COVID-19, Personal Protective Equipment, and Human Performance.

Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced field of vision, muffled speech, difficulty hearing, and heat stress. These effects are not caused by individual weakness; they are normal and expected reactions that any person will have when exposed to an unusual environment. The physiologic and psychologic challenges imposed by personal protective equipment may have multiple causes, but immediate countermeasures and long-term mitigation strategies can help to improve a clinician's ability to provide care. Ultimately, a systematic approach to the design and integration of personal protective equipment is needed to improve the safety of patients and clinicians.

Protan response times to red lights in a mildly hypoxic environment.

PURPOSE: This study was conducted to determine whether protans have slower reaction times to red lights than individuals with normal color vision and to identify whether protan reaction times increase differentially in a mildly hypoxic environment. METHODS: Simple reaction times (SRT) to a red light-emitting diode (LED) display were measured using the Psychomotor Vigilance Task (PVT) at ground (1293 ft/394 m), simulated 12,400-ft (3780-m) altitude, and 20 min after returning to ground. Subjects were 13 individuals with normal color vision (NCV), 12 with a deutan color vision defect, and 4 with a protan color vision defect. RESULTS: The mean reaction times increased by 8% with altitude and decreased after returning to ground for all groups. However, the reaction times of the protans were often faster than the NCV mean and never below the NCV 10(th) percentile. The only significant difference between color vision groups was the slowest mean reaction time of the NCV group was slower than both the pooled dichromats and pooled anomalous trichromats across all conditions by 23%. The number of lapses did not vary with altitude, but the dichromatic subjects had significantly fewer lapses than the trichromatic subjects across all conditions. CONCLUSION: Although protans may be slower to respond to some red warning lights, this decrement in performance could not be demonstrated under the conditions of our experiment. Furthermore, the protan group's simple reaction times were not differentially affected by mild hypoxia. These results suggest that the red LEDs were sufficiently bright for these protan observers.

Trichromatic and dichromatic relative sensitivity to green light in a mild hypoxic environment.

INTRODUCTION: Several studies have reported that individuals with normal color vision have a relative decrease in sensitivity to green light in hypoxic environments approximating altitudes above 4000 m. Because there is little available information describing the effects of mild hypoxic environments (less than 4000 m) in subjects with deficient color-vision, we examined the effect of mild hypoxia on the relative sensitivity to green light for color-normal and color-deficient subjects. METHODS: Relative sensitivity to the green light was measured using the Medmont C-100 at ground and 3780 m in an altitude chamber. There were 30 subjects, 13 with normal color vision and 17 with a congenital red-green defect, who participated in the study. The relative sensitivity to the green light was determined from the average of four settings measured during the 4.5-h trial. RESULTS: Color-normals and anomalous trichromats showed a small decrease in the relative sensitivity to the green light at 3780 m compared to ground. In contrast to the trichromatic results, the relative sensitivity of the dichromats to the green light did not differ between 3780 m and ground. DISCUSSION: Our results show that a decrease in the relative sensitivity to green light can occur in hypoxic environments that are equivalent to altitudes greater than 3700 m in individuals with trichromatic but not dichromatic color vision. Although the change in sensitivity was significant, it was small and unlikely to have any operational impact.

Hypoxia, color vision deficiencies, and blood oxygen saturation.

Chromatic thresholds were measured using the Cambridge Colour Test (CCT), the Colour Assessment and Diagnosis (CAD) test, and the Cone Specific Contrast Test (CSCT) at ground and 3780 m (12,400 ft) for subjects with normal color vision and red-green color vision defects. The CAD revealed a small (~10%) increase in the red-green thresholds for the trichromatic subjects and a similar increase in the blue-yellow thresholds for the dichromats. The other two color vision tests did not reveal any significant change in chromatic thresholds. The CAD results for the trichromats were consistent with a rotation of the discrimination ellipse counterclockwise with little change in the elliptical area. This alteration in the color discrimination ellipse can occur when retinal illumination is lowered.