Document text
4
DEFENCE RY i DEFENSE
Cc
Self-reported Health and Well-being
Outcomes of ASERE Students
Defence R&D Canada — Toronto
fechnical Report
DRDC Toronto TR 2005-100
July 2005
Canada
ner
106-0306 3 /
10
Self-reported Health and Well-being
Outcomes of ASERE Students
Donald R. McCreary
Megan M. Thompson
Defence R&D Canada — Toronto
Technical Report
DRDC Toronto TR 2005-100
July 2005
Author _
—_
teens =
Donald R. McCreary
Approved by
/\ A
Carol McCann
Head, Command Effectiveness and Behaviour Section
Approved for release by
\Cuidwe~
K. M. Sutton
Chair, Document Review and Library Committee
© Her Majesty the Queen as represented by the Minister of National Defence, 2005
© Sa majesté la reine, représentée par le ministre de la Défense nationale, 2005
Abstract
The Ist Canadian Air Division Surgeon requested that the Stress and Coping Group at DRDC
loronto undertake an evaluation based on the health and well-being self-reports of students
taking the Advanced Survival, Evasion, Resistance, and Escape (ASERE) training course
conducted at Canadian Forces School of Survival and Aeromedical Training (CFSSAT), CFB
Winnipeg. Students provided their expectations and perceptions concerning the course, as
well as self-reports of their health and well-being prior to the course, at the end of the course,
and six weeks following the course. While most students sustained some minor injuries (¢.g..,
bruises, cuts, scrapes, sore muscles), only 3 of the 52 study participants sustained a major
injury (i.e., broken bones, torn ligaments). Also, while there was a slight drop in phy sical
health scores (using a standardized measure) from pre- to post-course, there were no effects
on the two measures of psychological well-being. Finally, questions about expectations and
perceptions of the course showed that students were expecting to take a challenging course
and that those expectations were met.
Resume
Le médecin de I’air de la 1 Division aérienne du Canada a demandé que le Groupe du stress
et des stratégies d’adaptation de RDDC Toronto procéde a une évaluation basée sur les
auto-évaluations de leur santé et de leur bien-étre par les participants au cours de formation
sur les procédures avancées de survie, d’évasion, de résistance et de fuite (SERF), donne a
I’Ecole de survie et de médecine de l’air des Forces canadiennes (ESMAFC), BFC de
Winnipeg. Les stagiaires ont exprimé leurs attentes et leurs perceptions concernant le cours,
de méme qu’ils ont fourni leur évaluation de leur santé et de leur bien-étre avant le cours, a la
fin du cours et six semaines aprés la fin du cours. Bien que la plupart des stagiaires aient subi
des blessures mineures (p. ex. ecchymoses, coupures, éraflures, douleurs musculaires),
seulement trois des 52 participants étudiés ont subi une blessure grave (c.-a-d. fractures,
ligaments déchirés). De plus, bien qu’on ait observé (au moyen d’une mesure normalisée) des
scores légérement plus faibles dans |’évaluation de la santé physique a la fin du cours
comparativement 4 ceux indiqués avant le cours, aucun effet n’a été révele par les deux
mesures du bien-étre psychologique. Enfin, les questions sur les attentes et les perceptions
concernant le cours ont démontré que les stagiaires s’attendaient a suivre un cours exigeant et
que ces attentes ont été satisfaites.
DRDC Toronto TR 2005-100
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DRDC Toronto TR 2005-100
Executive summary
Background. Aircrew are required to be proficient in a wide variety of survival skills in case
they should crash or have to egress from their aircraft in wilderness areas. Additional survival
skills targeting evasion, resistance and escape are required in case a crash occurs behind
enemy lines. Thus, the Advanced Survival, Evasion, Resistance, and Escape (ASERE) course
is provided to all Canadian Forces (CF) aircrew that require these skills. The ASERE course is
run several times each year by the Canadian Forces School of Survival and Aeromedical
Training (CFSSAT), 17 Wing, Winnipeg. Because of the demanding nature of the course, all
students are required to have a medical clearance before taking the course.
However, even though the students are cautioned about the difficult nature of the course. and
are cleared for participation by their Medical Officer, injuries may occur. While serious
injuries may be tracked through the CF medical system, the nature, duration (e.g., short-
versus long-term), and types of general injuries sustained as a result of the ASERE course
have not been systematically assessed. Similarly, the incidence of psy chological distress
resulting from the ASERE course has not been studied.
Thus, in January 2004, the Ist Canadian Air Division Surgeon requested that the Stress and
Coping group at DRDC Toronto examine and evaluate the impact of the ASERE course on
the short- and longer-term health and well-being of the students. The tasking request can be
found in Annex 1.
Participants and Procedure. 52 students, recruited from three consecutive ASERE courses.
volunteered to participate in a three-phase survey. Immediately before the course began,
students completed questionnaires assessing physical and mental health (SF-12) and
psychological distress (K-10). The students also rated their expectations for how physically
and mentally demanding the course would be. Immediately following the course, the students
again completed the SF-12 and K-10 questionnaires, as well as questions about their
perceptions of how demanding the course was and the amount of physical contact used by the
enemy force during the capture, transfer, and tactical questioning phases of the course’s
practical component. The students also reported all injuries (both minor and major) that they
experienced as a result of the course. Finally, six weeks after the course concluded, the
students answered the same questionnaire as they had completed immediately post-course,
with one exception: the injury question this time asked them to report any injuries that
surfaced after they returned home, as well as any injuries that were a result of the course, that
were still having a negative impact on their life and their ability to do their work.
Results. 1. Physical health scores, as measured by the SF-12, declined somewhat from the
pre-course assessment to the post-course assessment.
2. While most students reported some minor injuries (e.g., cuts, scrapes, bruises,
sore muscles), only 3 of the 52 students experienced a major injury (i.e., broken
bone, torn ligaments or tendons).
DRDC Toronto TR 2005-100 iii
3. Participation in the ASERE course had no significant effect on students’
psychological well-being, as measured by cither the SF-12 or the K-10, either
immediately after or six weeks following completion of the course.
