First, I come from a program where all transport staff work =<12 hour shifts. Our program has a policy in place that limits medical crew duty time to either 16 or 18 hours. Our RW crews work 12 hours and are replaced by the on-coming duty crews. This mainly addresses our fixed wing side of our program and those late afternoon flight requests that come in through our communication center.
I believe that Dr. Thompson's points are well taken, at least by me. First, there is a reason that pilots have duty time. After a certain number of hours, anyone is bound to be less mentally alert. That is just plain fact. A duty time is in place so that safety doesn't become compromised, no matter whether or not the pilot believe's he or she is just fine, in their opinion.
Why shouldn't we expect the same of the care providers in the transport environment? It's nice to have cat naps when they are available. And, if you're in a program where 2 or 3 flights a day are generally completed, then all is well, for the most part. But, where is the safety when you are flying for 6-10 hours in the latter part of the shift after being on duty for 8-10 hours prior to the "busy time" of the shift? There are many variables in the situation I've presented. But I can clearly see the situation where someone has been up the majority of the day, only to have to fly the majority of the night because business has picked up.
Our patients should expect more than someone who has been up for more than 12 to 16 hours, transporting patients. It doesn't matter how mentally alert you think you are. If you've been flying in any aircraft for a significant amount of time, then you will have a certain amount of fatigue. Then take into account the energey expenditure from the "sick-as-snot" patients you're having to fly and work the majority of the flight to sustain their life. You can say that you're ok to transport, but are you really?
I certainly applaud the programs where safety nets are in place for those who are too tired to fly or have the backup of a chief flight nurse who will come in and work the rest of the shift if you recognize that you're too tired to care for patients. But, my impression is that this is more of an exception than the rule. I certainly would love to work 24 hour shifts and work less days per month. I'm just not convinced that it's in the best interest of our patients.
