Critical Care Performance in a Simulated Military Aircraft Cabin Environment

Purpose: Critical Care Air Transport Teams (CCATTs) care for 5%-10% of the injured/ill warriors transported on military aircraft to definitive treatment facilities. The purposes of this study were to determine the effects of altitude-induced hypoxia and aircraft noise on the cognitive/physiological performance of CCATT providers and to examine the contributions of fatigue and clinical experience to performance under conditions of altitude-induced hypoxia and aircraft noise.

Design and Sample: This repeated-measures 2 x 2 x 4 factorial study included a sample of 60 military nurses.

Methods: The participants completed a simulated patient scenario under conditions of aircraft cabin noise and altitude.

Instrumentation: Cognitive performance was measured with Critical Care (CC) Scores, CC Errors and Omissions, and CC Reaction Times during the scenario. Physiological performance was measured four times during the scenario via vital signs and oxygen saturation.

Analysis: Differences in cognitive and physiological performance were analyzed using RM ANOVA. A multiple regression model was developed to determine the independent contribution of fatigue and clinical experience to cognitive and physiological performance as a function of altitude and noise.

Findings: CC Scores (p = .020) and Errors/Omissions (p = .047) were negatively affected by aircraft cabin noise. Noise resulted in an increase in respiratory rate (p = .019). CC Scores (p .001) and Errors/Omissions (p = .002) worsened with altitude. Heart rate (p .001) and respiratory rate (p .001) increased with altitude, and oxygen saturation (p .001) decreased. A regression analysis of CC Reaction Time to First Defibrillation with altitude, noise, fatigue, current critical care experience, and experience accounted for 20% of the variance in reaction time (p = .028).

Nursing Implications: Care of critically ill patients is significantly affected by aircraft cabin noise and altitude. Noise and altitude largely act independently. Safety and quality of care may be positively affected with training and equipment better designed for monitoring and assessment during aeromedical transport.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2009107898.xhtml