4. Most students had realistic expectations for how difficult the course would be,
though students perceived the course to be somewhat more difficult immediately
after they finished the course, compared to how they remembered it to be six weeks
later.
5. Almost all students felt comfortable with the level of physical contact used by the
enemy force during the capture, transfer, and tactical questioning phases of the
course’s practical component. In fact, most students expected more physical contact
than they received.
Conclusion. In summary, the ASERE course is not without some degree of risk. However,
according to student self-reports, the majority of these risks were negligible, resulting largely
in minor injuries, although 3 major injuries were reported. Moreover, the course appeared to
have no long-lasting impact on the health or well-being of these ASERE students. These
students appear to be aware of the risks prior to taking the course, as reflected in their
expectations concerning the demanding nature of the upcoming ASERE course. The course
appeared to be consistent with those expectations, as evidenced by their perceptions
immediately after the course. Further, students recalled the course as less demanding six
weeks after its completion.
’
McCreary, D.R., & Thompson, M.M. (2005). Self-reported Health and Well-being
Outcomes of ASERE Students. DRDC Toronto TR 2005-100. Defence R&D Canada
Toronto.
iv DRDC Toronto TR 2005-100
Sommaire
Contexte. Les membres du personnel navigant des Forces canadiennes (FC) doivent maitriser
diverses techniques de survie au cas ou leur avion s’écraserait ou au cas ou ils devraient
évacuer leur avion dans des régions sauvages. Ils doivent connaitre d’ autres techniques de
survie a\ées sur l’évasion, la résistance et la fuite au cas ob leur avion s’écraserait derriére les
lignes ennemies. C’est pourquoi ils doivent tous suivre le cours de formation sur les
procédures avancées de survie, d’évasion, de résistance et de fuite (SERF). Ce cours est donné
plusieurs fois chaque année par |’Ecole de survie et de médecine de l’air des Forces
canadiennes (ESMAFC), 17° Escadre, Winnipeg. Compte tenu de la nature exigeante du
cours, tous les éiéves doivent subir un examen médical avant de suivre le cours.
Cependant, méme si les stagiaires sont informés de la nature exigeante du cours et sont jugés
physiquement aptes a suivre ce cours par leur médecin militaire, des blessures peuvent
survenir. Bien que les traumatismes graves soient éventuellement recensés par le biais du
régime médical des FC, la nature, la durée (p. ex. courte ou longue période) et le type des
traumatismes généraux subis dans le cadre de la participation au cours SERF n’ont pas été
systématiquement évalués. De la méme maniére, l’incidence de la détresse psychologique
associée au cours SERF n/’a fait l’objet d’aucune étude.
Par conséquent, en janvier 2004, ie médecin de l’air de la 1 Division aérienne du Canada a
demandé que le Groupe du stress et des stratégies d’adaptation de RDDC Toronto examine et
évalue les répercussions du cours SERF sur la santé et le bien-étre des éléves, a court et a long
terme. L’attribution des taches est présentée dans I’annexe |.
Participants et procédure. Cinquante-deux stagiaires, recrutés parmi les participants a trois
cours SERF consécutifs, se sont portés volontaires pour participer a une enquéte en trois
phases. Immédiatement avant le début du cours, les stagiaires ont rempli un questionnaire
évaluant leur santé mentale et physique (SF-12) et leur détresse psychologique (K-10). Les
stagiaires ont également exprimé leurs attentes quant a la difficulté du cours sur les plans
physique et mental. Immédiatement aprés la fin du cours, ils ont rempli de nouveau les
questionnaires S-12 et K-10, de méme qu’ils ont répondu a des questions sur leurs perceptions
quant aux exigences du cours et au nombre d’attaques physiques de la force ennemie dans le
cadre du volet pratique du cours axé sur la capture, le transfert et l’interrogatoire. Les
Stagiaires ont en outre indiqué toutes les b'essures (tant mineures que graves) qu’ ils ont subies
durant le cours. Enfin, six semaines aprés la fin du cours, les éléves ont répondu a ces mémes
questions, a une exception pres : dans la question sur les blessures, on leur demandait cette
fois d’indiquer les blessures découvertes aprés leur retour a la maison, ainsi que les blessures
associées a leur participation au cours, qui avaient encore des répercussions négatives sur leur
vie et leur capacité d°accomplir leur travail.
Résultats. |. Les scores pour la santé physique, établis au moyen du questionnaire SF-12,
étaient un peu plus faibles apres le cours comparativement a ceux obtenus lors de
l’évaluation antérieure au cours.
DRDC Toronto TR 2005-100 Vv
2. Bien que la plupart des éléves aient subi des blessures mineures (p. ex. coupure
éraflures, ecchymoses, douleurs musculaires), seulement trois des 52 participant
étudiés ont subi une blessure grave (c.-a-d. fractures, tendons ou ligament
déchirés )
3. La participation au cours SERF n’a eu aucun effet majeur sur le bien-etre
psychologique des éléves, mesuré au moyen des questionnaires SF-12 ou K-10,
immeédiatement apres la fin du cours ou six semaines plus tard
4. La plupart des éleves avaient des attentes réalistes quant a la difficulté du cours
méme si le cours leur semblait un peu plus difficile immédiatement aprés la fin du
cours que Six semaines plus tard
5. Presque tous les éléves considéraient comme raisonnable le nombre d’attaques
physiques de la force ennemie dans le cadre du volet pratique du cours axé sur la
capture, le transfert et |’interrogatoire. En fait, la plupart des éléves s’attendaient a
un plus grand nombre d’attaques physiques
Conclusion. En résumé, le cours SERF n’est pas sans présenter un certain risque. Cependant,
d’aprés les auto-éva
essentielle
rapportees
uations des éléves, la plupart de ces risques étaient négligeables, ayant
ment entrainé des blessures mineures, bien que trois blessures graves aient été
De plus, le cours semble n’avoir eu aucun effet a long terme sur la santé ou le
bien-étre de ce groupe de participants. Ces derniers semblaient étre ddment informés des
risques avi
cours SER
attentes, cc
int de suivre le cours, comme en témoignaient leurs attentes quant a la difficulté du
F auquel ils allaient bient6t participer. Le cours a semblé étre conforme a ces
ymme |’ indiquent les commentaires faits par les stagiaires immédiatement apres la
fin du cours. De surcroit, ceux-ci ont évalué le cours comme moins exigeant six semaines plus
tard
McCrea
Outcom
Toronto
vi
ry, D.R., & Thompson, M.M. (2005). Self-reported Health and Well-being
es of ASERE Students. DRDC Toronto TR 2005-100. Defence R&D Canada
DRDC Toronto TR 2
Table of contents
R¢ !
