DTIC ADA478058: Critical Care Performance in a Simulated Military Aircraft Cabin Environment

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Critical Care Performance in a Simulated Military Aircraft Cabin Environment
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Approval Sheet
Title: Critical Care Performance in a Simulated Militay Aircraft Cabin Environment
Name of Candidate: Margaret Mary McNeill
Doctor of Philosophy, 2007
Thesis and Abstract Approved: GOaA, '1V. X,.j
Patricia Gonce Morton, Ph), RN, CRNP, FAAN
Professor
School of Nursing
Date Approved: 1 VZAhtC4) / c 0 0 -7
Abstract
Title of Dissertation: Critical Care Performance in a Simulated Military Aircraft Cabin
Environment
Margaret Mary McNeill, Doctor of Philosophy, 2007
Dissertation Directed by: Patricia Gonce Morton, PhD, RN, CRNP, FAAN
Professor
School of Nursing
Since the start of Operation Enduring Freedom in 2001, over 42,063 patients have been
transported by the United States Air Force aeromedical evacuation system. Critical Care
Air Transport Teams (CCATTs) provide care for 5-10% of the injured and ill warriors
that are transported on military cargo aircraft to definitive treatment facilities. The
purposes of this study were to determine the effect of two stressors of flight, altitude-
induced hypoxia and aircraft noise, and to examine the contributions of fatigue and
clinical experience on cognitive and physiological performance of CCATT providers.
This repeated measures 2 x 2 x 4 factorial study included a sample of 60 military nurses.
The participants completed a simulated patient care scenario under aircraft cabin noise
and altitude conditions. Cognitive performance was measured with Critical Care Scores,
Critical Care Errors and Omissions, and Critical Care Reaction Times during the
scenario. Physiological performance was measured four times during the scenario via
vital signs and oxygen saturation. Differences in cognitive and physiological
performance were analyzed using RM ANOVA. A multiple regression model was
developed to determine the independent contribution of fatigue and clinical experience to
cognitive and physiological performance as a function of altitude and noise. Critical Care
Scores (p = .020) and Errors and Omissions (p = .047) were negatively impacted by
aircraft cabin noise. Noise resulted in increase in respiratory rate (p = .019). Critical Care
Scores (p < .00 1) and Errors and Omissions (p = .002) worsened with altitude. Heart rate
(p < .00 1) and respiratory rate (p < .00 1) increased with altitude, and oxygen saturation
(p < .001) decreased. A regression analysis of Critical Care Reaction Time to First
Defibrillation with altitude, noise, fatigue, current critical care experience, and
experience accounted for 20% of the variance in reaction time (p = .028).
The care of critically ill patients is significantly affected by aircraft cabin noise and
altitude. Noise and altitude largely act independently of each other. Safety and quality of
care may be positively impacted with training and equipment better designed to assist in
monitoring and assessment during aeromedical transport.
Name: Margaret Mary McNeill
Degree and Date to be Conferred: PhD., 2007
Collegiate Institutions Attended:
2007 PhD University of Maryland, Baltimore
1993 MS University of Maryland, Baltimore
1984 BS New York University
Major: Nursing Science
Professional Publications:
Chaffee, M.W. and McNeill, M.M. (2007). A model of nursing as a complex adaptive
system. Nursing Outlook, 55 (5), 332-341.
McNeill, M. (2004). Pericardial, Myocardial, and Endocardial Disease. In Woods SL,
Motzer SU and Froelicher ES: CardiacN ursing (5th edition). Philadelphia: Lippincott-
Raven.
McNeill, M. (2003). Review of "When Should a Chest Radiograph Be Obtained after
Chest Tube Removal in Mechanically Ventilated Patients? A Prospective Study" by
Pizano, L., Houghton, D., Cohn, S., Frisch M., Grogan, R. Journalo f Trauma Nursing,7 ,
45.
McNeill, M. (1999). Pericardial, Myocardial, and Endocardial Disease. In Woods SL,
Motzer SU and Froelicher ES: CardiacN ursing (4th edition). Philadelphia: Lippincott-
Raven.
McNeill, M. (1998). Endocrine. In Alspach JG: Core Review for CriticalC are Nursing.
