Practice effects of a breathing technique on pilots' cognitive and stress associated heart rate variability during flight operations.

Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots' psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots' stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots' energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots' psychological health, stress management, and operational performance.

Factors associated with approaching Pilot Peer Support: a cross-sectional study.

BACKGROUND: Pilot Peer Support Programs (PPSP) have been introduced in Europe as a measure to facilitate commercial pilots' mental health help-seeking in a confidential and non-punitive manner. However, research is scarce regarding what promotes and prevents pilots from approaching PPSP. AIMS: To investigate if, and in which way, different organizational and individual factors are associated with pilots' attitudes towards approaching PPSP, and to examine the prevalence of possible cases of depression and anxiety disorders among commercial pilots in Europe. METHODS: Data were collected using an anonymous web-based survey (n = 4494), covering pilots' work conditions, health and flight safety. Logistic regression was used to determine the impact of objective and psychosocial work environment factors, mental health factors, and demographic factors. RESULTS: Key findings were that just culture (odds ratio [OR] = 2.65, 95% confidence interval [CI] 1.97, 3.56), type of employment (OR = 0.60, 95% CI 0.46, 0.78), minimum guaranteed pay (OR = 1.98, 95% CI 1.48, 2.65), and symptoms of depression (OR = 0.62, 95% CI 0.50, 0.76) and anxiety (OR = 0.66, 95% CI 0.54, 0.80) significantly predicted pilots' attitude towards approaching PPSP. The prevalence of pilots scoring above threshold for possible depression (18%) and anxiety disorders (23%) were determined. CONCLUSIONS: Pilot Peer Support in its current form appears to be an insufficient means to facilitate pilots' mental health help-seeking, but could have an important preventive purpose. The findings could assist authorities and operators in developing measures to facilitate pilots' help-seeking, and improve mental health and flight safety.

Detection of Pilots' Psychological Workload during Turning Phases Using EEG Characteristics.

Pilot behavior is crucial for aviation safety. This study aims to investigate the EEG characteristics of pilots, refine training assessment methodologies, and bolster flight safety measures. The collected EEG signals underwent initial preprocessing. The EEG characteristic analysis was performed during left and right turns, involving the calculation of the energy ratio of beta waves and Shannon entropy. The psychological workload of pilots during different flight phases was quantified as well. Based on the EEG characteristics, the pilots' psychological workload was classified through the use of a support vector machine (SVM). The study results showed significant changes in the energy ratio of beta waves and Shannon entropy during left and right turns compared to the cruising phase. Additionally, the pilots' psychological workload was found to have increased during these turning phases. Using support vector machines to detect the pilots' psychological workload, the classification accuracy for the training set was 98.92%, while for the test set, it was 93.67%. This research holds significant importance in understanding pilots' psychological workload.

The Impact of Various Cockpit Display Interfaces on Novice Pilots' Mental Workload and Situational Awareness: A Comparative Study.

Future airspace is expected to become more congested with additional in-service cargo and commercial flights. Pilots will face additional burdens in such an environment, given the increasing number of factors that they must simultaneously consider while completing their work activities. Therefore, care and attention must be paid to the mental workload (MWL) experienced by operating pilots. If left unaddressed, a state of mental overload could affect the pilot's ability to complete his or her work activities in a safe and correct manner. This study examines the impact of two different cockpit display interfaces (CDIs), the Steam Gauge panel and the G1000 Glass panel, on novice pilots' MWL and situational awareness (SA) in a flight simulator-based setting. A combination of objective (EEG and HRV) and subjective (NASA-TLX) assessments is used to assess novice pilots' cognitive states during this study. Our results indicate that the gauge design of the CDI affects novice pilots' SA and MWL, with the G1000 Glass panel being more effective in reducing the MWL and improving SA compared with the Steam Gauge panel. The results of this study have implications for the design of future flight deck interfaces and the training of future pilots.

How flight experience impacts pilots' decision-making and visual scanning pattern in low-visibility approaches: preliminary evidence from eye tracking.

