Every Airman a Force Multiplier
Wayne Chappelle, Psy.D., ABPP
Kent McDonald, Col, USAF, MC, FS
Neuropsychiatry Branch
USAF School of Aerospace Medicine
Wright-Patterson Air Force Base, OH
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011

B A C K G R O U N D
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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B A C K G R O U N D
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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B A C K G R O U N D
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R EQ U IR EMEN TS
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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SC R EEN IN G
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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S T R E S S S U RV E Y
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R ESU LTS ( SU B JEC TIVE)
Every Airman a Force Multiplier
% verbally reporting high operational stress
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
46%
41%
39%
Global Hawk sensor operators (48%)
DCGS Intel operators (44%)
Global Hawk pilots (44%)
Noncombatant RPA control group
(36%)
Non-Intel control group (20%)
Pilots Sensor Operators
Operator
Coordinators (MICs)
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R ESU LTS ( Sour ces of St r ess)
Active Duty RPA and Intel (Preliminary)
Every Airman a Force Multiplier
Shift work, schedule changes Maintaining relationships w/family
“Shift changes every month.”
“Strange hours, working weekends, shift changes, all impact quality of life.”
“Not being around to do stuff at home.”
“Family care is complicated due to shift work.”
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.”
Relational conflict w/ Leadership & co-workers
“Not enough time for team building; communication gap w/ leadership”
Nature of job
“Sustaining vigilance is mind numbing.”
“Too much monotony/Ground Hog Day!”
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.
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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35%
30%
25%
20%
15%
10%
5%
0%
29%
R ESU LTS ( B U R N O U T)
Every Airman a Force Multiplier
% reporting high emotional exhaustion
(one or more times a week) from work
Active Duty
Reserve/Guard
Global Hawk sensor operators (34%)
DCGS Intel operators (29%)
17%
21%
10%
20%
4%
MICs
Noncombatant RPA control group (16%)
Global Hawk pilots (11%)
WebHA results for AD RPA operators (9%)
Non-Intel control group (7%)
Pilots Sensor Operators
Operator
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R ESU LTS ( C LIN IC A L D ISTR ESS)
Every Airman a Force Multiplier
Stress levels crossing the threshold into a high emotional distress
30% Operation Iraqi Freedom
(OIF) soldiers (28%)
25% Global Hawk sensor operators (25%)
Active Duty
Reserve/Guard
20%
15%
17%
16%
DCGS Intel Operators (17%)
Noncombatant RPA control group (15%)
General civilian population (13%)
10%
10%
12%
10%
5% 7%
Non-Intel operator control group (6%)
WebHA results for AD RPA operators (4%)
0%
Pilots Sensor Operators
Operator
MICs
Approximately 65%-70% of those with clinically significant distress report they do not use MH support services (i.e., chaplain, counselor, one-source).
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R ESU LTS
Every Airman a Force Multiplier
Hours worked and % of operators reporting burnout & clinical distress
40%
35%
30%
34%
34%
Occupational Burnout
Clinical Distress
30%
25%
20%
20%
15%
10%
5%
11%
9%
12%
10%
0%
40hr week 40 - 50hrs 51 - 60hrs 61+hrs
14% of Participants 53% of Participants 27% of Participants 6% of Participants
Hours Worked Per Week
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
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Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011

R E S U LT S ( P T S D )
Every Airman a Force Multiplier
% reporting to be at high risk of PTSD
20%
15%
OIF/OEF returning soldiers (12% to 17%)
10% Global Hawk sensor operators (10%)
Active Duty
Reserve/Guard
5%
General civilian population (5%)
4% 4%
DCGS Intel operators (3%)
Non-Intel control group (2%)
0%
2% 2% 3%
0%
MICs Pilots Sensor Operators
Operator
Noncombatant RPA control group (1%)
WebHA results for AD RPA operators (.5%)
Global Hawk pilots (0%)
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R E S U LT S ( P T S D )
Every Airman a Force Multiplier
Typical Combat PTSD
Clear/present danger & threat to life/safety
( fear/horror/helplessness )
PTSD Symptoms
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
Existential Conflict
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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D ISC U SSIO N
Every Airman a Force Multiplier
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
Finding: Greater the level of distress…, the more concern there is for seeking MH services
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R EC O MMEN D ATIO N S
Every Airman a Force Multiplier
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”
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R EC O MMEN D ATIO N S
Every Airman a Force Multiplier
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.
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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R EC O MMEN D ATIO N S
Every Airman a Force Multiplier
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
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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Q U ESTIO N S
Every Airman a Force Multiplier
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5795, 3 Nov 2011
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