Execut ma |
sommaire \
lable of ntent Vil
List of tieur .
List of tables x
Acknowledgements XI
Introduction |
Physiological Effects of Survival Conditions
Cognitive Effects of Survival Conditions 2
Emotional Effects of Survival Conditions 2
Capture by Enemy Forces , : 3
Military Survival Trainings
he Advanced Survival, Evasion, Resistance, and Escape (ASERE) course of the
Canadian Forces School of Survival and Aeromedical Training (CFSSAT) }
The Current Research }
Methods .
-articipant
pant
Procedure
Questionnaire )
RIM k vii
Course Expectations and Perceptions
Perceived Safety Concerns While on the Course
Summary and Conclusions
Self-reported Health and Well-being
Expectations and Perceptions
Level of Physical Contact from the Enemy Force
Self-Report Data
Future Research
Conclusion
References
Annexe |: Tasking Memo
Annexe 2: Information Sheet
Annex 3: Consent Form
Annexe 4: SF-12 Health Questionnaire
Annexe 5: K-10 Psychological Distress Questionnaire
List of symbols/abbreviations/acronyms/initialisms
EE AEE a ee 10
rat Means and lard deviations for the SF-12 Physical Health Components Scale,
pre-course, post irse, and at the six-week follow-up. A mean of 50 is the population
SU REREERIFESE 28S AS SEER AE CORO a 13
ible 2: Means and standard deviations for the SF-12 Mental Health Components Scale, pre-
cour ost ind at the six-week follow-up. A mean of 50 is the population norm.15
lable 3: Means and standard deviations for the K-10 Distress Scale, pre-course, post-course,
ind at th ee ee ss ecevawedweuueesuenceseasaccests 15
ible 4: Means and standard deviations for the four pre-course questions assessing course
pectations. Each question has a range of response from 0 to 6. .............cceeeees aeiipene. ee
lab Means and standard deviations for four questions assessing perceptions of the course,
isked at t | of the course. Each question has a range of response from 0 to 6 .. 16
lable 6: Means and standard deviations for four questions assessing perceptions of the course,
isked six-weeks after the course concluded. Each question has a range of response from 0
Pe eiacianeveiielisiakeigeaniaeaneiaiaadliliaeiiadaiiteiiadsdildandialiaaaaandalaiimbbeatiambernsirexcernesvevsesveceeeese .. 17
il Means and standard deviations for three questions from the post-course survey
perceptions of level of contact used by the enemy force during the capture,
transfer, and tactical questioning phases of the ASERE course. Each question has a range
of response fron (A Lot Less Than Expected) to +3 (A Lot More Than Expected). ... 19
ible 8: Means and standard deviations for three questions from the post-course survey
issessing perceptions of necessary contact required by the enemy force during the
ipture, transfer, and tactical questioning phases of the ASERE course. Each question has
a range of response tron (A Lot Less Contact is Needed) to +3 (A Lot More Contact
Needed) nie — nisaeblacmnneine , - ‘ wa 19
ible 9: Means and standard deviations for three questions from the follow-up survey
issessing perceptions of level of contact used by the enemy force during the capture,
transfer, and tactical questioning phases of the ASERE course. Each question has a range
f response fron \ Lot Less Than Expected) to +3 (A Lot More Than Expected). ... 20
List of figures
iby ASERE students to report injuries sustained during the
Table 10: Means and standard deviations for three questions from the follow-up survey
assessing perceptions of necessary contact required by the enemy force during the
capture, transfer, and tactical questioning phases of the ASERE course. Each question has
a range of response from —3 (A Lot Less Contact is Needed) to +3 (A Lot More Contact
BD Pe cinniincnrescisestoncsnnsieeiiaiieti chad eaieheiaenbiaaeaiaeetiitaretii clini painiaaianeineiaielssidsidaibialadiniieaninie 20
DRDC Toronto TR 2005-100
Acknowledgements
The authors would like to thank the ASERE staff at the Canadian Forces School of Survival
and Aeromedical Training for their assistance in with the development and implementation of
the project. We especially would like to thank Captains Wayne Willmott and Gary Johnston,
for their logistical assistance. Commander Cyd Courshesne, MD, was invaluable in assisting
us with the coding scheme for interpreting the severity of the injuries sustained on the ASERI
course. Finally, we wish to thank the ASERE students who volunteered their time for this
study, especially immediately after completing the course when they were tired and
understandably would have rather been elsewhere.
DRDC Toronto TR 2
xi
Introduction
Physiological Effects of Survival Conditions
Military personnel who find themselves in an emergency situation often must contend with a
variety of physiological and psychological threats to their survival. Basic physical needs must
be addressed, including thirst, hunger, protection from the elements, and fatigue. For instance,
thirst is a particularly significant physiological factor because the body can tolerate water
deficits for limited times, and dehydration is accelerated through loss of urine and sweating
(Leach, 1994). Food deprivation for periods of up to 3 days is not problematic. Indeed, in the
initial stages of a survival situation, people may lose their appetite entirely. However,
conditions of starvation and semi-starvation can lead to malnourishment. In these cases, the
body will begin to consume its fat stores, muscles, and finally the internal organs, potentially
leading to organ failure and death (Leach, 1994).
