Overcoming Jet Lag: Alternative Models - Seminar, April 27, 2000

David Flower, MD, Occupational Physician, British Airways

DR. DIMBERG: Dr. Flower is licensed in family medicine and occupational medicine. He has for some years had a research interest in the effects of travel fatigue and his doctoral thesis examined the impact of transmeridian flights on performance in long-haul passengers.

He is a recognized authority on the management of travel fatigue, and is currently a member of the British Olympic Association's Acclimatization Working Party, advising the British Olympic team on the management of jetlag in preparation for the Sydney Olympics. He represents British Airways extensively within Europe and will present on overcoming jet lag, alternative models, alertness management in British Airways.

Dr. Flower, please.

DR. FLOWER: Thank you very much, Lennart.

Thank you for the invitation and I would like to present to you a brief outline of how we have approached alertness management in flight and cabin crew within British Airways.

Firstly however, I would like to just touch on the physiology that Mark and Professor Lemmer have covered to try and give you a clearer understanding of why we felt there was a need to provide alertness management for individuals who, after all, spend their working lives crossing time zones .

Fatigue and alertness, as we have said, depend on a number of factors including prior sleep and wakefulness and circadian phase. Sleep patterns change with age and medications, either prescription or over-the-counter, may also impact on performance and alertness as will alcohol, the type of work and environmental conditions.

The effects of sleep loss are additive; and build into a sleep debt that leads to increased sleepiness, decreased physical and mental performance and increased negative mood.

The effects of circadian desynchronization may mean that the local sleep period does not coincide with the crew members preferred time of sleep and, as a result, peaks in sleep tendency may lead to inadvertent napping.

All of these effects apply to flight and cabin crew just as much as passengers, irrespective of whether they are operating short-haul or long-haul services. For short-haul crews, there are long duty days, early reports, night flights and multi-sector days. Long-haul crews fly for long periods often through the night with of course, time zone crossings as well.

It has been shown by NASA that short-haul pilots, on average sleep an hour less each night when they are on trips compared to home, and that flight crew are unable to obtain the extra sleep that they need to prepare for an early call.

In addition, for long-haul crew, the circadian system, which influences the timing and duration of sleep, cannot synchronize immediately to a new work rest pattern or to a new time zone.

As a result, alertness management has been identified by British Airways as an important factor in flight safety and now forms part of the company safety management culture involving Safety Services, the individual aircraft fleets, Corporate review committees and British Airways Health Services.

To develop the physiological contribution to the company's alertness management program, airline representatives attended one of the first NASA Fatigue Countermeasures courses. On their return they created a training module which has since been given to all of British Airways 3000 flight crew and 14000 cabin crew.

Flight crew received the training as part of their annual refresher in aviation medicine and cabin crew during their crew resource management course.

All crew have subsequently received documentation summarizing the lecture and highlighting details such as sleep scheduling, napping, and good sleep habits.

In addition, for long-haul crew, we also provide preventive and operational recommendations, individualized to the operations that they are flying; in other words, route and time-specific advice cards for every long-haul sector flown by British Airways.

This concept had been pioneered by Airbus Industrie during the proving flights of the A-340 and with their approval we have been able to develop a series of cards exclusively for use within British Airways.

The cards are grouped according to the direction of travel, time of departure, and the length of the layover. The aim being to reduce fatigue, sleep loss and circadian disruption and to improve alertness in the operating crew members.

The alertness management manual consists of 30 different cards, extending across 42 different flight schedules and covering the pre-flight period, the in-flight period and the layover.

For the pre-flight and in-flight period, the flight crew cards are separated into operations using basic crew and those involving augmented crew.

However, for the layover, both cabin and flight crew cards are broadly similar and divided into eastward, westward and north/south travel.

To use the cards, the crewmember must first identify the right card for the trip. For instance if they are operating from the UK to the US East Coast. They will select a Wastbound card with the appropriate departure time, length of layover and return departure.

The cards are well indexed so that crewmembers can identify the particular one they need and take it with them.

Each card has the aim clearly identified and depending on the length of the layover it may or may not be desirable to adjust to local time. Clearly, if you travel to the United States from Britain for 24 hours, it is impossible to adjust to local time within that time. So, the aim of the advice is to remain on London time.

If you are staying for 48 hours on the other hand, it is more difficult; and certainly beyond 48 hours, it is very difficult to remain on home time. In this case the advice is aimed at hastening adjustment to local time.

The crew cards are therefore separated into those where there is an emphasis on remaining on base time and those where the advice is aimed at facilitating adjustment to local time.

The text on each card contains general and specific advice concerning meals, avoidance or use of caffeine, napping, exercise, and so on. All of this information is also presented in diagrammatic form.

The cards are not intended to tell the crew what to do, but simply to highlight the physiology and to give them recommendations, advice, and a whole range of strategies from which they can choose their own individual approach.

In some cards, as I have mentioned the advice is aimed at adjusting to local time and guidance is therefore given on appropriate use of light exposure to assist phase adjustment to the new time zone.

In addition to crew, British Airways employs about 50,000 other staff members, who, like employees of any other global organization, travel on business and their needs also have to be taken into account.

Working with Alertness Solutions, in California we have developed a very comprehensive 50-page manual that sits on the British Airways Intranet, accessible only to BA staff members. As a result, when a staff member books their flight ticket, they have access to advice on how to manage their rest and alertness whilst they are away.

For our passengers, Dr Rosekind at Alertness Solutions has written a series of twelve articles for our in-flight magazine High Life. The series concludes in April 2000 and has comprehensively covered the basic physiology and key strategies as well as exposing some of the myths of jet lag management. A summary article has also appeared in our European Business Life magazine, which together with an in-flight video gives passengers the basic tools they need to assist them in managing their rest and alertness.

[APPLAUSE]

DR. DIMBERG: Thank you, David.

Disclaimer: These Proceedings have been produced from transcripts made from audio tapes. Efforts were made to check the accuracy of information with the various authors, but this accuracy is not guaranteed. If there is information that you believe requires correction, please send a message to our e-mail address.