The visual approach is the most accident-prone phase of a flight, especially in low-visibility conditions. This preliminary study aimed to examine the effects of flight experience on pilots' decision-making and visual scanning pattern in low-visibility approaches. Twenty pilots were separated into two groups based on their flight experience and completed the high- and low-visibility approaches in balanced order using a high-fidelity flight simulator. Pilots' mental workload and visual scanning patterns were recorded via an eye tracker. The results showed that, compared to less flight-experienced pilots (20%, 3/15), experienced pilots (80%, 4/5) were more likely to make go-around decisions in the low-visibility approaches. Furthermore, they exhibited a more flexible and adaptable visual scanning pattern by quickly shifting their attention, as evidenced by decreased fixations and increased saccades. These findings suggest that the integration of visual scanning strategy and training solution with a marginally meteorological approach may enhance decision-making safety for novice pilots.

This study investigates the 'expertise effects' in visual scanning pattern, mental workload and decision-making among pilots with different levels of flight experience in a modern flight simulator. For safer decision-making, less flight-experienced pilots should enlarge their visual scanning span in a more unburdened manner, especially in low-visibility approaches.

Consensus on the pharmacological treatment of acute stress disorder in Chinese pilots: a Delphi study.

BACKGROUND: Appropriate medication is very important for pilots with acute stress disorder. Improper medication can not only affect the physical and mental health of the pilots but can also endanger flight safety. Hence, we aimed to quickly and effectively relieve symptoms and restore cognitive function by forming a consensus of Chinese experts on the pharmacological treatment of acute stress disorder in pilots using the Delphi method. METHODS: Relevant literature was searched to enumerate the current status of pharmacological treatment of acute stress disorder in pilots, followed by two rounds of expert consultation and discussion according to the listed status of the survey using the Delphi method. A descriptive statistical method was used to analyze the basic information, authority coefficients, concentration of opinions, and survey items of the experts to develop a consensus on the pharmacological treatment of acute stress disorder in pilots. RESULTS: A total of 16 experts in psychiatry, pharmacology, and aerospace medicine from different provinces and cities across China were invited for consultation. The recovery rate of the two rounds of consultation was 100%, and the expert authority coefficients were 0.897 and 0.906, respectively. Kendall's coefficient of concordance of indicators at all levels was 0.564-0.594 (p < 0.01). Based on the number of votes received, alprazolam tablets (16), eszopiclone tablets (15), and lorazepam tablets (14) were recommended for the treatment of excitatory psychomotor symptoms of acute stress disorder; paroxetine tablets (15) and sertraline tablets (15) were available for psychomotor depressive symptoms; olanzapine tablets (15), olanzapine orally disintegrating tablets (14), and quetiapine fumarate tablets (14) were selected for psychotic symptoms. CONCLUSIONS: This study formed a consensus on rapid and effective pharmacological treatment for different symptoms of acute stress disorder pilots, which provides a reference for clinical treatment.

Quick coherence technique facilitating commercial pilots' psychophysiological resilience to the impact of COVID-19.

This study investigates the effect of quick coherence technique (QCT) on commercial pilots' resilience to the unprecedented impact of a pandemic. Eighteen commercial pilots voluntarily participated in a 2-day training course on QCT followed by 2 months of self-regulated QCT practicing during controlled rest in the flight deck and day-to day life. There are subjective and objective assessments to evaluate the effects of QCT on commercial pilots' psychophysiological resilience. Results demonstrated that QCT training can significantly increase pilots' psychophysiological resilience thereby improving their mental/physical health, cognitive functions, emotional stability and wellness on both subjective (PSS & AWSA) and objective measures (coherence scores). Moreover, pilots who continued practicing self-regulated QCT gained the maximum benefits. Current research has identified great potential to enhance pilots' mental/physical health via QCT training. Operators can develop peer support programs for pilots to increase resilience and maintain mental and physical health using the QCT technique. Practitioner summary: QCT breathing has been proven to increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental/physical capacity and sustaining positive emotions to deal with the challenges both on the flight deck and in everyday life.HIGHLIGHTSPilots have suffered from the impact of the Covid-19 pandemic across many factors including social, economic, mental, physical, emotional, and operational issuesBiofeedback training can increase commercial pilots' resilience by moderating psychophysiological coherence, strengthening mental and physical capacitySelf-regulated practicing QCT to form a habitual behaviour is required to sustain the maximum benefits either in the flight or day-to-day lifeQCT is an effective intervention for aviation authorities and airline operators to develop peer support programs to increase pilots' fatigue resilience.

Investigation of pilots' mental health and analysis of influencing factors in China: based on structural equation model.

