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Human Factors Kevin J. Bohnsack, Col, MI ANG, MC, SFS 110 th Medical Group Human Factors Kevin J. Bohnsack, Col, MI ANG, MC, SFS 110 th Medical Group Battle Creek ANG, MI Commander

Overview • Fatigue • Supplements • Spatial Disorientation Overview • Fatigue • Supplements • Spatial Disorientation

Fatigue and the Aviator Fatigue and the Aviator

Circadian Rhythm and Jet Lag §Circadian rhythm: your daily bodily activities (sleeping, waking, physical Circadian Rhythm and Jet Lag §Circadian rhythm: your daily bodily activities (sleeping, waking, physical activity, etc. ) §Max sleepiness: 0300 -0500 & 1500 -1700 §Light is brain’s wake-up call §Jet lag: physiologic “home” wake cycle remains despite new location §Caused by sleep deprivation §occurs when traveling too rapidly to permit immediate adjustment to a new environment §travel >1 time zone/day, and shift work §Sleep is “out of phase” with the world

Fatigue/Jet Lag Symptoms §Decreased physical activity level §Irritability §Inattention §Generalized discomfort Impact §Loss of Fatigue/Jet Lag Symptoms §Decreased physical activity level §Irritability §Inattention §Generalized discomfort Impact §Loss of situational awareness §Impaired judgment §Decreased efficiency §Decreased resistance to infections

Helpful Hints for Successful Sleep §Daily exercise (no exercise within 2 hours of sleep) Helpful Hints for Successful Sleep §Daily exercise (no exercise within 2 hours of sleep) §Eat a light snack at bedtime §Avoid excessive liquid consumption prior to lying down §Avoid caffeine 3 - 4 hours prior to bedtime §Avoid excessive alcohol §Don’t look at your clock to calculate amount of sleep time remaining! § 2 - 3 days prior to mission get plenty of sleep §Eat well §Avoid sleep aids if possible §The power of the “Power nap” Short: 10 - 30 minutes of sleep restores alertness for 3 - 4 hours Long: 3 - 4 hours of sleep restores alertness for 12 - 15 hours §Plan mission sleep schedule (in-flight up to 45 minutes IAW 11 -202 v 3 para 9. 9. 6 criteria) §Identify mission segments when fatigue symptoms will be worse

No-go Pills §“NO-GO” §AMBIEN – DNIF 6 hrs after single dose. Max 7 consecutive No-go Pills §“NO-GO” §AMBIEN – DNIF 6 hrs after single dose. Max 7 consecutive days/max 20 doses in any 60 day period §RESTORIL – DNIF 12 hrs after single dose. Max 7 consecutive days/max 20 doses in any 60 day period §SONATA – DNIF 4 hrs after single dose. Max 10 consecutive days/max 28 doses in any 60 day period § MELATONIN: NOT APPROVED FOR FLYERS § Known to cause nightmares, headaches, morning grogginess, and mild depression! §Come to clinic during normal business hours for No-Gos and you will sign a log and get 5 doses at a time.

Summary §Fatigue is like drinking 2 - 3 stiff drinks prior to boarding your Summary §Fatigue is like drinking 2 - 3 stiff drinks prior to boarding your aircraft §For sustained operations, “power nap” if time allows §Maintain good sleep habits even when not deployed!

Dietary Supplements MEDICAL TREATMENTS, MEDICATIONS, AND DIETARY SUPPLEMENTS AFI 11 -202 v 3 paragraph Dietary Supplements MEDICAL TREATMENTS, MEDICATIONS, AND DIETARY SUPPLEMENTS AFI 11 -202 v 3 paragraph 9. 8. 2. 1 Use of medication or dietary supplements is governed by AFI 48 -123, or as approved by a flight surgeon. AFI 48 -123 paragraph 6. 44 Use of any medication is prohibited, except as described in the Official Air Force Approved Aircrew Medication list updated periodically by AFMSA (approved by AF/SG 3 P). Use of any Over the Counter (OTC) Medications, except as described in the Official Air Force Aproved Aircrew Medications Over the Counter (OTC) Medications list, updated periodically by AFMSA (approved by AF/SG 3 P) is prohibited.

Approved Aircrew Medication List • Dietary, herbal, and nutritional supplements (other than a daily Approved Aircrew Medication List • Dietary, herbal, and nutritional supplements (other than a daily multivitamin) can only be used with the approval of a flight surgeon. • The flight surgeon should consider aeromedical implications of the supplement as well as the probability the supplement would actually enhance performance.

