Stress and Fatigue - Mar 07.ppt - STRESS AND FATIGUE IN AVIATION OPERATIONS TERMINAL LEARNING OBJECTIVE ACTION Reduce the adverse effects of stress and

Stress and Fatigue - Mar 07.ppt - STRESS AND FATIGUE IN...

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Unformatted text preview: STRESS AND FATIGUE IN AVIATION OPERATIONS TERMINAL LEARNING OBJECTIVE ACTION: Reduce the adverse effects of stress and fatigue on individual health, aviation safety, and mission completion. CONDITION: While performing as a aircrew member. STANDARD: IAW FM 3-04.301, Flight Stress, Fatigue in Aviation, US Army Aeromedical Policy Letters (March 2006) ENABLING LEARNING OBJECTIVE #1 ACTION: Define stress. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 STRESS!! STRESS! Hans Selye “The nonspecific response of the body to any demand placed upon it” The Role of Cognitive Appraisal Lazarus (1968) – Psychological Appraisal: Your thoughts about the situation impact how you experience it Primary Appraisal what meaning we place on the event meaning is positive, negative, or neutral Secondary Appraisal how we view our ability to cope with the stress/event Stress = Perceived Threat > Perceived Coping ENABLING LEARNING OBJECTIVE #2 ACTION: Select the signs of stress. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 Common Signs of Stress Behavioral Late to work Poor performance Explosiveness Alcohol and/or other drug abuse Social isolation Suicide Common Signs of Stress Physical Sweaty Palms ↑ Heart Rate Trembling Shortness of Breath Gastrointestinal Distress Muscle Tension Sleep Problems ↑ Blood Pressure Emotional Irritability Hostility Anxiety Loss of Self-Esteem Feelings of Helplessness Suppressed Emotions (Feeling Numb, Like You Don’t Feel Anything) Common Signs of Stress Cognitive (Mental) Obsession or excessive worrying Decreased attention Impaired memory Poor judgment Poor psychomotor coordination ENABLING LEARNING OBJECTIVE #3 ACTION: Identify the three types of stressors. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Flight Stress Types of Stressors Psychosocial Cognitive (Mental) External things that happen and impact you emotionally Internal ways you think and approach situations Physiological Your physical state and health Psychosocial Sources of Stress Some Major Events Are: Marriage / Divorce Death of a Close Relative Reassignment / Deployment Illness or Injury (Self or Family) Birth of a child Financial Issues Problems with Living Arrangements/Home Cognitive Stressors How you think and approach a situation will affect your level of stress. “All or nothing” thinking Failure to focus on the here and now Too many “Musts and shoulds” Physiological Stressors Your physical health/state can cause biological stress as well as change your ability to cope with external stressors Aircrew members have significant control over many physiological stressors Drugs Exhaustion Alcohol Tobacco Hypoglycemia (diet) ENABLING LEARNING OBJECTIVE #4 ACTION: Identify the impact of stress on pilot performance. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Flight Stress Necessary Pilot Abilities Psychomotor (stick & rudder) Attention Memory Judgment and decision making Prioritization of tasks Cockpit communication Performance Under “Stress” Attention Perceptual tunneling Cognitive tunneling – narrowing mental clarity or comprehension (missed radio call) Task shedding – entire tasks abandoned Psychomotor Decreased tracking abilities Performance Under “Stress” Memory Memory Capacity Declines (Short-term memory) Memory Strategies Compromised Over Simplification Speed/Accuracy Tradeoff New Learning Declines – Stress Related Regression Performance Under “Stress” Judgment/Decision Making Communication Speech production (articulation, pitch, syntax) Comprehension Group Think Performance Under “Stress” Boredom Increased risk-taking behaviors Vigilance declines (aspect of attention) Performance Under “Stress” Boredom Increased risk-taking behaviors Vigilance declines (aspect of attention) . . . . . ENABLING LEARNING OBJECTIVE #5 ACTION: Identify the four stress coping methods. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 Stress Coping Methods AVOIDING STRESSORS CHANGE YOUR THINKING LEARN TO RELAX VENTILATE AVOIDING STRESSORS Most powerful technique. Involves avoiding the stress or reducing exposure. Examples: Leaders model good time management Implement tough, realistic training Maintain an effective PT program Exercise sound judgement and decision-making Good cockpit communication CHANGE YOUR THINKING Practice positive self-talk Focus on the here and now Recognize the choices you make Avoid absolutes and perfectionism RELAXATION The opposite of stress is relaxation. You can’t be stressed and relaxed simultaneously. Learn how to relax: breathing relaxation exercises pleasurable hobbies VENTILATING STRESS Exercise Talk it out with a friend your spouse chaplain mental health Army One Source 1-800-342-9647 ENABLING LEARNING OBJECTIVE #6 ACTION: Identify Combat Stress. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and FM 4-02.51 Combat Stress Includes “all the physiological and emotional stresses encountered as a direct result of the dangers and mission demands of combat” - FM 4-02.51 “Combat and Operational Stress Control Reactions can range from positive to negative. Combat Stress Signs and Symptoms Hyperalertness Fear, anxiety Loss of confidence ↓ performance Impaired senses Weakness/paralysis Hallucinations or delusions ENABLING LEARNING OBJECTIVE #7 ACTION: Identify how combat stress may affect an aviator. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 Combat Stress and Aviators Aviators tend to do better as a whole than ground troops Good group cohesion prior to deployment Good use of coping mechanisms - esprit de corps denial of danger identification with the strength of one’s aircraft BUT, aviators will still experience combat stress and associated problems similar to ground troops Affects of Combat Stress on Aviators Pilot performance may degrade due to Anti-aircraft weaponry Pre-combat training in this area can improve performance High cockpit workload and task overload Additional chemical/combat gear degrades mood and reaction times while flying. ENABLING LEARNING OBJECTIVE #8 ACTION: Select the factors that will decrease one’s vulnerability to combat stress. CONDITION: Given a list of categories. STANDARD: IAW FM 22-51, Flight Stress Combat Stress Buddy Aid Reassurance If no response, seek medical treatment Decreasing Your Vulnerability Competence in your work Confidence in your abilities High morale, group cohesion, and esprit de corps Control, or even perceived control Bottom Line on Combat Stress Abnormal Stressors = Unexpected Reactions Stress unlike anything experience in daily life back home Consequently you may experience new, unexpected reactions unlike those you normally experience. “Normal Reaction to an Abnormal Experience” Your normal methods for coping with “normal” stress may not be as affective Get Creative! Try New Things. Ask for ideas. Make an purposeful effort to manage stress. Don’t Give Up! MAKE the time for yourself WATCH YOURSELF and OTHERS! Abnormal Stress = Abnormal Reactions CAN EQUAL PROBLEMS!!! Unmanageable stress Sleep problems / Health problems Peer/relationship problems Poor decision making Problems on the battlefield Get help if your stress is outside of your ability to manage it, or if you are concerned about your reactions. ENABLING LEARNING OBJECTIVE #9 ACTION: Identify posttraumatic stress disorder and treatments. CONDITION: Given a list. STANDARD: IAW FM 22-51, US Army Aeromedical Policy Letters (March 2006) Posttraumatic Stress Disorder PTSD: caused by exposure to an intensely traumatic event; characterized by: re-experiencing the traumatic event (flashbacks, nightmares, persistent thoughts, hallucinations, etc) avoidance of trauma-associated stimuli (conversations, people, places, memories) increased arousal (hyperalertness, difficulty sleeping and concentrating, irritability) Not everyone exposed to trauma develop PTSD! Impact of PTSD PTSD can impact every aspect of your life! Relationships Work Temporary or Permanent Grounding Job Changes (whether in aviation or not) Motivation / Mood Leisure Time Reactions can be short-term, but can also last for years. Symptoms can reoccur over time Treatment in Aviation THERE IS HELP FOR PTSD!!! DON’T assume you have to get through it alone! Treatment can alleviate problematic symptoms and improve quality of life. Pilots/Aircrew CAN be in treatment and still maintain flight status! Myth that you can’t have mental health treatment and still fly Key is safety. Goal of treatment is to get you healthy and back to safely flying. In the minority of cases, permanent grounding may occur. But in these cases it is due to safety reasons. Treatment -- Aeromedical Policy Therapy – can fly when symptoms are not a safety issue Medication Use (specific meds for Depression/Anxiety) CAN have mental health file and still fly. Don’t always need medications to get better!!!! Can get a waiver to take specific medications Must be at stable dose for 4 months without aeromedically significant symptoms/side effects (temporary grounding) Variety of treatment options Some short term, some longer in nature Can seek civilian treatment. (let your FS know so they can monitor tx and meds) The Good News PTSD doesn’t happen to everyone You will have some combat/trauma reactions, but it doesn’t mean they will be extreme or something that will disrupt the rest of your life Individuals react differently depending on their experiences and personality. If you have/get PTSD, there is treatment. It can be worked through Check on Learning! Q: What is the definition of stress? The nonspecific response of the body to any demand placed upon it Q: What are the four classes of coping methods? Avoiding stressors, change your thinking, relaxation, ventilation Q: What is the most effective coping method? Avoiding stressors Q: What is Combat Stress? Combat stress includes “all the physiological and emotional stresses encountered as a direct result of the dangers and mission demands of combat” Q: What 4 factors will decrease your vulnerability to combat stress? Confidence, competence, cohesion, control BREAK!!! ENABLING LEARNING OBJECTIVE #10 ACTION: Define fatigue. CONDITION: Given a list of definitions. STANDARD: IAW FM 3-04.301 FATIGUE “The state of feeling tired, weary, or sleepy that results from periods of anxiety, exposure to harsh environment, or loss of sleep.” Overkill or Prevention? Presley, P. (2001). Fatigue: Army aviator’s willingness to utilize stimulants as countermeasures. 