Fatigue Risk Management
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1 Fatigue Risk Management Stefan Becker Head of Corporate Development SASCON 15 8 September Scientific Background FRMS Agenda Implementing FRMS incl. results Rulemaking & Discussion Slide 2 No&publica5on&without&wriIen&permission& 1&
2 Fatigue A measurable factor? Subjective Measurement Karolinska Sleepiness Scale (KSS) Visual Analogue Scale of Fatigue Severity (VAS-F) Samn Perelli Scale (SPS) Objective Measurement Polysomnography with EEG Electro-oculography Actigraphy Slide 3 Fatigue An overestimated factor? Fatigue-related risks Sleep debt Long wakefulness Sleep quantity Sleep quality Sleep disruptions Awareness Slide 4 No&publica5on&without&wriIen&permission& 2&
3 Error rates Objective fatigue Subjective fatigue hr sleep 6 hr sleep 8 hr sleep hr sleep 6 hr sleep 8 hr sleep Error rate BL days with limited sleep -1.0 BL days with limited sleep Van Dongen, Maislin, Mullington, and Dinges (2003) Slide 5 Performance 2008 National Sleep Foundation! 28% of the 1,000 respondents: sleepiness interferes with their daytime activities at least a few days each month. NASA Study! Pilots on trans-pacific flights were instructed to nap for 40 minutes.! 26 minutes (avg.) led to 34% improved performance and 54% improved alertness Slide 6 No&publica5on&without&wriIen&permission& 3&
4 NASA Aviation Safety Reporting System (ASRS)! 21% of the incidents reported to ASRS are fatigue-related! 261,000 incident reports with about 52,000 of these reporting a fatigue-related occurrence! The FAA has identified fatigue research as an important aviation safety issue in its National Plan for Aviation Human Factors Slide 7 Cumulative Fatigue: Guantanamo Bay Accident CPT (8h per day requ.)! 50h awake / 15h sleep! slept 8h! 9h awake! 2h nap prior to FDP! 17h awake! 5h sleep in DFW! 23.5h awake FO (8h per day requ.)! 30h awake / 12h sleep! slept 8h! 9h awake! 2h nap prior to FDP! 19h awake! 8h sleep in DFW! 19h awake 41h awake / 5h sleep 38h awake/10h sleep NTSB/AAR-94/04 Slide 8 No&publica5on&without&wriIen&permission& 4&
5 Cumulative Sleep / Wake Debt NTSB/AAR-94/04 Slide 9 Fatigue Causes & Consequences Job Factors Individual Factors Fatigue Human Performance Health Operational Performance Roster Timing Individual Factors Operational Performance Duration Rotation Predictability Time zones Work Factors Traits! " e.g. health! " medications! " chronotype Lifestyle! " e.g. sleep environment! " recreation! " second job! " domestic situation FATIGUE Human Performance Mood Communication Memory Health Cardiovascular Gastrointestinal Well-being Incidents Insurance Absenteeism Productivity Costs Morale Workload Vigilance Retention Job design Opportunity for naps Problem solving Risk taking Reputation Environment Reaction time Clockwork Research Ltd. Slide 10 No&publica5on&without&wriIen&permission& 5&
6 Medical-operational Conclusions! Sleep is a vital human physiological function! Sleepiness affects waking performance, vigilance, and mood! Sleep loss accumulates into a sleep debt! Discrepancy of physiological vs. subjective sleepiness Slide 11 Scientific Background FRMS Agenda Implementing FRMS incl. results Rulemaking & Discussion Slide 12 No&publica5on&without&wriIen&permission& 6&
7 Fatigue Risk Management System (FRMS) Fatigue Risk Management Safety Slide 13 FRMS Cycle Policy Safety Promotion Processes Documentation Safety Assurance Processes Risk Management Processes Slide 14 No&publica5on&without&wriIen&permission& 7&