BACKGROUND: Pilots' physical and mental health might be significant contributing factors to flight safety. Exploring pilots' health-related quality of life (HRQoL) is crucial for aviation security, health management, and psychological security. This study aimed to explore HRQoL and mental health of pilots and analyze the health characteristics and influencing factors, such as demographic data, personality traits, social support, and resilience. It may provide data for a theoretical basis for aviation security work and health management strategy. METHODS: This is a cross-sectional study using quantitative approaches. Two hundred twenty male pilots with an average age of 33.31 years participated. They answered a social demographic questionnaire, Symptom Checklist-90, Short Form 36 Health Survey Questionnaire, Perceived social support scale, Connor-Davidson resilience scale, and Big Five Personality Inventories, whose data were analyzed using descriptive and inferential statistics. RESULTS: The mediating effect of personality factors between resilience and the HRQoL of pilots was observed. Personality factors also mediated the relationship between social support and the mental health of pilots. CONCLUSION: Pilots' mental health and quality of life need to be taken seriously. Social support, resilience, and personality factors affect pilots' mental health and quality of life.

[Analysis of the stressors and mental status of civil aviation pilots under the background of the major infectious disease].

Objective: To study the stressors and mental status of civil aviation pilots under the background of major infectious disease. Methods: From January to March 2021, a cluster sampling method was used to select 143 airline pilots in service as the research objects. The self-made emotion and stress source questionnaire, Chinese version of stress perception scale (CPSS) , self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to investigate the airline pilot population. 136 valid questionnaires were collected, with an effective recovery rate of 95.1%. The measurement data conform to the normal distribution and are expressed by (x±s) . T-test and analysis of variance are used for comparison between groups, and Pearson correlation is used for correlation analysis. The data that do not conform to the normal distribution are expressed by the median and quartile [M (Q(1), Q(3)) ], and the non parametric test is used for the comparison between groups. Multiple linear stepwise regression was used to analyze the influencing factors of pressure perception. In addition, Amos 23.0 software was used to construct structural equation models of stress perception and negative emotions. Results: Under the background of the epidemic, the main sources of stress for civil aviation pilots are: the risk of possible reduction in income, the risk of contracting COVID-19, the pressure at work, and the risk of possible slow progress of upgrading. Among them, the first co pilot was more worried about the possible reduction of income than the instructor (P=0.009) ; The first co pilot and the captain of the airline were more worried about the possible slowdown of the upgrade progress than the instructor (P<0.001, P=0.014) . The mean pressure perception of pilots was higher than that of Chinese norm (t=3.11, P=0.002) . The standard scores of anxiety and depression were slightly higher than the standard scores of the Chinese norm under the non epidemic situation (t=7.00, 4.07, all P<0.001) . The results of multiple linear stepwise regression analysis showed that stress perception was negatively correlated with good family relations (t=-8.50, P=0.000) , and positively correlated with worries about slow progress of upgrading, COVID-19 infection, lack of interpersonal communication and income reduction (t=3.31、3.86、2.88、2.06, P<0.05) . Pressure perception was positively correlated with negative emotion (all P<0.001) . The results of structural equation model show that stress perception affects pilots' negative emotions directly or indirectly, and its standardized total effects on anxiety, depression, hypochondriac, fear, compulsion and irritability are 0.719, 0.811, 0.403, 0.355, 0.295 and 0.244 respectively. Conclusion: Public health emergencies have an impact on the mental status of pilots. Should pay attention to the stressors and psychological conditions of pilots in time, and consider formulating measures to relieve the stress of pilots.

The Effects of Increased Visual Information on Cognitive Workload in a Helicopter Simulator.

OBJECTIVE: To test the effects of enhanced display information ("symbology") on cognitive workload in a simulated helicopter environment, using the detection response task (DRT). BACKGROUND: Workload in highly demanding environments can be influenced by the amount of information given to the operator and consequently it is important to limit potential overload. METHODS: Participants (highly trained military pilots) completed simulated helicopter flights, which varied in visual conditions and the amount of information given. During these flights, participants also completed a DRT as a measure of cognitive workload. RESULTS: With more visual information available, pilots' landing accuracy was improved across environmental conditions. The DRT is sensitive to changes in cognitive workload, with workload differences shown between environmental conditions. Increasing symbology appeared to have a minor effect on workload, with an interaction effect of symbology and environmental condition showing that symbology appeared to moderate workload. CONCLUSION: The DRT is a useful workload measure in simulated helicopter settings. The level of symbology-moderated pilot workload. The increased level of symbology appeared to assist pilots' flight behavior and landing ability. Results indicate that increased symbology has benefits in more difficult scenarios. APPLICATIONS: The DRT is an easily implemented and effective measure of cognitive workload in a variety of settings. In the current experiment, the DRT captures the increased workload induced by varying the environmental conditions, and provides evidence for the use of increased symbology to assist pilots.