Sports Supplements are NOT regulated by the FDA. • Follow label instructions • Consult Sports Supplements are NOT regulated by the FDA. • Follow label instructions • Consult with your medical provider prior to taking supplements • Do not take products such as creatine or weight loss aides for extended periods • Ensure proper hydration while using supplements on a regular basis • Failure to do so may lead to painful and serious conditions such as kidney failure and liver disease

Health Concerns of Some Supplements • Creatine – May cause dehydration – Method: Water Health Concerns of Some Supplements • Creatine – May cause dehydration – Method: Water goes directly into the muscles • Thermogenetics – Variety of effects – Increase body temperature to burn calories • Increase body temp = water loss = dehydration – May stimulate central nervous system to boost energy – Possible side effects: Nausea, irregular/increased heart rate, anxiety, sweating, shaking • All need to be reviewed/approved by a flight surgeon.

Multivitamins with additional Supplements §Positive Effects: antioxidant, immune system boost §Airborne §Ingredients: zinc, vitamins Multivitamins with additional Supplements §Positive Effects: antioxidant, immune system boost §Airborne §Ingredients: zinc, vitamins A, C, and E, magnesium, echinacea and others §Possible side effects: gastrointestinal (nausea, upset) and metallic taste §Zicam §Ingredients: zinc, vitamins C, B 6, B 12, green tea extract, grape seed extract, echinacea and others §Possible side effects: gastrointestinal (nausea, upset) and skin reaction §All need to be reviewed/approved by a flight surgeon.

Multivitamins/Supplements Bottomline • Unless you are strictly taking a plain multivitamin, any special multivitamin Multivitamins/Supplements Bottomline • Unless you are strictly taking a plain multivitamin, any special multivitamin or supplement requires the approval of a flight surgeon. • Please bring in the bottle of what you are taking so we can see the actual ingredients… …and not have to ask Google.

Average Flag Conditions Deployed Location Feb Mar Apr May Jun Jul Aug Sep Oct Average Flag Conditions Deployed Location Feb Mar Apr May Jun Jul Aug Sep Oct

Effects of Dehydration • • Fatigue/weakness Mental confusion/headaches Low blood pressure (less blood volume) Effects of Dehydration • • Fatigue/weakness Mental confusion/headaches Low blood pressure (less blood volume) High heart rate Muscle cramping and spasms Nausea Impaired vision Kidney stones with more long-term dehydration Recovery: Requires time with rest and rehydration

Dehydration: Concern all year round • Prevention: – Drink water throughout the day – Dehydration: Concern all year round • Prevention: – Drink water throughout the day – Hydrate hours before and during exercise – Exercise at cooler times of the day – Avoid/limit alcoholic and caffeinated beverages – Drink more water with certain medications and supplements – Educate yourself on the medications and supplements you take – Unless it’s a simple multivitamin, get approval by a flight surgeon!

Questions Questions

SPATIAL DISORIENTATION AE An erroneous sense of any of the parameters displayed by aircraft SPATIAL DISORIENTATION AE An erroneous sense of any of the parameters displayed by aircraft control and performance flight instruments AFMAN 11 -217, Vol. 1

SD Rate Across All MDS 0. 40 Rate/100 k hrs 0. 35 0. 30 SD Rate Across All MDS 0. 40 Rate/100 k hrs 0. 35 0. 30 0. 25 0. 20 0. 15 0. 10 0. 05 0. 00 91 92 93 94 95 96 FY 97 98 99 00

SD Costs to USAF: FY 1991 -FY 2000 Category Total FY 91 -00 Class SD Costs to USAF: FY 1991 -FY 2000 Category Total FY 91 -00 Class A Mishaps Cost SDO / % of Class A GLOC / % Class A 323 65 / 20. 2% 11 / 3. 5% $5. 5 Billion $174 Mil / 3. 2% 8 / 2. 5% Fatal Incidents 92 >$1. 4 Billion / 26. 8% 36 / 39% Fatalities 310 60 / 19. 4% *GLOC used as comparison 7 / 7. 6%

Three Types of Spatial Disorientation • Type One—Unrecognized • Type Two—Recognized • Type Three—Incapacitating Three Types of Spatial Disorientation • Type One—Unrecognized • Type Two—Recognized • Type Three—Incapacitating

Spatial Disorientation • Aircrew are inherently susceptible to SDO • Why? • The human Spatial Disorientation • Aircrew are inherently susceptible to SDO • Why? • The human weapon system is designed to perform at peak efficiency on the ground, at 1 G, with all five senses working in concert • Frankly, that is not how we do business

Orientation Senses—All Fallible VISUAL SEAT-OF-THE-PANTS VESTIBULAR AUDITORY Orientation Senses—All Fallible VISUAL SEAT-OF-THE-PANTS VESTIBULAR AUDITORY

Vision • Vision is the dominant and most reliable sense • The best vision Vision • Vision is the dominant and most reliable sense • The best vision uses a combination of cones and rods from the retina • During night sorties the rods become dominant – Rod vision is not as accurate as cone vision – Night blind spot • The incidence of spatial disorientation is greatly increased when our vision is impaired due to weather or night flights

