173 fighter wing kingsley field oregon top knife fighter surgeon course rsv-3a human performance...
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173 Fighter Wing173 Fighter WingKingsley Field OregonKingsley Field Oregon
TOP KNIFETOP KNIFEFIGHTER SURGEON COURSEFIGHTER SURGEON COURSE
RSV-3ARSV-3A
HUMAN PERFORMANCE HUMAN PERFORMANCE SUSTAINMENTSUSTAINMENT
Apr 21, 2023 2
Criterion Referenced ObjectivesCriterion Referenced Objectives
• Describe the impact of fatigue on Air Force Describe the impact of fatigue on Air Force operationsoperations
• Describe strategies to combat fatigue, to Describe strategies to combat fatigue, to include non-pharmacologic and include non-pharmacologic and pharmacologicpharmacologic
OverviewOverview
• The problemThe problem
• FatigueFatigue
• SleepSleep
• Circadian RhythmCircadian Rhythm
• NutritionNutrition
• StrategiesStrategies
• PharmacologyPharmacology
• Take home pointsTake home pointsApr 21, 2023 3
The ProblemThe Problem
• 18 hours awake = blood alcohol of 0.05%18 hours awake = blood alcohol of 0.05%
• 24 hours awake = blood alcohol of 0.10%24 hours awake = blood alcohol of 0.10%
• Fatigue listed present in 234 of 1837 Class Fatigue listed present in 234 of 1837 Class A mishaps 1972-2000A mishaps 1972-2000– Causal in 18Causal in 18– Major contributor in 8Major contributor in 8– Minor contributor in 102 Minor contributor in 102
Apr 21, 2023 4
The ProblemThe Problem• AF personnel face fatigue-inducers regularlyAF personnel face fatigue-inducers regularly
– Night workNight work
– Cross time zonesCross time zones
– Stress of operationsStress of operations
• Results in poor performanceResults in poor performance– Slowed reaction timeSlowed reaction time
– Increased errorsIncreased errors
– IrritabilityIrritability
Apr 21, 2023 5
The Problem The Problem
• CONOPS – Continuous OperationsCONOPS – Continuous Operations– Operations Operations continue over 72 hourscontinue over 72 hours– Individual may work a shift and be relievedIndividual may work a shift and be relieved– Shifts may change, conflict with circadian Shifts may change, conflict with circadian
rhythmrhythm– Sleep can be intermittent, broken, unrestorative Sleep can be intermittent, broken, unrestorative
Apr 21, 2023 6
The ProblemThe Problem
• SUSOPS – Sustained SUSOPS – Sustained OperationsOperations– IndividualIndividual works over works over
72 hours72 hours
– Work continues until it Work continues until it is finishedis finished
– Sleep deprivationSleep deprivation
– Ground warfareGround warfare
Apr 21, 2023 7
Performance – A WrinklePerformance – A Wrinkle• Vietnam Naval AviatorsVietnam Naval Aviators
– Carrier landings improved at night after 22 days of Carrier landings improved at night after 22 days of combat flyingcombat flying
• Operation Desert Shield/Desert StormOperation Desert Shield/Desert Storm– LSO scores same or improved as operations LSO scores same or improved as operations
progressedprogressed
• Lesson: Despite fatigue, performance in Lesson: Despite fatigue, performance in inherently arousing situations is better than in inherently arousing situations is better than in boringboring
Apr 21, 2023 8
FatigueFatigue
• Physical FatiguePhysical Fatigue– Unable to continue to work because of intense or Unable to continue to work because of intense or
prolonged workprolonged work– Sleep lossSleep loss– Noise or heat stressNoise or heat stress– Poor nutrition or hydrationPoor nutrition or hydration– HypoxiaHypoxia– Poor physical conditionPoor physical condition– Change in work/rest scheduleChange in work/rest schedule
Apr 21, 2023 9
FatigueFatigue
• Mental fatigueMental fatigue– Boredom from Boredom from
repetitive, nonphysical repetitive, nonphysical taskstasks
– Can be induced in Can be induced in minutesminutes
– AnxietyAnxiety
– ApprehensionApprehension
– StressStress
Apr 21, 2023 10
FatigueFatigue
• First indicator of unit fatigue can be a First indicator of unit fatigue can be a change in everyone’s sense of humorchange in everyone’s sense of humor
• Poor communicationPoor communication
• Increased irritabilityIncreased irritability
Apr 21, 2023 11
SleepSleep
• Slow wave sleep (SWS)Slow wave sleep (SWS)– Stages 3-4Stages 3-4– High amplitude slow waves on EEGHigh amplitude slow waves on EEG– Replenishment of neurotransmitters and removal Replenishment of neurotransmitters and removal
of waste productsof waste products– Onset in approximately 60 minutesOnset in approximately 60 minutes– Arousal from SWS difficult (sleep inertia high)Arousal from SWS difficult (sleep inertia high)– Naps and sleeps try to avoid waking during SWSNaps and sleeps try to avoid waking during SWS
Apr 21, 2023 12
SleepSleep
• Combat napCombat nap– Less than 40 minutesLess than 40 minutes– Strategy is to awaken before first SWSStrategy is to awaken before first SWS
