Combat stress, combat fatigue, and psychiatric disability in aircrew

A survey of the literature reveals little data regarding modern aviation and combat-related stress, fatigue, or psychiatric disabilities. What little is known about combat fatigue in aircrew is largely inferred from literature written about ground personnel. Understanding the unique aviation environment is necessary in order to develop effective combat fatigue prevention programs. This paper reviews and summarizes the literature regarding aeromedical aspects of combat stress reactions. Combat stress, fatigue, and psychiatric disabilities are common battlefield conditions, but are largely preventable. If not prevented or treated appropriately, combat stress reactions will frequently lead to more serious psychiatric disabilities, causing the evacuation of the combatant away from his or her unit with no expectation of return to duty. Appropriate intervention using the basic principles of proximity, immediacy, and expectancy are crucial in reducing these casualties and returning aviation personnel to combat duty.