MAR 1999
STRESS AND FATIGUE
TERMINAL LEARNING OBJECTIVE:
ACTION: Identify the adverse effects of stress and fatigue in the aviation environment and countermeasures to reduce their impact on individual health, aviation safety and mission completion.
CONDITION: While performing as an aircrew member.
STANDARD: In accordance with (IAW) FM 26-2, FM 8-2, FM 1-301, DA Pam 600-24 and the Leader’s Guide to Crew Endurance.
A. ENABLING LEARNING OBJECTIVE (ELO) #1:
ACTION: Select the definition of stress.
CONDITION: Given a list of definitions.
STANDARD: IAW FM 1-301.
a. Definition of stress – The nonspecific response of the body to any demand
placed upon it.
(1) This definition was proposed by Hans Selye. He was an Austrian endocrinologist and the researcher that brought the concept of stress to public attention.
(2) Selye’s definition is intentionally broad and points out that stress is a physiological or "body" response to some "demand" or challenge.
b. Selye described three stages of the stress response he called the "General Adaptation Syndrome."
(1) The Alarm Stage. When the body’s senses perceive a threat or challenge, a message is sent to the brain, which stimulates the manufacture of adrenalin and other hormones that cause the body to prepare for "fight or flight." Breathing and heart rate increase, blood pressure rises, sugars and fat are released into circulation, and the skeletal meuscles tense. Such responses prepare muscles for action, provide fuel and oxygen for quick energy, and improve sight and hearing.
(2). The Resistance Stage. After the immediate threat is over, the body relaxes and returns to normal baseline.
(3) The Exhaustion Stage. If the actual or perceived danger is prolonged, a new stage develops that may end in illness or death by exhaustion.
B. ENABLING LEARNING OBJECTIVE (ELO) #2:
ACTION: Describe the relationship between stress and performance.
CONDITION: Given a list of descriptions.
STANDARD: IAW FM 1-301.
a. Performance and stress are related in the form of a bell-shaped curve.
(1) Performance is best at some intermediate level of stress "the Comfort Zone". This functional, motivating stress is known as "eustress."
(2) Stress is most functional on moderately complex tasks.
(3) Past one’s stress threshold there is a rapid decline in performance. Debilitating stress is known as "distress."
b. Deprivation Zone 1
(1) Inattention comes with underarousal.
(2) Boredom - repetitive or simplistic tasks. This may lead to an aviator taking "risks" and violate safety standards to get some excitement into their lives.
(3) Complacency - overconfidence/undermotivation.
c. Distress Zone 2
(1) Inattention - overarousal.
(2) Internal distraction - inattention due to non-task-related thoughts or emotional distraction.
(3) External distraction - over-stimulated in the external environment; informational overload can create difficulties in prioritizing. "Flight or Fight reaction"
(4) Fascination - attention anomaly in which the individual observes cues but does not process or respond to them. Associated with high stress or crisis situation; freeze-up.
C. ENABLING LEARNING OBJECTIVE (ELO) #3:
ACTION: Select types of responses to stress overload.
CONDITION: Given a list of stress responses.
STANDARD: IAW FM 1-301.
a. Emotional responses to stress overload include:
(1) Irritability.
(2) Hostility.
(3) Anxiety/increase worrying.
(4) Loss of self-esteem.
(5) Feelings of helplessness.
(6) Withdrawal from friends and relatives.
(7) Inability to enjoy life.
(8) Loss of concentration/focus.
(9) Alcohol/substance abuse.
b. Cognitive responses.
(1). Obsession/ excessive worrying.
(2). Poor concentration/attention.
(3). Poor judgement.
(4). Suicidal ideation.
c. Physical responses to stress include:
(1) Tension headaches.
(2) Upset stomach - heartburn/indigestion.
(3) Sleep problems.
(4) Backaches.
(5) High blood pressure.
(6) Muscle tension.
(7) Fatigue.
(8) Shortness of breath/nervousness.
(9) Sweaty palms.
d. Behavioral responses.
