Narrative:

This report is not about one specific event; but about a series of events that taken on the whole illustrate that chronic fatigue is; in my observation; having a significant impact on operations and safety at air carrier in this fleet. The average line and reserve pilot that I fly with; including myself; has been flying/deadheading over 90 hours month after month. This quantity of flying in and of itself is challenging; but has been made more challenging due to delays; re-assignments; flow control; maintenance issues; cold weather operations; bad weather; and crew scheduling; (e.g. The practice of calling in the middle of the night to 'reset' pilot rest and the practice of 180 degree circadian rhythm swaps). The symptoms of chronic fatigue I have experienced; observed; or heard confessions of include: forgetting that an altitude was changed even after it is set in the window and verified (so one pilot thinks that we are blowing through an altitude and yells out or pushes over); pilots putting altitude changes in the radio frequency window; pilots not caring enough to enter the weight and balance information after receiving final weights; pilots falling asleep at the stick due to micro sleep (when they cannot physically stay awake); and pilots routinely asking if I mind if they take a nap because they cannot keep their eyes open; pilots' inability to retain the radio frequency long enough in their head to repeat it back; and several almost missed altitude and/or speed restrictions. I think the two things that are preventing a hull loss or critical incident at air carrier are SOP and muscle memory from having so much experience in these airplanes. So I am seeing errors mostly of 'omission' vs. Errors of 'commission;' but of course; every accident is caused by a chain of events. While I am ZZZ based; I often fly with other domiciles and the fatigue factor seems to apply across the board. At ZZZ; our trips are normally first out and last in to save on hotel costs; which we understand; but this means that your body does a 180 turn in two days typically. In addition; the last two final legs I've flown into ZZZ1 were delayed over two hours because our airplane was given to another crew. This; according to my line holding co-pilots is standard practice out of ZZZ2. The other factor that adds to fatigue is that often times the narrow body fleets; even on reserve; give a block of days (more than four) off and then bunch up flying in one half of the month. While most people like a long break; the day after day flying in the environment we now fly in with maintenance issues (I do not remember the last flight when I did not have to reset a circuit breaker or deal with a maintenance issue); cold weather operations; flow control delays; passenger issues each flight becomes 'pc like;' and this adds to the stress and distraction level. In addition; numerous crews I have flown with have had issues with food poisoning; myself included; due to food being boarded and not chilled between flights; and in my case; oj being left out all day. It is not uncommon to find mold on the fruit. The additional stressor is that many of the crews are flying while 'marginally' healthy due to feeling pressure to fly. Every co pilot I flew with in the last 17 days was sick; or had been sick within the last two weeks due to a cold or stomach virus. I personally had the dry heaves from bad oj for my two days off; and was unable to eat much for a week after. I flew 14 days in the last 17 days. Every co pilot I flew with; with the exception of the last senior co pilot on my reassigned final leg; had been flying as hard as I had. Today I signed into computer to check whether I would fly tomorrow and I found an e-mail from the system chief pilot about 'absenteeism.' while I have intended to write this report since my last trip; I wanted to decompress for a few days and talk with other air carrier captains to make sure what I was experiencing was not simply a function of being a reserve pilot. The e-mail fromour system chief pilot made me realize that even the pilots within management have a blind spot about fatigue and are exacerbating the situation with their correspondence. The e-mail implies that crews are perpetrating a unilateral job action on the company. The truth is that the fleet is broken; spent; and completely exhausted and our immune systems have finally caught up with us. Unfortunately; we also feel pressure to complete the mission; and so many are flying fatigued for fear of financial or professional reprisals. I have developed a list of personal 'flags' for when I know I am fatigued; not unlike developing one's personal signs of hypoxia. I was experiencing them on my last flight when I got reassigned to a trip; which with flow control would have put me over 14 hours. I tried to get the coordinator to move up the flight; and after arguing with him about the fact that my duty day is 14 hours; not 16 hours; he agreed to move us up; but he said he had to verify with the crew schedulers. I called them and told them the coordinator was going to call them to verify I was running up against my duty day and they did not respond to me except saying 'ok.' when the coordinator called them; the supervisor told him I was not over duty time because they could lay me over at ZZZ3 and cross town me to ZZZ4 the next day. Subsequently we did not get a move up; we got a move back and our flow time kept getting extended and we ended up getting into ZZZ3 right under my 14 hour day and landing in gusty crosswinds (70 degrees off runway heading and winds 17 gusting to 30 knots). I could have taxied back to the gate and stranded the plane full of passengers; many of whom had been stranded for a day trying to get out; but I wanted to 'make it work' for them and for my co pilot who would have lost 6.5% of his monthly salary. I was safe to fly; but this is a case of a captain trying to mitigate fatigue issues and being co-opted by the crew desk supervisor. In addition; I had also tried to get a crew room to rest between flights since my situation was going to be 5.5 hours; but it was scheduled at 3+25 not accounting for the wheels up; and even though the flight had had a wheels up time since the early morning; the crew desk said sorry but his hands were tied and could he not help me. In summary; I have flown this aircraft type for eight years (four as a co pilot and four as a captain) and have been at air carrier for almost 14 years and have never seen the operation this close to a hull loss. The increase in sick leave is due to suppressed immune systems and exhaustion. Those of us pushing our absolute physical and mental limits are doing the best we can to manage our risk; especially in light of the pressure being placed on us. I am personally interviewing to fly for another airline because I can no longer fly this schedule safely month after month. Finally; unfortunately; when it comes to fatigue; I speak out of experience from having lost close friends in the military to accidents directly related to fatigue and distraction. If this were a military unit; we would take a safety 'down' day given the trends I am seeing. It is my hope that air carrier will take immediate steps to address crew fatigue in order to prevent a major mishap.

