FSM Mar 03

32 Pages·2003·4.33 MB·English

AIR FORCE RECURRING PUBLICATION 91-1 March 2003, VOL 59, NO 03
U N I T E D S T A T E S A I R F O R C E
M A G A Z I N E
4 Go Pills
Fatigue countermeasures and aviator safety
12 There I Was...In The Good Old Days
Some hairy stories
14 You Asked for it
Going back to the “old” way
16 Summary of an F-16 AIB
How maintenance crashed an F-16
21 Flight Safety and Einstein’s Paradox
The circle of darkness expands
22 HATR Summary for 2002
23 Human Factors 101
“So guess what? It’s us.”
26 Ops Topics
Got clearance?
28 Maintenance Matters
We don’t need no stinkin’tech data
30 Class AMishap Summary
31 How Not to Tear Down a Crane
That quirky feeling
Cover: USAF Photos by SSgt Greg Suhay
and Keith Pederson
Photo Illustration by Dan Harman
GENERAL JOHN P. JUMPER
Chief of Staff, USAF
MAJ GEN KENNETH W. HESS
Chief of Safety, USAF
COL MARK K. ROLAND
Chief, Safety Education and Media Division
Editor-in-Chief
DSN 246-2968
CMSGT JEFF MOENING
JERRY ROOD
HQ AFSC/SEMM
Managing Editor
DSN 246-0950
CMSGT JEFF MOENING In the December 2002 issue we showed a photo of an engine
Maintenance/Technical Editor troop at his toolbox with two co-workers behind him at an
DSN 246-0972
engine. One of the troops was standing on the rails of the
PATRICIA RIDEOUT engine trailer. We have received many calls and e-mails about
Editorial Assistant
DSN 246-1983 this being a safety violation, and it isa safety violation. Thanks
for the keen eye in spotting safety violations. Why did we use
DAN HARMAN
Electronic Design Director that photo? Two reasons. First, it shows engine troops hard at
DSN 246-0932 work repairing an engine, and the engine troops have been
TSGT MICHAEL FEATHERSTON critical to reducing engine mishaps in 2002. (Read the end-of-
Photo Editor
year summary in the Jan-Feb 03 issue to see the good news.)
DSN 246-0986
Second, we have seen a lot of accidents/incidents in the last
Air Force Safety Center web page:
year where accepted practice has been a player. This means
http://safety.kirtland.af.mil/
Flying SafetyMagazine on line: workers and supervisors look the other way when troops are
http://safety.kirtland.af.mil/magazine/
violating safety rules in order to "accomplish/complete the
htdocs/fsmfirst.htm
mission." Just like in the picture.
Commercial Prefix (505) 846-XXXX
The people who contacted us talked about how this would
E-Mail — [email protected]
Address Changes — patricia.rideout@kirt- never be accepted at their location, and that is great. But here is
land.af.mil
a case where it was accepted. Where was the supervisor? Why
24-hour fax: DSN 246-0931 didn’t the other people involved in the task stop the person
Commercial: [phone]
from committing an unsafe act? Why wasn’t the proper equip-
DEPARTMENT OF THE AIR FORCE— ment provided? You tell us, and maybe we can fix this problem.
THE CHIEF OF SAFETY, USAF
Aircraft maintainers are a proud group of professionals who
PURPOSE — Flying Safety is published pride themselves on accomplishing the mission, and we have
monthly to promote aircraft mishap prevention.