• Some restorationSome restoration
• Less difficulty awakeningLess difficulty awakening
– Provide 2-4 hours useful activityProvide 2-4 hours useful activity– Can help for up to 2-3 daysCan help for up to 2-3 days
Apr 21, 2023 13
SleepSleep
• Short sleepShort sleep– 3-4 hours3-4 hours
– Extends past SWSExtends past SWS
– Performance improves Performance improves 4-10 hours4-10 hours
– Anecdotes indicate Anecdotes indicate crews can function 4-5 crews can function 4-5 daysdays
Apr 21, 2023 14
SleepSleep
• Easiest to initiate twice a day – early afternoon and Easiest to initiate twice a day – early afternoon and just before normal bed timejust before normal bed time
• Mid afternoon nap helps prep for night shiftMid afternoon nap helps prep for night shift• 3 hour sleep midafternoon more effective than 3 hour sleep midafternoon more effective than
eveningevening• Sleep cannot be preloaded; but fatigue Sleep cannot be preloaded; but fatigue isis• Continuous better than fragmented sleepContinuous better than fragmented sleep• Resting on a bed isn’t sleepingResting on a bed isn’t sleeping• Need 6-8 hours/day for SUSOPSNeed 6-8 hours/day for SUSOPSApr 21, 2023 15
SleepSleep
• Try to sleep the same time daily, including Try to sleep the same time daily, including weekendsweekends– Same routine (clothes, darkness, background noise, Same routine (clothes, darkness, background noise,
temperature) helps when different time or locationtemperature) helps when different time or location
• Avoid heavy exertion 4 hrs before sleepAvoid heavy exertion 4 hrs before sleep
• Alcohol worsens sleep duration and qualityAlcohol worsens sleep duration and quality
• Caffeine interferes with sleepCaffeine interferes with sleep
• Avoid large meals 2 hours before bedAvoid large meals 2 hours before bedApr 21, 2023 16
Crew RestCrew Rest
• Officially 12 hour minimum prior to Officially 12 hour minimum prior to missionmission– Allows 2 hours before and after uninterrupted Allows 2 hours before and after uninterrupted
sleepsleep
• 24 hours is poor timing24 hours is poor timing– Sends crews back to work when they should Sends crews back to work when they should
begin rest periodbegin rest period– 16 or 36 hour crew rest superior16 or 36 hour crew rest superior
Apr 21, 2023 17
Circadian RhythmCircadian Rhythm
• Averages 25 hoursAverages 25 hours
• Biological clock rest daily to 24 hoursBiological clock rest daily to 24 hours– Light/dark cycle, sleep, meals, activity, clocksLight/dark cycle, sleep, meals, activity, clocks
• CONOPS, SUSOPS, and crossing time zones CONOPS, SUSOPS, and crossing time zones all force changesall force changes
• Jet lag – Crossing 4+ time zonesJet lag – Crossing 4+ time zones
• Shift lag – Transition day to night shift most Shift lag – Transition day to night shift most difficultdifficult
Apr 21, 2023 18
Jet Lag – EastJet Lag – East
• Body adaptationBody adaptation– 40 min/day40 min/day
– Reduced total sleep duration upon arrivalReduced total sleep duration upon arrival
• Seek daylight/bright light exposure early to advance Seek daylight/bright light exposure early to advance sleep onset prior to travelsleep onset prior to travel– Between 0300 and 0700 for day workers in originating Between 0300 and 0700 for day workers in originating
time zonetime zone
– Get advanced daylight exposure first 3 days especially Get advanced daylight exposure first 3 days especially upon arrival to advance body clockupon arrival to advance body clock
– By third day, daylight exposure as soon as awakenBy third day, daylight exposure as soon as awakenApr 21, 2023 19
Jet Lag – WestJet Lag – West
• Body adaptationBody adaptation– 60 min/day60 min/day
– Fatigue earlier than usual in day upon arrivalFatigue earlier than usual in day upon arrival
• Seek daylight/bright light exposure in sync Seek daylight/bright light exposure in sync destination prior to traveldestination prior to travel– Get prolonged daylight exposure of 1-3 hours to delay Get prolonged daylight exposure of 1-3 hours to delay
sleep onsetsleep onset
Apr 21, 2023 20
Shift LagShift Lag
• Physical and mental adaptation to sudden Physical and mental adaptation to sudden change in work schedule lags behindchange in work schedule lags behind
• Most difficult changing day to early morning or Most difficult changing day to early morning or nightnight– Two weeks continuous nights required to adjust Two weeks continuous nights required to adjust
body cycle body cycle fromfrom day shift day shift– One week to adjust back One week to adjust back toto day shift day shift– Single period of night work better tolerated than 3-4 Single period of night work better tolerated than 3-4
consecutiveconsecutiveApr 21, 2023 21
Shift LagShift Lag