31 experienced pilots from various airframes Average flight hours = 2240.5 hours Average age = 37 years Average education = 15.1 years Question: I have flown when I was fatigued • • • • • • Never One time Twice 3-5 times 5-10 times Over 10 times 3% 3% 6% 13% 6% 68%!! Preston, P. (2001). Question: I have nodded-off in the cockpit while performing duties as a pilot or PIC • • • • • • Never 48% One time 23% Twice 13% 3-5 times 6% 5-10 times 10% Over 10 times 0% 52%!! Preston, P. (2001). ENABLING LEARNING OBJECTIVE #11 ACTION: Select the signs and symptoms of fatigue. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fatigue in Aviation Signs and Symptoms of Fatigue Attention/Concentration difficult Feel or appear dull and sluggish Accuracy, timing, and ability to reason logically degrade General attempt to conserve energy Feel or appear careless, uncoordinated, confused, or irritable Social interactions decline Involuntary lapses into sleep begin to occur Signs and Symptoms of Fatigue Cognitive deficits are seen before the physical effects are felt ENABLING LEARNING OBJECTIVE #12 ACTION: Select the effects of fatigue on performance. CONDITION: Given a list. STANDARD: IAW FM 3-04.301, Flight Stress, and Fatigue in Aviation Impairment in the Cockpit Reaction time increases Errors in timing and accuracy Not as smooth Slow and irregular motor inputs Attention is reduced Lapse or “microsleeps” Tunneling Need enhanced stimuli Reduced audio-visual scan Impairment in the Cockpit Diminished memory Recall declines Learning declines Greater tolerance for error Overall poor and careless performance Impaired communication, cooperation, and crew coordination More fragmented conversations Misinterpretations ENABLING LEARNING OBJECTIVE #13 ACTION: Describe the stages of sleep and sleep inertia. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fatigue in Aviation. What Is Sleep? Biological process/drive that involves physical and mental changes and results in recuperation Adequate sleep is not “optional” Changes in brainwaves Changes in physiology Core Temperature, Digestion, Heart Rate Hormone / Chemical Levels Tissue Repair A biological drive, similar to the drive to eat Average person needs 8 hours of sleep a night. About 95% of fatigue is due to inadequate sleep! Stages of Sleep 5 stages of sleep, identified by brain activity Stage 1 (drowsiness)= transition between awake and sleep. Lasts just five or ten L minutes. You are easily awakened during Stage 1 sleep. “Microsleeps” go into this stage Stage 2 (light sleep)= light sleep stage. eye movements stop, heart rate slows, and body temperature decreases. Stages of Sleep Stages 3 and 4 (deep sleep)= deeper sleep, also called “slow wave” sleep because of slowing of brain waves/activity. People are difficult to awaken during these stages. Most important stages for recovering from fatigue. Stage 5 (REM) – Rapid Eye Movement. Dream Stage Happens about 70 to 90 minutes into your sleep cycle. You usually have three to five REM episodes per night. Brainwaves faster, closer to awake state. - Adams and Victor’s Principles of Neurology – 8 th Ed. After each cycle, you go back to Stage 2. Complete cycle takes approximately 90 minutes Sleep Inertia Short-term grogginess right after awaking More problematic when you wake up in stages 3 and 4. Takes longer to get brain from slow-wave activity to faster, awake activity Can be a problem while napping or when poorly timed when waking up. If wake up naturally less than 30-40 minutes before alarm, will be less groggy if you simply get up then. If wake up during slow wave sleep, plan for up to approximately 30 minutes of grogginess. ENABLING LEARNING OBJECTIVE #14 ACTION: Identify factors that influence your sleep cycle. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fatigue in Aviation Factors that Influence Sleep Cycle Level of Fatigue (sleep deprivation) Most common modifier of sleep cycle Slow-wave (stages 3-4) sleep increases in length REM shortens or sometimes doesn’t happen Timing of Sleep (bedtime) Day sleep usually has more REM activity in the first period Shift workers may have a reversal in cycle (REM first, slow wave second) for the first few days of their change to sleeping days. Greatly affects amount of restorative sleep (stages 3-4) Factors that Influence Sleep Cycle Age Infants spend most of sleep time in REM As we age, slow wave sleep increases until adulthood From 30s on, amount of slow wave sleep declines 60s/70s, almost all slow wave sleep is gone Medications More frequent nighttime awakenings. Can inhibit both slow wave and REM sleep Can interfere with going to sleep or staying asleep. Can cause excessive sleepiness or alertness Environment Can improve or degrade sleep Temperature, noise, lighting, familiar vs. unfamiliar places ENABLING LEARNING OBJECTIVE #15 ACTION: Identify specific types of sleep disruptions. