Bob Kiser, MD, CAPT, USN Navy Family Practice Specialty Leader
Having worked as a USAF Flight Surgeon for the past nine years, I read with interest Colonel Volpe's article entitled Personnel Readiness for Deployment. I hoped to come up with a few new ideas to add to my list, and I did. However, these were overshadowed by questions relating to some of his other suggestions. First, after reviewing the suggested items, I believe this is supposed to be a personal list and not a personnel list. Because this appears to be an all-encompassing list, I will assume that the need for herbal medications or dictating equipment (?) will be left to the individual. However, I was floored by his suggestion to pack Ativan-10 pills. There are many ways touted to minimize the effects of jet lag but none have passed the test of scientific scrutiny. Melatonin, which appears in the list, appears to help some people overcome jet lag. Melatonin doesn't seem to affect duration of sleep, but some people report a faster return of normal sleep patterns and a quicker return of normal energy levels. Bright light exposure purportedly entrains the internal clock very rapidly to the destination time. Coffee also seems to help in recovery from jet lag. The single most essential requirement is to obtain carefully planned sleep and rest during the first 24 hours. An eastward daytime flight to Europe should be followed by a good night's sleep before scheduled activities. An eastward nighttime flight calls for a morning nap, a leisurely afternoon and early to bed that night. Conversely, going from east to west, the traveler literally races the sun across the sky and arrives at his destination with local time much the same as the time of departure. The many hours of elapsed time mean a long day, early retirement and a long sleep are essential.The International Civil Aviation Organization (ICAO) has evolved a travel-time formula to help ensure that disturbance in circadian rhythm neither works a hardship nor impairs cerebral function on trips to distant places. The immediate and long-range benefits to the parent organization may not be apparent at first, but they have a sound biological basis. The ICAO formula is as follows:
Rest Period (in tenths of days)=Travel Time (hrs) divided by 2 +Time Zones in excess of 4 + DTC + ATC
Where: DTC = Departure Time Coefficient (local time) and ATC = Arrival Time Coefficient (local time)
In applying the formula, the following rules are observed by ICAO:
a) The value obtained for rest period is to be rounded up to the nearest higher half-day. Rest stops that add up to less than a day before rounding will not be scheduled unless the journey involves an overnight flight on mission travel
b) Travel time, in hours means the number of hours of elapsed time required for the journey, rounded off to the nearest hour.
c) Time zones are computed in increments of 14 degrees of longitude from Greenwich.
d) Departure time and arrival time are local times.
Which brings us back to Ativan. Education of commanders should help in the establishment of policies beneficial to individual performance and safety. Education of personnel should aid in the employment of personal sleep counter-measures. Those few people who have problems adjusting should be handled on an individual basis as exceptions to the rule. There are a slew of other medications used as hypnotics, which are not controlled substances. Carrying ones own controlled substance, be it for jet lag or pain, is a path physicians should not go down.
Bob Kiser, MD, CAPT, USN Navy Family Practice Specialty Leader