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Original NASA ASRS Text

Title: AN AIR CARRIER PILOT ALLEGES SERIOUS FATIGUE ISSUES CAUSED BY OVER SCHEDULING; WX; SICKNESS; AND SLEEP LOSS. REPORTER FEARS SERIOUS CONSEQUENCES MAY OCCUR.

Narrative: THIS REPORT IS NOT ABOUT ONE SPECIFIC EVENT; BUT ABOUT A SERIES OF EVENTS THAT TAKEN ON THE WHOLE ILLUSTRATE THAT CHRONIC FATIGUE IS; IN MY OBSERVATION; HAVING A SIGNIFICANT IMPACT ON OPERATIONS AND SAFETY AT ACR IN THIS FLEET. THE AVERAGE LINE AND RESERVE PILOT THAT I FLY WITH; INCLUDING MYSELF; HAS BEEN FLYING/DEADHEADING OVER 90 HOURS MONTH AFTER MONTH. THIS QUANTITY OF FLYING IN AND OF ITSELF IS CHALLENGING; BUT HAS BEEN MADE MORE CHALLENGING DUE TO DELAYS; RE-ASSIGNMENTS; FLOW CONTROL; MAINTENANCE ISSUES; COLD WEATHER OPERATIONS; BAD WEATHER; AND CREW SCHEDULING; (E.G. THE PRACTICE OF CALLING IN THE MIDDLE OF THE NIGHT TO 'RESET' PILOT REST AND THE PRACTICE OF 180 DEGREE CIRCADIAN RHYTHM SWAPS). THE SYMPTOMS OF CHRONIC FATIGUE I HAVE EXPERIENCED; OBSERVED; OR HEARD CONFESSIONS OF INCLUDE: FORGETTING THAT AN ALTITUDE WAS CHANGED EVEN AFTER IT IS SET IN THE WINDOW AND VERIFIED (SO ONE PILOT THINKS THAT WE ARE BLOWING THROUGH AN ALTITUDE AND YELLS OUT OR PUSHES OVER); PILOTS PUTTING ALTITUDE CHANGES IN THE RADIO FREQUENCY WINDOW; PILOTS NOT CARING ENOUGH TO ENTER THE WEIGHT AND BALANCE INFO AFTER RECEIVING FINAL WEIGHTS; PILOTS FALLING ASLEEP AT THE STICK DUE TO MICRO SLEEP (WHEN THEY CANNOT PHYSICALLY STAY AWAKE); AND PILOTS ROUTINELY ASKING IF I MIND IF THEY TAKE A NAP BECAUSE THEY CANNOT KEEP THEIR EYES OPEN; PILOTS' INABILITY TO RETAIN THE RADIO FREQUENCY LONG ENOUGH IN THEIR HEAD TO REPEAT IT BACK; AND SEVERAL ALMOST MISSED ALTITUDE AND/OR SPEED RESTRICTIONS. I THINK THE TWO THINGS THAT ARE PREVENTING A HULL LOSS OR CRITICAL INCIDENT AT ACR ARE SOP AND MUSCLE MEMORY FROM HAVING SO MUCH EXPERIENCE IN THESE AIRPLANES. SO I AM SEEING ERRORS MOSTLY OF 'OMISSION' VS. ERRORS OF 'COMMISSION;' BUT OF COURSE; EVERY ACCIDENT IS CAUSED BY A CHAIN OF EVENTS. WHILE I AM ZZZ BASED; I OFTEN FLY WITH OTHER DOMICILES AND THE FATIGUE FACTOR SEEMS TO APPLY ACROSS THE BOARD. AT ZZZ; OUR TRIPS ARE NORMALLY FIRST OUT AND LAST IN TO SAVE ON HOTEL COSTS; WHICH WE UNDERSTAND; BUT THIS MEANS THAT YOUR BODY DOES A 180 TURN IN TWO DAYS TYPICALLY. IN ADDITION; THE LAST TWO FINAL LEGS I'VE FLOWN INTO ZZZ1 WERE DELAYED OVER TWO HOURS BECAUSE OUR AIRPLANE WAS GIVEN TO ANOTHER CREW. THIS; ACCORDING TO MY LINE HOLDING CO-PILOTS IS STANDARD PRACTICE OUT OF ZZZ2. THE OTHER