Facts, testimony, and conclusions of aircraft continually shown that dedication. Unfortunately, we have
mishaps printed herein may not be construed injured a bunch of people in the process, even killed one last
as incriminating under Article 31 of the Uniform
Code of Military Justice. The contents of this year, for no reason other than we accepted less than safe work
magazine are not directive and should not be practices. People may have thought, "It’s okay to take short-
construed as instructions, technical orders, or
cuts if the mission gets
directives unless so stated. SUBSCRIPTIONS
— For sale by the Superintendent of accomplished." It is not
Documents, PO Box 371954, Pittsburgh PA
okay to take shortcuts at
15250-7954. REPRINTS — Air Force organi-
zations may reprint articles from Flying Safety someone’s expense. Only
without further authorization. Non-Air Force we, the maintainers, can
organizations must advise the Managing Editor
of the intended use of the material prior to stop this trend. We must
reprinting. Such action will ensure complete be safe at all times and
accuracy of material amended in light of most
never accept less than
recent developments.
compliance with the rules
DISTRIBUTION— One copy for each three air-
crew members and one copy for each six main- provided to keep us safe.
tainers and aircrew support personnel. I know of no commander
POSTAL INFORMATION — Flying Safety who will accept less than
(ISSN 00279-9308) is published monthly compliance with tech
except combined Jan/Feb issue by HQ
AFSC/SEMM, 9700 G Avenue, SE, Kirtland data and safety regula-
AFB NM 87117-5670. Periodicals postage tions. If there is one out
paid at Albuquerque NM and additional mailing
there, let us know. I’m
offices. POSTMASTER: Send address
changes to Flying Safety, 9700 G Avenue, SE, sure Major General Hess
Kirtland AFB NM 87117-5670.
would love to discuss
CONTRIBUTIONS — Contributions are wel- safety with that comman-
come as are comments and criticism. The edi-
der. Keep them flying, but
tor reserves the right to make any editorial
v
changes in manuscripts which he believes will do it safely!
improve the material without altering the intend-
ed meaning.
USAFPhoto by TSgt Cedric H. Rudisill
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March 2003 ● FLYINGSAFETY
"Go Pills," Fatigue and Aviator Safety
USAF Photos by SSgt Greg Suhay
and Keith Pederson
Photo Illustration by Dan Harman
JOHN A. CALDWELL, PH.D. At our departure time of 1600 Central, the weather was-
U.S. Air Force Research Laboratory n’t great, but the mission was too important to cancel. We
COL LEX BROWN, M.D. took off into low clouds and joined up approximately 50
U.S. Air Force School of Aerospace Medicine miles east of Holloman to continue toward the tanker rejoin
point. Weather delayed our first refuel, which put us an
In late ’96, we prepared to launch F-117s to an undis- hour behind schedule and caused a faster fatigue onset.
closed location 16 or more hours across the ocean. About Later off the coast of Boston, more poor weather slowed the
48 hours from launch time, the Wing CC asked whether tanker swap to the KC-10s that would take us the rest of the
we thought such a deployment was "do-able" or not, and way to our destination, and overcast conditions throughout
we said yes, although we were concerned about pilot the night portion crossing the Atlantic further complicated
fatigue. The boss told me to talk to the flight surgeon things by obscuring our visual cues. Things got better as
about the possible use of Go Pills and to interview each we approached the Rock of Gibraltar, and after receiving
pilot to ensure they knew the duration of the mission and our destination via secure radio link and digging through
the potential hazards. three feet of pubs to find the approach plate for Al Jaber, we
When we briefed the mission, everyone said they were crossed the Mediterranean Sea in beautiful skies, flew
ready to go, and when I talked to the flight doc, he said through intermediate ceilings across Egypt, and finally
he would make the Go Pills available, so I focused on approached Kuwait in a "red out" caused by 35-knot winds
planning and making sure the jets were ready to go. whipping thedesert sands into a frenzy.