(1). Late to work.
(2). Decreased motivation.
(3). Explosiveness/"acting out."
(4). Alcohol abuse.
(5). Social isolation.
(6). Suicide.
e. Effects of stress "underload."
(1). Increased risk taking.
(2) Boredom.
D. ENABLING LEARNING OBJECTIVE (ELO) #4
ACTION: Select the definition of a stressor.
CONDITION: Given a list of definitions.
STANDARD: IAW FM 1-301.
a. Definition of Stressor- Any stimulus (event) that requires the person to adjust or adapt in some way: physiologically, emotionally, or behaviorally.
b. A stressor can be an external or internal event.
E. ENABLING LEARNING OBJECTIVE (ELO) #5:
ACTION: Identify the four categories of stressors.
CONDITION: Unaided, from memory.
STANDARD: IAW FM 1-301.
a. Environmental stressors.
(1). Altitude.
(2). Heat.
(3). Cold.
(4). Terrain.
(5). Weather.
(6). Ergonomics.
b. Psychosocial stressors.
(1). Marriage.
(2). Death in the family.
(3). Reassignment.
(4). Illness or injury to self, family, or close friend.
c. Cognitive stressors.
(1) We can increase our stress by the way we view situations and events. The following is a list of cognitive "bad habits":
(a) "All or nothing thinking," e.g., "either I get an award for my work performance or I am a failure." There is no "in between" or flexibility in such thinking.
(b) "Failure to focus on the here and now" involves distracting oneself from the task at hand by worrying about mistakes of the past or potential problems in the future.
(c) Too many "musts" and "shoulds." We increase our stress when we expect that events must turn out exactly as we expect.
(2) Having courage to stand up for one’s beliefs can decrease stress, as opposed to passively standing by, against your better judgement.
d. Physiological stressors -- "DEATH".
(1) Drugs.
(a) Drugs have potentially dangerous side effects.
(b) Don't self-medicate.
(c) Consult the flight surgeon!
(2) Alcohol.
(a) Can cause dehydration and reduces the brain’s ability to use oxygen.
(b) Adversely affects attention, judgement, perception, coordination, communication, and visual acuity.
(c) Is a depressant.
(d) Twelve hours after last drink and until no residual effects are present before flying again.
(e) Review slide on alcohol intoxication rates based on sex and weight of the soldier.
(3) Caffeine.
(a) Has stimulant effects that can lead to restlessness, poor concentration, distrubed sleep, decreased awareness, and heart palpitations.
(b) Review slides on "Pre-Flight Beverage List" and "Hidden Caffeine."
(4) Nicotine.
(a) Increases likelihood of health problems.
(b) Reduces overall oxygen in the system. Smoking produces carbon monoxide which displaces and competes for oxygen in the system. Decreased oxygen in the brain can lead to hypoxia. Three cigarettes pre-flight puts you at a physiological altitude of 4000 feet.
(c) Hypoxia may lead to compromised night vision.
(d) Nicotine is a stimulant whether ingested by chewing tobacco or smoking.
(5) Exhaustion.
(a) Lack of rest and sleep.
(b) Affects attention, concentration, and other cognitive abilities.
(c) Physical exercise can combat exhaustion through aerobic effects.
(d) Physically fit individuals will have a higher tolerance to exhaustion.
(6) Hypoglycemia.
(a) Due to lowering of blood sugar.
(b) Eat a balanced diet.
F. ENABLING LEARNING OBJECTIVE (ELO) #6:
ACTION: Select the definition of a stress coping mechanism.
CONDITION: Given a list of definitions.
STANDARD: IAW FM 1-301.
a. Definition - Stress coping mechanisms are the psychological and behavioral strategies people use to manage the internal and external demands placed upon them by stressors.
b. Coping mechanisms restore balance and reduce discomfort.
G. ENABLING LEARNING OBJECTIVE (ELO) #7
ACTION: Match individual stress coping mechanisms to the four classes of stress coping mechanisms.
