Occupational Medicine 2006;56:263–268

doi:10.1093/occmed/kql021

Prevalence of fatigue among commercial pilots

Craig A. Jackson1 and Laurie Earl2
...................................................................................................................................................................................

Background Short-haul pilots have largely been neglected in studies of fatigue, sleep loss and circadian disruption

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created by flight operations, but anecdotal evidence from pilots suggests that with the increasing
amount of low-cost air travel, commercial pilots working short-haul operations may be becoming
seriously fatigued.
...................................................................................................................................................................................

Aims This study attempted to ascertain how much subjective fatigue short-haul pilots reported, and makes
comparisons between low-cost and scheduled airline pilots.
...................................................................................................................................................................................

Methods Pilots completed anonymous questionnaires (encompassing aviation factors, flight experience and
a fatigue scale) posted on the Professional Pilots’ Rumours Network website.
...................................................................................................................................................................................

Results Data were collected from 162 short-haul pilots and statistical adjustment for operational factors was
made. Seventy-five percent reported severe fatigue and 81% reported the fatigue to be worse than
2 years ago. Eighty percent considered their thought processes were reduced while flying.
Severe fatigue was reported more frequently by low-cost airline pilots than scheduled airline pilots
(P 5 0.05) and fatigue ratings were higher in this group (P 5 0.03). Pilots who reported regularly
flying into their ‘discretion’ hours had lower physical and psychological health, and overall fatigue
scores, and poorer self-rated general health. Flying into discretion time occurred no more frequently
in low-cost airline pilots than scheduled airline pilots.
...................................................................................................................................................................................

Conclusions Identifiable fatigue problems are reported by short-haul pilots, but this cannot be attributed solely
to the work schedules of low-cost airlines as regular use of discretion time appears to be associated
with fatigue regardless of airline.
...................................................................................................................................................................................
Key words Aviation; fatigue; pilots; short-haul.
...................................................................................................................................................................................

Introduction Aviation technology and operational demands have

all evolved significantly, yet the human operator’s need
Fatigue is an important factor in aviation, and is associ- for sleep remains. Fatigue degrades most aspects of per-
ated with sleep loss and shift work. Long duty cycles can formance, including judgement, decision making, mem-
cause pilots to become inattentive, careless and inefficient ory, reaction time, concentration, selective attention,
[1]. Civil aircrew frequently experience loss or distur- fixation and mood [6,7]. Low arousal produced by sleep
bance of sleep, transmeridian flight, irregular work–rest
loss is accompanied by a greater performance decrement
cycles and a variety of other job-related factors associated
on simple rather than on complex tasks [6]. The techno-
with this problem [1]. Fatigue management requires an
logical simplification of the aviation process may contrib-
understanding of the relationship between working
ute to this performance decrement.
conditions and fatigue. In one-third of all reports to the
Although individuals differ in the amount of sleep they
UK Confidential Human Factors Incident Reporting
require, studies suggest most require between 8 and 9 h
Programme reports pilots attribute incidents, errors or
sleep per night [8]. Shift workers generally sleep less than
problems to fatigue. NASA’s Aviation Safety Reporting
non-shift workers [9] and UK pilots claim to need 7.5 h
System indicates that 21% of reported aviation incidents
sleep a night [10]. Sleep duration is influenced by sleep
are fatigue related [2]. Fatigue has been cited as a cause
timing. Hence, pilots crossing time zones can develop
in many aviation accidents and is a continuing problem
cumulative sleep deprivation [11]. Continual disruption
facing crews flying aircraft of all sizes [3]. It is not affected
may lead to physical symptoms, with pilots reporting gas-
by motivation, professionalism, training or status [4,5].
trointestinal and bowel problems.
1
Health Psychology, Faculty of Health, UCE Birmingham B42 2SU, UK.
Clear links are established between circadian rhythm
2
and accidents with peaks at 02.00, 06.00 and 16.00 h,
Institute of Occupational and Environmental Medicine, University of
Birmingham, Edgbaston, Birmingham B15 2TT, UK. even after adjustment for traffic volume [12,13]. Field
Correspondence to: Craig A. Jackson, Health Psychology, Faculty of Health, studies have consistently revealed that fatigue has complex
UCE Birmingham B42 2SU, UK. e-mail: [email protected] and diverse causes, with 24-h duty/rest cycles, circadian

