CCATT Duty & Rest Cycle
Know The Rules
MEMORANDUM FOR SEE DISTRIBUTION
FROM: HQ AMC/SGK
203 West Losey Street, Suite 1600
Scott AFB IL 62225-5219
SUBJECT: Guidance for Clinical Practice and Patient Safety Related to Duty/Rest Cycle for Critical Care Air Transport Teams (CCATTs).
- In a recent trip to CENTCOM, AMC/CC, visited with the CCATTs at Bagram Airfield. One of the subjects discussed concerned crew rest for CCATT member s. As you know CCATT members are not aircrew and are not required to meet crew rest as outlined in AFI 11-2 AE Volume 3; AE Operations Procedures. More importantly, crew rest as outlined in this AFI is not appropriate for CCATTs because of the clinical nature of their work. However, it is incumbent on us to ensure the CCATTs receive adequate duty/rest cycles.
- The AF Tactics Techniques and Procedures; 3-42.51 ; Critical Care Air Transport Teams is currently in coordination. Part of the update includes an expanded explanation and guide for CCATT duty/rest cycles.
- Critical care air transport is a physically, emotionally, and intellectually demanding field. It requires a longitudinally-concentrated effort on the part of the team. The Accreditation Council for Graduate Medical Education (ACGME) and the healthcare industry, in order to affect patient safety and improve patient outcomes, drafted standards and guidelines on duty/rest cycles for physicians and student physicians who likewise must expend longitudinally-concentrated effort. AMC/SG has operationalized these guidelines for CCATT employment. In some instances, the AMC/SG guidelines surpass the ACGME standards. The updated guidelines are attached for reference.
- The setting of critical care air transport strives to ensure the provision of safe, effective clinical care by assuring each team members' skills, knowledge, and attitude are optimally utilized. This can only be accomplished when team members are well rested. My point of contact is Col Mark Ervin at DSN, 779-5496 or commercial at (618) 229-5496.
ROBIN L. SCHULTZE, Colonel, USAF, NC
Chief, En Route Medical Care Division
Office of the Command Surgeon
1st Ind, HQ AMC/SGK
MEMORANDUM FOR DISTRIBUTION
I Concur with this policy letter on CCATT Duty/Rest Cycles.
BART O. IDDINS
Brigadier General, USAF, MC, CFS
CCATT Duty/Rest Cycle
ALL CRITICAL CARE AIR TRANSPORT TEAM PERSONNEL
USAFSAM CCATT BASIC COURSE
USAFSAM FN/AET COURSE
ALL AE SQUADRON COMMANDERS
ALL AEROMEDICAL EVACUATION CREW MEMBERS
ALL VALIDATING FLIGHT SURGEONS
ALL AEROMEDICAL STAGING FACILITIES
ALL PATIENT MOVEMENT REQUIREMENTS CENTERS
CCATT Duty/Rest Cycle
- Contingency, i.e. Wartime/DSCA/1-HumanitarianUnder typical operating conditions, the standard duty cycle for the FFCCT, FFCCE, and FFCCN teams is based on a duty period of 16 hours. The 16-hour duty period begins with show time for mission preparation at the AEOT. The duty-period ends when the team has delivered the patient(s) to the next level of care, the receiving facility has assumed care responsibilities for the patient, and all duties have been completed (to include replenishment of supplies/kits, pallet building when required, etc.).
- Non-contingency Individual BeneficiaryWhen the CCATT originates at the same medical treatment facility as the patient being transported, the 16-hour duty period begins four hours prior to scheduled takeoff. When the CCATT is transported via aircraft to another facility to pick up a patient, the duty period will begin three hours prior to scheduled takeoff.
- Under certain circumstances, such as mission require1nents, the CCATT chief may extend the duty day beyond 16 hours. In making this decision, the team chief will consider potential benefits to include improved continuity of patient care and potentially harmful delays in transport while awaiting the availability of a replacement CCATT. When extending the duty day, the CCATT chief will notify the MCD; if an MCD is not available, the CCATT chief will notify the governing C2 agency (AECT, 618 AOC (TACC) or assigned Air Operations Center). The CCATT chief also needs to consider the ability of the entire team to rest when not engaged in patient care, the appropriateness of the team resting in shifts while engaged in patient care, the team's response to fatigue countermeasures, and individual team member factors affecting operational riskThe CCATT chief will assess if the team is mentally and physically able to safely complete the mission and provide satisfactory critical care. If the team is assessed as unsafe, the CCATT chief will notify the AEOT. The AEOT will coordinate mission re-tasking with the AECT or 618 AOC (TACC) as applicable. CCATT Duty/Rest Cycle policy may be waived by the Theater CCAT Director (or AECT if a Theater CCAT Director is not appointed) when there is an operational requirement for a team to be returned sooner to the AOR.
- There may be times (inclement weather, winds, crew duty day, aircraft maintenance issues, etc.) when the AE crew must remain overnight (RON) at fields where local medical care is less capable than the care provided by the CCATT. To maintain standard of care, the CCATT may be required to continue caring for the patient, impacting duty/rest cycles. The local MTF commander (or equivalent), MCD, and CCATT chief should collectively determine the optimal solution to satisfy competingIn instances where the CCATT duty day is projected or has exceeded the recom1nended 16-hour period, the CCATT chief has the authority to determine if any of the CCATT members are in need of rest/sleep and authorize rest/sleep if deemed necessary.
- To ensure adequate time for rest/sleep cycles for CCATT, a rotational schedule must be established among the deployed teams at a particular location. The CCATT Director at the AE element level will establish the rotational schedule in coordination with the AEOT. In special circumstances, this rotational schedule may be disrupted according to the flow of patients or when the CCATT Director (or designee, if not available) determines that it is medically or operationally necessary to accomplish the mission successfully.