CONDITION: Given a list of coping mechanisms and the four classes of stress coping mechanisms.
STANDARD: IAW FM 1-301.
a. Avoid stressors.
(1) Most powerful technique. Involves avoiding stress or reducing exposure.
(a). Examples include good time management, training, good problem solving skills, and good nutraition.
(b). Practice good cockpit and crew communication.
1. Talk!
2. Ask questions.
3. 3 Way confirm responses.
4. Lost communications briefed.
b. Change your thinking.
(1) Focus on the here and now.
(2) Recognize the choices you make. Increase your sense of personal control.
(3) Avoid absolutes and perfectionism.
(4) Practice positive self-talk.
(5) Review the Serenity Prayer as an example of positive self-talk that minimizes perfectionism and maximizes personal control.
c. Learn to relax.
(1) The opposite of stress is relaxation. You can’t be stressed and relaxed at the same time, so learn how to relax.
(2) Breathing, progessive muscle relaxation and other exercises.
(3) Pleasurable hobbies.
(4) Find outlets to "let off steam."
(5) Talk it out.
(6) Exercise.
H. ENABLING LEARNING OBJECTIVE (ELO) #8.
ACTION: Choose the definition of fatigue.
CONDITION: Given a list of definitions.
STANDARD: IAW FM 1-301, and Leader’s Guide to Crew Endurance.
a. The progressive decrement in ability due to prolonged or
intense mental or physical activity.
b. Sleep deprivation, disrupted diurnal cycles, and stressful life events all play a role in producing fatigue and impairing performance.
I. ENABLING LEARNING OBJECTIVE (ELO) #9:
ACTION: Describe the types of fatigue.
CONDITION: Given a list of descriptions.
STANDARD: IAW FM 1-301, and Leader’s Guide to Crew Endurance.
Learning Steps/Activity: Provide instruction on the types of fatigue.
Method of instruction: CO. Instructor to Student ratio 1:35
Time of Instruction: 0003
Media: Digitized slides: 46
a. Acute.
(1) Associated with physical or mental activity between two regular sleep periods.
(2) Eliminated after regular sleep period.
b. Chronic.
(1) Results from an inadequate recovery from successive periods of acute fatigue.
(2) One regular sleep period will not eliminate chronic fatigue; however, several sleep periods and reduced interim activity can help eliminate it.
c. Motivational exhaustion or "burnout."
(1) Unmanaged stress (i.e., unresolved psychosocial problems, prolonged frustration, excessive worry, loss of control) will lead to exhaustion and burnout.
(2) Without resolution to the stress, restorative measures may only have temporary effects.
(3) Burnout is especially dangerous if unrecognized.
NOTE: Conduct a check on learning and summarize the learning step/activity
J. ENABLING LEARNING OBJECTIVE (ELO) #10.
ACTION: Select the effects of fatigue on performance.
CONDITION: Given a list of fatigue effects.
STANDARD: IAW FM 1-301, and Leader’s Guide to Crew Endurance.
Learning Steps/Activity: Provide instruction on the effects of fatigue.
Method of instruction: CO. Instructor to Student ratio 1:35
Time of Instruction: 0010
Media: Digitized slides: 47-48
a. Reaction time.
(1) Errors in timing and accuracy of response sequences due to not thinking through response.
(2) Not as smooth at the controls.
(3) Increases - impulsive and reactive.
(4) Decreases - slow and irregular.
b. Attention is reduced.
(1) Overlook/misplace sequential task elements; inattention to minor but significant details.
(2) Preoccupation with single task or elements.
(3) Need enhanced stimuli to maintain attention.
(4) Reduced audiovisual scan.
(5) Less aware of poor performance - cognitive effects will show impairment BEFORE physical effects will be felt.
(6) Reduced ability to remain task-focused, tendency to daydream or become non-task oriented, especially with more demanding tasks.
c. Memory is diminished.
(1) Inaccurate recall of operational events.
(2) Neglect peripheral tasks.
(3) Ability to assimilate new learning into long-term memory is compromised.
d. Overall impairment in cockpit performance.