Ó The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: [email protected]
264 OCCUPATIONAL MEDICINE

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Figure 1. The PPRUNE screen-shot of the website questionnaire.

desynchronization and night-time flying all related to fa- multi-sector airline flight crews working for low-cost
tigue in long-haul operations [14]. Two consecutive airlines are being scheduled to work into their ‘discretion
night-time flying duties have been estimated to have periods’ [23,24]. Discretion is an extended period of time
the equivalent loss of 9.3 h of sleep [15]. The problems needed to complete a duty, should it become necessary
of the long-haul pilot in operating transmeridian sectors due to unforeseen circumstances such as aircraft delays.
of extended length are relatively well researched, and the Shorter turn around periods (when aircraft are on the
findings have been reviewed widely [15–19]. By compar- ground between flights) are being implemented for
ison, the situation of the short-haul pilot has been less economic reasons and this can result in greater flying
well studied, although it has been acknowledged that time. Flight time regulations allow a two-h maximum
the types of fatigue in long-haul and short-haul opera- discretion period, with a further single hour that can be
tions will differ considerably [20]. It is possible that cur- used for absolute emergencies only. Once discretion has
rent flight duty time legislation which is based mostly on been used, extra time must be given before the start of the
the experiences of long-haul pilots, may be inadequate next duty to allow an adequate rest period between flying.
to prevent the occurrence of potentially hazardous levels In the competitive short-haul industry, long duty days,
of fatigue in short-haul pilots [21]. short night-time stopovers and shortened sleep episodes
This concern has been raised in the media by some due to earlier report times may all serve to create and
pilots. Some former low-cost pilots claimed they no lon- exacerbate flight crew fatigue [1,4,24]. The National
ger trusted airlines that harboured a culture in which Transportation Safety Board showed growing concern
pilots are required to work close to the legal maximum over the long hours worked by short-haul pilots, stating
of flying hours. It was perceived that such pilots that it was ‘clearly established that fatigued pilots with up
may make errors due to tiredness [22]. Increasingly, to 19 hours waking time were more prone to make errors
 C. A. JACKSON AND L. EARL: PREVALENCE OF FATIGUE AMONG COMMERCIAL PILOTS 265

of judgement in tactical decision making’ [14]. Flight of all pilots was 38.3 years (SD 9.1, range 5 21–59).
crews routinely report concern over fatigue, often admit- Ninety-four percent (n 5 152) were male, with a mean
ting to having fallen asleep during flight [3], and that age of 38.3 years (SD 9.2). The females had a mean age
many pilots already work longer hours behind their con- of 27.9 years (SD 8.1). Age was normally distributed in
trols than heavy goods vehicle drivers are allowed to [24]. the sample (Kurtosis ÿ0.5), and was not significantly
This study examined how short-haul operations are different between the sexes (P 5 0.88). Hours between
performed in relation to flight time limitations and dis- ending the last flying duty and completion of the ques-
cretion periods and looked for any differences in reported tionnaire ranged from 0 to 504, with a mean duration
fatigue in those operating for scheduled and low-cost since last duty of 32 h (SD 52). The pilots had held
airlines. This study also investigated if other operational a Commercial Pilot’s Licence or an Airline Transport

