Aerodoc. - Nå, hvad sagde doktoren? - Han sagde, at jeg trængte til ro, og det har gjort mig urolig.

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1 Aerodoc Stress?

2 Aerodoc

3 Aerodoc - Nå, hvad sagde doktoren? - Han sagde, at jeg trængte til ro, og det har gjort mig urolig.

4 Jeg føler mig vældig veloplagt til morgen Jeg tror jeg bliver hjemme fra arbejde i dag Aerodoc

5 What is stress? s. 121 Aerodoc

6 Aerodoc

7 STRESS is: - not a disease - not only business or nervousness - not something that must be avoided Without stress you are: DEAD s. 119 Aerodoc

8 STRESS = STRINGERE (latin) = stramme, snørre til Definition: Stress is the changes that occur in the body as a consequence of an internal or external action s. 119 Aerodoc

9 Stress is often creeping (you get used to it) and you will not see it before it is too late! Aerodoc

10 Purpose of stress: FIGHT OR FLIGHT (Normal reaction to maintain our life - homeostasis) s. 121 Aerodoc

11 Stress an increasing problem Andel af danskere som føler sig stresset i hverdagen 60% 50% 40% 30% 35% 44% 50% 20% 10% 0% Kilde: Susy,2000. SFI: J. Bonke, Tid og velfærd 2003 s. 121 Aerodoc

12 The Three part brain Human brain (Rational thinking and fantasy) Mammal brain (feelings good/bad) Memmory Hippocampus Reptile brain ( Instinct ) Life - dead s. 121 Aerodoc

13 Stress is subjective Why? s. 122 Aerodoc

14 THE STRESS MODEL Reduced STRESS s. 122 Aerodoc

15 Situation Thoughts Feelings Physiological and psychological reaction Aerodoc

16 Stress may be beneficial but if it is too high it becomes unpleasant. Symptoms? s. 121 Aerodoc

17 Sweating Dry mouth Difficulty in breathing Increased heart rate Anxiety/apprehension Fatigue Fear s. 121 Aerodoc

18 Sweating Stress barometer Personnel limit for stress (inborn + learnt) Dry mouth Difficulty in breathing Increased heart rate Anxiety/apprehension Fatigue Fear 0 % 100 % Degree of stress s. 122 Aerodoc

19 Performance Stress barometer 0 % 100 % Degree of stress Remember: Stress is cumulative s. 121 Aerodoc

20 Arousal and Performance Function of The Nervous system is low => -Low attention -Low perception Arousal: The measure of the Human Being s readiness to respond s. 123 Aerodoc

21 Types of stress positive/good stress helps the body to maintain homeostasis negative/bad stress destroys the body if not counteracted Aerodoc

22 A definition of ( negative( negative ) ) stress Negative Stress is is the physical and psychical reaction, that arise, when we sense an imbalance between the demand we perceive and our ability to cope with the demand. Aerodoc

23 Positiv stress When something is important, and demanding an extraordinary - and time limit effort ex.: A demanding task An examination An athletic challenge An acute crises Aerodoc

24 Effects of stress Perceived Ability (personality + experience + skill) Perceived Demand Degree of stress Aerodoc

25 SYMPTOMS ON HIGH STRESS Psychological and Physiological Aerodoc

26 The most ordinary stress symptoms Phychological: Irritability / anger Reduced concentration Bad mood Nervousness Impatient / Restless Worry ness Loss of appetite / increased appetite Feeling of increased workload Aerodoc

27 The most ordinary stress symptoms Physiological: Headache Sleeplessness Fatigue Anxiety/apprehension Fainting Increased heart rate Dry mouth and throat Trembling Sweating Nausea Tenderness of muscles in neck Aerodoc

28 What is the physiological explanation behind the stress reaction? ANS (Autonomic Nervous System) s. 123 Aerodoc

29 The function of ANS Psychological Reaction: The brain registers fear, alarm or crisis Psychosomatic Reaction: Adrenalin Cortisol Somatic Reaction: Response of various organs s. 123 Aerodoc

30 Autonomic Nervous System (ANS) Heart rate Blood pressure Muscles Skin Digestive system Breathing Sweat and saliva Pupils Brain activity Sympathetic System Parasympathetic System s. 124 Aerodoc