• Permanent night shiftPermanent night shift– Avoid daylight in morning after night missionAvoid daylight in morning after night mission– Avoid daylight before bedtimeAvoid daylight before bedtime– Schedule sleep onset 0400-sunriseSchedule sleep onset 0400-sunrise– Avoid daylight until 1200Avoid daylight until 1200– Work outside in afternoonWork outside in afternoon
Apr 21, 2023 22
Shift LagShift Lag
• Temporary night shift Temporary night shift (1-3 days)(1-3 days)– Short sleep immediately Short sleep immediately
after midnight shiftafter midnight shift– Short sleep before next Short sleep before next
midnight shiftmidnight shift– Upon awakening from Upon awakening from
second sleep (prior to second sleep (prior to work), need daylight work), need daylight exposureexposure
Apr 21, 2023 23
Nutrition and PerformanceNutrition and Performance
• No magic bulletNo magic bullet• Adequate nourishment Adequate nourishment
– Don’t skip meals if avoidable; if unavoidable, snackDon’t skip meals if avoidable; if unavoidable, snack
– Balanced diet bestBalanced diet best
• HydrationHydration– Don’t dehydrate to avoid the piddle packDon’t dehydrate to avoid the piddle pack
• Caffeine in moderationCaffeine in moderation• All dietary supplements should be approved by the All dietary supplements should be approved by the
flight surgeonflight surgeonApr 21, 2023 24
StrategiesStrategies
• Wing levelWing level– Wing/CC should recognize everyone else will Wing/CC should recognize everyone else will
get tired firstget tired first– CO’s will fatigue from planning/ground duty CO’s will fatigue from planning/ground duty
prior to initiating opsprior to initiating ops– Minimize unnecessary last minute changesMinimize unnecessary last minute changes– Allow units to commit to day Allow units to commit to day oror night ops when night ops when
ablable
Apr 21, 2023 25
StrategiesStrategies
• Squadron LevelSquadron Level– Be on the lookout for change in dynamics, Be on the lookout for change in dynamics,
especially a loss in sense of humorespecially a loss in sense of humor– Plan rest periodsPlan rest periods– Make people sleep, away from squadron when Make people sleep, away from squadron when
able, combat naps when unableable, combat naps when unable– Schedule more time for sleep if necessary during Schedule more time for sleep if necessary during
day; it’s more difficult to sleep during dayday; it’s more difficult to sleep during day
Apr 21, 2023 26
StrategiesStrategies
• Flight SurgeonFlight Surgeon– Be a resourceBe a resource– To be a resource, you have to know the aircrew To be a resource, you have to know the aircrew – To know the aircrew you have to spend time To know the aircrew you have to spend time
with them inside and outside the aircraftwith them inside and outside the aircraft– You are an “out” for an aviator who needs to You are an “out” for an aviator who needs to
rest but wants to save facerest but wants to save face– Know your Go and No-Go pillsKnow your Go and No-Go pills
Apr 21, 2023 27
PharmacologyPharmacology
• Go PillsGo Pills– DexedrineDexedrine– ModafinilModafinil
• Ground trials and informed consentGround trials and informed consent
• Use is voluntary, approved by FS and Use is voluntary, approved by FS and wing/CCwing/CC
• Operational use documented and reported to Operational use documented and reported to MAJCOM/SGMAJCOM/SG
Apr 21, 2023 28
PharmacologyPharmacology
• No Go PillsNo Go Pills– TemazepamTemazepam– ZaleplonZaleplon– ZolpidemZolpidem
• Ground trials and informed consentGround trials and informed consent
Apr 21, 2023 29
PharmacologyPharmacology
• Verbal DNIF for 6 hrs before resume duties Verbal DNIF for 6 hrs before resume duties after each No Go pillafter each No Go pill
• Max 7 consecutive days, not to exceed 20 Max 7 consecutive days, not to exceed 20 days/60 day perioddays/60 day period
• Not authorized for use during routine Not authorized for use during routine training missionstraining missions
Apr 21, 2023 30
Apr 21, 2023 31
Take HomeTake Home
• Operating with fatigue is operating impairedOperating with fatigue is operating impaired• Strategic use of naps can ameliorate fatigueStrategic use of naps can ameliorate fatigue• Plan for jet lag and shift lag to minimize impactPlan for jet lag and shift lag to minimize impact• Pharmacology helps for aviators and special Pharmacology helps for aviators and special
operatorsoperators• Be a resource for your line commanders and Be a resource for your line commanders and
operatorsoperators• Next slide for quiz instructionsNext slide for quiz instructions
• Go to quiz
• Enter your answers on the Enter your answers on the answer sheet
• Print only one answer sheet for entire Print only one answer sheet for entire coursecourse
• Press ESC to go back to main menuPress ESC to go back to main menu
Apr 21, 2023 32