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factors such as the number of sectors (take-offs and land- Pilot’s Licence for a mean duration of 11.9 years (SD
ings) affected pilot fatigue. 8.2, range 5 1–39). Seventy-six percent (n 5 123) were
flying aircraft fitted with Electronic Flight Information
Systems. Forty-seven percent (n 5 77) were flying aircraft
Methods capable of performing semi-automatic or automatic
The study was granted ethical clearance by the student- landings. The mean number of sectors typically per-
projects sub committee of the local UK National Health formed by pilots in a single duty was 4 (SD 2, range 5
Service research ethics committee. Fatigue levels in 1–20). With only 8% of the sample belonging to general
short-haul pilots were recorded by use of an anonymous aviation, we excluded such pilots. The general aviation
Internet-based questionnaire hosted for 4 weeks on the group was excluded from analyses comparing short-haul
Professional Pilots’ Rumours Network (PPRUNE— and scheduled airlines, as their duties can be a combina-
www.pprune.com) website. The PPRUNE website di- tion of both such schedules.
rected pilots to the on-line questionnaire page via a link, Twenty-one percent (n 5 34) reported regularly flying
asking pilots: into their discretion periods; 69% did not and 10% did
not record a response. When asked if they had flown in-
Are you a short-haul commercial pilot? to discretion time on their most recent duty, 24% had,
Will you take 5 minutes to complete a survey about 66% had not and 10% did not record a response. The
flight time limitations? mean global fatigue score on the fatigue scale was 17.8
(SD 5.0, range 5 2–31) and this was normally distributed
The questionnaire (Figure 1) contained the 11-item (Kurtosis ÿ0.9). Table 1 shows how many pilots were
chronic fatigue scale (CFS) which is used to detect severe classified with severe fatigue (binary score $4) as well
fatigue at a point in time in cross-sectional studies. It as responses to other specific items about fatigue symp-
gives physical, psychological and global fatigue scores, toms. Odds ratios (ORs) were calculated for those clas-
as well as a binary classification of whether respondents sified as severely fatigued, and the results are shown in
are likely to be severely fatigued or not [25]. Pilots were Table 2.
also asked a range of questions about any tiredness symp- Comparisons between low-cost and scheduled airlines
toms such as ‘Do you feel sufficiently tired while flying pilots were made using t-tests and chi-square tests (with
that your judgement is affected?’ and ‘Do your tiredness Yates’ correction for continuity of smaller samples). This
levels feel any different from two years ago?’. Pilots were is shown in Table 3. Table 4 shows the comparisons
asked to give details on their usual flight duties, such as between those who regularly flew into discretion time
the number of sectors (single period of flight) per duty and those who did not. Comparisons are adjusted for
and aircraft information. The number of hours between
ending the last flying duty and completion of the ques-
tionnaire, duration of duty and the time of day (GMT) Table 1. Fatigue responses from short-haul pilots
when completing the questionnaire, and pilot location
were recorded for statistical adjustment purposes in sub- Fatigue measure Response n %
sequent data analyses.
Severe fatigue on the CFS Yes 121 75
(score $4) No 41 25
Results ‘Fatigue levels worse than Yes 131 81
2 years ago?’ No 23 14
Use of the word ‘fatigue’ was deliberately avoided to Not sure 8 5
reduce the likelihood of any fatigued-biased respond- ‘Feel tired with impaired Yes 129 80
ents taking part. A total of 162 pilots responded. All judgement while flying?’ No 31 19
Not sure 2 1
performed short-haul operations for low-cost airlines ‘Concerned with the level of Yes 127 78
(34%, n 5 55), scheduled airlines (58%, n 5 94) or in fatigue you experience?’ No 35 22
‘general aviation’ operations (8%, n 5 13). The mean age
266 OCCUPATIONAL MEDICINE

the time of day of questionnaire completion, duration of viously had been. The posting of this questionnaire on the
duty and the number of hours since ending the most PPRUNE website introduces a possible source of bias to
recent duty. this study. The survey was highlighted on the PPRUNE
website as a survey concerning flight time limitations and
not concerning fatigue, and we anticipate that this may
Discussion have reduced the possibility of those respondents with
strong issues concerning pilot fatigue from being over-
This study has demonstrated that three-quarters of represented in the sample. There are 99 000 registered
the pilots studied were operating despite feeling severely users of the PPRUNE website and about half of those are
fatigued. The majority of the pilots believed they were pilots. The age and sex proportions of our sample are