31 Autonomic Nervous System (ANS) Heart rate Blood pressure Muscles Skin Digestive system Breathing Sweat and saliva Pupils Brain activity Sympathetic System Increase Increase Greater blood flow Reduced blood flow Reduced activity Increase Increase Dilate Increase Parasympathetic System Fight or Flight Response Improved quality of immediate decisions + speeding up the decisionmaking process + memory improvement + improved alertness s. 124 Aerodoc

32 Autonomic Nervous System (ANS) Heart rate Blood pressure Muscles Skin Digestive system Breathing Sweat and saliva Pupils Brain activity Sympathetic System Increase Increase Greater blood flow Reduced blood flow Reduced activity Increase Increase Dilate Increase Parasympathetic System Reduced Reduced Reduced blood flow Increased bloodflow Increased activity Reduced Reduced Contract Reduced Prolongs response + restore body s. 124 Aerodoc

33 The GAS syndrome (General Adaption Syndrome) 3 phases: 1) Alarm Reaction (adrenalin) 2) Resistance (cortisol( cortisol) 3) Exhaustion s. 124 Aerodoc

34 Stress hormones Adrenalin (rapid action) + Cortisol (delayed action) Aerodoc

35 Adrenalin (Alarm Reaction) The pupil of the eye will dilate The flow of saliva will be inhibited The heart beat rate will increase The breathing rate and depth will be increased The bronchi will be dilated Peristalsis will be inhibited Bladder contraction will be inhibited Increased blood pressure Greater flow of blood to the muscles Muscles are tensed The senses are sharpened Improved quality of immediate decisions A speeding up of the decision-making process Increased memory function Improved alertness s. 124 Aerodoc

36 Cortisol Resistance phase If short acting: Secure sugar to the muscles (fat sugar) Improved memory of stress situations s. 124 Aerodoc

37 Short-term term stress Short-term stress may facilitate memory of an event Aerodoc

38 Cortisol Resistance phase If short acting: Secure sugar to the muscles (fat sugar) Improved memory of stress situations If long acting: Depression. Helplessness. Lack of control. Dislike. Discomfort. Reduced memory s. 124 Aerodoc

39 Long-term stress Long-term stress ex. prepare for an examine may decrease your memory function Aerodoc

40 GAS reaction syndrome: 1 Psychological Reaction: The brain registers fear, alarm or crisis Psychosomatic Reaction: 1 Adrenalin 2 Cortisol Somatic Reaction: Response of various organs 3 s. 125 Aerodoc Exhaustion

41 Test your response to stress Aerodoc

42 Stress factors (stressors) ALL ARE CUMULATIVE s. 125 Aerodoc

43 Categories of stressors - Physiological External (Environmental stress) Internal (hunger, fatigue, lack of sleep) - Cognitive (depending on knowledge, experience and skills) - Non-professional personal factors - Imaginary stress (stress without stressor) - Organisational stress s. 126 Aerodoc

44 Categories of stressors - Physiological External s. 124 Aerodoc

45 Stress factors (stressors) REMEMBER: ALL ARE CUMULATIVE s. 126 Aerodoc

46 Stress factors (stressors) s. 126 Aerodoc

47 Will cause: Excessive Noise Stress (above 90 db)? s. 127 Aerodoc

48 Excessive Noise Stress (above 90 db) Annoyance or irritability Fatigue Loss or tunneling of attention Disrupted concentration Decreased information in working memory increase of workload Increasing number of crew errors Remember the brain s ability to adapt to physiological stressors ex. noise s. 127 Aerodoc

49 Performance Arousal the effect of noise Optimal attention and cerebral capacity Increased by stressors s. 127 Aerodoc noise

50 Stress factors (stressors) s. 127 Aerodoc

51 Whole-body vibration Effect on body is depending of 1) Frequency (function affected) 2) Strength (severity of affection) FREQUENCY 1 to 4 Hz 4 to 10 Hz 8 to 12 Hz 10 to 20 Hz EFFECTS/SYMPTOMS interferes with breathing backache s. 127 Aerodoc chest and abdominal pains Headache, eyestrain, pain in throat, speech difficulties, muscular tensions, degraded visual acuity

52 Backache among Helicopter pilots (the aircraft s s main rotor has vertical (G( z ) vibrations energy ranging between 3 and 7 Hz) s. 127 Aerodoc

