Clinical Aviations

1. Date of Flight

2. Operating Base

3. Transport / Run Number

4. Crew Rest Prior to Patient Mission

5. Air Medical Transport Experience

6. External / Non-Alpha Star Stressors or Illness

7. Days Since Last Mission

8. Day or Night Mission Start Time (Night = Departure between 2200–0400)

9. Total Duty Time (includes positioning, live legs, ground transports and return to base)

10. Number of Patients to be Transported

11. Patient Acuity

12. KSS — Self Assessment (Karolinska Sleepiness Scale)

13. Total Score

Add each of the points above to obtain the total score

— Fill in all fields above

14. Completed By