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fatigued, and that their fatigue was worse than it pre- comparable with the general PPRUNE-user population.
The researchers monitored the uniqueness of the IP
Table 2. ORs associated with classification of severe fatigue addresses of respondents to ensure questionnaires were
not completed more than once (from the same com-
Factor OR 95% CI puter). Cross checking of the CFS data was also per-
lower–upper formed to look for any similarity in ‘extreme’ responses.
No such incidents of this nature were observed. It is likely
Concerned about fatigue 11.1 4.6–26.7 that commercial pilots would be concerned that knowl-
Fatigue worse now than 2 years ago 10.2 3.8–27.3 edge of their fatigue status or concerns about fatigue
Believe general health is now poorer 7.5 2.2–25.8
could be harmful and this should reduce the likelihood
Has to use discretion regularly 5.7 1.3–25.5
Believe a revision of regulations needed 5.3 2.3–12.7 of over-reporting.
Believes judgement is affected when flying 4.6 2.0–10.6 We propose that this form of data collection is a useful
Used discretion on last duty 2.9 0.1–9.0 method of studying this highly responsible occupational
Believe more research is needed into 2.1 0.3–13.4 group who wish to remain anonymous. Other studies
pilot fatigue
looking at fatigue have commonly used combinations of
Regular changing of duty times 1.4 0.7–3.0
Malea 0.7 0.7–0.8 self-reports and physiological measures, including back-
Found air traffic control to be generally 0.7 0.2–3.8 ground questionnaires and pilots’ logbooks [26]. This
uncooperative method may limit the external validity (generlizability)
of the results, which may need cautious and sensible in-
a
Sex 5 Male was found to be ‘protective’ as all eight female pilots were classified as terpretation, but we believe that both under and over-
fatigue cases. reporting are not likely.

Table 3. Comparisons between low-cost and schedule operations pilots

Measure Low-cost pilots n 5 55 Scheduled pilots n 5 94 t or X2

Age 39.8 (SD 8.0) 37.9 (SD 9.8) 1.21

Licence years 11.6 (SD 6.9) 11.8 (SD 8.9) 0.15
Auto-landing equipment used 49 (89%) 70 (74%) 3.74a,*
Male 51 (93%) 88 (94%) 0.00a
Uses discretion regularly 12 (22%) 21 (27%) 0.37
Used discretion on last duty 13 (24%) 23 (29%) 0.47
Sectors normally flown per duty 3.0 (SD 1.0) 4.0 (SD 2.5) 2.20*
Regular changing of duty times 27 (49%) 51 (55%) 0.55
Concerned about fatigue 48 (87%) 71 (76%) 2.28a
Believes more research is needed 53 (96%) 90 (97%) 0.00a
Revision of regulations needed 48 (87%) 73 (78%) 1.24a
Physical fatigue score (CFS) 12.9 (SD 3.4) 11.7 (SD 3.2) 2.03*
Psychological fatigue score (CFS) 6.2 (SD 2.1) 5.7 (SD 1.8) 1.69
Total fatigue score (CFS) 19.1 (SD 5.1) 17.4 (SD 4.6) 2.08*
Fatigue cases 47 (85%) 66 (70%) 3.60a,*
Believes general health is now poorer 14 (25%) 27 (29%) 0.18
Fatigue worse now than 2 years ago 50 (94%) 73 (82) 2.89a
Judgement impaired when flying 49 (89%) 71 (77%) 2.51a

a
Denotes chi-square testing using Yates’ continuity correction.
*P , 0.05, **P , 0.01, ***P , 0.001.
 C. A. JACKSON AND L. EARL: PREVALENCE OF FATIGUE AMONG COMMERCIAL PILOTS 267

Table 4. Comparisons between pilots who do and do not regularly fly into discretion