Protection from the environment also is critical in survival situations. Heat stress has been
associated with lethargy & apathy (Baron & Bell, 1976; see also Cheung, McLellan, &
Tenaglia, 2000). Heat stroke, however, is a serious medical condition whose symptoms
include gross impairment in mental performance, general confusion, headaches, impaired
motor co-ordination, delirium, unconsciousness, convulsions, organ failure, and death (Leach,
1994). At the other extreme is cold. The most significant danger associated with cold is death
due to hypothermia, during which the person’s core body temperature cools to lethal levels
(see Tikuisis, 1995; 1997). As the extremities are usually first affected by cold, the ability to
conduct fine motor tasks becomes impaired (Brajkovic, Ducharme, & Frim, 2001).
Fatigue, the pervasive weariness associated with mental and physical strain and effort, has
been shown to reduce physical efficiency. “Its onset is [often] insidious, its effects rapid,
frequently devastating, and it often catches the victim unaware” (Leach, 1994, p. 59). In an
emergency or survival situation, sleep disturbances are often also a factor, exacerbated by
anxiety, as well as physical discomfort from injuries and environmental conditions. For
example, in a five-day, life raft survival study, apathy and behavioral disorganization set in
within the first 24 hours, even though the study was conducted under controlled experimental
conditions and the volunteer participants were experienced naval personnel (Jensen &
Madsen, 1974).
Beyond their individual effects, these factors often operate in sy nergistic ways in survival
situations. For instance, cold disrupts sleep, which further increases fatigue. Similarly,
starvation causes body temperature to drop, increasing susceptibility to the effects of cold and
greater fatigue. Arctic conditions, especially, have been found to lead to sleep disturbances
(Angus, Pearce, Buguet, & Olsen, 1979). Fatigue or sleep loss also can induce a susceptibility
to heat stress. Fatigue erodes mental and physical efficiency, and can result ina lack of
attention and effort directed at the basics of survival, causing a greater cold, hunger, thirst,
lack of good sleep and further fatigue. Thus, separately and together, these factors carry
significant concomitant burdens, each feeding off the others and further decreasing the ability
to carry out the vital tasks of survival.
DRDC Toronto TR 2005-100 1
Cognitive Effects of Survival Conditions
As summarized by Leach (1994) each of these physical stresses also has implications for
cognitive functioning. Severe dehydration upsets the balance of salt and other electrolytes
within the body and this can be associated with delusions, visual hallucinations, and irrational
behavior. Although, in the short-term, hunger is largely a distraction for survivors, should
starvation conditions occur, hunger can become an overriding focus of thoughts and attention,
distracting mental focus and causing a substantial decrease in concentration and memory, as
well as listlessness. Heat and cold exposure beyond normal ranges can also impact cognitive
functioning; for instance, impaired memory and attentional processes can be adversely
affected (e.g., Angus, et al., 1979), although the literature has produced some mixed results in
this regard. These environmental effects may be particularly significant factors in modern
military personnel, who are often required to move rapidly between temperate, arctic, tropical
and desert climates (Leach, 1994).
Although people can survive reasonably well for up to 100 hours of sleep deprivation, there
are decreases in mental efficiency in terms of response rates and processing time, especially
for tasks of at least ten minutes duration (Angus & Heselgrave, 1985; Angus, Pigeau, &
Heselgrave, 1992). Under extended sleep deprivation, personality and rational behavior can
deteriorate. Mental disorganization can occur, as well as perceptual illusions and
hallucinations (minor at first) (Leach, 1994). Tasks that are most affected by sleep loss are
those that are dull, routine, repetitive and monotonous (e.g., observational tasks), with higher
cognitive functioning (e.g., reasoning and decision making) remaining reasonably intact, at
least in the short- to medium-term (Leach, 1994). Even a moderate amount of fatigue can
reduce mental efficiency.
Emotional Effects of Survival Conditions
Not surprisingly, the emotional stress associated with survival also can be intense, and derives
from a variety of sources, including heightened fears for personal survival, safety and physical
discomfort, as well as concern for comrades (Leach, 1994). Moreover, the emotional effects
of dehydration and starvation include apathy, depression, irritability, agitation, and
restlessness (Leach, 1994). Exposure to extreme, prolonged heat has been associated with
lethargy and irritability, while exposure to extremes of and prolonged cold can lead to
increased anxiety (Leach, 1994). Extended periods of sleep loss have been associated with
experiencing more negative moods (Johnson, 1982), paranoid ideation, and perceived loss of
personal control (Leach, 1994). Individuals experiencing intense fatigue show evidence of
lethargy and lassitude, and irritability. Anxiety and fear-inducing situations further sap vital
mental energies and increase fatigue and contribute to sleep disturbances.
Beyond the physical and psychological impairment associated with survival, these factors also
conspire to erode feelings of mastery and hope. Indeed, stress in survival situations is often
exacerbated by a profound loss of a sense of control where personnel are “... taken out of a
predictable environment and faced with uncertainty [and] fear ...” (Laberg, Eid, Johnsen,
DRDC Toronto TR 2005-100
Eriksen, and Zachariassen, 2000, p. 334). Indeed, the need for control is so great in humans
that stress can trigger a variety of behaviors specifically designed to restore a sense of control,
including even magical thinking, superstitious rituals, and behaviors that are
counterproductive to survival (Keinan, 2002; see also Leach, 1994).
Capture by Enemy Forces
Capture by hostile forces occurs for approximately 8 to 10% of military personnel engaged in
either combat or operations other than war (Flach & Ziljmans, 1997; Mehlum, 1995).
Personnel in high-risk occupations, such as aircrew, are particularly vulnerable in this regard.'
If aircrew are shot down or crash behind enemy lines, additional issues beyond basic survival
emerge. These include concerns about torture and about divulging sensitive strategic and
tactical information. Indeed, even the fear of capture, rather than capture itself, is thought to
reduce operational effectiveness (Walker-Smith & Feggetter, 2001).
Military Survival Training
In response to these potentially critical stressors and their consequences, many military forces
have developed survival courses. These courses are designed to prepare their personnel, in
particular those in high-risk occupations, for the possibility of survival situations, as well as
capture, internment, and interrogation by the enemy. Indeed, many militaries assume this
responsibility as part of their duty of care (Walker-Smith & Feggetter, 2001).
