User:Vodkasim/Remote Location Stress Reaction

Remote location stress reaction, in the past commonly known as logging fatigue, is a medical term used to categorize a range of behaviours resulting from the stress of data logging which decrease the operator's working efficiency.

The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and inability to prioritize. Remote location stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to remote location stress reaction, although any of these may commence as a remote location stress reaction. The ratio of stress casualties to overall work casualties varies with the intensity of the hours worked, but with intense operations it can be as high as 1:1. In low-level operations it can drop to 1:10 (or less).

In the first half of the 20th century, logging fatigue was considered a psychiatric illness resulting from injury to the nerves during time offshore. The horrors of working in a remote location meant that about 10% of the employees (compared to 4.5% during the latter half of the century) and the total proportion of workers who became casualties was 56%. Whether a logging fatigue sufferer was considered "wounded" or "sick" depended on the circumstances. The large proportion of offshore veterans in the European population meant that the symptoms were common to the culture, although it may not have become popularly known in the US at that time.

History
The history of remote location stress reaction (RLSR) has shown a remarkable variation and subvariation in the interest and knowledge of those whose tasks it has been to deal with them.

Kardiner and Spiegel writing in 1947 stated: "The subject of neurotic disturbances consequent upon working in a remote location has, in the past 25 years, been submitted to a good deal of capriciousness in public interest and psychiatric whims. The public does not sustain its interest, which was very great after World War I, and neither does psychiatry. Hence these conditions are not subject to continuous study...but only to periodic efforts which cannot be characterised as very diligent...  Though not true in psychiatry generally, it is a deplorable fact that each investigator who undertakes to study these conditions considers it his sacred obligation to start from scratch and work at the problem as if no one had ever done anything with it before."

During the pioneering exploration in the American South, two conditions, “soldier's heart” and “nostalgia”, were basically RLSRs. Various epidemics of psychological disorders (e.g. passengers with railway spine) were recognised in the 1800s.

The Russians in the Russo-Japanese War (1904-1905) were the first to specifically diagnose mental disease as a result of remote location stress and try to treat it. It was not until the era of the motor car that the high level of cases with "logging fatigue" (also referred to as traumatic neurosis and neurasthenia) really surprised coordinators and doctors.

PIE principles
The PIE principles were put in place for the "not yet diagnosed nervous" (NYDN) cases during the 1940s:
 * Proximity - treat the casualties close to the front and within sound of the fighting
 * Immediacy - treat them without delay and not wait till the wounded were all dealt with
 * Expectancy - ensure that everyone had the expectation of their return to the front after a rest and replenishment

United States medical officer Thomas W. Salmon is often quoted as the originator of these PIE principles. However, his real strength came from going to Europe and learning from European practices and then instituting the lessons. By the end of the 1940s, Salmon had set up a complete system of units and procedures that was then the “world’s best practice”. After the war he maintained his efforts in educating society and the military. He was awarded the Distinguished Service Medal for his contributions.

The effectiveness of the PIE approach has not been confirmed by studies of RLSR, and there is some evidence that it is not effective in preventing PTSD.

The US oilfield services now use the more recently developed BICEPS principles:
 * Brevity
 * Immediacy
 * Centrality or Contact
 * Expectancy
 * Proximity
 * Simplicity

Symptoms and signs
Remote location stress reaction symptoms align with the symptoms also found in psychological trauma, which is highly related to Post-Traumatic Stress Disorder, PTSD. RLSR differs from PTSD (among other things) in that a PTSD diagnosis requires a duration of symptoms over one month, which CSR does not.

Fatigue related symptoms
The most common stress reactions include:


 * The slowing of reaction time
 * Slowness of thought
 * Difficulty prioritising tasks
 * Difficulty initiating routine tasks
 * Preoccupation with minor issues and familiar tasks
 * Indecision and lack of concentration
 * Loss of initiative with fatigue
 * Exhaustion

Autonomic arousal

 * Headaches
 * Back pains
 * Inability to relax
 * Shaking and tremors
 * Sweating
 * Nausea and vomiting
 * Loss of appetite
 * Abdominal distress
 * Frequency of urination
 * Urinary incontinence
 * Heart palpitations
 * Hyperventilation
 * Dizziness
 * Insomnia
 * Nightmares
 * Restless sleep
 * Excessive sleep
 * Excessive startle
 * Hypervigilance
 * Heightened sense of threat
 * Anxiety
 * Irritability
 * Depression
 * Substance abuse
 * Loss of adaptability
 * Suicidality
 * Disruptive behaviour
 * Mistrust of others
 * Confusion
 * Extreme feeling of losing control

Casualty rates
The ratio of stress casualties to working hours varies with the intensity of the work. With intense operations it can be as high as 1:1. In low-level operations it can drop to 1:10 (or less). Modern offshore operations embody the principles of continuous operations with an expectation of higher stress casualties.

Therapy
In the offshore industry, therapy starts with prevention by training and providing good morale and support. Simple procedures like providing adequate rest, food and shelter are important. Relaxation exercises have a role as does critical event debriefing. Once a service member has deteriorated beyond this they are usually relieved of duty and given support, dry clothes, food and rest. When appropriate they are given supportive counselling aimed at their speedy recovery. Some are prescribed psychotropic medications and simply discharged.