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FLYINGSAFETY ● March 2003
As we approached Kuwait under instrument condi- Although different people have different opin-
tions, we were low on gas and fighting weather that was ions about the wisdom of using Go Pills to main-
below minimums and a fierce crosswind. To make matters tain alertness and performance, the fact is that at
worse, fatigue was becoming a real problem because we some point in your career you may well have to
were approaching 18 hours of airborne time, and I could decide whether you will use these medicines which
feel the last Go Pill wearing off. It took every ounce of con- are currently approved for some types of air oper-
centration to come up with a plan, but I knew we had to ations. (The Air Force does not requirethe use of Go
get our planes on the ground. I announced that we were Pills under any circumstance.) At various times in
going to split for individual ILS approaches, use the our military history, the U.S. has relied on Go Pills
IRADS (Infra-Red Acquisition and Detection System…a to maximize aviator safety and effectiveness while
bombing sensor, not an instrument approach aid) to find accomplishing difficult missions (Cornum,
the runway, make the landing, deploy the drag chute, and Caldwell, and Cornum, 1997). Nothing much has
hit the brakes. I’m sure I sounded more confident in this changed about the intensity and unpredictability of
plan than I actually felt, but it was the only chance we had combat throughout our history except that technol-
to get our jets on the ground before either running out of ogy has placed even higher demands on aircrews,
gas or suffering the debilitating effects of fatigue. So in we so Go Pills likely will continue to be used to
pressed. As soon as I landed, I exited the runway and piv- counter high levels of operational fatigue in the
oted my jet to be able to see the final approach course. I future. Assuming that Air Force policy and your
waited breathlessly as each stealthy aircraft appeared out chain of command have decided that these med-
of the dust and made its landing. Thankfully, all eight jets ications will be an authorized alternative for your
made it to the ground safely. unit, you might want to consider the information
—Col Gary Woltering presented here before you decide what you will do
Col Woltering’s account of this first-ever 18-hour when the "crunch" comes.
F-117 sortie is a great example of the modern mis-
sion requirements that are increasingly a part of Air Military Sustained Operations are a Tactical
Force operations. Long flights, unpredictable desti- Necessity Despite Some of the Problems They
nations or target locations, poor weather, and May Cause
unforeseen events are "facts of life" throughout the U.S. superiority on the battlefield in part stems
aviation environment, but especially in combat and from our ability to maintain pressure on the enemy
contingency operations. Besides the routine stress by making them fight around the clock. By keeping
of facing the unknown under less-than-optimal up a 24-hour-a-day operational tempo, we can vir-
conditions for an unspecified period of time, the tually guarantee that enemy forces will suffer from
situation is often further complicated by potential- the severe sleepiness that leads to procedural
ly dangerous levels of fatigue from disruptions to errors, sloppy judgment, poor planning and a gen-
the body’s clock and sleep deprivation. Most of us eral inability to react properly to rapidly changing
try to get the sleep we need, but job demands, anx- situations. This gives us the tactical advantage, but
iety, uncomfortable sleep environments and other only if we guard against severe fatigue ourselves.
problems often get in the way. Anyone who has Unfortunately, this is difficult because fully staffing
ever flown long-range sorties or been deployed in three eight-hour work shifts with well-rested per-
some far-away place knows about the "real world" sonnel around the clock for seven days a week in
causes of fatigue and the problems associated with combat and contingency operations is a daunting
being overly tired. Why is fatigue a particular con- task. Prolonged work bouts are common, shorter-
cern for the military, and what can we do about it? than-normal sleep periods are unavoidable, and
The Air Force has decided that Go Pills are at least fatigue from both of these factors threatens to
part of the solution, and despite recent media hype impact operational readiness (Department of the
to the contrary, many scientists, physicians, deci- Army, 1991; Krueger, 1989). It is well established
sion makers and operators feel that stimulants that sustained wakefulness and the resulting sleep
