Fatigue Cited as ‘Enemy’ of Safety

Patrick M.E McGarry, M.B., F.R.C.P.

To the Editor

In the supplement of the December, 1986 Newsletter reference is made to the airline industry. This is in regard to technological advances in safety.

I would like to draw attention to this industry also, but from a different viewpoint. The airline pilots to whom we are often compared, are light years ahead of our specialty in one particular aspect, i.e., the limitations on their hours of work. As a result the public appreciates that at the controls there will always be a Captain who is not fatigued.

In the same vein our patients, plus the insurance industry, would I’m sure, be very appreciative if the same could be said of anesthesiologists.

I have no idea of the part played by fatigue in anesthetic accidents, but it must be considerable. As a practicing anesthesiologist for 36 years, I am only too aware of the near misses when one has been sleepless. It is customary, where I practice, to live in the hospital for 24 hours when on call. Frequently sleep is impossible and equally frequently our most critical cases come in well after midnight.

This is a situation and circumstance that must be changed. No anesthesiologist should be permitted to work a 24 hour shift. Would any of us like to be subjected to the ministrations of a sleepless colleague? Obviously if hours of work are restricted, fee schedules will have to be adjusted accordingly.

I consider fatigue to be Enemy No. I in our efforts to increase the safety of anesthesia. Its elimination might obviate the cacophonous orgasm of flashing lights and warning buzzers heralding yet another anesthetic disaster.

Patrick M.E McGarry, M.B. F.R..C.P. (C) Winnipeg, Manitoba