AFMOA Instructor Guidelines

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AFMOA Instructor Guidelines

• You have the freedom to tailor this
  presentation to your local audience. Please read
  the note pages carefully. They include the
  details you will need to be properly prepared to
  present this important information. If you are
  using USAF official mishap data, you are required
  to show the AFI 91-204 Disclaimer Slide.
• Many thanks to MSgts Doug Schmidt (Aviano AB),
  Mark Brandt (Lakenheath AB), and Darryl Swartz
  (Spangdahlem AB) for their work in creating this
  presentation

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AFMOA Instructor Guidelines

• For Official Use Only
• All limited-use safety mishap investigation
  reports are for official, mishap prevention use
  only. Unauthorized disclosure of the information
  in the reports is a criminal offense under
  article 92, uniform code of military justice.
  See AFI 91-204, paragraphs 1.7.1.4 and 1.7.1.5
  for restrictions. Destroy according to AFI
  37-133 when no longer needed for mishap prevention

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AFMOA Instructor Guidelines
For more questions or further instructor
guidance, please e-mail or phone the MAJCOM
points of contact HQ Col Susan
Richardson susan.richardson_at_pentagon.af.mil
297-4200 AETC Col Kent Magnusson
kent.magnusson_at_randolph.af.mil 487-4869 AMC
Col Al Hartzell albert.hartzell_at_mgmc.af.mil
857-4654 AFMC Col James Dooley
james.dooley_at_brooks.af.mil 240-3281 ACC LtC
Daniel Caulkins daniel.caulkin_at_langley.af.mil
574-7827 SPACE Maj Joe Balas
joseph.balas_at_peterson.af.mil 834-4185 USAFE
Maj James Lasswell james.lasswell_at_spangdahlem.a
f.mil 314-452-6923 PACAF Maj Rick Fofi
richard.fofi_at_kadena.af.mil 315-634-1967 AFSOC C
apt Randy McCalip randy.mccalip_at_hurlburt.af.mil
579-6242 Further points of contactLtC Don
White don.white_at_kafb.saia.af.mil
246-0880 Capt Nereyda Sevilla
nereyda.sevilla_at_whiteman.af.mil 975-4891 MSgt
Doug Schimidt douglas.schimidt_at_aviano.af.mil
314-632-5688
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Cassandra D Howard, Col, FS, MC, TNANG
Photo source ANG Creative, Health Professions
Recruiting Campaign

• 164 MDG/CC, Memphis, TN
• AANGFS, Vice-President
• Cassandra.Howard_at_ang.af.mil

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Endurance Management Ground Initiative

• Air Force Medical Operating Agency

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You Must Not Needlessly Fatigue The
TroopsNapoleon Bonaparte
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Sleep or Die
Basic Sleep Physiology
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Overview

• Impact of Fatigue
• Sleep Physiology
• Circadian Rhythm
• Consequences
• Recognition
• No-Go Pills

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Impact of Fatigue
Fatigue Related Crashes
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Impact of Fatigue
The Cost
Major Accidents
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Impact of Fatigue

• The Evidence
• Major Accidents
• Annual Cost
• Military Strategy
• Human Performance

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Aeromedical Causal Factors
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Military Strategy
While remembering our own limitations
Exploit the Enemys Weakness
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Military Strategy
While remembering our own limitations
Exploit the Enemys Weakness
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Monday Night Football
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Causes of Fatigue
Circadianrhythms
Sleep loss

• Types of Fatigue
• AcuteWork induced
• ChronicRepeated sleep loss
• SubjectiveStress induced
• Circadian RhythmShift Work or Jet lag

FATIGUE
Effect of operations on sleep and circadian
physiology
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Basic Human PhysiologySleep Circadian Rhythms

• Sleep A Vital Physiological Function
• Sleepiness Affects Waking Performance, Vigilance,
  and Mood
• Sleep Loss Accumulates Into A Sleep Debt
• Physiological Versus Subjective Sleepiness
• The Circadian Pacemaker

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Physiology of Sleep
NREM Sleep
REM Sleep

• Dreams
• Muscle Twitching
• Rapid Eye Movement
• Problem Solving
• Short- to Long-Term Memory

• Stages 1 2
• Stages 3 4
• Physical Restoration
• Hormone Production
• Tissue Repair

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Whats Supposed To Happen(Normal Sleep Histogram)
Wake REM Stage 1 Stage 2 Stage 3 Stage 4
REM Sleep
NREM Sleep
2400 0100 0200
0300 0400 0500 0600
0700
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Sleep Histogram
REM - Mental restoration
NREM - Physical restoration
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Circadian Rhythm

• Circa Approximately or about
• Dian 24-hour period or a day

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Types of Physiological Rhythms

• Sleep-Wake
• Temperature
• Mental Performance
• Hormones
• Digestion

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Body Temperature
Sleep
No Sleep
98.6
96.5
Maximum Sleepiness
2400 0600 0900 1200 1500
1800
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Alertness Level
Maximum Alertness
High
Low
0900 1200 1800 0000 0600
0900
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Fatigue, Alcohol and Performance

• After 17 hours of sustained wakefulness,
  performance decreased to a level similar to .05
  BAC
• After 24 hours of sustained wakefulness,
  performance decreased to a level similar to .10
  BAC

Center for Sleep Research, University of South
Australia,and University of Adelaide, South
Australia (Nature, 1997)
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Fatigue, Alcohol and Impairment
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Alcohol-Induced Sleep
Wake REM Stage 1 Stage 2 Stage 3 Stage 4
2400 0100 0200
0300 0400 0500 0600
0700
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Fatigue Signs Symptoms

