Introduction: Fatigue is a complex entity with contributing factors that may include insufficient sleep, circadian dysrhythmia, high workload, extended duty periods, clinical sleep pathology, psychosocial aspects, environmental factors, and many others. It can contribute to significant performance deficits and crucial safety lapses. Despite maximal implementation of accepted techniques and best practices for mitigation strategies, the deployed military rotary-wing (RW) environment must still contend with substantial fatigue-related issues among aircrew. Methods: We introduce a novel subjective peer-to-peer fatigue rating system recently demonstrated in a deployed military RW environment. Each pilot provides an anonymous weekly fatigue rating for every other pilot in the unit exclusive of self. Median and variance of the peer ratings for each pilot are recorded by the safety officer and tracked over time. Results: The program allows for a multidimensional external perspective on a pilot's fatigue state, relative function, and degree of coping. Scoring is predicated upon the recognition of a significant deviation from a peer's baseline that may include social and interpersonal interactions or the observation of deficits in duty performance. Discussion: The research basis for scientific validity and reliability regarding current peer fatigue scoring systems is exiguous. This novel approach may be of merit, particularly among military aircrew in a deployed-type setting with sustained high workload, operational stress, and limited time for supernumerary tasks. An anonymous subjective peer-to-peer fatigue scoring system is worthy of further scientific investigation, particularly warranting studies of reliability and validity.