53 Resonance of the human body s. 127 Aerodoc

54 Gallopin Gertie November 1940 YOUTUBE Aerodoc

55 Effects of whole-body Vibrations Degraded safety or health - vibration white finger - decreased neural activity Reduced working efficiency - impaired acquisition of information via the senses - impaired transmission, interpretation, storage and decision making - impaired level of arousal and motivation (increased/decreased) - impaired output of information (speech and movements) Impaired comfort Motion sickness Fatigue s. 127 Aerodoc

56 Stress factors (stressors) s. 125 Aerodoc

57 Humidity Humidity in the cockpit is typically between 5% and 15% (outside air 5% at ft) Mucous membranes tend to dry out (nose, throat and eyes) Human comfort requires a relative humidity of 40%-60% THINK about drinking enough fluid s. 127 Aerodoc

58 Stress factors (stressors) s. 128 Aerodoc

59 Temperature Normal temperature range 36,1 0 37,2 0 Performance start to decrease with - temp. > 38,0 0 - temp. < 34,5 0 Homeostasis maintained by heat production heat loss The time to acclimatise to hot environment is 2 weeks s. 128 Aerodoc

60 Temperature regulation in body HOW? Aerodoc

61 Regulering af varmeafgivelse sker ved at variere blodgennemstrømningen til overfladen af kroppen ( hud og underhud ) hvorfra varmen kan undslippe til omgivelserne Aerodoc

62 Extreme Heat Stress (T>41 0 ) - homeostasis fail Excessive sweating (loss of fluid and electrolytes) Very high heart rate (increased oxygen demand) Cell damage Heat stroke Coma Death (T> 43 0 ) s. 128 Aerodoc

63 Extreme Cold Stress (T<29,5 0 ) Uncontrollable shivering Cell damage Sleepiness Feeling of contentment Impaired circulation Decreased sensory nerve function Severe damage to the skin Coma Death s. 128 Aerodoc

64 Cold Aerodoc

65 C Kerne temperatur General hypothermia I isvand er afkølingen ca. 1 pr. 5 min ved alm. påklædning (når energien til kulderystelser efter ca. 10 min. er opbrugt) Normal kulderystelser begynder Nedsat mental kapacitet Apatisk - desorienteret Tiltagende bevidsthedssvækkelse kulderystelser ophører Bevidstløshed General hypotermi: Sikker konstatering af død er umulig No one is dead until warm and dead!! Vejrtrækning kan ikke konstateres - meget langsom puls Ingen pupil reflexer Død af hjertestop eller ventrikelflimren Aerodoc

66 Afkøling i vand Selv ved en vandtemperatur på 20 er overlevelsestiden begrænset, hvis man kun er iklædt alm. tøj Immersion suit når vandtemperaturen er < 10 Overlevelse tvivlsom - afhængig af kropsbygning Aerodoc

67 Eksempel Draken uheld September måned To personer - ejection over vand Vandtemperatur 15 1/2 time før redning Den ene kom ikke op i flåden Person i flåde: 36 Person i vandet: 35 Aerodoc

68 Wind-chill faktor (Ubeskyttet hud) - 30 : forfrysning på minutter - 60 : forfrysning på sekunder Aerodoc

69 Generelt ved ditching Sørg for at komme op af vandet i flåden så hurtigt som muligt - Vand leder varme ca. 240 gange bedre end stille luft - Ved ophold i koldt vand får arme og ben meget hurtigt omgivelsernes temperatur -- MINUTTER Aerodoc

70 Generelt ved ditching Sørg for at komme op af vandet i flåden så hurtigt som muligt - Vand leder varme ca. 240 gange bedre end stille luft - Ved ophold i koldt vand får arme og ben meget hurtigt omgivelsernes temperatur Ved 7 C lammes musklerne - man er hjælpeløs og kan ikke selv trække sig op i en flåde eller gribe en line Har man ingen flåde, så lig stille, da man mister mere varme hvis man bevæger sig Er det nødvendigt at svømme, så vent til vejrtrækningen er kommet nogenlunde i ro, da man ellers meget hurtigere udmattes Aerodoc

71 1. Forfrysning (frost bite) Lokal hypothermi 2. Skyttegravsfod (trench foot) I vinteren 1943 var antallet af frostskader på amerikanske tunge bomberbesætninger større end alle andre tab til sammmen (NEJM 1962, 266, 974) I Falklandskrigen var forfrysninger dominerende årsag til ukampdygtighed (Jessen: Accidentel hypothermi) Aerodoc