Training carries with it a certain level of technical expertise, providing personnel with a
potentially vital advantage during a survival situation. People trained in survival techniques
are more effective in survival situations (Glass, 1959; Cohen, 1988). Practical training helps
the person respond at a more automatic level, ameliorating the negative effects of stress and
panic on decision making skills (Leach, 1994). Moreover, in a group situation, inexperienced
people will usually look to those with training for practical guidance, but also for clues as to
how to respond emotionally. People with survival training experience will usually be quite
purposeful in their activities, exuding a sense of calm and focus that is transmitted to people
who do not have this training (Leach, 1994). Moreover, this technical expertise is often the
basis of leadership in survival situations. Early on in survival situations, those individuals
with practical training and experience will develop the overall survival plan, including
schedules, often distributing materials (e.g., rations of food and water) and the workload in
order to survive (Leach, 1994).
Survival training is usually addressed through a combination of lectures and practical training
exercises. The specific level of training that military personnel receive is dependent upon the
level of risk associated with their occupation. In general then, soldiers in what are considered
lower risk occupations receive less intense training focusing on basic survival skills.
Personnel in high-risk roles, such as aircrew and Special Forces, will undergo advanced
survival training in order to provide them with the knowledge and skills to persevere and
1 . . . :
However, events in Iraq serve as a reminder that even soldiers in what can be considered to be less
risky occupation, may also be vulnerable to capture.
DRDC Toronto TR 2005-100 3
prevail in evasion, capture, resistance, and escape situations. The intent of basic and advanced
training is to provide students with an opportunity to learn, rehearse, and succeed in mastering
the skills that will aid them in survival until rescue. Given the intensity of certain levels of this
training, it is particularly important that students are monitored by instructors and training
supervisors.
The Advanced Survival, Evasion, Resistance, and Escape
(ASERE) course of the Canadian Forces School of Survival
and Aeromedical Training (CFSSAT)
The Canadian Air Force response to the requirement for intensive survival skills training is
the Advanced Survival, Evasion, Resistance, and Escape (ASERE) course, taught by the
Canadian Forces School of Survival and Aeromedical Training (CFSSAT), 17 Wing,
Winnipeg. Run several times a year, ASERE is a required course for many Canadian Forces
(CF) aircrew. Its goal is to teach a wide variety of survival skills in case aircrew should crash
behind enemy lines. Because of the demanding nature of the course, all students are required
to have a medical clearance before taking the course. The ASERE course is described to both
Medical Officers and students in the following manner:
“The Advanced SERE (Survival, Evasion, Resistance and Escape) course is very
physically and mentally demarding. It is intended to train aviators in procedures
required if shot down behind enemy lines. Part of the program requires the students
to evade capture for 36 hours over uneven ground while carrying a 40 Ib. rucksack.
During this time they do not have access to food, and the individual may not be able
to take medications as prescribed. Also, individuals are subjected to Tactical
Questioning. It is important to ensure that each student is physically and mentally fit
prior to the course to prevent aggravation of coexisting medical problems. In
assessing the student’s fitness, please pay particular attention to ankle, knee, back,
cardiovascular system, and any conditions made worse by dehydration and fatigue.
Also, ensure that there are no significant mental health stressors or psychological
issues. Please also ensure that any patient allergic to bee stings be issued an anakit
during summer months.”
However, even though the students are cautioned about the demanding nature of the course,
and are cleared for participation by their Medical Officer, injuries may occur. Serious injuries,
such as broken bones and torn ligaments, may also occasionally occur. While serious injuries
may be tracked through the CF medica! system, the nature, duration (e.g., short- versus
longer-term), and types of general injuries sustained on the ASERE course have not been
assessed formally. Similarly, the incidence of psychological distress resulting from the
ASERE course has not been systematically assessed.
The Current Research
In January 2004, the Ist Canadian Air Division Surgeon requested that the Stress and Coping
Group at DRDC Toronto examine and evaluate the impact of the ASERE course on the short-
DRDC Toronto TR 2005-100
and longer-term health and well-being of the students. The tasking request can be found in
Annex I.
In order to address this request, we asked ASERE students a series of questions designed to
assess their expectations and perceptions of specific aspects of the course, health and well-
being associated with the ASERE course. Moreover, we assessed these factors at three points
in time: during the in-clearance process immediately prior to leaving for the training site,
immediately after their return from the training site, and six weeks after completing the course
(via a mailed out, follow-up questionnaire).
Healt & Well-being
Given the specific physical and mental demands of the ASERE course, we asked students
about their perceptions of their health and well-being at three time points. The pre-course
assessment served as a baseline measure of their health and well-being, with the post-course
assessment designed to assess the immediate physical and psychological impact of the
ASERE course. We also were interested in those health and well-being symptoms that might
be of longer duration or that had emerged as a result of the course. Thus, we also administered
a six-week follow-up survey. Health and well-being were assessed using commonly used and
validated questionnaires, as well as with an injury self-report question.
Expectations and Perceptions
Dynamic and situation-specific, expectations assess perceptions of future experiences, while
perceptions reflect current assessments (Thompson & Gignac, 2001). Expectations and
perceptions that are key to the ASERE course concern whether the event is interpreted as a
potential for threat, harm, loss, versus as a challenge, and whether people perceive that they
have sufficient coping resources, including adequate knowledge and the requisite skills to
succeed (Bandura, 1977, 1982; Lazarus & Folkman, 1984).
Indeed, the psychological literature has demonstrated that expectations and perceptions are
directly linked to the intensity of people’s stress reactions and coping efforts (Catanzero &
Mearns, 1999). Negative expectations and perceptions are associated with decreased positive
affect and with less adaptive coping efforts than are positive expectations and perceptions
(e.g., Kassel, Jackson & Unrod, 2000; Pierce & Lydon, 1998). However, people with overly
positive or idealized expectations also may report psychological distress when the ‘realities’
of situations they experience become evident (Pancer, Hunsberger, Pratt, & Alisat, 2000;
Thompson & Holmes, 1996). The survival literature, in particular, concludes that people ...