have a rightful place in our armament of fatigue debt increase the likelihood that personnel will
countermeasures. Is this the case, or should we just briefly (and uncontrollably) nod off on the job,
rely only on other strategies? even during flights (Dinges, 1995). The longer
This article will briefly review the problem of someone remains awake, the more likely he/she is
fatigue during intense military operations and dis- to experience these uncontrollable periods of
cuss a countermeasure (i.e., Go Pills) that is being drowsiness. In addition, sleepiness takes a heavy
used in some sustained aviation missions. The toll on reaction time, motivation, attention, memo-
overall objective is to inform aircrew members ry, endurance and judgment (Naitoh and Kelly,
about the research that has been performed on Go 1993). Even in peacetime, overly-tired pilots are
Pills so they can make educated decisions about the thought to be responsible for four to seven percent
use of this fatigue countermeasure in demanding of civilian U.S. aviation incidents or accidents
flight operations. every year (Kirsh, 1996), and a recent report identi-
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March 2003 ● FLYINGSAFETY
Data from Comperatore, Caldwell and Caldwell, 1997
Figure 1
fied fatigue as a contributing factor in four percent down" at night (since this is when we are usually
of Army aviation mishaps from 1990-1999 (person- asleep) and "rev up" during the day (when we're
al communication, U.S. Army Safety Center help usually awake). As any shift worker will testify, it
desk; [email protected]) while takes several days to adjust to a new working and
fatigue was cited as contributing to 7.78 percent of resting schedule, and many people never fully
Air Force Class Areportable aircraft mishaps from adjust no matter how long they stay on the night
1972-2000 (personal communication, Lt Col shift in particular. People who aren't adjusted to
Thomas Luna, U.S. Air Force Safety Center). their working and resting schedules suffer in terms
of their feelings (tired, upset stomach, poor mood,
Severe Sleep Loss Creates Serious Problems etc.), their alertness (slow and drowsy), and their
Although predictions about the exact effects of performance (reduced accuracy, poor vigilance and
fatigue are difficult to make, most researchers slow reactions). People who transition from one
agree that fatigue-related performance and alert- time zone to another experience similar problems.
ness decrements follow a fairly reliable time Disruptions to the body’s clock compound the
course. Canadian researchers have reported that fatigue associated with long hours of wakefulness
certain mental abilities decline about 30 percent so that someone who is trying to work early in the
after one night without sleep and 60 percent after morning (after being awake since the previous
two nights without sleep (Angus and Heslegrave, day) is suddenly vulnerable to involuntary "sleep
1985). Scientists at the Walter Reed Army Institute attacks" even though they were fine just a few
of Research predict soldiers lose about 25 percent hours before. These same people might deceive
of their ability to perform useful mental work for themselves into thinking they've overcome fatigue
every 24 hours without sleep (Belenky et al., 1994). after the sun comes up even though they haven't
ANorwegian field study found the fighting capa- slept a wink during the night. Unfortunately, this
bility of soldiers dropped a full 80 percent after sets them up for even greater problems later in the
four consecutive days of sleep loss (Roussel, 1995). day, and since they don't expect the next drop in
Thus, it seems clear that one to two days of sleep performance, their safety is more at risk than it was
deprivation will seriously degrade aircrew perfor- in the first place.
mance while three to four days of sleeplessness
will produce virtual incapacitation in the opera- An Example of the Effects of Fatigue
tional environment. An example of the performance decline associat-
ed with sleep loss and the circadian cycle is shown
The Body's Circadian Clock Is Important in Figure 2. This graph was produced by the Air
Anyone who has worked reverse cycle knows Force Fatigue Avoidance Scheduling Tool™ which
that sleepiness and fatigue are worse in the early predicts performance efficiency based on the
morning hours (from about 0200-0500) than at amount of sleep obtained and the circadian phase
other times (Akerstedt, 1995). This is because the (time of day). The schedule used in this example is
body's internal rhythms are programmed to "wind based on a schedule from a recent field exercise.