8 Fatigue Risk Management System FRMS%Policy Effective%Reporting%System Fatigue%Risk%Management%(FRM)%Processes FRMS%Safety%Assurance%Processes Data%Collection%&%Hazard% Identification Performance%Monitoring%&% Continuous%Improvement Risk%Assessment Safety% Performance% Indicators% (SPI) Managing%changes%that%may% impact%on%the%frms Risk%Mitigation Annual%FRMS% Audit%and%Review Communication:%Safety%Promotion%&%Feedback Fatigue%Management%Training%Program%(FMTP) Clockwork Research Ltd. Slide 15 FRMS Integration SMS Safety Policy & Objectives Safety Risk Management Safety Assurance Safety Promotion FRMS FRMS Policy & Documentation FRM Processes FRMS Safety Assurance Processes FRMS Promotion Processes IFALPA/ICAO/IATA Implementation Guide for Operators Slide 16 No&publica5on&without&wriIen&permission& 8&
9 Scientific Background FRMS Agenda Implementing FRMS incl. results Rulemaking & Discussion Slide 17 Data Enquiry Process Wrist movements are recorded 24/7 and downloaded over the internet Conduct mitigation training Flight personnel wear the ReadiBand that measures wrist movements; no GPS! Individual fatigue risk levels are amalgamated into a group report Downloaded data are converted to daily sleep/wake/work times FAST evaluates the fatigue risk and effectiveness of each individual Daily sleep/wake/work times are fed into the SAFTE risk evaluation model Slide 18 No&publica5on&without&wriIen&permission& 9&
10 Rega Data Components for Studies Actigraph Objective fatigue Sleep Log Subjective fatigue acc. Samn-Parelli- Scale before and after sleep phases PVT Performance absolute relative PVT: Thorne, Johnson, Redmond, Sing, Belenky, & Shapiro, 2005 Slide 19 Actigraphy vs. Polysomnography EEG = 92%? ReadiBand Slide 20 No&publica5on&without&wriIen&permission& 10&
11 FAST/SAFTE Model Components Clockwork Research Ltd. Slide 21 Results: Fatigue in AEMS Slide 22 No&publica5on&without&wriIen&permission& 11&
12 Sleep / Wakefulness Analysis Slide 23 Relative Analysis Slide 24 No&publica5on&without&wriIen&permission& 12&
13 Performance Classification Slide 25 Personal Mental Effectiveness Slide 26 No&publica5on&without&wriIen&permission& 13&
14 Results: FAST Data Analysis Check&in&ZRH&06:30& Deviation between Check&in&Asia&00:15& forecasted and actual Check&out&Asia&23:35&& effectiveness: 17&h&05min& 18h&45min& -4% / +3% Check&out&19:00&ZRH& Sector$1:$$02:20103:11$ Sector$2:$$04:07110:41$ Sector$3:$$11:30118:23$ based on 172 block hours Sleep phases in blue Work phases in red Slide 27 Results: Operational risk factors! Duty hours and cumulative duty! Basic maximum flight duty period! Night, early and late duties! Duty extensions (also due to in-flight rest)! Positioning and travelling! Extension by on-ground break! Pilot-in-command discretion! Airport standby! Standby other than airport! Basic rest (incl. basic rest-reduced rest)! Time zone crossing Slide 28 No&publica5on&without&wriIen&permission& 14&
15 Operational mitigation strategies "! Predicting the expected level of fatigue during the mission phases by means of FAST and, where necessary, scheduling additional crew members! Activating the crew as early as possible! Pre-positioning with night stop ideally in the same time zone! Planning missions in accordance with circadian principles, in particular avoiding starts and landings during the window of circadian low (WOCL) Slide 29 Operational mitigation strategies #! Food! Planned in-flight rest (bunk/cabin) in accordance with the crew members circadian rhythms and potentially fatiguing mission phases! Changed in-flight rest structure! Caffeine! Increased use of SOPs! Took fatigue into consideration during briefings! Notified flight crew member (FCM) of fatigue! Increased use of automation Slide 30 No&publica5on&without&wriIen&permission& 15&
16 Operational mitigation strategies $! Enhanced use of crew resource management (CRM)! Targeted advance sleeping at the Rega Centre before early-start duties! Naps in the afternoon before starting a night duty! Naps during ground patient transfers at airports! Use of cockpit ipad! Use of ear plugs and sleep masks! Use of own sleeping bags and pillows Slide 31 Fatigue mitigation strategies Long term Medium term Short term Diet / Healthy eating Good physical fitness Optimal sleep (sound & sufficient sleep) FAST planning Naps Light Social Interaction Caffeine/Oxygen, other drugs Slide 32 No&publica5on&without&wriIen&permission& 16&