“with a knowledge of what to expect in a survival situation will show a higher degree of
effectiveness should such a situation arise” (Leach, 1994, p. 123-124).
In order to determine this impact in the present study, we assessed student expectations
immediately before they began the course, and their perceptions immediately after completing
the course and six weeks after the end of the course. More specifically, we compared
students’ pre-course expectations of the physical and mental demands with their perceptions
of these factors immediately after completing the course. Students who may have been
DRDC Toronto TR 2005-100 5
expecting a less demanding course than they received may not have been adequately prepared
for the course, which may in turn leave them vulnerable to health and well-being issues.
Perceptions of Safety during Capture, Transfer and Tactical Questioning
As noted earlier, the ASERE course has more intense components, including evasion, capture
and tactical questioning exercises. Thus, we also asked about students’ perceptions of their
safety, and the degree of force used by the “enemy” force during the capture, transfer, and
tactical questioning stages of the practical component of the ASERE course.
DRDC Toronto TR 2005-100
Methods
Participants
Students from three consecutive ASERE courses, conducted in 2004, participated in this
survey. A total of 52 of the total course load of 60 students (or 87% response rate) volunteered
to participate in the initial stage of the research, while 51 students (85% response rate)
completed the end-of-course survey, and 25 students completed the six-week follow-up
survey (or a response rate of 48%). We were concerned with protecting the students’
anonymity in such a small CF community. After discussions with the ASERE training staff,
we decided collect demographic information on only two variables: number of years of
service in the CF and aircraft platform (Transport and Non-transport). This information
indicated that the ASERE students had served between 3 and 28 years in the CF at the time of
the survey, with an average time in of 14 years. Most of the ASERE students were in Non-
transport occupations (65%).
Procedure
After receiving the tasking request from | Canadian Air Division Surgeon (see Annex 1), the
two authors met with the ASERE instructors in order to determine the best way to assess the
health and well-being of the ASERE students, as well as the types of questions to be asked of
them and the best wording of those questions.
Accordingly, it was decided that a three-part survey would best meet the needs to the tasking.
Each student would complete a baseline survey before leaving the CFSSAT training building
at 17 Wing, CFB Winnipeg for the ASERE training site. The students then would complete a
post-course survey immediately after returning to the CFSSAT school from the ASERE
training site, prior to release from the course. Finally, a follow-up survey would be sent to
students six weeks after the end of the ASERE course in order to determine if there were any
ASERE course-related health or well-being concerns that emerged after the course ended, or
if any injuries sustained on the course had a continuing and significant negative impact on the
students’ lives and work.
The students were met either by the first author, or by a research assistant, ina CFSSAT
classroom before leaving 17 Wing in Winnipeg for the ASERE training site. The goals of the
study were explained to the students (both verbally and via an information sheet; see Annex
2) and they were asked to volunteer their participation. An informed consent sheet (see Annex
3) was then signed and their six-week contact information was gathered on a separate sheet of
paper. These contact addresses were destroyed at the end of the study. The questionnaires
were then distributed in the classroom to the volunteers, who were asked to complete the
questionnaire individually.
The students were met in a CFSSAT classroom at the end of the ASERE course by the same
person who introduced the study to them five days previously. The goals of the study were
reiterated and the students were asked to complete the end-of-course survey. At both
DRDC Toronto TR 2005-100 7
meetings, questions were encoul wed an € oF e particiy
was reiterated
Finally, students who had provided a mailing address were sent the follow-up questionnaire
by mail, six weeks after the course ended. In the package was a letter reminding them of the
goals and the voluntary nature of the study. A pre-stamped return envelope also was included
;
) link students
| three surveys. However, we also felt it was important to provide students with
Because this was a longitudinal study, it was imperative that we be able
responses to a
complete anonymity in order to facilitate full disclosure of course-related health concerns and
expectations/perceptions. In order to provide students with a confidential reporting system, no
names were used on any of the questionnaires. However, to allow us to link responses across
surveys, we used a four-question Personal Identification (PIN) system. These four questions
were created to give us enough information to link respondents across surveys, but would not
allow us to be able to identify people by name. These four PIN questions were
|. What are the first three letters of your mother’s maiden name?
2. What colour are your eyes?
What day of the month were you born (01 to 31)’
4. What are the first three letters of the city or town in which you graduated
>
from High School?
Questionnaires
Each of the three surveys assessed the students’ general health and psychological well-being,
as well as how strenuous they anticipated the course would be (assessed during the pre-course
survey) and their perceptions of how strenuous the course actually was (assessed on the end-
of-course and follow-up surveys). Since all students had to have received medical clearance
before participating in the course, it was assumed that all students were healthy and not
injured at the beginning of the ASERE course. Injuries obtained on the course were assessed
in the end-of-course and follow-up surveys using a self-report format. Details of each of the
surveys are given below.