Philadelphia, W.B. Saunders Company.
Professional Positions Held:
Aug 2004-Nov 2007 Air Force Institute of Technology-sponsored Fulltime PhD Student
University of Maryland, Baltimore
May 2002-Feb 2007 Consultant to the Air Force Surgeon General for Critical Care
Nursing
Nov 2001-Aug 2004 Deputy Director, Chief Nurse, and Critical Care Faculty
Air Force Coalition for Sustainment of Trauma and Readiness
Skills
RA Cowley Shock Trauma Center
University of Maryland Medical System, Baltimore, MD
Nov 1999-Nov 2001 Chief, Hospital and Ambulatory Branch, Clinical Support Division
May 1999-Nov 1999 Chief, Medical Support Branch, Clinical Support Division
Joint Readiness Clinical Advisory Board, Fort Detrick, MD
Oct 1996-May1999 Manager, 5-bed Multiservice Special Care Unit
1st Medical Group, Langley Air Force Base, VA
Nov 1998-May 1999 Deputy Commander, Chemically-Hardened Air Transportable
Hospital
1s t Medical Group, Langley Air Force Base, VA
Sep 1998 Trauma Nursing Consultant on US Tri-service Medical Team
deployed for evaluation of Kuwaiti Armed Forces Medical System
Oct 1997-May 1999 Deputy Commander, Medical Services Flight
1s t Medical Group, Langley Air Force Base, VA
Jan 1997-May 1999 Assistant Chief Nurse/Emergency Room Team Chief, Chemically-
Hardened Air Transportable Hospital
1 st Medical Group, Langley Air Force Base, VA
Jan 1997-May 1999 1 st Medical Group Liaison to LifeNet Organ Procurement Agency
and Lion's Eye Bank
Mar 1996-Sep 1996 Manager, 10-bed Multiservice Intensive Care Unit and 6-bed
Cardiothoracic/Vascular ICU
81st Medical Group, Keesler Air Force Base, MS
Sep 1995-Sep1996 Manager, 10-bed Multiservice Intensive Care Unit
81 st Medical Group, Keesler Air Force Base, MS
Jul 1993-Aug 1995 Assistant Manager, 10-bed Multiservice Intensive Care Unit
81st Medical Group, Keesler Air Force Base, MS
Sep 1991-Jun 1993 Graduate Student, sponsored by the Air Force Institute of
Technology
University of Maryland, Baltimore, MD
Oct 1988-Aug 1991 Team Leader/Unit Staff Development Officer, 12-bed Multiservice
Intensive Care Unit
Malcolm Grow USAF Medical Center
Andrews Air Force Base, D.C.
Jun 1986-Sep 1988 Staff Nurse, 7-bed Medical-Surgical Intensive Care Unit
David Grant USAF Medical Center,
Travis Air Force Base, CA
Jul 1984-May 1986 Staff Nurse, 42-bed Female Medical-Oncology Unit
David Grant USAF Medical Center,
Travis Air Force Base, CA
Jan 1984-May 1984 Staff Nurse, 24-bed Urology-Medical Unit,
Good Samaritan Hospital, West Islip, NY
Current Committee Memberships:
Nov 2007-present Scholarship Committee, Pi Chapter, Sigma Theta Tau International
Honor Society of Nursing
Sep 2007-present Evidence-based Practice and Research Council, Bethesda National
Naval Medical Center
Apr 2007-present Member, Scholarship Review Panel, American
Association of Critical Care Nurses
Apr 2002-present Member, Continuing Education Article Review Panel, American
Association of Critical Care Nurses
Special Awards:
2005 Global War on Terrorism Service Medal
2004, 1999, 1996 Air Force Meritorious Service Medal
2003 Air Force Element Field Grade Nurse of the Year
2001 Defense Meritorious Service Medal
1998 Joint Service Achievement Medal
1993 MS with academic honors, Hewlett Packard Award for Academic
Excellence
1992 Sigma Theta Tau International Honor Society of Nursing Induction
1991 Air Force Commendation Medal
1988 Air Force Achievement Medal
1987 Letter of Excellence for Writing, Squadron Officer School
1984 BS cum laude, Founders Day Award for Academic Excellence