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INTRODUCTION: Air medical teams provide around-the-clock critical care, a pattern at risk of inducing performance-altering fatigue from circadian disruption and sleep deprivation. Safety is an essential issue in the air medical industry, but little data are available on shift length and on-duty rest practices. We report the results of a survey concerning those practices and analyze the relationships to crew duty practices by program model (hospital-operated, vendor-operated, independent, or public safety), base location, flight volume, and job requirements. METHODS: A survey was mailed to 182 Association of Air Medical Services-member rotor-wing air medical programs in the United States that complete scene flights with a flight nurse. One-hundred-twenty-nine programs (70.9%) returned anonymous surveys, all of which were used for data analysis. Results were analyzed with descriptive and nonparametric statistics. RESULTS: All pilots work shifts between 10 and 14 hours. For medical team members the shift distribution is: </= 8 hours, 0.4%; 9 to 12 hours, 44.2%; 12 to 16 hours, 7.0%; 17 to 24 hours, 45%; > 24 hours, 3.5%. An independent association exists between shift length greater than 12 hours and each of the following: flight volume per-aircraft under 731 flights/year, program model other than hospital operated, and nonhospital base (Fisher's exact test with Bonferroni correction, P < .01 for each). All pilots are allowed on-duty rest on both day and night shifts. On-duty rest is permitted for 67.4% of medical team members: 18.2% only at night, and 49.2% at any time of day. The presence of any period of on-duty crew rest is significantly associated with nonhospital base, program model other than hospital-operated, and shift length exceeding 12 hours (Fisher's exact test with Bonferroni correction, P < .01 for each). The presence of a nonflight clinical assignment while on flight duty is associated with a prohibition against on-duty rest (Fisher's exact test with Bonferroni correction, P < .05). CONCLUSION: Notable differences arose between on-duty work and rest patterns for pilots and medical team members. Medical team members generally work longer shifts than pilots do, with shifts exceeding 12 hours as the most common staffing pattern. Medical team members also have less access to on-duty rest than do pilots. Traditional hospital-operated programs are more likely to use shorter shifts and prohibit on-duty rest for the medical teams, whereas vendor-operated, independent, or public safety programs are more likely to use longer shifts and permit on-duty rest. As the industry works toward a unified approach to mitigating the impact of fatigue on safe operation, variable practices based on job description and program style may be a factor.