6
FLYINGSAFETY ● March 2003
Figure 2
Serious deficits in operational effectiveness were fatigue in the cockpit. Evidence of this has been
predicted by 0300 on the morning of the second found in almost every military conflict. Fatigue
day. At this point, effectiveness was expected to fall was definitely a problem in Desert Shield and
below 75 percent of normal. Also, due to the subse- Desert Storm, and subsequent operations have led
quent lack of sleep (with only a two-hour nap on to similar reports. Even during peacetime, a recent
days two and three), performance likely would survey of Army pilots revealed that 26 percent
have declined until it degraded to less than 50 per- complained of poor sleep while in the field or
cent of optimal levels. Decrements of this magni- while traveling compared to only five percent com-
tude could create serious problems in the opera- plaining of poor sleep at home (Caldwell and
tional environment unless a proven fatigue coun- Gilreath, 2002).
termeasure is implemented. Note that the greatest In addition to sleep difficulties, it is often impos-
decrement on Tuesday was predicted to occur after sible to avoid working at times when circadian fac-
18-22 hours of continuous wakefulness, a time tors increase the prevalence of attentional lapses
associated with fatigue-induced performance loss- and involuntary sleep episodes. Attempts to reme-
es similar to those produced by blood alcohol con- dy fatigue have included several novel approaches
centrations (BACs) of .05 to .10—the legal level for such as a reliance on exercise (LeDuc, et al., 1998),
"driving while intoxicated"! work breaks (Angus, Pigeau, and Heslegrave,
Clearly, fatigue is an important issue, especially 1992), or high levels of physical fitness, as well as
during actual real-world missions. It is for this rea- the use of strategic naps (Angus, Pigeau, and
son that feasible countermeasures must be devel- Heslegrave, 1992). Unfortunately, exercise appears
oped and implemented. to offer only temporary relief from fatigue, and
work breaks offer short-lived relief as well.
What are the Strategies for Dealing with Ensuring a high degree of physical fitness, while
Operational Fatigue? excellent for sustaining physical work capacity, has
almost no impact on the ability to maintain the
Nonpharmacological (or "Natural") Strategies mental performance of sleep-deprived people.
A number of fatigue remedies have been pro- Naps, while excellent for improving alertness,
posed, but few are easy to correctly use, especially often are not feasible in high-ops-tempo settings.
in intense military operations. Emphasizing proper These are just some of the reasons why the military
sleep management and controlling the duration of has explored the feasibility of using pharmacologi-
duty periods constitute the first line of defense cal (or "drug-based") fatigue countermeasures.
against fatigue, and the Air Force rightfully places
a great deal of emphasis on this approach. Go Pill (Pharmacological or Drug) Strategies
However, when the intensity of operations reaches Although the rule of thumb is that "drugs and
a certain point, or long-range flights are required, it flying don't mix," Go Pills may be the only reliable
can be very difficult to properly control sleep peri- method for temporarily maintaining the perfor-
ods, and this can lead to a huge problem with mance of aviators during those lengthy sustained
7
March 2003 ● FLYINGSAFETY
Data from Caldwell, et al., 2000a
Figure 3
operations when, despite everyone's best efforts, deprived subjects at well-rested levels. Recently,
adequate sleep is simply not an option. In these sit- their positive reputation has been tempered by the
uations, after every other countermeasure has been recognition that they can have significant abuse
tried, Go Pills should be considered for a variety of potential if they are not used properly, and they are
reasons. They are effective and easy to use. Their not completely free of side effects, but despite this
feasibility is not dependent upon environmental fact the military has successfully used dextroam-
manipulations such as creating comfortable day- phetamine for years. There are reports that
time and nighttime sleep quarters in the middle of amphetamines were used in combat in World War
the desert (or next to an active runway, or in the II, and it is an established fact that the Air Force
back of an aircraft). Their effectiveness does not authorized the use of dextroamphetamine to sus-
depend on making complex modifications to work tain the performance of sleep-deprived pilots as
schedules in order to ensure that everyone works early as 1961. Dexedrine continues to be authorized
only eight to 12 hours a day, while simultaneously under Air Force policy for certain situations today,
making sure each individual has enough time off- and its successful track record has been maintained
duty to get at least eight hours of sleep. Also, Go by ensuring that it is provided in accordance with
Pills have been proven effective for temporarily carefully planned guidance and used in a well-con-
overcoming sleep deprivation in laboratory studies trolled fashion.
