Dextroamphetamine use during B-2 combat missions.

INTRODUCTION: Fatigue among warriors can jeopardize mission success. Prescribed stimulant medications, in-flight sleep, and self-medication with caffeine can mitigate fatigue. During Operation Iraqi Freedom, pilots flew the B-2 bomber to targets in Iraq from one of two airfields. Sortie durations were long (16.9 h) from one field and very long (35.3 h) from the other. Controversy exists concerning the use of stimulant medication, in part because of a paucity of combat data.

METHODS: A retrospective analysis of 75 pilots who performed 94 combat sorties was performed. We examined the prevalence of the pilot's decision to use dextroamphetamine, caffeine, and in-flight sleep during combat. We compared demographic factors, the impact of one anti-fatigue tool on the use of others, stimulant benefit, and adverse effects.

RESULTS: Pilots on shorter missions used dextroamphetamine for 97% and in-flight naps for 13% of sorties. Those on longer missions used dextroamphetamine on 58% and naps on 94% of sorties. Stimulant use was not affected by pilot age, bomber experience, or long-duration experience. The opportunity to obtain in-flight sleep was limited by certain mission profiles, which influenced the decision to use dextroamphetamine. Among pilots who used the medication, 97% noted a benefit. Side effects and failure to observe benefits were uncommon.

CONCLUSIONS: B-2 pilots in long-duration combat flight selectively employ dextroamphetamine, naps, and other fatigue countermeasures. Major determinants of these decisions are mission requirements and the pilot's experience with each measure and its effect.