Measure Regularly flies into Does not fly into t or X2

discretion, n 5 34 discretion, n 5 111

Physical fatigue score 13.4 (SD 3.6) 11.6 (SD 3.3) 2.59**
Psychological fatigue score 6.7 (SD 2.3) 5.6 (SD 1.8) 3.04***
Total fatigue score 20.2 (SD 5.5) 17.3 (SD 4.7) 3.02***
Fatigue cases 31 (91%) 80 (72%) 4.28a*
Believes general health is now poorer 16 (47%) 27 (24%) 6.44**
Fatigue worse now than 2 years ago 30 (88%) 89 (80%) 0.19a

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Judgement is impaired when flying 27 (79%) 91 (82%) 0.00a

a
Denotes chi-square testing using Yates’ continuity correction.
*P , 0.05, **P , 0.01, ***P , 0.001.

A biopsychosocial interpretation of the ORs associated long-haul studies such as the ‘40 minute in-flight rest
with severe fatigue status suggests that those pilots who opportunity’ that is proven to reduce the effects of fa-
are ‘concerned about fatigue’, ‘feel more fatigued than tigue [30]. In Australia, Qantas, the Civil Aviation Safety
before’ and who ‘believe their health is poorer now than Authority and the Australian and International Pilots
before’ are likely to be the pilots who score sufficiently Association are currently conducting the largest study
high on the CFS to qualify for ‘severe fatigue’. We found on pilot fatigue involving airlines, safety authorities and
that those reporting this had ORs for severe fatigue status pilot’s associations together, and is due for completion
of 11.1, 10.2 and 7.5, respectively. However, regularly in 2006. Similarly, a project that provides flexibility of
flying into discretion time, feeling a revision of FLTs is choice of flight times in pilots’ own environments has
due and a belief of impaired judgement when flying also been operating in New Zealand since 2001, as a joint
had raised ORs for severe fatigue (OR 5.7, 5.3 and 4.6, venture between NASA, the New Zealand Civil Aviation
respectively, with CI of 1.3–25.5, 2.3–12.7 and 2.0–10.6, Authority and Air New Zealand [31]. Results showed
respectively). This suggests that it is not just the belief operational decisions about layover time, flight lengths
that one is suffering from a condition (fatigue) that is and rest periods based on the performance and expertise
associated with increased reporting but that procedural of their own aviators has had tangible benefits to many
and operational factors may play a role too. pilots, including reduced fatigue and lower reliance on
Our results can be translated into operationally rele- hypnotic medication. This also demonstrated that broader
vant considerations that could help maintain safe aviation approaches to the management of fatigue are available
in the short-haul industry whereby reducing human and feasible [31].
error will reduce the number of accidents [27]. The role Our study suggests that further work should be under-
of fatigue may be underestimated. This study shows that taken to examine the role of discretion-time flying and
many modern day short-haul commercial pilots report fatigue in short-haul pilots. It is therefore important that
severe fatigue. The potential for more accidents with all accident prevention research units working with pilots
pilots operating when fatigued is high. The issue of man- explore all avenues and work together to implement
aging fatigue in aviation operations must move beyond strategies and effectively link human factors and fatigue
current regulatory schemes that are based upon long-haul information. For aircrew, working hours restrictions
flying while ignoring the increasing demands of commer- may need to be related to the time of day or night
cial short-haul flying. A range of approaches could be they start work and whether long- or short-haul flying.
considered incorporating research, scientific data and Articles in the United Kingdom have referred to in-
the experience of those flying. While global demand for creased pilot fatigue [19,24] but no changes have yet
aviation operations continues to grow, safety resources been made in the short-haul industry.
will probably need to develop too. The Royal Aeronauti-
cal Society [28] argued that safety is in danger of being
exchanged for profit, and declared that ‘current profits Conflicts of interest
are derived from cost reduction, rather than revenue
None declared.
improvement’. Attempts to play down the important
role of pilot fatigue in short-haul operations may delay
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