RPA_pilot_screeningx - Air Force Magazine

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Nov 18, 2013 (3 years and 6 months ago)

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Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

Wayne Chappelle,
Psy.D
., ABPP

Kent McDonald, Col, USAF, MC, FS

Neuropsychiatry Branch

USAF School of Aerospace Medicine

Wright
-
Patterson Air Force Base, OH


Occupational Health

Stress Screening for

Remotely Piloted Aircraft


& Intelligence (Distributed

Common Ground System) Operators

Every Airman a Force Multiplier

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

2


BACKGROUND

Questions & concerns from Air Force (AF) leadership on the impact on
psychological health of operators

Unit commanders (CCs) & flight docs

operational tempo (manning, hours, shift work)

systemic stressors (involuntary assignments, hold on personnel moves,
career progression concerns).

geographical location (commute, limited access to services)

human
-
machine interface & developments in technology

nature of the work (deployed in garrison w/domestic life)

High interest from Headquarters/Chief of Staff of the AF, AF Medical
Operations Agency (post
-
traumatic stress disorder, PTSD), major
command chiefs of aerospace medicine (MAJCOM/
SGPs) (Air Combat Command/AF Special Operations
Command), Intelligence, Surveillance, &
Reconnaissance Agency chief of aerospace medicine



Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

3


BACKGROUND

Research needed to fully understand nature of remotely piloted
aircraft (RPA) & intelligence (Intel) operations and impact on operator
health

Supports aeromedical consultations for RPA operators to:

USAF/SG: RPA aeromedical policy/standards

MAJCOM/SGPs:
Aeromedical

Consultation Service (ACS) RPA
operator medical consultations in neurology, psychiatry/
psychology, internal medicine

Enhance
aeromedical

screening/selection of
nonpilot

(e.g., beta
test) RPA pilot applicants


Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

4

Main concerns are impact of operations on mental health
(MH) of RPA precision strike operators (Predator/Reaper)
within the media and supporting units (Intel & Cyber ops)


Subjective stress

Occupational fatigue

Clinical distress

PTSD


How do Predator/Reaper crew compare with:

Noncombatant control groups (enlisted/officer) at same
geographic locations

Distributed Common Ground System (DCGS) Intel
operators & non
-
Intel control groups



BACKGROUND

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
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2011
-
5795, 3 Nov 2011

5


REQUIREMENTS

Line CC study implementation requirements:

Minimal interference on line operations

Quick, flexible administration

Immediate feedback & recommendations on solutions

Installation & squadron specific solutions

Air Force Specialty Code specific solutions

Collaborative meeting w/line CCs, MAJCOM representatives,
medical leadership/providers





Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

6

10
-
15 minutes to complete

Multiple choice, write
-
in responses

Demographics (personal & occupational)

Sources of stress (write
-
in & rate)

Standardized measures/instruments

Occupational fatigue

Clinical distress

PTSD

Nonstandardized

items (
Likert

rating scales)

Subjective stress

Medical & mental health service utilization

Alcohol usage, relationship changes, job satisfaction



SCREENING

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

7


STRESS SURVEY


2010

Brief, yet comprehensive

Qualitative items assessing sources of stress

Evaluation of healthcare utilization & changes in physical and
psychological health

Standardized instruments: burn
-
out, clinical distress, PTSD

Includes: active duty (AD), Air National Guard (ANG), Reserves
-

Predator/Reaper/Global Hawk



2011 (modifications)

Web
-
based version to increase access/ease of administration

Increased focus items on medical care utilizations and prescription
medications

Includes: AD, ANG, Reserves &
Intel, Cyber operators


Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

46%

41%

39%

0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pilots
Sensor Operators
MICs
8


RESULTS (SUBJECTI VE)

% verbally reporting high operational stress

DCGS Intel operators (44%)

Noncombatant RPA control group
(36%)

Non
-
Intel control group (20%)

Global Hawk pilots (44%)

Global Hawk sensor operators (48%)

Percent Reporting High Operational Stress

Operator

Mission Intel

Coordinators (MICs)

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

9


RESULTS (Sources of Stress)

Shift work, schedule changes

“Shift changes every month.”

“Strange hours, working weekends,


shift changes, all impact quality of life.”

RPA operators

“Rotating every 30 days” (RPA AD).


Long hours & low manning

“Too much to do, not enough people!”

“Can’t make plans due to low manning.”

“Never ending surge & restricted leave.”


Nature of job

“Sustaining vigilance is mind numbing.”

“Too much monotony/Ground Hog Day!”


Maintaining relationships w/family

“Not being around to do stuff at home.”

“Family care is complicated due to shift

work.”


Relational conflict w/ Leadership &
co
-
workers


“Not enough time for team building;
communication gap w/ leadership”


Deployed In
-
Garrison (nature of job)


“Still expected to do admin minutia


despite deployed status.”


“6 days on w/1 day devoted to


admin.”



Those surveyed did not list exposure or participation in
combat as
a top occupational
stressor.