72 Forfrysninger: Opstår når væv køles under dets frysepunkt = -1,6 C. 90 % fødder - 10 % hænder. Forfrysninger - frost bite Hudens følenerver lammes ved +7-8 C. Første og eneste symptom på truende forfrysning er derfor: INGENTING altså at man intet mærker (gælder specielt tæer - på fingrene vil man som regel mærke kulden) Aerodoc

73 Forfrysninger I. Overfladisk II. Dyb Aerodoc

74 Skademekanisme Kulde medfører sammentrækning af blodkar Kan blive så kraftig, at blodomløbet standser Når blodomløbet standser og temperaturen kommer under -1,6 dannes iskrystaller i vævet Aerodoc

75 -1,6 C Forfrysning Det er skrumpningen af cellerne der dræber vævet Balance mellem salte inden i cellerne og uden for cellerne Dannelse af is-krystaller i væsken uden om cellerne øger saltkoncentrationen og medfører at vand suges ud af cellerne - de skrumper Aerodoc Når også væsken inden i cellerne er frosset sker der ikke yderligere skade

76 Optøning -1,6 C Det er skrumpningen af cellerne der dræber vævet Ved optøning sker den modsatte proces Derfor skal optøning ske så hurtigt som muligt, så cellerne ikke mister yderligere vand Aerodoc

77 Behandling af forfrysninger Overfladisk: Skal optøs straks f. ex.: Ansigt: Tryk med en varm hånd Fingre: I armhule Tæer: Anbringes på en kammerats (varme) mave Dyb: Skal optøs fuldstændigt i varmt vand (test med albue) Optøning er meget smertefuld (evt. morfin) Langsom opvarmning må ikke forsøges - kan medføre yderligere skade Kan man ikke optø fuldstændigt er det bedre at lade vævet være frosset! Man kan gå på en frosset fod, men ikke på en delvist optøet! Vævstabet kan ved rigtig optøning selv efter flere dage være næsten 0 Aerodoc

78 Forebyggelse af kuldeskader Påklædning: Ruller man ærmerne op når det er varmt, kan varmetabet øges med knapt 20 % Varmetab fra ubeskyttet hoved: + 10 C: 25 % + 5 C: 50 % - 10 C: 75 % af varmeproduktionen hos et hvilende menneske C clean O open before overheated L loosely and in layers D dry Aerodoc

79 Categories of stressors - Physiological External Internal The most important are? s. 129 Aerodoc

80 Internal stressors Hunger Thirst (remember low humidity) Fatigue Lack of sleep Pain Never start duty with any of these stressors s. 129 Aerodoc

81 Categories of stressors - Physiological External Internal - Cognitive s. 129 Aerodoc

82 Cognitive stress factors Can occur under the following conditions: Unexpected problem and no procedure to resolve it Insufficient time to resolve problem Result is not as expected and the problem remains unsolved The level of stress will depend on: -the pilot s professional knowledge, experience and skill. -The time available to resolve the problem s. 127 Aerodoc

83 Categories of stressors - Physiological External Internal - Cognitive - Non-professional? s. 130 Aerodoc

84 Non-professional personal stressors Be aware of the amount of stressors you bring with you to work s. 130 Aerodoc

85 STRESS TABLE - domestic (average Western s life) Stress is cumulative Scoring in the last six month: Below 60 marks marks marks 100+ marks A life unusually free of stress Normal amount of stress Stress in life is rather high Under serious amount of stress s. 130 Aerodoc Death of a spouse partner, or child Divorce Marital separation Death of a close family member Personal injury or illness Marriage Loss of job Retirement Pregnancy Sexual problems Birth Change of financial situation Son or daughter leaving home Change Change of eating habits Change of residence Taking on a bank loan or HP debt Vacations Minor violations of the law

86 Categories of stressors - Physiological External Internal - Cognitive - Non-professional - Imaginary stress? s. 131 Aerodoc

87 Imaginary stress A unpleasant events earlier in life may cause anxiety that is activated later in life by senses or distort perception s. 131 Aerodoc

88 Situation Thoughts Feelings Physiological and psychological reaction s. 131 Aerodoc

89 Categories of stressors - Physiological External Internal - Cognitive - Non-professional - Imaginary stress - Organisational stress s. 131 Aerodoc

90 Organisational stress Financial pressure on companies Not prepared for an emergencye Maximum use of staff / equipment by company Bad scheduling and rostering (night flights ect.) Poor relationships with colleagues / management Poor communication A lack of control of events in lives Fatigue and flying patterns Anxiety over courses/checks Home to work interface Career prospects and achievements Lack of responsibility and decision making INSUFFICIENT HANDS-ON FLYING (96% auto) s. 132 Aerodoc

