Sleep deficit and stress hormones in helicopter pilots on 7-day duty for emergency medical services

Introduction: Helicopter-based emergency medical services in Germany operate from sunrise to sunset, requiring up to 15.5 h of continuous duty during the summer months for pilots, who work for seven consecutive days. Because of concerns regarding the safety of this procedure with respect to pilot fatigue and stress, the German Ministry of Transport asked our laboratory to investigate the risks involved. Methods: There were 13 pilots (mean age 38 yr) who were studied in the summer months for 2 d before, 7 d during, and 2 d after their duty cycle. Measured variables included sleep duration and quality, subjective fatigue, and heart rate, as well as 24-h excretion levels of stress hormones. Results: During actual helicopter operations, maximum heart rates did not exceed 120 bpm. Over the 7-d duty period, mean sleep duration decreased from 7.8 h to 6 h or less, resulting in a cumulative sleep loss of about 15 h. Mean levels of excreted adrenalin, noradrenalin, and cortisol increased significantly by 50 to 80%; cortisol and noradrenalin excretion also remained elevated for the two post-duty days. Conclusions: Although the actual flights did not cause critical physiological responses, the acute and accumulated sleep deficit led to incomplete recuperation between duty hours and induced elevated stress indicators. It was, therefore, recommended that the duty cycle be amended as follows: 1.) enforce a 10-h rest period and at least an 8-h sleep opportunity per day; 2.) modify the duty period to allow no more than 3 consecutive rest periods of reduced sleep opportunities (8.5 h); and 3.) follow duty with several days that offer unrestricted sleep opportunities.