https://doi.org/10.33573/ujoh2020.02.115
1 Ukrainian Military Medical Academy,Kyiv
2 SI “Kundiiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine”, Kyiv
Introduction. Prolonged and strained work of a specialist can contribute to the development of states of chronic stress and fatigue. Especially such circumstances, complicated by the objective and frequent risk to human health and life (which are manifested in the combat conditions) can promote this process. A problem of chronic fatigue in servicemen who are staying in the combat zone for a long time is not well studied. Related to this are methodological difficulties in obtaining relevant information immediately after the departure of such fighters from a zone of joint forces operation (JFO).So, there are few such studies, especially in the aspect of assessing the level of chronic fatigue.
Purpose of the study was to determine peculiarities of development of chronic fatigue in servicemen who have a long experience in staying in the combat zone and, based on this, to develop methods for assessing levels of their fatigue and burnout.
Methods and scope of research. 98 male servicemen aged 21 to 57 were examined after occurring injuries or illnesses as a result of their stay in the zone of JFO. Treatment of combatants was conducted in a mobile hospital. Psycho-physiological studies were carried out after receiving a bioethical consent. To determine the tendencies in development of chronic fatigue, a Boiko method "Diagnosis of emotional burnout" was used. The assessment of the level of an "individual minute" was made according to the method of F. Halberg. The degree of satisfaction with the service was assessed by a binary scale: 1 - satisfied with the service; 0 - not satisfied with the service. Statistical analysis of data was made by methods of variation and nonparametric statistics, as well as cluster stepwise discriminant and correlation analysis.
Results. The structure of manifestation of burnout symptoms among combatants after a long exposure to combat stress has been established. The absence of a pronounced phase of exhaustion and the presence of a relatively small number of symptoms indicating the availability of a pronounced phase of resistance is shown in combatants. The possible presence of additional mechanisms was stated ensuring the existence of the state of burnout among combatants. A likely operating mechanism leading to such a result may be a spontaneous selection of weaker servicemen during their stay in the zone of JFO.
It is stated that in order to maintain combat readiness and the health of military personnel, it is necessary to have an effective mechanism to ensure timely "withdrawal" of individuals with low stress resistance and transferring them to work, not related to the constant effects of combat stress. For this, it is necessary to provide for the presence of special mobile groups of psycho-physiologists, psychologists, physicians, who will quickly assess the functional state of combatants, inform on the results of their research and give relevant recommendations to the command units.
Conclusion. Significant heterogeneity of the emotional state by a burnout level parameter in combatants, who have been staying for a long time in the zone of JFO, has been established. In 16.3% of them, a manifestation of the existing phase of resistance was observed; in 43.9% the phase of resistance was at the level of formation, and in 39.8% none of the burnout phases was yet formed. Symptoms of emotional burnout are highlighted, which can be informative for assessing the functional state of combatants. It is shown that a comprehensive analysis of symptoms of individual phases of the emotional burnout makes it possible to obtain sufficiently complete information on a combatant's belonging to a subgroup with an appropriate degree of manifestation of such condition. Special rules have been developed to assess the burnout in a combatant with varying degrees of reliability of the data obtained: separately according to the symptoms of the strain phase - 65.3%, resistance phase - 77.6% and exhaustion phase - 81.6%, which makes it possible to use the limited number of burnout symptoms to obtain express screening assessments of its level for their practical use. It was revealed that more burned out combatants have a higher level of activation, disadaptation, anxiety and dissatisfaction with themselves. Symptoms of the strain phase can be used for thorough diagnosis of burnout, especially for regulation of the level of strain of physiological and psycho-physiological components, affecting the formation of the functional state of a combatant.
Based on the obtained data, it was proposed to use mobile groups of psycho-physiologists, psychologists and physicians in order to increase the combat readiness and maintain the health of combatants, who can quickly assess the functional state of military personnel both directly in units and in mobile hospitals, and provide relevant specific recommendations to the command to rationalize the staff of military units.
Key words: syndrome of emotional burnout, strain, resistance, exhaustion, combatants, long stay in conditions of combat actions