91 Increased pressure from company: Financial Career Increased pressure from work: Emergency Technical delay Rostering of crew Increased demands on one selves: Making a good effort Career No mistake Timetrap s. 130 Aerodoc

92 Effects of STRESS s. 132 Aerodoc

93 Performance - Stress PERFORMANCE BREAKPOINT MEDIUM STRESS s. 133 Aerodoc STRESS

94 What happens after the breakpoint.? CHRONIC STRESS s. 133 Aerodoc

95 Normal healthy use of stress Mental strain Rest Time s. 133 Aerodoc

96 Danger Mental strain Rest Time s. 133 Aerodoc

97 When stress becomes chronically Mental strain Rest Time s. 133 Aerodoc

98 Health effect of stress Nausea - indigestion diarrhoea - ulcers Increased coronary heart disease Permanently high blood pressure Diabetes Mellitus Astma Headache and sleep disorders Neuroses and depression Skin diseases s. 133 Aerodoc

99 Behavioural Effects of stress Restlessness Trembling Nervous laugher Slowly resolving tasks Rush into decisions Changes in mood Changes in appetite Increased smoking and drinking s. 133 Aerodoc

100 Cognitive Effects of stress Reduced reaction speed Decreased objectiveness Forgetfulness Regression - Reduced ability to think and concentrate Mental blocking (fixation) Confirmation Bias Decreased / loss of situational awareness NOTE: auditory attention is the first to get discarded under extreme stress s. 133 Aerodoc

101 What can we do to cope with stress? s. 134 Aerodoc

102 3 different and necessary way's of coping with stress : By setting focus on stressing conditions in our private life and at work. Be aware of the problem. (Stress Awareness) By active reducing or changing the demand. Get a new job. (Action coping) By teaching ourselves to protect and strengthen our resistance under stressing conditions. Engage the defence mechanisms of the brain (Cognitive coping) s. 134 Aerodoc

103 Use of drugs (Symptom directed Coping) Coffee Tea Tobacco Alcohol Tablets (anxiolytica( antidepressiva) NOTE: ONLY SYMPTOMS ARE TREATED, NOT THE STRESSORS s. 135 Aerodoc

104 Coping with stress on the flight deck Reducing stress in flight involves mainly psychological mechanisms and includes behavioral patterns / responses which can be learned. We must learn and acquire experience to develop automatic responses which cost little in energy and is highly resistant to stress s. 135 Aerodoc

105 THE STRESS MODEL Reduced STRESS s. 135 Aerodoc

106 Individually Training REGULAR SIMULATOR FLIGHTS Learning from past. Learning from the experience of others Good pre-flight briefing and preparation s. 135 Aerodoc

107 Collectively by CRM to reduce the total stress on one person Make use of all member s s knowledge Prevent any on individual becoming overloaded Use combined efforts to improve situational awareness Good atmosphere on flight deck and don t forget humor s. 135 Aerodoc

108 5 major guidelines: Keep I simple and basic fly the aircraft Accept the situation Use all crew resources The Captain must decide Never give up s. 136 Aerodoc

109 Stress management away from the flight deck Day to day strategies Use systems to assist stress coping strategies => Make changes in lifestyle stress management Long term s. 134 Aerodoc

110 Techniques: Health and Fitness Programs s. 136 Aerodoc

111 Facts about fitness and stress You can exercise your stress system a better form gives better resistance Better fitness makes blood pressure coming up and down more quickly. Good fitness makes it more easy to relax after a demanding day of work. Fitness is, by the way, one of the best way of getting relaxed properly. 30 minutes times a week is effective. s. 136 Aerodoc

112 Techniques: Health and Fitness Programs Relaxation Techniques Religious Practice Counselling Techniques s. 136 Aerodoc

113 THE STRESS MODEL COGNITIVE COGNITIVE COPING COPING s. 136 Aerodoc

114 Situation Thoughts Feelings Physiological and psychological reaction s. 136 Aerodoc

115 SUMMARY HOW TO DEAL WITH STRESS: EXPERIENCE LEARNING CRM Accept stress and cope with it. s. 137 Aerodoc

116 STRESS EXERCISE Relaxation Technique (5 min.) Aerodoc

117 Take a break before: Aerodoc

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