Active Duty RPA and Intel (Preliminary)

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

10


RESULTS (BURNOUT)

% reporting high emotional exhaustion

(one or more times a week) from work

Noncombatant RPA control group
(16%)

29%

21%

20%

17%

10%

4%

0%
5%
10%
15%
20%
25%
30%
35%
Pilots
Sensor Operators
MICs
Active Duty
Reserve/Guard
WebHA

results for AD RPA operators (9%)

DCGS Intel operators (29%)

Non
-
Intel control group (7%)

Global Hawk pilots (11%)

Global Hawk sensor operators (34%)

Percent Reporting Emotional
Fatigue/Burnout from Work

Operator

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

17%

16%

12%

7%

10%

10%

0%
5%
10%
15%
20%
25%
30%
Pilots
Sensor Operators
MICs
Active Duty
Reserve/Guard
11

Stress levels crossing the threshold into a high emotional distress


RESULTS (CLINICAL DISTRESS)

General civilian population
(
13%)

Operation Iraqi Freedom
(OIF) soldiers (28%)

Noncombatant RPA control group
(15%)

WebHA

results for AD RPA operators (4%)

Approximately 65%
-
70% of those with clinically significant distress report they
do not use MH support services (i.e., chaplain, counselor, one
-
source).


DCGS Intel Operators (17%)

Non
-
Intel operator control group (6%)

Global Hawk sensor operators (25%)

Percent Reporting Clinical Distress

Operator

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

12

11%

12%

34%

34%

9%

10%

20%

30%

0%
5%
10%
15%
20%
25%
30%
35%
40%
40hr week
40 - 50hrs
51 - 60hrs
61+hrs
Occupational Burnout
Clinical Distress

RESULTS

Hours worked and % of operators reporting burnout & clinical distress

Overall results for RPA
and Intel operators



Lack of perceived control
over work environment,
duties/schedule is likely a
contributing factor to the
onset of burnout/distress

Operators working over 50 h/wk are at higher risk


Percent Reporting Burnout and Clinical Distress

Hours Worked Per Week

14% of Participants

53% of Participants

27% of Participants

6% of Participants

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

4%

4%

3%

2%

2%

0%

0%
5%
10%
15%
20%
Pilots
Sensor Operators
MICs
Active Duty
Reserve/Guard
13


RESULTS (PTSD)

% reporting to be at high risk of PTSD

General civilian population

(5
%)

Noncombatant RPA control group (
1
%)

OIF/OEF returning soldiers (12% to 17%)

WebHA

results for AD RPA operators (.5%)


DCGS Intel operators (3%)

Non
-
Intel control group (2%)

Global Hawk pilots (0%)

Global Hawk sensor operators (10%)

Percent Reporting PTSD Symptoms

Operator

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

14


RESULTS (PTSD)

Typical Combat PTSD

Clear/present danger & threat to life/safety
(
fear/horror/helplessness
)

Symptoms of
hypervigilance
, avoidance (emotional
numbing), re
-
experiencing (
nightmares, flashbacks
)

Focus on internal & external threat


RPA operator… post clinical distress… existential

conflict


“Aerial Sniper” status/discomfort (guilt/remorse/role
conflict)

Psychological identification/attachment to combatant

Collateral damage/post
-
battle damage assessment

Focus on internal conflicts





PTSD Symptoms

Existential Conflict

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

15

At
-
Risk Operators

“Stressed to extremely stressed”
(17x more likely)

Shift
work
with frequent changes
(5x more likely)

Chronic/long work hours (50+ h/wk)

Rank & age

(18
-
35; enlisted 4x more likely)

High level of emotional exhaustion/fatigue

Career & future prospect concerns

High level of cynicism about duties

Single
or married/children &
family troubles

Supervisor w/conflict with others at work




DISCUSSION

Finding: Greater the level of distress…, the more concern there is
for seeking MH services

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

16


RECOMMENDATIONS


First Tier


Line recommendations:

Optimize work/rest cycles (4 on 3 off/less than 50 h)

Optimal shift rotation schedules

Unless first two are addressed, all other recommendations are
considered simple “band
-
aids”



Stress inoculation briefings during training

Base/Sq/Partner
-
relational/family retreats, events, and off
-
site
workshops

CC awareness “last 3 months, stressed
-
extremely stressed”









Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

17

Second Tier


Medical treatment facility recommendations:

Access, continuity of care, and identification of at
-
risk airmen

Single/dedicated medical/MH provider (Flight Surgeon (FS)
model of care) assigned to specific Sq/units with Top Secret
clearance

Implementation of OQ45 screener in medical clinic
appropriately briefed to increase self
-
disclosure & identify
at
-
risk airmen

Experienced MH provider (FS model) briefing units on
operational stress and co
-
located in medical clinic.


RECOMMENDATIONS

Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

18


RECOMMENDATIONS


Third Tier


Aeromedical

recommendations:

Retain high selection/screening standards

RPA operators to meet aeromedical criteria (cognitive &
noncognitive

aptitudes) and effectively screened upon career field entry


Aeromedical Adaptability Rating with initial physicals or
recommendations for cross training

Weapons deployment

Occupational awareness

Air Crew Standards Working Group

Medical standards

Medical fatigue management tools

Crew rest requirements

Review of Selective Serotonin Reuptake Inhibitors (anti
-
depressants)
policy









Every Airman a Force Multiplier

Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW
-
2011
-
5795, 3 Nov 2011

19


QUESTIONS