Sleep

Fatigue Characteristics and Perceptions in US Helicopter Air Ambulance Pilots.

Baumgartner H, Durham J, Sanders T, Hilditch C • Air medical journal • 2026

PubMed 42946508 DOI 10.1016/j.amj.2026.06.003

TL;DR

A survey of 120 US helicopter air ambulance pilots across 21 operators found that poor sleep quality, in-flight nodding off, and sleep inertia effects are common, and that pilots identified flight request volume and the return-to-base leg as key fatigue risks.

Key Findings

Results

More than half of surveyed HAA pilots reported poor sleep quality.

The survey included 120 pilots across 21 US HAA operators.
53% of the sample reported poor self-reported sleep quality.
Sleep quality was assessed with standardized questionnaires including the Pittsburgh Sleep Quality Index.

Results

Most pilots felt fatigue was most prevalent on the return-to-base leg of a trip.

71% of participants identified the return-to-base leg as the point of greatest fatigue.
The data came from a survey conducted during a larger field study.

Results

Pilots identified the number of flight requests as the greatest schedule-related contributor to fatigue.

69% of pilots felt the number of flight requests was the greatest schedule-related fatigue contributor.
Pilots suggested flight request limits as a way to mitigate fatigue risk.

Results

A substantial minority of pilots reported nodding off during a flight.

34% (about one-third) reported 'nodding off' during a flight.

Results

Most pilots reported that sleep inertia had affected their work performance.

87% said their work performance had been affected by sleep inertia.
Pilots suggested sleep inertia protections as a fatigue mitigation.

Conclusions

Pilots suggested operational mitigations including flight request limits, duty duration maximums, and sleep inertia protections.

These suggestions were provided by pilots in the survey.
The authors state the results can help identify fatigue risk areas to address through operational policies and highlight areas needing further research.

What This Means

This study surveyed 120 helicopter air ambulance pilots from 21 operators across the United States about their sleep, work schedules, and fatigue. The pilots completed standard sleep questionnaires as well as questions about their work, as part of a larger field study. The goal was to give an updated picture of how fatigue affects this group, whose shift work puts them at higher risk of tiredness. The results suggest fatigue is a widespread concern. About half of the pilots (53%) reported poor sleep quality, and about a third (34%) said they had nodded off during a flight. Most (87%) said sleep inertia, the grogginess after waking, had affected their work performance. Pilots also said fatigue was worst on the flight back to base (71%), and most (69%) said the number of flight requests was the biggest scheduling factor contributing to fatigue. The pilots proposed limits on flight requests, maximum duty durations, and protections for sleep inertia. This research suggests these areas could be considered when setting operational policies and directing further research. Because the findings come from self-reported survey answers, they reflect pilots' perceptions rather than direct measurements of fatigue.

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Citation

Baumgartner H, Durham J, Sanders T, Hilditch C. (2026). Fatigue Characteristics and Perceptions in US Helicopter Air Ambulance Pilots.. Air medical journal. https://doi.org/10.1016/j.amj.2026.06.003

Key Findings

What This Means

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