(1) Poor and careless performance.
(2) Greater tolerance for error.
(3) Impairments in communication, cooperation and crew coordination.
(a) Conversation may become fragmented and repetitive.
(b) Misinterpretation occurs more easily.
(c) Increased potential for error in communicating critical mission, flight, or safety information.
NOTE: Conduct a check on learning and summarize the learning step/activity
K. ENABLING LEARNING OBJECTIVE (ELO) #11.
ACTION: Identify indicators of fatigue.
CONDITION: Given a list of indicators.
STANDARD: IAW FM 1-301 and Leader’s Guide to Crew Endurance.
Learning Steps/Activity: Provide instruction on the indications of fatigue.
Method of instruction: CO. Instructor to Student ratio 1:35
Time of Instruction: 0004
Media: Digitized slides: 49
a. Mood is withdrawn.
b. Less likely to converse.
c. Less likely to perform low demand tasks.
d. More distracted by discomfort.
e. Frequent sick call visits; complaints of headaches or stomachaches.
f. Irritable.
g. Apathetic, may appear sluggish and dull.
h. Appear careless, uncoordinated, and confused.
i. Decreased motivation and morale.
NOTE: Conduct a check on learning and summarize the learning step/activity.
L. ENABLING LEARNING OBJECTIVE (ELO) #12.
ACTION: Select the effects of the body’s diurnal rhythms on performance.
CONDITION: Given a list of effects of diurnal (or circadian) rhythms.
STANDARD: IAW Leader’s Guide to Crew Endurance.
a. We have an intrinsic biological clock with a cycle of roughly 24-25 hours.
b. Many bodily functions cycle about these daily circadian rhythms.
(1). Core body temperature.
(2). Alertness.
(3). Heart rate.
c. Perhaps most importantly, performance varies with these cycles. Given the typical circadian cycle, performance peaks between 1200 and 2100 hours and falls to a minimum circadian trough between 0300 and 0600 hours.
d. While the body clock is inherently capable of monitoring the passage of time, it differs from most clocks in that it is flexible and must be set, or synchronized, before it can accurately predict the timing of events.
e. External synchronizers or "Zeitgebers" (German word meaning literally "time givers") are:
(1). Sunrise/sunset.
(2). Ambient temperature.
(3). Meals.
(4). Social cues.
f. Circadian Desynchronization ("Jet lag"). Symptoms are those of fatigue and are usually accompanied by sleep disturbance. Rapidly traveling from one time zone to another, the body clock and rhythms it controls must resynchronize to the local geophysical and social zeitgebers.
(1). Eastward travel shortens the day.
(2). Westward travel lengthens the day.
(3).Resynchronization occurs much more rapidly when traveling west.
(4) Until intrinsic rhythms are reset, sleep disorders and fatigue will prevail.
M. ENABLING LEARNING OBJECTIVE (ELO) #13.
ACTION: Select the description of the sleep cycle and the impact of sleep deprivation-induced fatigue on performance.
CONDITION: Given a list of descriptions and impacts.
STANDARD: IAW Leader’s Guide to Crew Endurance.
a. Sleep is not simply being unconscious, it is a life-essential active process.
b. The Sleep Cycle.
(1) The sleeping brain cycles between rapid eye movement (REM) and Non-REM sleep through 5 stages.
(2) The cycling occurs every 90 minutes. In 8 hours of sleep you normally attain 5-6 REM stages.
(3) The sleep wake cycle is closely tied to our circadian body temperature.
(4) The duration and "quality" of sleep are dependent upon body temperature. People sleep longer and report a better night’s sleep when they retire near the temperature trough.
(5) It is the timing of sleep, not necessarily the amount of sleep that is most significant.
(6) Sleep efficiency deteriorates with age.
c. Sleep deprivation.
(1) Leads to impaired transfer of information from short-term memory into long-term memory.
(2) Decreased mental abilities.
(3) Impaired speed and accuracy of skilled tasks (ie., handling emergency procedures).
