Fatigue Risk Management at Swiss Air-Rescue

The different ways of dealing with "fatigue" are particularly evident in aviation. The International Civil Aviation Organization (ICAO), in cooperation with the Air Transport Association (IATA) and the pilots' association IFALPA, has compiled recent findings in this regard and published them in 2011 in a guide on the implementation of Fatigue Risk Management Systems (FRMS). However, identical or blanket implementation of FRMS is difficult. After all, regulators such as the Federal Office of Civil Aviation FOCA do not find it easy to control overly general checklists for operational risks in aviation. Nevertheless, an FRMS should be less complex, sometimes situation-dependent and verifiable at any time.

Rega had already investigated fatigue risk management before the ICAO publication. On a scientific basis and with external experts, research was carried out into whether and how, for example, the cumulative sleep deficits of its pilots are made up and have an impact. Risk reduction strategies have been developed on the basis of these analyses.

Prudent employer

"When it comes to fatigue risk management in the context of flight and rest times, Rega does more than is required by law," says Stefan Becker, Head of Corporate Development. For him, risk management means not simply monitoring employees by means of stringent questionnaires, but enabling them to get a good, adequate night's sleep, continuing to encourage them to take responsibility for their own sleep.

Once again, and on a daily basis, both helicopter and jet crews set out to live and cultivate Rega's safety culture.

responsibility. Stefan Becker: "For us, 'Just Culture' plays a decisive role." "However, the more overtired you are, the more difficult it becomes to correctly assess your own performance capability yourself. In our rescue work, however, the highest level of attention is always required. The fact that we place a high value on FRMS benefits each of our patients," Becker says. However, experts admit that FRMS often have to give way to corporate realism, where general operating costs and productivity take precedence over safety items that cannot be stringently calculated.

Stefan Becker: "Such short-sighted considerations are inappropriate for Rega. For the safety of our crews, patients and third parties, we always go one step further than the law requires." In fact, only a few Swiss operations operate fatigue risk management systems. Rega is therefore making pioneering history not only in terms of rescue flying. Through FRMS, the private, non-profit foundation shows itself to be a prudent and innovative employer.

Safety at every level

At Rega, fatigue risk management is an integral part of crew resource management. At regular intervals, crew members reflect together on their assignments, giving each other personal and objective feedback as part of Rega's "Just Culture". This procedure is greatly appreciated by the staff.

Thomas Gnägi, Rega's senior helicopter flight instructor (postholder crew training), explains at the Rega Centre in Kloten: "Only after analysing possible mitigation procedures does the actual flight take place. "Before a rescue helicopter or an ambulance jet takes to the skies, the pilot in charge must first consider five important points:

1. obtain relevant data

2. check aircraft and other hardware

3. define operation by flight responsible

4. identify possible exceptions/incidents

5. know the safety risks of all participants

By means of these process-relevant clarifications, the pilot decides, for example, whether he is approaching a location that is difficult to reach and whether risks for crew members and patients can be further reduced by means of uniform measures, Gnägi continues.

6. exercise actual performance

Such planning units and procedures sound simpler than they actually are - especially in the case of rescue flights that cannot be planned. Legal and operational parameters can therefore only be effective to the extent that workforces function or, as Stefan Becker emphasizes, "how crew members interact with each other".

"Stressing yourself out"

Here, the Head of Corporate Development refers to a not insignificant clause in Rega's employment contract for flight crews: "All our flight staff have the right to refuse assignments that compromise safety". Be it primary or secondary missions, Rega strives never to overwork its flight personnel and to prevent overtiredness consistently and efficiently. Respectful treatment in all situations is part of Rega's "Just Culture".

So if a crew member "feels unwell or tired in any way", it is essential to inform the other crew members independently in order to jointly agree on suitable and safe procedures. "When life and limb are at stake," says senior flight instructor Gnägi, "we appeal to every employee to think primarily about safety and to adhere to our credo 'Patient first - Safety always'.

Although Rega has three specialists working in one helicopter, a crew is only as good as the individual crew member. Thomas Gnägi, himself an operational pilot on both of Rega's rescue helicopters (see info boxes), points to what is perhaps the most important element of Rega's "just culture": "If a crew member does not feel up to a mission, perhaps because of a lack of sleep, or has safety concerns, the mission is not accepted without a lot of toing and froing, or the mission is cancelled in favour of the other crew members.

Respectful treatment in all situations is part of Rega's "Just Culture".

tion of the mission." At Rega, the coordination of emergency crews relies on resources and forces in such a way that a crew not only gets to the scene quickly, but must also be able to carry out several missions in succession or an unplanned extension of the mission. Fatigue risk management is therefore one of the most important tools in the deployment of rescue teams.

Rega does its utmost to limit any avoidable stress for crew members with Fatigue Risk Management. "When the alarm goes off, no one should rush to the helicopter. Unnecessary adrenaline surges can lead to mistakes. The five seconds it takes to gain an overall view and climb calmly and serenely into the helicopter are worth it in terms of a safe operation," says company developer Stefan Becker, referring to a procedure shared by many professional colleagues. Experienced pilot Thomas Gnägi shares this aspect, adding in an even tone: "Stress is something you do."

routine before overmotivation

In longer training sessions, Rega pilots practise handling difficult situations. "For example, we train working under increasing oxygen deprivation. In this way, we simulate fatigue," Gnägi continues. Through this, and certainly also through compulsory rest breaks, Rega optimises the constitution of its personnel. Stefan Becker continues: "Loss of attention is caused in particular by long duty periods and cumulative sleep deficits. No one can work through the night and pilot an aircraft or helicopter in a clear mind. »

A transatlantic flight study conducted by NASA also proves that just a 30-minute short nap improves the performance of long-haul pilots by 24 percent. "Controlled short sleep on board, just as regular breaks promote performance and concentration. »

Becker nevertheless observes that each crew member uses the prescribed rest breaks differently to recover: "One recuperates on a walk, while the other actively reacts on a climbing wall. It's only overnight that the helicopter crews rest in a prescribed manner at the Rega bases in order to be fit for upcoming missions."

In any case, Rega is not guided by rigid guidelines or regulations. It prefers to rely on routine and team spirit in its safety culture: "Every morning, however, we hold a briefing - regardless of whether the same people have already been on rescue flights together shortly before or not," emphasises Thomas Gnägi, Postholder Crew Training. - Inquiring about the well-being of a crew member, ultimately living out a constructive culture, is "vital" in his professional environment.

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Read more about the "Implementation Guide" on Fatigue Risk Management Systems at www.iata.org/publications.