Psychophysiological Response to Disorientation Training in Different Aircraft Pilots.

Disorientation is one of the most important hazards in flights, but there is a need for a deeper analysis of its effect on the psychophysiological response of pilots. This study aimed to analyse the effect of disorientation training in cortical arousal, autonomic modulation, muscle strength, and perception. We analysed 39 male pilots of the Spanish Army and Air Force (27 Helicopter Pilots, 7 Transport Pilots and 5 F-18 Fighter Pilots) before and after disorientation training. Disorientation training produced an increase in perceived stress and effort in Helicopter Pilots (HP) and Transport Pilots (TP), and lower Heart Rate Variability (RMSSD) in all pilots. Rating of Perceived Exertion (RPE) and Handgrip Strength were more negatively affected among HP than in TP. RPE was more negatively affected in HP than among Fighter Pilots (FP). Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were significantly higher in FP (FVC 5.44 ± .407 l, FEV1 4.57 ± .407 l) than in HP (FVC 4.73 ± .547 l, FEV1 3.79 ± .712 l). Disorientation training affects the psychophysiological response of pilots, and different responses are depending on each job profile. These results could help to improve specific training for better preparation of pilots that face disorientation threats.

Responding to an Unexpected In-Flight Event: Physiological Arousal, Information Processing, and Performance.

OBJECTIVE: The study was designed to investigate whether a simulated unexpected abnormal flight event can lead to startle and explore differences in behavioral responses between expected and unexpected abnormal flight events. BACKGROUND: Recent research suggests startle (an autonomic response to an acute stimulus) following unexpected abnormal flight events can impact pilot performance and can increase the probability of a negative outcome following the event. METHOD: Information processing, physiological measures, and performance differences between responses to expected and unexpected flight events were compared. General aviation (GA) pilots flew a series of flights in a fixed-base flight simulator including two experimental flights which included an unexpected and an expected, engine failure. During the flights, heart rate, eye tracking, and flight data were recorded. RESULTS: During the unexpected engine failure, pilots showed greater increases in heart rate and pupil dilation. Significant differences in scanning were evident with fewer areas scanned following the unexpected event. During the unexpected engine failure, performance was impaired when compared to the expected events. However, poor performance was not associated with higher levels of arousal. CONCLUSION: The study provides an empirical demonstration of impaired pilot response to unexpected events with associated symptoms consistent with the induction of startle. The present research builds on Landman et al.'s conceptual model of startle and surprise. APPLICATION: Standardized training protocols may not adequately prepare pilots to deal with the unexpected effects of startle in real-world encounters. Introducing greater variety into training events may be useful. The effects of startle in disrupting well-trained responses may also occur in areas other than aviation where critical events may occur unexpectedly or present in an unfamiliar manner.

Impact of Smoking and Smoking Cessation Medications in Aviators.

PURPOSE OF REVIEW: To (1) compare the effects of cigarette smoking, nicotine withdrawal, and smoking cessation medications in US civilian and military aviators and (2) review the regulations in place regarding the use of smoking cessation medications for US aviators. RECENT FINDINGS: Cigarette smoking and associated cessation attempts are associated with multiple hazards in flight to aviators including effects from nicotine intoxication, nicotine withdrawal, carbon monoxide intoxication, and side effects related to smoking cessation medications. Current civilian and military regulations place significant restrictions on the use of smoking cessation medications to aviators; however, recent research suggests that the hazards associated with these medications might be lower than the risk-associated unassisted nicotine withdrawal. An evidence-based approach to smoking cessation may require changing restrictions against smoking cessation medication use in US civilian and military aviators. Use and cessation of smokeless tobacco and e-cigarettes require additional attention and research in this population.

Distributed cognition in aviation operations: a gate-to-gate study with implications for distributed crewing.