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fatigue in Aviation Sleep Disruptions Circadian Disruptions Intentional Sleep Restriction Personal Habits (Poor Sleep Habits) Circadian Cycle Internal pattern, or “clock”, which regulates biological function on a cycle of approximately 24 hours. Regulate bodily functions Core Body Temperature Hormone secretions Alertness / Drive for Sleep 24 Hour Cycle 0800 - 1200 hrs. Peak 1300 - 1500 hrs. Decrease 1500 - 2100 hrs. Increase 2100 + Decrease to sleep Cycle is set by: Sunrise/sunset Ambient temperature Meals Social cues Circadian Disruption People have difficulty adjusting to a schedule that does not coincide with the regular 24 hour cycle. Humans are not as alert/awake at night. Electric light has caused societal expectations that aren’t in sync with our circadian cycle Can work around the clock, no matter what time Shift work Circadian Disruption Circadian Desynchronosis = disrupted cycle Fatigue , insomnia Melancholy / depressed mood Lack of motivation Confusion Digestive disorders Disconnect between environmental cues and what our body is programmed to do. Main causes = travel (jet lag) and shift work (shift lag) Intentional Sleep Restriction Intentional Sleep Restriction Decreasing sleep time by a few hours a night Due to long work hours, family demands, activities Usually avoidable with time management In operational environment, can be unavoidable and necessary due to mission Decreasing needed sleep time by even 1 hour a night causes noticeable decrease in attention and performance within one week. Personal Habits Personal Habits (Poor Sleep Habits) We are creatures of habit!! We create habitual behavior through Chaining Chaining = behaviors that are linked to other behaviors The connections can become so strong that one action will act as a cue for the next without us having to think about it. Personal Habits Good Things about Chaining Frees up our mind to think about other things Well practiced behavioral chains decrease probability of errors Problems with Chains and Sleeping Disruptive, stressful, alerting behaviors can become chained to our sleep environment and routine Causes sleep problems and chronic insomnia Example: Pay bills or study in bed, associate being in bed with stress. Makes it harder to go to sleep, introduces habitual thoughts about stressors, can cause “dread” of going to bed Sometimes Medical TX is Needed You Can Do Everything Right and Still Have Problems!! Could be Medical / Physiological Condition See Flight Surgeon If: You have sleep disruption/insomnia that persists more than 2 weeks (and you are practicing appropriate sleep methods) You notice sleep problems that make you unsafe to fly (regardless of the timeframe of sleep problems) You have any significant sleep concerns or questions ENABLING LEARNING OBJECTIVE #16 ACTION: Identify specific countermeasures for general fatigue and sleep problems. CONDITION: Given a list. STANDARD: IAW FM 3-04.301 and Fatigue in Aviation. Fatigue Prevention Risk Indicators for Fatigue Often fly at “sleepy” times (pre-dawn, early morning) Work 12-14 hours a day Often have 9 or fewer hours off duty per day Often fly after less than 7 hours sleep Chronically rely on caffeine to stay awake Little or no time off in the previous week Inflexible work schedules with no time for short breaks or naps Calculating your Sleep Requirement How Much Sleep Do You Need? Sleep Calculation Method #1 – On Vacation Put away your alarm clock. Let yourself wake naturally Allow 2-3 days to overcome any sleep debt For next 3-4 days, write down best estimate of what time you went to sleep and time you naturally wake up. Stick to a regular bed time. Can help accuracy Calculate how much time you slept and average it across the 3-4 days. Good estimate of how much sleep you need a night Calculating your Sleep Requirement Sleep Calculation Method #2 – Systematic Changes Systematically change how much sleep you get one week to the next. If you average 6 hours a night, increase it to 7 hours for one week. At end of each day notice how alert you feel Next week, increase it to 8 hours a night. Again notice any differences If you don’t think you noticed a difference, next week decrease back to 6 hour schedule and notice any differences Probably notice as you increase your sleep your alertness, mood, functioning will increase. Fatigue Countermeasures Best countermeasures are prevention (adequate sleep) and maintaining optimal circadian adaptation. Not always possible in military/aviation operational environment Stick to a consistent bedtime/wake-up schedule Alterations (like on weekends) disrupt circa...
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