Sailors, surgeons, scheduling: the deadly consequences of fatigue

Sailors are now the latest profession, along with truck drivers and airline pilots, taking the dangers of fatigue and the need for balanced shift schedules seriously. When will medicine finally catch up?

Recently, Navy officials sat down in front of Congress and talked about tiredness. With a $171.5 billion annual budget and some of the most sophisticated military technologies in the world, it is increasingly looking like human fatigue is a main culprit behind the spate of deadly naval accidents in the last year. “Some members of ship crews in the Pacific were forced to work 100 hours or more a week because of undermanning and poor scheduling,” reported

The Navy is responding by implementing new safety measures, including mandating watch schedules that match circadian rhythm cycles:

… the guidance tells them that they should aim to give each sailor at least seven hours of sleep per day, including a minimum of five hours of uninterrupted sleep, and that not doing so leaves personnel in a mental state of long-term ‘jet lag.’ The new rules also incorporate U.S. Coast Guard guidance suggesting shipboard workdays of no more than 12 hours each, and preexisting rules from the Navy’s own aviation community based on studies that showed accident rates skyrocketed when personnel were awake for 18 hours or more at a time.

While this guidance should help go a long way to creating safer work conditions for sailors, there still appears to be a troublesome culture of toughness around fatigue in the Navy that will ring familiar to physicians. The head of U.S. Fleet Forces Command, Adm. Phil Davidson, said that sailors “need to get used to working better while sleep deprived or physically worn out.”

The science shows us that this isn’t possible. Fatigue isn’t something you can tough out. A recent study showed that even mild sleep deprivation causes the same levels of impairment as alcohol intoxication — impairment that doesn’t care how much you love your job, how strong you are, or how deadly the consequences could be.

Health care is rife with fatigue. Residency hours are capped at a “mere” 80 hours a week under 2003 and 2011 regulations; however, there are widespread reports from the front lines of medical residency showing that limits are commonly violated and hours are encouraged to be underreported. One 2007 study found that 1 in 5 residents said they had fallen asleep while driving because of work-related fatigue.

Long and unpredictable work hours don’t stop during medical training. American doctors are in an epidemic of burnout and exhaustion. Physicians — like sailors — are human, and when they’re tired, they are more likely to make potentially deadly mistakes.

It is time for medicine to take fatigue seriously, the same way that the Federal Aviation Administration (for pilots), the Federal Motor Carrier Safety Administration (for truck drivers), and now the Navy are doing. Responsible schedule guidelines are one step forward. Better, more balanced scheduling is another.

Thanks to sophisticated, AI-powered shift scheduling technology, it is now possible to optimize work schedules for both the needs of organizations and the needs of the humans who work in them. Shift scheduling technology can help create calendars that respect circadian rhythms and automatically build in time to recover from long shifts. They can give more flexibility in work schedules for days off, sick time, and training. It is time to use technology to support the well-being of physicians and, in turn, the safety of patients.

Suvas Vajracharya is founder and CEO, Lightning Bolt Solutions.

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