The network analysis method, Event Analysis of Systemic Teamwork (EAST), was used to examine routine aviation operations from multiple perspectives from six key areas (i.e. Dispatch, ATC, ATM, Maintenance, Loading, and the Cockpit). Data was collected over a five-day observational field trial at an international air cargo operator. Researchers recorded the activities of agents operating within the six key areas over three outbound and two inbound flights. Three networks (i.e. social, information and task) were created for four key phases of flight: (i) pre-flight checks and engines start (ii) taxi, take-off and assent, (iii) descent, landing and taxi, and (iv) park and shut down. The networks represent a 'work audit' of short-haul cargo operations, which enabled a detailed understanding of the interactions and connections within the current system. Implications for the future of distributed crewing concepts are discussed. Practitioner Summary: An analysis of the aviation system was undertaken using the amalgamated data from three outbound and two inbound flights. These analyses show the social, information and task interactions for cargo operations. This has been used to specify requirements for future distributed crewing options.

Helicopter pilots' views of air traffic controller responsibilities: a mismatch.

Controllers and pilots must work together to ensure safe and efficient helicopter flight within the London control zone. Subjective ratings of pilot perception of controller responsibility for five key flight tasks were obtained from thirty helicopter pilots. Three types of airspace were investigated. Results indicate that there is variation in pilot understanding of controller responsibility compared to the formal regulations that define controller responsibility. Significant differences in the perception of controller responsibility were found for the task of aircraft separation in class D airspace and along helicopter routes. Analysis of the patterns of response suggests that task type rather than the airspace type may be the key factor. Results are framed using the concept of a shared mental model. This research demonstrates that pilots flying in complex London airspace have an expectation of controller responsibility for certain flight tasks, in certain airspace types that is not supported by aviation regulation. Practitioner Summary: The responsibility for tasks during flight varies according to the flight rules used and airspace type. Helicopter pilots may attribute responsibility to controllers for tasks when controllers have no responsibility as defined by regulation. This variation between pilot perceptions of controller responsibility could affect safety within the London control zone.

Comparison of NASA-TLX scale, modified Cooper-Harper scale and mean inter-beat interval as measures of pilot mental workload during simulated flight tasks.

The sensitivity of NASA-TLX scale, modified Cooper-Harper (MCH) scale and the mean inter-beat interval (IBI) of successive heart beats, as measures of pilot mental workload (MWL), were evaluated in a flight training device (FTD). Operational F/A-18C pilots flew instrument approaches with varying task loads. Pilots' performance, subjective MWL ratings and IBI were measured. Based on the pilots' performance, three performance categories were formed; high-, medium- and low-performance. Values of the subjective rating scales and IBI were compared between categories. It was found that all measures were able to differentiate most task conditions and there was a strong, positive correlation between NASA-TLX and MCH scale. An explicit link between IBI, NASA-TLX, MCH and performance was demonstrated. While NASA-TLX, MCH and IBI have all been previously used to measure MWL, this study is the first one to investigate their association in a modern FTD, using a realistic flying mission and operational pilots. Practitioner summary: NASA-TLX scale, MCH scale and the IBI were evaluated in a flight training device. All measures were able to differentiate most task conditions and there was a positive correlation between NASA-TLX and MCH scale. An explicit link between IBI, NASA-TLX, MCH and performance was demonstrated. Abbreviations: ANOVA: Analysis of Variance; ECG: Electrocardiograph; F/A: fighter/attack; ft: feet; FTD: flight training device; G: Gravity; km: kilometer; m: meter; m/s: meters per second; MWL: mental workload; MCH: modified cooper-harper; NASA-TLX: NASA Task Load Index; NM: Nautical Mile; NN: normal-to-normal; IBI: inter-beat interval; ILS: Instrument Landing System; RR: R-Wave to R-Wave; SD: standard deviation; TTP: tactics, techniques and procedures; WTSAT: Weapon Tactics and Situation Awareness Trainer.

Burnout among pilots: psychosocial factors related to happiness and performance at simulator training.