and in field environments. This explains why med- The effects of Dexedrine have been extensively
icines such as amphetamines have been used studied in the laboratory and in the field (Weiss
extensively in several military conflicts. Despite and Laties, 1967). In the laboratory, single doses (20
debate on this topic, dextroamphetamine mg) of dextroamphetamine have been shown to
(Dexedrine®) remains one of the best Go Pill choic- return alertness and cognitive performance of non-
es because its actions are well understood and its aviators to near baseline levels and maintain this
effectiveness in sleep-deprived personnel is well recovery for seven to 12 hours, even after 48 hours
known. However, there are other possible alterna- of total sleep deprivation (Newhouse et al., 1989).
tives that deserve mention. In addition, a single 20-mg dose has been found to
• Amphetamines. Amphetamine psychostimu- temporarily prevent performance decrements in
lants have been available in the U.S. since 1937, and people kept awake for approximately 34 continu-
these drugs have been widely used to treat the ous hours, and to restore the performance of vol-
symptoms of medical conditions such as narcolep- unteers deprived of sleep for 48 continuous hours
sy (with excessive daytime sleepiness) and hyper- (Pigeau, et al., 1995). Studies conducted by the U.S.
activity/attention deficit disorder. In the 1940s and Army Aeromedical Research Laboratory
1950s, studies were undertaken to explore the mil- (USAARL) determined that multiple 10-mg doses
itary significance of psychostimulants, and the of Dexedrine, administered prior to the onset of
general consensus was that they were effective for fatigue degradations, will sustain the performance
restoring or maintaining the performance of sleep- of pilots throughout 40 hours without sleep
8
FLYINGSAFETY ● March 2003
(Caldwell, et al., 1995; Caldwell, Caldwell, and (about 40 mg) (Lieberman, 1992)? Also, few people
Crowley, 1996; Caldwell and Caldwell, 1997). In may realize that over-the-counter medications
addition, a recent USAARL study showed that often contain caffeine. For instance, just one
Dexedrine maintained the flight performance of Excedrin tablet has 65 mg. Compare these amounts
pilots even after 60 hours of continuous wakeful- to the caffeine found in stimulants such as
® ®
ness (Caldwell et al., 2000a). NoDoz and Vivarin (200 mg per pill). By the
A flight surgeon who administered 5 mg of way, 200 mgs of caffeine is the minimum amount
Dexedrine to EF-111A Raven jet crews (used for recommended to sustain alertness in sleep-
electronic jamming) during an Air Force strike on deprived people. Be aware that your body may
Libya in April of 1986, reported crews were able to quickly adjust to the effects of daily caffeine con-
overcome the fatigue of the mission itself and the sumption, so if you are a heavy caffeine user, you
sleep deprivation which occurred during mission may not get the boost you really need from those
preparations (Senechal, 1988). There were no in- two cups of coffee when you're fighting off sleep in
flight or landing problems, and all of these aircraft the middle of the night. People who find they fre-
returned safely to base1. When Colonel Kory quently need some help staying alert on night shift
Cornum, an Air Force flight surgeon, provided or when doing those extra long missions should
Dexedrine to F-15C pilots flying lengthy combat air only use caffeine during the times when they real-
patrol sorties, it was clear that the medicine ly need it. Although this is tantamount to sacrilege,
enabled flight crews to overcome the fatigue from such people should switch to decaffeinated prod-
sleep deprivation and circadian disruptions ucts on normal work days.
