Ms. Madeline Loftus, 24, was just one of the 50 individuals who lost their lives on February 12, 2009 when Continental Flight 3407 crashed in a neighborhood near Buffalo, NY. The NTSB investigation and a frightening PBS Frontline investigation called “Flying Cheap” identified airline industry practices that compromise pilots’ fitness for duty, including severe fatigue, as contributors to the disaster.
The Feb 2009 Pinnacle/Colgan/Continental airline disaster was not the first one in which fatigue was identified as a contributing factor in pilots’ errors and poor performance. Following an October 19, 2004 crash at the Kirksville, Missouri Regional Airport that killed 15, the NTSB noted that the pilots had inadequate overnight rest periods, early report for duty times, and too many consecutive flight legs. In response, the NTSB recommended in 2006 that FAA amend its regulations related to crew hours-of-service, and require the airlines to develop fatigue management programs. FAA responded in September 2010 to the NTSB recommendation by proposing comprehensive improvements and responding to thousands of comments on them. The final result is what was announced this week by the FAA.Continue reading…
I have much experience with serious illness. And so I am a connoisseur of fatigue: the sleepless edginess of post-radiation fatigue; the heavy constancy of cardiac fatigue; the blur and blues of chemotherapy-related fatigue.
I am learning again about post-surgical fatigue, which this time is characterized by short bursts of energy randomly emerging from an otherwise constant whacked-upside-the-head-with-a-golf-club sleeping/waking fog.
Regardless of the flavor, it is the force of fatigue that exacerbates the discomforts and symptoms of an illness. It is fatigue that makes each sip of water an action to be carefully planned, each trip to the refrigerator an accomplishment. It is fatigue that exhausts my hands holding a book and my mind when reading more than a few sentences. It is fatigue that shrinks my world to the size of my living room, leaching the meaning from family news, work developments and the impending election.
Fatigue diminishes me: I consist only of this disease, this body.
Into this gray desolation drop brief messages of support, of encouragement, of good wishes. These words are not sent to the thin figure lying on the couch staring at the sky. Rather, they are addressed to a friend, acquaintance, colleague, daughter, or sister – a person who stands up straight, is passionately engaged in her life and has a lot of work to do.
These messages remind me of the parts of myself that are eclipsed by my illness. And they reassure me that I will be able to find those parts again.
Several years ago, I spoke at Baylor College of Medicine in Houston, where Michael DeBakey, the legendary heart surgeon, was master of the universe for nearly half a century. I heard lots of DeBakey stories during my visit, but one in particular really stuck with me. “A few years back,” someone told me in a voice of hushed reverence usually reserved for descriptions of flawless beach days and single malt scotch, “he performed 16 open heart operations in a single day.” This was clearly intended to impress, but all I could think was, “Boy, I wouldn’t want to be patient #16.”
Lacking any information to help us understand when fatigue trumps even legendary prowess, such monumental tales of endurance can take on Man of Steel proportions. But a recent study in the Journal of the American College of Radiology may be the start of efforts to trim Superman’s cape.
Researchers from the Universities of Arizona and Iowa observed radiologists as they reviewed a handpicked set of 60 bone x-rays, half with fractures and half without. As their eight-hour workdays wore on, the radiologists’ accuracy fell by an average of 4%, with equal drops in sensitivity (missing a true fracture) and specificity (incorrectly calling a fracture when there was none). The degradation in performance was statistically significant.
On September 2, Assistant Secretary David Michaels for Occupational Safety and Health received a petition requesting that OSHA regulateresidentphysician and subspecialty resident physicians. “Depending on the type of residency, physicians-in-training can work anywhere from 60 to 100 or more hours a week, sometimes without a day off for two weeks or more.” The petition requests that OSHA exercise the authority granted under §3(8) of the Occupational Safety and Health Act to implement the following federal work-hour standard:
(1) A limit of 80 hours of work in each and every week, without averaging;
(2) A limit of 16 consecutive hours worked in one shift for all resident physicians and subspecialty resident physicians;
(3) At least one 24-hour period of time off work per week and one 48-hour period of time off work per month for a total of five days off work per month, without averaging;
(4) In-hospital on-call frequency no more than once every three nights, no averaging;
(5) A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off after a night shift;
(6) A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.