lines; emergency medicine residents are less comprehensive on their patient history and physical exams; and family medicine residents score lower on the ABFM in-training exam. A number of studies suggest that the deficits identified in these types of controlled studies translate into real practice medical errors. In 2004, The New England Journal of Medicine published a pair of landmark studies from the intensive care unit of the Brigham and Women’s hospital. These studies demonstrated that the attentional failures identified by continuous EEG monitoring in sleep-deprived residents working as part of a rigorous overnight call schedule correlated with documented medical errors. The best remedy for fatigue is to avoid it altogether with good sleeping and lifestyle habits. While it may seem that common sense should prevail, when it comes to fatigue management, “rocket science� is at the forefront.
Figure One: Performance in the sustained wakefulness condition expressed as mean relative performance [compared to the start of the study] and the % blood alcohol concentration equivalent. Fatigue, alcohol and performance impairment. Nature vol 388 pg 235. July 17, 1997
chewing gum; and using caffeine strategically one hour before times of expected decreased alertness The NASA Fatigue Countermeasures Program - 3 to 5 am and 3 to 5 pm. While these strategies operates out of the NASA Ames Research Center may be helpful in minimizing some of the risks in Mountain View, CA and serves military pilots associated with sleep deprivation, it is important and astronauts. This program distinguishes to understand that operational measures only sleepiness from fatigue; noting that sleepiness conceal underlying physiologic sleepiness. As a produces drowsiness and decreased alertness result the use of these strategies should be limited while fatigue produces a sense of weariness and to the middle of the night when you are providing depleted energy. Additionally, it distinguishes anesthesia, operating, or working-up a patient in preventative strategies that keep sleep loss the ER or on the wards. and circadian interruption to a minimum from operational countermeasures that provide relief NASA also encourages the strategic use of naps, from the symptoms of fatigue, by temporarily both prior to and during prolonged shifts. However, enhancing alertness and performance at times it warns of the risk of sleep inertia if one is to nap when one is physiologically sleepy during a shift. Sleep inertia is the disorientation, confusion, and cognitive dysfunction that may Preventative strategies include maximizing sleep accompany disruption from sleep during the prior to shift extension or change, taking preemptive slow wave cycle. It typically lasts minutes but naps, and developing good sleep habits in general. can be prolonged to hours in extremely fatigued Good sleep habits include, avoidance of alcohol and sleep-deprived subjects. In addition to sleep and caffeine, daily exercise, and establishment of stage upon awakening, the magnitude of sleep a routine sleep time in a dark, cool room with no inertia depends on sleep duration, time of day, TV. and prior sleep deprivation. Because of this, NASA recommends a nap duration of less than 45 Operational countermeasures include, remaining minutes or longer than two hours in order to avoid actively involved in conversation; keeping arousal during slow wave sleep. physically active by stretching, writing, or even 2