Fatigue in Aeromedicine: An Exploration of Team Cohesion as a Countermeasure against Adverse Events

ABSTRACT Objective: Current evidence-based guidelines to mitigate fatigue and protect against adverse events in the emergency medical service industry are minimally effective. Since flight medicine is a team event, the performance-cohesion relationship is examined as a potential countermeasure against fatigue-related errors in aeromedicine. Background: Fatigue has been implicated in decision-making errors, suggesting that it impacts cognitive abilities and clinical performance. Although the impact of fatigue on medical performance in aeromedicine has yet to be examined, it is intuitive flight providers are also susceptible to fatigue-induced errors. Given the additional fatiguing effects of flight, research is needed to elucidate protective factors that can reduce the likelihood of fatigue-induced errors in flight medicine. Method: A comprehensive review of literature was conducted on the relationship between fatigue and medical performance. The multidimensional construct of team cohesion (i.e., including task and social subdimensions) was also examined to understand the potential moderating effect of team cohesion on the relationship between fatigue and error. Results: The empirical evidence on the relationship between fatigue and error is robust. Although the performance-cohesion relationship is strong, the distinctive subdimensions of team cohesion, including task and social, may differentially impact team performance. Conclusion: Whereas higher levels of social cohesion may contribute to groupthink and degradations in performance when fatigued, evidence suggests that task cohesion is an area for future investigation as a possible countermeasure against fatigue-induced errors.