Managing fatigue in EMS Flight Operations: challenges and opportunities

http://www.nemspa.org/Shared%20Documents/Rosekind_WhitePaper.pdf
Report by Mark R. Rosekind

Modern society’s 24/7 demands create significant physiological challenges for the humans
responsible for safe and effective operations. Around-the-clock requirements create sleep and
circadian disruptions that lead to reduced performance, alertness, safety, and health. Decades of
scientific research and an extensive scientific literature clearly demonstrate that fatigue (created
by sleep and circadian disruption) is a significant risk factor across diverse operational settings,
including aviation and all other modes of transportation (1, 2, 3). The humans involved in EMS
flight operations confront these same, well-documented physiological challenges and safety risks
related to fatigue.
Acknowledging these fatigue-related safety risks, the National EMS Pilot Association
(NEMSPA) requested a brief, summary examination of the challenges and opportunities related
to managing fatigue in EMS flight operations. In response to this NEMSPA request, the
following addresses four critical areas that represent the most significant challenges and
opportunities related to fatigue in current EMS flight operations.

Physical Fitness and Body Composition After a 9-Month Deployment to Afghanistan

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA489599&Location=U2&doc=GetTRDoc.pdf

Sharp, M. A., Knapik, J. J., Walker, L. A., Burrell, L., Frykman, P. N., Darakjy, S. S., Lester, M. E., Marin, R. E.

To examine change in physical fitness and body composition after a military deployment to Afghanistan. Methods: one hundred and ten infantry soldiers were measured before and after a 9-month deployment to Afghanistan for Operation Enduring Freedom. Measurements included treadmill peak oxygen uptake (peak VO2), lifting strength, medicine ball put, vertical jump, and body composition estimated via dual-energy x-ray absorptiometry (percent body fat), absolute body fat, fat-free mass, bone mineral content, and bone mineral density. Results: There were significant decreases (P<0.01) in peak VO2 (-4.5%), medicine ball put(-4.9% body mass {-1.9%}, and fat-free mass{-3.5 %}, wheras percent body fat increased from 17.7% to 19.6%.

Measuring the Strategic Value of the Armed Forces Health Longitudinal Technology Application (AHLTA)

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA489619&Location=U2&doc=GetTRDoc.pdf

Bigelow, James H., Harris, Katherine M., Hillestad, Richard
The Military Health System (MHS) has more than 9 million eligible beneficiaries, including active duty service members and their families, retirees and their families, and Guard and Reserve members serving on active duty and their families. The MHS provides health care through its own facilities and personnel (direct care); it also purchases care from civilian providers (purchased care). In January 2004, the MHS's Clinical Information Technology Program Office (CITPO) began implementation of the Armed Forces Health Longitudinal Technology Application (AHLTA), DoD's global electronic health record. AHLTA will ultimately be used by all providers in the military's direct care system at the point of care. It will also promote population health, conduct medical surveillance, support clinical decision making, and support force health protection for deployed service members. As of December 2006, AHLTA was being used to document virtually all outpatient c are delivered at fixed MHS facilities. The objective of this project was to help MHS develop an analytic framework and define specific outcome measures for assessing and reporting the efficiency, safety, and health benefits of AHLTA as it becomes fully deployed. This monograph describes the framework the authors recommend that DoD adopt in measuring AHLTA's contribution to MHS performance. To develop the framework, they reviewed AHLTA's current and planned capabilities, reviewed the literature on the measured benefits of health information technology, consulted with senior MHS leaders to understand the dimensions of performance that the leadership deemed important and how the leadership anticipated that AHLTA would affect those dimensions, identified and assessed performance measures in current use by civilian health systems for their applicability to MHS strategic objectives, and suggested new approaches for measuring MHS strategic objectives where civilian measures are la cking.

Cerebrovascular Responses to Incremental Exercise During Hypobaric Hypoxia: Effect of Oxygenation on Maximal Performance

Subudhi, A. W., Lorenz, M. C., Fulco, C. S., Roach, R. C.

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA489111&Location=U2&doc=GetTRDoc.pdf

While performing demanding physical activity for long durations, fluid and electrolyte imbalance is common in athletes, military personnel, and recreational hikers. The military and civilian communities have introduced extensive heat mitigation measures to manage heat strain and reduce the risk of serious exertional heat illnesses (EMI). These heat mitigation measures include fluid and electrolyte replacement guidelines, vigilance, and identifying high-risk individuals. Despite these measures, exercise in hot weather continues to result in preventable injuries and deaths in young healthy individuals. With existing emphasis on appropriate fluid intake during exercise for the avoidance of dehydration, heat illness, and associated performance decrements, there has been a subsequent increase in reported exertional hyponatremia (MYPO) cases related to excessive water intake, elevated sweating rates, excessive sodium losses in sweat, and inadequate sodi um intake in soldiers (I), athletes (2,3,4), and recreational hikers (5,6).

Exertional Heat Illness and Hyponatremia: An Epidemiological Prospective

by R. Carter
http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA489367&Location=U2&doc=GetTRDoc.pdf

While performing demanding physical activity for long durations, fluid and electrolyte imbalance is common in athletes, military personnel, and recreational hikers. The military and civilian communities have introduced extensive heat mitigation measures to manage heat strain and reduce the risk of serious exertional heat illnesses (EHI). These heat mitigation measures include fluid and electrolyte replacement guidelines, vigilance, and identifying high-risk individuals. Despite these measures, exercise in hot weather continues to result in preventable injuries and deaths in young, healthy individuals. With existing emphasis on appropriate fluid intake during exercise for the avoidance of dehydration, heat illness, and associated performance decrements, there has been a subsequent increase in reported exertional hyponatremia (HYPO) cases related to excessive water intake, elevated sweating rates, excessive sodium losses in sweat, and inadequate sod ium intake in soldiers (1), athletes (2,3,4), and recreational hikers (5,6). The primary purpose of this article is to systemically examine the epidemiological literature of fluid and electrolyte imbalances that occur during physical activity. The secondary purpose of this article is to examine signs and symptoms of HYPO and EHI cases from the literature (1,2,5,7Y26) and the U.S. Army Research Institute of Environmental Medicine (USARIEM) Total Army Injury and Health Outcomes Database (TAIHOD). While it is acknowledged that the populations at risk for HYPO and EHI may differ, reasonable comparisons are made by examining incidence rates to better understand relative magnitude of each condition. It has been reported that these two conditions have several overlapping clinical features, which has led to misdiagnosis in some rare cases. This article is not intended to persuade the reader of the relative importance of either condition.