(4) Occasional visual and/or tactile illusions.
(5) Reduced motivation for mission completion.
(6) Confusion and disorientation.
(7) No amount of training will prevent deterioration caused from sleep deprivation.
d. Minimum sleep requirement = approximately 4-5hrs/4-5 days before performance degredation occurs.
N. ENABLING LEARNING OBJECTIVE (ELO) #14.
ACTION: Select strategies for preventing fatigue.
CONDITION: Given a list of strategies.
STANDARD: IAW FM 1-301, FM 26-2, FM 8-2, and Leader’s Guide to Crew Endurance.
a. Maintain physical conditioning.
b. Scheduled appropriate sleep periods.
c. Limit work periods, especially when traversing multiple time zones.
d. Deal effectively with acute fatigue.
e. Take regular leave.
e. Rotate duties to avoid boredom.
f. Practice effective crew endurance management principles.
g. Deal effectively with stress.
h. Napping.
(1). When sleep is not available or shortened by operational concerns, naps are a viable alternative.
(2). Naps as short as 10 minutes are restorative.
(3). Longer naps (> 1 hour) may result in a period of sluggishness ("Sleep Inertia") for 5-20 minutes after awakening.
O. ENABLING LEARNING OBJECTIVE (ELO) #15.
ACTION: Identify the treatment for sleep deprivation and fatigue.
CONDITION: Given a list of treatments.
STANDARD: IAW FM 1-301, and Leader’s Guide to Crew Endurance.
a. Rest and natural sleep (not drug-induced). Alcohol is the #1 sleep aid in the US, but it suppresses REM sleep.
b. Rotate duties to avoid boredom, or, change of duties.
c. Pace self and avoid heavily task-loaded activities, those requiring short-term memory, or those demanding prolonged or intense mental activity.
d. Avoid complex tasks.
e. Limit work periods and delegate responsibility- if possible suspending activity during periods when fatigue is higher and efficiency is lower.
f. Physical exercise - use brief periods of exercise immediately before task performance, particularly administrative work.
(1) Discuss the benefits of aerobic conditioning
(2) Discuss the benefits of anaerobic conditioning
g. Use fans to maintain cool temperature, all soldiers to splash their faces with cool water to enhance alertness.
h. Removal from flying duties when fatigue affects safety of flight.
i. Nutrition
(1) Moderation in everything you eat
(2) Eat a variety of foods with emphasis on starches, carohydrates, vegetables and fruit. Minimize fats.
j. Discuss the variable fatigue factors with differences in flight
(1) Day time
(2) Day time, Contoured terrain
(3) Night time
(4) Night time, Nap of the Earth navigation
(5) Night time, terrain or Night Hawk missions
(6) Night time with night vision goggle use
(7) MOPP-4 Protection gear donned while flying.
P. ENABLING LEARNING OBJECTIVE (ELO) #16.
ACTION: Identify the risks associated with suicide.
CONDITION: Given a list of risks.
STANDARD: IAW DA Pam 600-24.
a. Talking about or hinting at suicide.
b. Giving away possessions; making a will.
c. Obsession with death.
d. Specific plans to commit suicide and access to lethal means.
e. Buying a gun.
f. Previous suicide attempts.
g. Financial difficulties.
h. Major life events (ie., divorce, death, job layoff, on-going relational problems).
i. Difficulty with alcohol or history of other substance abuse.
j. The more risk factors the individual has the greater the suicide potential.
Q. ENABLING LEARNING OBJECTIVE (ELO) #17.
ACTION: Identify the resources available for counseling soldiers and their families.
CONDITION: Given a list of resources.
STANDARD: IAW DA Pam 600-24.
a. Flight surgeon or aeromedical physician assistant.
b. Aeromedical Psychologist.
c. Hospital psychiatry, psychology, and social work.
d. Community Mental Health Services.
e. Division Mental Health Services.
f. Chaplains.
g. Drug and alcohol facilities.
h. Army Community Service (ACS).