Pre-course Survey
Health and Well-being. Two commonly used and validated, self-report measures of health
and well-being were used. The first measure was the SF-12 Health Survey (Ware, Kosinski,
& Keller, 1998; see Annex 4). Each item on the questionnaire is weighted and contributes
independently to both of the two SF-12 summary scores: the Physical Health Component
Summary (PCS) and the Mental Health Component Summary (MCS). Both the PCS and the
MCS are interpreted using a population mean of 50 and a standard deviation of 10. Thus,
scores less than 50 are indicative of poorer than average health, while scores above 50 are
indicative of better than average health. The second measure was the K-10, which ts a 10-item
survey that assesses psychological distress (Kessler et al., 2002; see Annexe 5). The items on
the K-10 are rated on a 0-4 interval scale. To score the K-10, all items are summed. Higher
scores are indicative of greater levels of psychological distress
Course Expectations. In order to assess their expectations for the course, we also asked the
students to answer the following four questions
(1) How physically demanding do you think the course will be? (6-point response scale
Not At All Demanding - Extremely Demanding)
(2) How mentally demanding do you think the course will be? (6-point response scale
Not At All Demanding - Extremely Demanding)
» ; } ; 2. 2 j ai ; , ; ‘7 7
(3) How physically fit do you think you will Nave to De lo comptete (nis Course (6 point
response scale: Not At All Fit - Extremely Fit)
(4) How apprehensive are vou about being physically injured whi le you are on this
urse? (6-point response scale: Not At All Apprehensive - Extremely Apprehensive)
End-of-Course Survey
Health and Well-being. Both the SF-!2 and the K-10 were given to students at the end of the
ASERE course
Injuries. Students were presented with a four-sided representation of a human (front, back,
right side, left side; see Figure 1). They were given the following instructions: “Please
indicate any injuries that were a direct result of the ASERE course. The injuries could be as
minor as a cut or bruise. Indicate the position of the injuries on the figures above using
numbers (e.g. 1-7) and then briefly describe the injury, its severity, and how it was obtained
below, after the corresponding numbers.” A table was also provided for them to describe their
injuries
Discussion with an Aircrew Medical Officer at DRDC Toronto subsequently provided us with
a coding scheme that enabled us to categorize the injuries that the students reported. Thus,
each injury was coded as Minor (e.g., minor cuts, scrapes, bruises, mosquito and other bug
bites) or Major (e.g., broken bones, cuts requiring stitches, other injuries requiring medical
attention) according to this coding scheme
Figure 1: Injury rating figures used by ASERE students to report injuries sustained during the
course.
Justification of Initial Course Expectations. To determine whether students’ initial course
expectations were justified, three of the four questions asked in the Pre-course survey were
reframed and asked again here
(1) How physically demanding do you think the course was? (6-point scale: Not At
All Demanding - Extremely Demanding)
(2) How mentally demanding do you think the course was? (6-point scale: Not At All
Demanding - Extremely Demanding)
and
(3) How physically fit do you think students should be in order to complete this
course? (6-point scale: Not At All Fit - Extremely Fit)
I'wo other questions also were asked to assess this issue
(1) Were your initial expectations for the course justified (Y es/No);
and
(2) Was the course easier or tougher than you thought it would be? (6-point scale
A
Lot Easier - A Lot Tougher)
Perceived Safety Concerns While on the Course. In order to ascertain how students
perceived their safety at the hands of the enemy force, we asked three questions in two
level of force or contact used by the enemy force was less or more
than expected, and whether they felt that more or less contact was needed. More specifically,
le q est ons were as f |
separate ways: whether the
th ws
la) How was the level of physical contact used by the enemy force during the capture
phase mpared to what you expected? (7-point scale: A Lot Less than Expected -
Exactly as Expected to A Lot More than Expected)
(1b) Do you think the enemy force used an appropriate amount of physical contact
capture phase, or does there need to be more or less physical contact at
that point’ (7-point response scale: A Lot Less Contact is Needed - Amount of
Contact Exactly as Needed - A Lot More Contact is Needed)
(2a) How was the le f physical contact used by the enemy force during the
transfer phase, compared to what you expected? (7-point response scale: A Lot Less
than Expected - Exactly as Expected to A Lot More than Expected)
(2b) Do you think the enemy force used an appropriate amount of physical contact
during the transfer phase, or does there need to be more or less physical contact at
that point’ (7-point response scale: A Lot Less Contact is Needed - Amount of
Contact Exactly as Needed - A Lot More Contact is Needed)
yuestioning phase, compared to what you expected? (7-point response scale: A Lot
Less than Expected - Exactly as Expected - A Lot More than Expected)
and
(3b) Do vou think the enemy force used an appropriate amount of physical contact
luring the tactical questioning phase, or does there need to be more or less physical
contact at that point? (7-point response scale: A Lot Less Contact is Needed -
(3a) How was the level of physical contact used by the enemy force during the tactical
: Amount of Contact Exactly as Needed - A Lot More Contact is Needed)
Six-week Follow-up Survey
) Because students may not have had time to fully evaluate how they felt immediately after
completing a difficult and exhausting five-day course, we also administered a six-week
follow-up survey. This gave the students a chance to go home and have time to reflect upon
| the ASERE course. It also allowed for the assessment of injuries that were continuing to
bother students, and for the assessment of injuries that emerged during those six weeks that
students felt were the result of the course. The six week follow-up survey also allowed for the
assessment of any student attitudes and evaluations shift during this time period.
)
)
Accordingly, the follow-up survey was almost identical to the end-of-course survey, save for
one change. The injury rating instructions were re-worded to focus on whether any ASERE
course-related injuries surfaced after the students returned home, and whether any injuries
they sustained during the course were still affecting them. The instructions read as follows:
“Please indicate any injuries that were a direct result of the ASERE course that either were not
apparent at the end of the course or continue to affect you. Indicate the position of the injuries
on the figures above using numbers (1-7) and then briefly describe the injury and how it
affected your job performance or day-to-day living, after the corresponding numbers.”
DRDC Toronto TR 2005-100
Results
Attrition
Response rates for the pre-course and post-course surveys were very high (87% and 85%,
respectively), while 48% of students completed the final, six-week follow-up portion of the
study. Because of this, an attrition analysis was conducted in order to determine whether there
were any significant differences between those who did, versus those who did not, return the
follow-up survey. This analysis was conducted on the following variables: demographics
(years in the CF, airframe type), health and well-being scores (both pre- and post-course), and
course expectations and experiences (both pre- and post-course).
A series of t-tests and chi-square analyses were performed, with Follow-up Return (Yes/No)
as the independent variable, and demographics, health and well-being scores, and course
expectations and experiences as the dependent variables.’ None of the tests were statistically
significant. Thus, there were no significant differences between those students who did,
versus those who did not, return the follow-up survey, on any of the dependent variables.
Health
Health was measured by two outcomes: the Physical Health Component Summary (PCS) of
the SF-12 (a comparison between both pre- and post-course scores, as well as a comparison
across all three administrations of the scale) and the number and type of injuries sustained on
the course (as reported both post-course and at the six-week follow-up).
