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Driving fatigue

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Doctors are very well acquainted with what it’s like to work long hours under pressure.

The experience begins in the undergraduate years with what seems like a Herculean effort to keep passing all of those exams.

By my second year as a medical student, I didn’t even sneeze when the anatomy lecturer said that we could be examined on anything at all from the 820 pages of Gardner, Gray and O’Rahilly’s textbook – that is, except for anything about teeth.

Looking for some respite, I quickly flicked through the pages to find that Chapter 61’s description of teeth was only eight pages long, leaving another 812 pages to memorize.

On my first day as a resident in a hospital with 300 beds I was rostered to do the 4pm to midnight shift in Casualty, with the last two hours in the hospital on my own.

That was until a phone call just before midnight to tell me that the night RMO had called in sick and that I’d need to work on my own until 8am.

Fast forward to life as a hospital registrar with the once-a-week 8am to 5pm (the next day) shift.

Or worse still, the monthly 8am Friday until 5pm Monday mix of on-duty and on-call.

The words “proximate” and “remote” don’t quite convey how gruelling the work was.

Of course, there was no possibility of complaining about the hours worked. The threat of not having a position in the following year would silence any complainers.

You are most vulnerable to fatigue when you don’t get enough sleep, you work at night, are awake for long periods of time, or some combination of the above.

But my experiences pale in comparison to the hours involved in some forms of surgery.

One well-known neurosurgeon recently found his gown dripping with saline and blood after a 14-hour operation.

He commented, “Oh my God, it looks like I wet myself”, only to then find himself the subject of an AHPRA investigation when his off-the-cuff comment was taken literally.

Thankfully, heavy vehicle drivers can attend to calls of nature in a more timely fashion, compliments of the Heavy Vehicle National Law (2012).

After 5¼ hours of work they can take a 15 minute break or, if they choose to keep working, they must have a 30 minute break after 7½ hours or at least a one hour break after 10 hours.

They also must have a full seven hours of rest every 24 hours, and can’t work for longer than a total of 12 hours in that period.

There are heavy penalties for not taking the stipulated rest breaks, and all of this is recorded in a National Driver Work Diary for verification.

That is, of course, everywhere in Australia except for Western Australia and the Northern Territory, where they presumably don’t drive long distances.

Oh, by the way, any hours spent waiting to be loaded and not resting in a bed are all counted as work hours.

The fatigue-regulated heavy vehicles that this legislation applies to includes any truck with a gross vehicle mass (GVM) over 12 tonnes and buses over 4.5 tonnes with a seating capacity of more than 12 adults (including the driver).

There are very good reasons for preventing fatigue on the road, as truck drivers are more than 12 times as likely to be killed on the job compared with the average worker.

This easily makes road freight transport Australia’s most dangerous job. It carries a 50 per cent greater risk than farming, which is our next most dangerous occupation.

The community expects that pilots and truck drivers are taking enough breaks to ensure they are performing well and are not fatigued.

Undoubtedly, fatigue management practices have improved in medical workplaces, but as I recall it, this change has always lagged behind other industries, which is just not good enough.