Vestibular System • The vestibular system is very accurate on the ground but can Vestibular System • The vestibular system is very accurate on the ground but can be very inaccurate in the air • Semicircular canals orient in the planes of roll-pitch-yaw (angular acceleration) • SSCs are not able to recognize “sub-threshold” turns (less than two degrees per second) • SSCs are easily fooled in flight: – Leans – Graveyard Spiral – Coriolis Illusion

Vestibular System • The vestibular system is highly sensitive to alcohol • Alcohol negatively Vestibular System • The vestibular system is highly sensitive to alcohol • Alcohol negatively affects how the fluid shifts in the SSCs and makes one more prone to SDO • This negative effect can occur up to 48 hours after consumption

Vestibular System • The otolith organ is also in the middle ear and senses Vestibular System • The otolith organ is also in the middle ear and senses linear acceleration • Accerlation can give a false “nose-high” feeling • Deceleration can elicit a false “nose-low” feeling

Seat Of The Pants Sensation • Proprioception—impulses from the muscles, nerves, tendons in response Seat Of The Pants Sensation • Proprioception—impulses from the muscles, nerves, tendons in response to stimuli • Changes in pressure are felt by the body and the impulses are sent to the brain • These impulses can be inaccurate with a change in G-forces

Auditory Sense • Auditory cues may actually assist you in recovering from SDO • Auditory Sense • Auditory cues may actually assist you in recovering from SDO • As an aircrew members get more experience in their airframe, they “know how it should sound” in various stages of flight • Unusual sounding wind noises, configuration changes may be ones’ first clue to a SDO situation

Spatial Disorientation Factors • • • Night Ops—(SOAR, RT refueling) Fatigue Weather Lack of Spatial Disorientation Factors • • • Night Ops—(SOAR, RT refueling) Fatigue Weather Lack of visual cues (Landing Illusions) Attention deficits Excessive head movement • Complacency

15 # SD Contributing Factors (FY 1991 -2000) 30 25 20 10 5 0 15 # SD Contributing Factors (FY 1991 -2000) 30 25 20 10 5 0 ng es ni ai su Tr r Is pe id Su Gu rt oc pp s Pr Su nd rw Dm Ac ion n s is tio n M ma atio to ent Au m ru n st In ility atio b si nic y Vi mu nt m om m s C /Co nce rs lue Pe Inf er Pe r hv e Be at St M /D Em nt r gm to Jd Mo gue rc ati Pe l F t ta mn en g M Mn s r tn ct At h F yc Ps Contributors

LANDING ILLUSIONS • Runway width/length • Runway slope • Surrounding terrain • Smooth/solid surfaces LANDING ILLUSIONS • Runway width/length • Runway slope • Surrounding terrain • Smooth/solid surfaces • Runway lighting • Haze • Black hole illusion

OVERCOMING LANDING ILLUSIONS • Thorough mission planning • Use all available Nav aides • OVERCOMING LANDING ILLUSIONS • Thorough mission planning • Use all available Nav aides • Visual glideslope indicators (VASI, PAPI) • VVI, Altimiter • INCREASE CROSSCHECK FREQUENCY

SDO PREVENTION • Understand Limitations • Remedy Correctable Factors • Use Capabilities Properly (CRM) SDO PREVENTION • Understand Limitations • Remedy Correctable Factors • Use Capabilities Properly (CRM) • Recognize High Risk Situations • Stay Alert!

Recovery From SDO • Reestablish visual dominance (get on instruments) • Make instruments read Recovery From SDO • Reestablish visual dominance (get on instruments) • Make instruments read right and believe them • Straight-and-level flight (autopilot, if available) • Notify other crewmember or flight members – Verbally confirm flight parameters

Summary • SDO is a real threat for aircrew • Know when you are Summary • SDO is a real threat for aircrew • Know when you are being set up (night, weather, fatigue) • Instruments—Instruments • Be prepared to transfer/assume control…other crew members, autopilot • It can happen to you!

LANDING ILLUSIONS n n n RUNWAY WIDTH/LENGTH RUNWAY SLOPE SURROUNDING TERRAIN n n n LANDING ILLUSIONS n n n RUNWAY WIDTH/LENGTH RUNWAY SLOPE SURROUNDING TERRAIN n n n SMOOTH, SOLID SURFACES RUNWAY LIGHTING HAZE CLASS A FLIGHT MISHAP C-130, Kuwait FOR OFFICIAL USE ONLY

“. . . impacted the desert floor 2890 ft short of the runway. . “. . . impacted the desert floor 2890 ft short of the runway. . . ” ILS Antennae Struck Landing Gear Found Various Aircraft Parts Found Initial Impact Point