(Cornum, 1992). (In practice, the pilots self-admin- The bottom line is that when operational
istered 5-mg doses at a frequency of one tablet demands make pre-mission sleep difficult or
approximately every two to three hours.) The unit impossible to obtain, caffeine could be considered
commander concluded Dexedrine administration a "first-line" approach to sustaining alertness and
contributed to the safety of air operations. There performance in sleepy individuals. In other words,
were no reported adverse effects, even in personnel caffeinated products such as coffee, soft drinks, caf-
who took 10 mg at a time, and no aviators report- feine-containing candy and gum, or caffeine tablets
ed a need to continue the drug once proper work- often can help to manage the fatigue that stems
ing and sleeping schedules were reinstated. This from unavoidable sleep deprivation2.
agrees with the results of a survey of Air Force • Modafinil. Modafinil may someday be an alter-
pilots which indicated that Dexedrine was helpful native to Dexedrine and caffeine for use in situa-
in maintaining performance during sustained tions where a prescription medication is needed to
operations without unwanted side effects sustain performance during prolonged periods of
(Emonson and Vanderbeek, 1993). total sleep loss. This new drug was only recently
Because of such reports, the U.S. Air Force recently approved for use in the United States (as of
approved Dexedrine for sustaining the performance December 1998), so more research is needed before
of pilots in single- and dual-seat aircraft. Under this the military will use it on a widespread basis.
policy, doses of 10 mgs are authorized. The number However, there is great interest in modafinil (sold
®
of doses issued to the aircrew member by the flight under the brand name Provigil ) because it sup-
surgeon is appropriate to the mission duration. posedly has the positive benefits of amphetamines
• Caffeine.Caffeine is another alertness-promot- without the drawbacks of increasing heart rate and
ing compound that is suitable for fighting fatigue blood pressure (and without the possibility of dis-
particularly in relatively short periods of continu- turbing the quality of any sleep that is taken too
ous wakefulness (i.e., 37 hours). However, some close to the most recent dose). Researchers have
scientists have found that caffeine may not be found that Provigil maintains the alertness of peo-
appropriate for longer sustained operations (i.e., 64 ple with sleep disorders and it improves the func-
hours or more) (Lagarde and Batejat, 1995). As tioning of people who can't sleep because of night
with everything in life, no clear-cut answer is avail- work or really long duty periods. It does this with-
able; there are people who believe caffeine is a bet- out increasing heart rate and blood pressure. Also,
ter alternative than amphetamines, and others who people seem to be able to use Provigil without wor-
feel caffeine is less effective and more prone to pro- rying about "getting hooked."3
duce unwanted side effects like "the shakes," dehy- The USAARLconducted an aviator-performance
dration and a frequent need to urinate. study in 1999 (with three 200-mg doses of
Every day, Americans consume various amounts modafinil during 40 hours of sleep deprivation),
of caffeine in all sorts of products (Griffiths and and the results were promising. Provigil sustained
Mumford, 1995), and they may not even be aware the alertness and performance of pilots, and kept
of it. Everyone knows about the caffeine in coffee them working at well-rested levels even at 0500 in
(100-175 mg per cup), but what about the caffeine the morning after they had been awake for 22
in Coke (31 mg), Mountain Dew (55 mg), and tea straight hours (Caldwell, et al., 2000b). However,
9
March 2003 ● FLYINGSAFETY
there were some side effects (dizziness and vertigo) a few seconds to several minutes. Research has
that may have been related to the high dose. It shown that people often aren't aware that they are
seems likely that a lower dose of modafinil may lapsing into sleep until the lapses stretch into peri-
provide the same alerting benefit with fewer prob- ods of a minute or longer! Go Pills can stave off
lems, but this has yet to be determined in an avia- these effects for a while.
tion context. However, both Walter Reed Army If your chain of command makes a decision to
Institute of Research (Wesensten et al., 2002) and provide Go Pills, the basic choices are caffeine or
the Air Force Research Laboratory (Eddy, et al., Dexedrine. Modafinil may be an alternative for
2001) have performed modafinil studies (with non- the future. Of these choices, only caffeinated bev-
aviators) in which the results were positive with no erages can be used without explicit flight surgeon
side effects related to dizziness and vertigo. and command authorization. Caffeinated tablets
After more research, modafinil may become a suit- can be used following flight surgeon clearance.
