "insensible flight stressors." These include low humidity, low O2 environment, high stress, high noise and relatively high pt. acuity. these things combined create an increased metabolic state in the flight crew. (pilot included). Stated plainly, we chew up all our natural glucose and we're damn tired with our bodies having been in overdrive to maintain homeostasis for the duration of the flight. Now, in the hospital, the effects of being tired can range from fairly simple, like walking into the wrong pt. room to moderately bad, such as a med error. In the flight arena, the consequences can be much more dire. Walking into a tail rotor, in my opinion is a FAR greater consequence. (i know we've all been habitualized to maintaining our situational awareness, but people still get punchy, or they're new, or they're just plain tired and not paying attention) The tired flight nurse/medic is also prone to making pt. care mistakes. Often the pt's we fly are of the higher acuity and thus, much more medically fragile. Medical mistakes in this pt. population have far greater consequences that giving 60 Keterolac IV instead of IM in the hospital. Furthermore, when and IF a pt. goes south in the hospital, multitudes of people rush in and the medical menagerie begins. In the aircraft, its just you and your equally tired partner. No help. No pulling over. No flying faster. Just you and your partner.
I guess what I'm saying is this; Nurses get tired on duty, but comparatively, flight nurses face greater fatigue factors than hospital based RN's. The consequences however are far greater for the flight team. Not only for the safety of the crew, but for the quality of care provided, the utilization of limited care providers and the reputation and quality of the flight program.
12 hr shift or 24 hr shift? it doesn't matter. I've also worked both types of schedules flying, and there is little difference given the topic of fatigue. (I much prefer 24 hr shifts however.)
Flight crews should be required to rest while on duty. Their duties, responsibilities and the sheer gravity of the job they volunteer for demands their full attention, not standardization of flight RN vs. Hospital RN rest requirements.

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