In this study among airline pilots, we aim to uncover the work characteristics (job demands and resources) and the outcomes (job crafting, happiness and simulator training performance) that are related to burnout for this occupational group. Using a large sample of airline pilots, we showed that 40% of the participating pilots experience high burnout. In line with Job Demands-Resources theory, job demands were detrimental for simulator training performance because they made pilots more exhausted and less able to craft their job, whereas job resources had a favourable effect because they reduced feelings of disengagement and increased job crafting. Moreover, burnout was negatively related to pilots' happiness with life. These findings highlight the importance of psychosocial factors and health for valuable outcomes for both pilots and airlines. Practitioner Summary: Using an online survey among the members of a European pilots' professional association, we examined the relationship between psychosocial factors (work characteristics, burnout) and outcomes (simulator training performance, happiness). Forty per cent of the participating pilots experience high burnout. Job demands were detrimental, whereas job resources were favourable for simulator training performance/happiness. Twitter text: 40% of airline pilots experience burnout and psychosocial work factors and burnout relate to performance at pilots' simulator training.

Use of Highways in the Sky and a virtual pad for landing Head Up Display symbology to enable improved helicopter pilots situation awareness and workload in degraded visual conditions.

Flight within degraded visual conditions is a great challenge to pilots of rotary-wing craft. Environmental cues typically used to guide interpretation of speed, location and approach can become obscured, forcing the pilots to rely on data available from in-cockpit instrumentation. To ease the task of flight during degraded visual conditions, pilots require easy access to flight critical information. The current study examined the effect of 'Highways in the Sky' symbology and a conformal virtual pad for landing presented using a Head Up Display (HUD) on pilots' workload and situation awareness for both clear and degraded conditions across a series of simulated rotary-wing approach and landings. Results suggest that access to the HUD lead to significant improvements to pilots' situation awareness, especially within degraded visual conditions. Importantly, access to the HUD facilitated pilot awareness in all conditions. Results are discussed in terms of future HUD development. Practitioner Summary: This paper explores the use of a novel Heads Up Display, to facilitate rotary-wing pilots' situation awareness and workload for simulated flights in both clear and degraded visual conditions. Results suggest that access to HUD facilitated pilots' situation awareness, especially when flying in degraded conditions.

Psychophysiological response of different aircrew in normobaric hypoxia training.

Hypoxia remains the most important hazard in high altitude flights, but there is still a need for deeper analysis of the effect of hypoxia exposition in the psychophysiological and cognitive functions. The aim of this study was to study the effect of hypoxia training in cortical arousal, autonomic modulation, muscle strength and cognitive function. We analysed 23 male aircrew personnel of the Spanish Army and Air Force (10 Helicopter Pilots, 7 Transport Aircrew, 3 Transport Pilots and 3 F-18 Fighter Pilots) before, during and after a normobaric hypoxia exposition. Hypoxia produced an increase in perceived stress and effort, a higher Heart Rate and a decreased function of breath muscles. Working memory and pattern recognition were impaired after hypoxia exposition. Significant differences were found in cognitive tests performance among aircrew groups, suggesting differences on their previous training. These results can improve specific training for better preparation of pilots and aircrews for hypoxic threats. Practitioner summary: Distinct aircrew preparation produces a different hypoxia exposition effect on psychophysiological response and cognitive functions. Hypoxia produced an increase in Heart Rate, a decreased function of breath muscles, being more negatively affected in Transport Pilots. Cognition abilities were impaired after hypoxia exposition, independently of the aircrew group.

Force of Habit: Developing Situation Awareness in Critical Care Transport.

Situation awareness (SA) is a vital cognitive skill for high-stakes, high-hazard occupations, including military, aviation, and health care. The ability to maintain SA can deteriorate in stressful situations, exposing patients to dangerous errors. The literature regarding how to best teach SA techniques is sparse. This article explores specific techniques to promote and maintain SA in dynamic clinical environments using principles derived from cognitive psychology, neuroscience, and human behavioral and organizational research. The authors propose strategies to help individuals and teams to develop ingrained, subconscious behaviors that can help to maintain effective SA in high-stress environments. Situation awareness (SA) is critical in high-stakes circumstances, such as the resuscitation of critically ill or injured patients. Exploratory research in psychology, neuroscience, human factors engineering, and to a lesser extent health care has led to a deeper understanding of what SA is and how it can be measured. Unfortunately, little is known about how we can adapt training in order to more consistently create behaviors that heighten SA during dynamic, high-stakes clinical events. In this article, the prevailing theory of SA is reviewed, and the evidence for evaluating it in medicine is presented. In addition, the authors draw from the fields of neuroscience and cognitive psychology to suggest some strategies that can develop effective behaviors that promote SA in resuscitation.