Managing aviator fatigue in a deployed environment: the relationship between fatigue and neurocognitive functioning.

The current military battlefield requires aviators to make split-second decisions that often have life-and-death consequences, making identifying predictors of diminished cognitive performance a vital aeromedical and safety concern. The current study explored the relationship between aviator effectiveness, as determined by sleep-wake patterns, and neurocognitive functioning in a brigade-size rotary wing aviation element deployed in Iraq. Actigraphy and the Fatigue Avoidance Scheduling Tool (FAST) were used to assess the ratio of sleep-wake patterns over a 24-hour time period, and a computerized multitasking measure, which mimics the task demands of flying, was utilized to evaluate neurocognitive functioning during preflight operations. Results showed a significant positive association between level of effectiveness and neurocognitive functioning before flight operations. The reported sleep habits and trends in types of sleep difficulties are noted. The results speak to the potential efficacy of using actigraphy and software to evaluate a pilot's effectiveness before flight operations, and suggest that flight surgeons and psychologists may be able to play a vital role in improving overall sleep patterns and enhancing the warfighting efforts of aviators in combat. They also suggest that mandated crew rest and evaluation of total reported sleep time may not be sufficient to ensure optimum performance levels.

Division mental health in the new brigade combat team structure: part I. Predeployment and deployment.

OBJECTIVE: Recent Army transformation has led to significant changes in roles and demands for division mental health (DMH) staff members. This article focuses on predeployment and deployment. METHODS: Surveillance of Combat and Operational Stress Reactions data, review of DMH implementation plans, and observations by staff members, providers, and soldiers were reviewed. RESULTS: During the course of the deployment, the Task Force Baghdad DMH unit had >22,000 soldier encounters with 5,542 clinical encounters. The duration of the deployment and increased levels of threat later in the deployment resulted in increased stress problems but not a substantial or sustained increase in mental health casualties. CONCLUSIONS: Predeployment education and communication probably eliminated some problems during deployment, and communication among mental health and command units during deployment resolved most problems encountered.

Division mental health in the new brigade combat team structure: part II. Redeployment and postdeployment.

OBJECTIVE: Recent Army transformation has led to significant changes in roles and demands for division mental health staff members. This article focuses on redeployment and postdeployment. METHODS: The postdeployment health assessment behavioral health screening and referral process and redeployment plan are reviewed, and data on postdeployment rates of negative events are reported. RESULTS: All soldiers and many of their families participated in an aggressive education program. Of the 19,500 soldiers screened, 2,170 (11.1%) were referred for behavioral health consultation; of those referred, 219 (10.1%) were found to be at moderate or high risk for mental health issues (1.1% of total screened). Of the moderate/highrisk soldiers, 146 (71.9%) accepted follow-up mental health treatment upon return to home station. Fewer cases of driving under the influence, positive drug screens, suicidal gestures/ attempts, crimes, and acts of domestic violence were seen, in comparison with rates seen after an earlier deployment of this unit to Iraq. CONCLUSIONS: A formalized approach with command support and coordination can have a positive impact on successful referral and treatment and reduce negative postdeployment events.