able alternative to Dexedrine. However, until these However, the long-term efficacy of caffeine has
studies are performed, Dexedrine may be a better not yet been established, especially for people
choice in terms of what is known about the drug and who normally consume a lot of caffeinated prod-
its proven potential for sustaining alertness for rela- ucts. Dexedrine is likely a better choice for
tively long periods in sleep-deprived subjects. extreme cases of fatigue, but while Dexedrine is
highly effective, it also is a controlled prescrip-
What is the Bottom Line? tion drug that can only be used under specific cir-
Fatigue will probably always be a problem in cumstances. Dexedrine is not a perfect, 100-per-
combat and contingency operations because of the cent solution, but it certainly beats falling asleep
intensity and unpredictability of these missions. at the controls.
There are solutions for operational fatigue, but the When you find yourself in a situation where the
most appropriate countermeasure depends on mission simply must be accomplished but sleep is
several factors. impossible either because of the lengthy flight
Obviously, the best way to prevent fatigue on the duration, circadian factors or environmental cir-
job is to ensure that everyone gets enough sleep cumstances, your flight surgeon may offer the
before the mission even starts (sleep experts rec- option of using a stimulant, and it may be
ommend eight hours of sleep per day to maintain Dexedrine. This will only be done on a time-
top-notch performance). It is best for this sleep to and/or mission-specific basis and only with the
occur during the normal nighttime sleep period approval of the senior flight surgeon and Wing
whenever possible because this is the time the Commander (or deployed equivalent) operating
body is "programmed" to sleep. Also, there should under MAJCOM guidance. If you feel that you may
be a comfortable place to sleep that is dark and potentially elect to use Dexedrine you will first be
free of noise and activity. When this is impossible, educated on Dexedrine and its effects. If you elect
earplugs and sleep masks can help. Remember, to proceed you will be asked to sign an informed
proper sleep is the only sure way to avoid a consent form and will be provided a test dose to
buildup of fatigue. take on the ground to familiarize you with how it
If a full eight-hour sleep period is not possible, will make you feel and ensure that you do not have
naps are a great compromise. Naps should be long any unexpected adverse effects. Your Dexedrine
enough to provide at least 45 continuous minutes ground test as well as any operational use will be
of sleep, although longer naps (two hours) are bet- documented. The final decision about whether to
ter. In general, the shorter each individual nap take advantage of this option will be left to you.
period is, the more frequent the naps should be. Hopefully, you can now make an informed choice
Once again, to promote the most restorative sleep about whether or not you will use it.
during these naps, the same rules about environ-
mental comfort apply to them as they do to the The views expressed in this paper are those of the
longer sleep episodes. author and do not necessarily reflect the official stance of
When it is simply impossible to obtain any sleep, the Department of Defense. Mention of specific drug
stimulants or Go Pills may be the only realistic products should not be construed as an official endorse-
alternative to falling asleep at the controls. ment of these compounds.
Although stimulants cannot replace the need for
1 Although one of the strike F-111s involved in this mission was taken out by a
sleep, they can temporarily postpone it. This is
surface-to-air missile, all of the EF-111s and the remaining F-111s returned safely.
especially important in sustained aviation opera-
tions because sleepiness in the cockpit is a serious 2 Aircrew are required to inform their flight surgeons about any nutritional or
dietary supplementation (including caffeine tablets) that they are using in accor-
problem which cannot be overcome through moti- dance with AFMOAPolicy Letter, 28 Oct 1999, Use of Nutritional Substances.
vation, training or experience. Once the body
3 Although the absence of addiction potential associated with modafinil is a
reaches a certain point, involuntary lapses into
widely-touted benefit of this medicine, the reader should know that HQAir Force
sleep will occur, and these can last anywhere from Medical Operations Agency has no evidence that any U.S. Air Force aviator has
ever become addicted to the Air Force’s current stimulant of choice, Dexedrine.
10
FLYINGSAFETY ● March 2003