FACTOR THAT ADDS TO FATIGUE IS THAT OFTEN TIMES THE NARROW BODY FLEETS; EVEN ON RESERVE; GIVE A BLOCK OF DAYS (MORE THAN FOUR) OFF AND THEN BUNCH UP FLYING IN ONE HALF OF THE MONTH. WHILE MOST PEOPLE LIKE A LONG BREAK; THE DAY AFTER DAY FLYING IN THE ENVIRONMENT WE NOW FLY IN WITH MAINTENANCE ISSUES (I DO NOT REMEMBER THE LAST FLIGHT WHEN I DID NOT HAVE TO RESET A CIRCUIT BREAKER OR DEAL WITH A MAINTENANCE ISSUE); COLD WEATHER OPS; FLOW CONTROL DELAYS; PASSENGER ISSUES EACH FLIGHT BECOMES 'PC LIKE;' AND THIS ADDS TO THE STRESS AND DISTRACTION LEVEL. IN ADDITION; NUMEROUS CREWS I HAVE FLOWN WITH HAVE HAD ISSUES WITH FOOD POISONING; MYSELF INCLUDED; DUE TO FOOD BEING BOARDED AND NOT CHILLED BETWEEN FLIGHTS; AND IN MY CASE; OJ BEING LEFT OUT ALL DAY. IT IS NOT UNCOMMON TO FIND MOLD ON THE FRUIT. THE ADDITIONAL STRESSOR IS THAT MANY OF THE CREWS ARE FLYING WHILE 'MARGINALLY' HEALTHY DUE TO FEELING PRESSURE TO FLY. EVERY CO PILOT I FLEW WITH IN THE LAST 17 DAYS WAS SICK; OR HAD BEEN SICK WITHIN THE LAST TWO WEEKS DUE TO A COLD OR STOMACH VIRUS. I PERSONALLY HAD THE DRY HEAVES FROM BAD OJ FOR MY TWO DAYS OFF; AND WAS UNABLE TO EAT MUCH FOR A WEEK AFTER. I FLEW 14 DAYS IN THE LAST 17 DAYS. EVERY CO PILOT I FLEW WITH; WITH THE EXCEPTION OF THE LAST SENIOR CO PILOT ON MY REASSIGNED FINAL LEG; HAD BEEN FLYING AS HARD AS I HAD. TODAY I SIGNED INTO COMPUTER TO CHECK WHETHER I WOULD FLY TOMORROW AND I FOUND AN E-MAIL FROM THE SYSTEM CHIEF PILOT ABOUT 'ABSENTEEISM.' WHILE I HAVE INTENDED TO WRITE THIS REPORT SINCE MY LAST TRIP; I WANTED TO DECOMPRESS FOR A FEW DAYS AND TALK WITH OTHER ACR CAPTAINS TO MAKE SURE WHAT I WAS EXPERIENCING WAS NOT SIMPLY A FUNCTION OF BEING A RESERVE PILOT. THE E-MAIL FROMOUR SYSTEM CHIEF PILOT MADE ME REALIZE THAT EVEN THE PILOTS WITHIN MANAGEMENT HAVE A BLIND SPOT ABOUT FATIGUE AND ARE EXACERBATING THE SITUATION WITH THEIR CORRESPONDENCE. THE E-MAIL IMPLIES THAT CREWS ARE PERPETRATING A UNILATERAL JOB ACTION ON THE COMPANY. THE TRUTH IS THAT THE FLEET IS BROKEN; SPENT; AND COMPLETELY EXHAUSTED AND OUR IMMUNE SYSTEMS HAVE FINALLY CAUGHT UP WITH US. UNFORTUNATELY; WE ALSO FEEL PRESSURE TO COMPLETE THE MISSION; AND SO MANY ARE FLYING FATIGUED FOR FEAR OF FINANCIAL OR PROFESSIONAL REPRISALS. I HAVE DEVELOPED A LIST OF PERSONAL 'FLAGS' FOR WHEN I KNOW I AM FATIGUED; NOT UNLIKE DEVELOPING ONE'S PERSONAL SIGNS OF HYPOXIA. I WAS EXPERIENCING THEM ON MY LAST FLIGHT WHEN I GOT REASSIGNED TO A TRIP; WHICH WITH FLOW CONTROL WOULD HAVE PUT ME OVER 14 HOURS. I TRIED TO GET THE COORDINATOR