• Fixated
• Apathetic
• Lethargic
• Bad mood
• Nodding off

• Forgetful
• Poor decisions
• Slowed reaction time
• Reduced vigilance
• Poor communication

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If You Remember Nothing Else

• Physiological mechanisms underlie fatigue
• Just like water and food,sleep is a
  physiological necessity
• Fatigue can havesevere consequences
• Financial
• Human performance
• Take sleepand fatigue seriously

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Fight The Good Fight Combating Fatigue
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Fatigue CountermeasuresPersonal Strategies

• Preventive Strategies
• Minimizing sleep loss
• Naps
• Good sleep habits
• Effects of food, alcohol, and exercise
• Sleep environment
• Circadian strategies

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Preventive StrategiesSleep Loss Strategic
Napping

• Sleep Requirements and Debt
• Strategic Napping (Prior to Duty)
• Can Acutely Improve Alertness
• Limit Nap 10 - 30 Minutes
• Decreases Continuous Wakefulness
• Some Sleep is Better Than None

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Sleep Histogram

• Best method to minimize fatigue
• Limit to 10 or 20 minutes
• Try not to nap within 5 hours bedtime
• Avoid sleep inertia
• Disorientation and lethargy for 5-20 mins

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Preventive StrategiesGood Sleep Habits

• Regular Sleep/Wake Schedule
• Develop/Practice Regular Pre-Sleep Routine
• Avoid Heavy Meals
• Avoid Alcohol and Caffeine
• Physical/Mental Relaxation Techniques
• No Sleep in 30 MinutesGet Out of Bed

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Preventive StrategiesSleep Environment

• Dark, Quiet Room
• White Noise
• Comfortable Temperature
• Comfortable Sleep Surface
• Large Meals Indigestion
• Lack of Food

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Self-Medication
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Supplements and the Human Trend

• 2000 B.C.Here, eat this root.
• 1000 A.D.Roots are heathen.
• Say this prayer.
• 1850 A.D.Prayer is superstition.
• Drink this potion.
• 1940 A.D.That potion is snake oil.
  Swallow this pill.
• 1985 A.D.That pill is ineffective.
• Take this antibiotic.
• 2000 A.D.That antibiotic is artificial.
• Here, eat this root.

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Self-Medication

• Effects of Medications
• Desired Effects treats the symptoms
• Side Effects other effects on the body
• Allergic Reactions
• Combined Effect 1 1 3
• Companies combine antihistamines and
  decongestions to off set each other
• Over-the-Counter Medications
• Antihistamines sedation, drowsiness
• Decongestants nervous, dizzy, sleepy
• Cold preps most contain alcohol

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Personal StrategiesOperational Countermeasures

• Physical Activity Combats Sleepiness
• Social Interaction and Conversation
• Diet and Hydration
• Bright Lights
• Strategic Caffeine Consumption

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Strategic Caffeine Use

• 15 to 30 minutes to take effect
• Effects can last for up to 3-4 hours
• Chocolate 1-35 mg caffeine 1 oz
• Pepsi 36 mg caffeine 12 oz
• Coke 46 mg caffeine 12 oz
• Mt Dew 54 mg caffeine 12 oz
• Instant Coffee 40-108 mg caffeine 5 oz
• Drip Coffee 90-150 mg caffeine 5 oz

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Sleep Food

• Carbohydrates
• Pasta
• Corn
• White Bread
• Potatoes

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Alert Foods

• Protein
• Nuts and Seeds
• Meats/Cold Cuts
• Peanut Butter
• Cheese
• Eggs
• Fish
• Yogurt
• Beans

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• Optimize Sleep
• Dark, cool room
• Warfighter Sleep Kit
• AMMO

Alertness Management in Military
Operations http//www.AlertnessManagement.org
or Email info_at_AlertnessManagement.org.
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No Go Pills
Medication Dose Half-life Grounding
Temazepam (Restoril) 15 or 30 mg 8.0-12.0 h 12 hours
Zolpidem (Ambien) 10 mg 2.0- 2.5 h 6 hours
Zaleplon (Sonata) 10 mg 1.0 h 4 hours
Ground testing required prior to operational use.

• AF guidance (vol 3)
• lt 7 consecutive days (Sonata lt10 consecutive
  days)
• lt 20 in a 60 day period (Sonata lt 28 in a 60
  day period)
• FS Recommendations
• As little as needed (but they can help jet lag)
• Bad sleep is not an Ambien deficiency
• Melatonin is a no-go thats a no-go

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Smart Phone Apps
Android iPhone
Bedtime Calculator (Free) - REM cycle monitoring Crew Alert (29.99) - Your wildest dreams come true!
Sleepy Time (Free) - Chromotherapy Sleep Science Alarm (.99) - REM cycle monitoring
Sleep Watcher (Free) - Daily fatigue estimation Fatigue Calculator (Free) - Daily fatigue estimation
Relax and Sleep Plus (Free) - Ambient noises aSleep 3 (.99) REM cycle monitoring Chromotherapy
Sleep Now! (Free) - Ambient noises Circadian Alarm (.99) - REM cycle monitoring
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Summary

• Impact of Fatigue
• Sleep Physiology Circadian Rhythms
• Consequences Recognition
• Preventive Strategies
• Operational Countermeasures
• No Silver Bullet, No Magic Pill