17 Applied Overall Risk Reduction in ULR Missions Standard planning high risk in 3 cases Planning with FAST and FRMS high risk in 0 cases "# =9.90 "# =6.45 & "# =10 & "# =6 Slide 33 Results: Fatigue in HEMS Slide 34 No&publica5on&without&wriIen&permission& 17&
18 Results: Fatigue factors in HEMS! Night missions! +1 point on the KSS per mission! +2 points on the KSS per mission using NVG! Length of the mission! Sleep quantity! Sleep quality! Sleep disruptions! No significant differences between the fatigue experienced by pilots and by HCM/TCM Slide 35 Results: Sleep disruptions on bases Slide 36 No&publica5on&without&wriIen&permission& 18&
19 Results: Comparison study 48h 76 duties 24h 138 duties 226 missions 366 missions No advantages relating to operational safety could be identified in connection with the 24-hour model, thus reconfirming the results of the preceding HEMS main study. Clockwork Research Ltd., 2013 Slide 37 Swiss Air-Ambulance HEMS OM! Each crew member must have at least one period of 48 consecutive hours of rest time during a period of 10 days.! Each crew member is entitled to at least eight days free of duty and on-call duty within every calendar month, and 96 days within a calendar year. In the event of holiday, part-time employment and military service, this entitlement is reduced on a pro rata basis. Slide 38 No&publica5on&without&wriIen&permission& 19&
20 Swiss Air-Ambulance HEMS OM! The requirement for taking over a night-time on-call duty after 22:00 LT is that during a duty day, breaks totalling at least three hours must have been taken between 08:00 LT and 22:00 LT, at least once two hours of them consecutively. If it is not possible to guarantee that these breaks have been observed, a rest period without on-call duty lasting 6 hours must be observed. Slide 39 Swiss Air-Ambulance HEMS OM! If within one duty day, between 22:00 LT and 06:00 LT more than one mission is carried out, or a mission lasts more than 3 hours, the pilot and the HEMS crew member should subsequently, however at the latest by 08:00 LT, observe a rest time without on-call duty lasting 6 hours. Slide 40 No&publica5on&without&wriIen&permission& 20&
21 SASCON& 15& Scientific Background FRMS Agenda Implementing FRMS incl. results Rulemaking & Discussion Slide 41 From Operators & Regulators Slide 42 No&publica5on&without&wriIen&permission& 21&
22 The last line of defence Legal Framework Operational Instructions (e.g. OM) Supervision Crew Member Behaviour Causal Error Trajectory Slide 43 Relevance to unsafe acts Preconditions Causes Unsafe Acts Preconditions for Unsafe Acts Condition of Individuals (60%) Personnel Factors (23%) Environmental Factors (17%) Errors (84%) Judgement & Decision- Making Errors (60%) Skill-Based Errors (28%) Violations (16%) Perceptual Errors (12%) European Helicopter Safety Team (2008) Slide 44 No&publica5on&without&wriIen&permission& 22&
23 FTL Rulemaking and risk management Identified risks Concise mitigation strategies Operational risks Human factor risks Latent risks Safety buffer Technical risks Slide 45 FTL Rulemaking and risk management Operational risks Human factor risks Identified risks Latent risks Concise mitigation strategies Fatigue Risk Assessment & Management Technical risks Safety buffer Slide 46 No&publica5on&without&wriIen&permission& 23&
24 NASA: Alertness reports often inaccurate Sasaki, Kurosaki, Mori, Endo: ASEM (1986) Slide 47 Slide 48 No&publica5on&without&wriIen&permission& 24&
25 Fatigue Risk Management Thank you for your attention. No&publica5on&without&wriIen&permission& 25&
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