TO MOVE UP THE FLIGHT; AND AFTER ARGUING WITH HIM ABOUT THE FACT THAT MY DUTY DAY IS 14 HOURS; NOT 16 HOURS; HE AGREED TO MOVE US UP; BUT HE SAID HE HAD TO VERIFY WITH THE CREW SCHEDULERS. I CALLED THEM AND TOLD THEM THE COORDINATOR WAS GOING TO CALL THEM TO VERIFY I WAS RUNNING UP AGAINST MY DUTY DAY AND THEY DID NOT RESPOND TO ME EXCEPT SAYING 'OK.' WHEN THE COORDINATOR CALLED THEM; THE SUPERVISOR TOLD HIM I WAS NOT OVER DUTY TIME BECAUSE THEY COULD LAY ME OVER AT ZZZ3 AND CROSS TOWN ME TO ZZZ4 THE NEXT DAY. SUBSEQUENTLY WE DID NOT GET A MOVE UP; WE GOT A MOVE BACK AND OUR FLOW TIME KEPT GETTING EXTENDED AND WE ENDED UP GETTING INTO ZZZ3 RIGHT UNDER MY 14 HOUR DAY AND LANDING IN GUSTY CROSSWINDS (70 DEGREES OFF RUNWAY HEADING AND WINDS 17 GUSTING TO 30 KNOTS). I COULD HAVE TAXIED BACK TO THE GATE AND STRANDED THE PLANE FULL OF PASSENGERS; MANY OF WHOM HAD BEEN STRANDED FOR A DAY TRYING TO GET OUT; BUT I WANTED TO 'MAKE IT WORK' FOR THEM AND FOR MY CO PILOT WHO WOULD HAVE LOST 6.5% OF HIS MONTHLY SALARY. I WAS SAFE TO FLY; BUT THIS IS A CASE OF A CAPTAIN TRYING TO MITIGATE FATIGUE ISSUES AND BEING CO-OPTED BY THE CREW DESK SUPERVISOR. IN ADDITION; I HAD ALSO TRIED TO GET A CREW ROOM TO REST BETWEEN FLIGHTS SINCE MY SIT WAS GOING TO BE 5.5 HOURS; BUT IT WAS SCHEDULED AT 3+25 NOT ACCOUNTING FOR THE WHEELS UP; AND EVEN THOUGH THE FLIGHT HAD HAD A WHEELS UP TIME SINCE THE EARLY MORNING; THE CREW DESK SAID SORRY BUT HIS HANDS WERE TIED AND COULD HE NOT HELP ME. IN SUMMARY; I HAVE FLOWN THIS ACFT TYPE FOR EIGHT YEARS (FOUR AS A CO PILOT AND FOUR AS A CAPTAIN) AND HAVE BEEN AT ACR FOR ALMOST 14 YEARS AND HAVE NEVER SEEN THE OPERATION THIS CLOSE TO A HULL LOSS. THE INCREASE IN SICK LEAVE IS DUE TO SUPPRESSED IMMUNE SYSTEMS AND EXHAUSTION. THOSE OF US PUSHING OUR ABSOLUTE PHYSICAL AND MENTAL LIMITS ARE DOING THE BEST WE CAN TO MANAGE OUR RISK; ESPECIALLY IN LIGHT OF THE PRESSURE BEING PLACED ON US. I AM PERSONALLY INTERVIEWING TO FLY FOR ANOTHER AIRLINE BECAUSE I CAN NO LONGER FLY THIS SCHEDULE SAFELY MONTH AFTER MONTH. FINALLY; UNFORTUNATELY; WHEN IT COMES TO FATIGUE; I SPEAK OUT OF EXPERIENCE FROM HAVING LOST CLOSE FRIENDS IN THE MILITARY TO ACCIDENTS DIRECTLY RELATED TO FATIGUE AND DISTRACTION. IF THIS WERE A MILITARY UNIT; WE WOULD TAKE A SAFETY 'DOWN' DAY GIVEN THE TRENDS I AM SEEING. IT IS MY HOPE THAT ACR WILL TAKE IMMEDIATE STEPS TO ADDRESS CREW FATIGUE IN ORDER TO PREVENT A MAJOR MISHAP.

Data retrieved from NASA's ASRS site as of May 2009 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.