Learning Objective #1: 1. The learner will be able to describe the effect of military aircraft noise on critical care performance during long patient transports

Learning Objective #2: 2. The learner will be able discuss the effects of aircraft cabin altitude-induced hypoxia on critical care performance during long patient transports.

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Critical Care Air Transport Teams (CCATTs) provide close monitoring and care for 5-10% of the injured and ill warriors of Operations ENDURING and IRAQI FREEDOM that are transported on military cargo aircraft to definitive treatment facilities. On these long aeromedical evacuation (AE) missions, flight stressors impact both the patients and CCATT members. The overall objectives of this study are to determine the effect of two stressors of flight, altitude-induced hypoxia and aircraft noise, and to examine the contributions of fatigue and clinical experience, on the cognitive and physiological performance of CCATT providers. The design for this research study is a mixed repeated measures 2 X 2 factorial design with counterbalancing. The following research questions will be addressed:  1) What are the effects of military aircraft noise and altitude-induced hypoxia on cognitive and physiological performance of CCATT personnel during a simulated critical care patient scenario? 2) What are the effects of fatigue and clinical experience on cognitive and physiological performance during a simulated critical care patient scenario with military aircraft noise and altitude-induced hypoxia? Differences in cognitive work performance and physiological response will be analyzed using repeated measures ANOVA. A multiple regression model will be developed using a part and partial correlation to determine the independent contribution of fatigue, perceived physical exertion, and clinical experience as a function of noise and altitude. The study sample will include 66 military critical care clinicians. These findings will be used to guide the development of interventions to improve operational readiness, ensure patient safety, and improve design of medical equipment used in the AE environment.