Table 1: Means and standard deviations for the SF-12 Physical Health Components Scale, pre-
course, post-course, and at the six-week follow-up. A mean of 50 is the population norm.
N | Mean _| Std. Deviation
SF-12 Physical Components Scale, Pre-test 52 49 5438 5.26041
SF-12 Physical Components Scale, Post-test 50 46 4393 8 66452
SF-12 Physical Components Scale, Follow-up 25 47.7428 7.29153
SF-12 PCS Scores. Table | shows the means and standard deviations for the three PCS
scores. As Table | shows, the baseline physical health score approximates the average score
found in a normal, healthy population (Ware et al., 1998). However, there was a three-point
“ Because of the large number of statistical tests, there is an increased probability of finding a
significant difference by chance alone. To control for this, a Bonferroni correction was applied to the
minimum acceptable probability value of the statistical tests being conducted (i.e., .05/24 analyses
.002). Thus, a minimum p-value of .002 is required for any differences in these attrition analyses to be
considered statistically significant.
DRDC Toronto TR 2005-100 13
drop in students self-reported physical health scores immediately following the ASERI
course, followed by a slight increase at the six-week follow-up point
lo test whether these changes were statistically meaningful, two repeated measures analyses
of variance (ANOVAs) were conducted.’ First, a repeated measures ANOVA comparing the
pre- and post-course physical health scores showed that the post-course drop was statistically
significant, F(1,49) = 6.43, p < .01 (n° = .14). However, it should be noted that the drop was
within one standard deviation of the average baseline PCS score, and accounted for only 14%
of the variability in the change in physical health scores (i.e., the size of the effect was small,
in practical terms). Thus, while statistically significant, the practical significance of this result
is likely not great.
A second ANOVA compared all three PCS means. Results here revealed that the changes in
students physical health self-reports across pre-, post- and follow-up surveys were not
Statistically significant (p < .365)
Injuries. The second method of assessing the health impact of the ASERE course was to
explore the number and type of injuries that occurred during the course, as well as whether the
impact of those injuries extended beyond the course
At the end of the course, 86% of the students reported at least one injury. However, most of
those injuries were minor. The most common minor injuries were bruises (44%), cuts (38%),
scrapes (25%), sore muscles/sore back (23%), blisters (13%), sore feet (13%), water
immersion discomfort (13%), self-diagnosed muscle sprains (12%), sore knees (11%), and
chafing (8%).
Only 3 (6%) students sustained a major injury. Of the three people suffering a major injury,
two sustained broken bones, two reported tendon or ligament damage, and one person
reported a chipped bone
At the six-week follow-up, students were asked if there were any injuries that they did not
notice at the end of the course, or if there were injuries that arose after returning home, but
which they attributed to the ASERE course. Finally, students were asked if any of the injuries
they sustained were still having a negative impact on their health or their ability to do their
job.
Just less than half of the students (48%) reported existing or new injuries, all of which were
minor. The most common ailments were numb toes or feet (16%), sore knees (12%), sore
muscles/sore back (8%), and bruises (8%). Two of the three students who reported a major
’ The comparison across the three time periods included only those cases where the follow-up PCS
scores were available, thus the sample size for the analysis dropped from 50 to 25 respondents. This
lower sample size would have a negative impact on the ANOVA’s ability to detect significant
differences. This is referred to as a reduction in power. Thus. we adopted a two-step approach to these
analyses: a repeated measures ANOVA comparing the pre- and post-course PCS scores (N = 50) and a
repeated measures ANOVA comparing all three means (N = 25)
DRD¢
injury during the course were still experiencing problems, and one of those two people
reported that the end of their course-related health problems was “still a long ways away”.
Psychological Well-being
Psychological well-being was measured by two outcomes: the Mental Health Component
Summary (MCS) from the SF-12 (Ware et al., 1998) and the K-10 measure of psychological
distress (Kessler et al., 2002). ANOVAs were again conducted to determine whether students’
SF-12 or K-10 scores varied across the course’.
Table 2 displays the means and standard deviations in mental health (MCS) scores across the
three testing periods, while Table 3 shows the means and standard deviations in K-10 scores.
None of the repeated measure ANOVAs were significant (all p-values > .10). Thus, the
psychological well-being of the students was not adversely affected by their participation in
the ASERE course.
Table 2: Means and standard deviations for the SF-12 Mental Health Components Scale, pre-
course, post-course, and at the six-week follow-up. A mean of 50 is the population norm.
N | Mean Std. Deviation
SF-12 Mental Components Scale, Pre-test 52 | 49.0005 4.02897
SF-12 Mental Components Scale, Post-test 50 | 50.2340 5.94317
SF-12 Mental Components Scale, Follow-up 25 | 50.3944 4.19650
Table 3: Means and standard deviations for the K-10 Distress Scale, pre-course, post-course, and
at the six-week follow-up.
N | Mean Std. Deviation
K-6 Psychological Distress Score, Pre-test 52 1.5769 1.48649
K-6 Psychological Distress Score, Post-test 50 | 1.4400 1.85340
K-6 Psychological Distress Score, Follow-up 25 1.6000 1.77951
Course Expectations and Perceptions
Pre-Course Survey. In the pre-course survey, we asked four questions about students’
expectations for the course. Each item was scored on a scale from 0 to 6, where higher scores
meant higher expectations. Responses to those questions are shown in Table 4. As these
responses show, students had fairly high expectations; the averages for their expectations of
how physically and mentally demanding the course was going to be were well above the mid-
4 wp — ° . : . _
The same two-stage statistical testing proc ess used in the analysis of the PCS scores were used to
determine whether the differences in MCS and K-10 scores across surveys were statistically significant
DRDC Toronto TR 2005-100 15
point (mid-point value = 3.00), while their expectation for how physically fit they should be to
complete the course was slightly above the mid-point value. Students had relatively little
worry about being physically injured on the course.
Table 4: Means and standard deviations for the four pre-course questions assessing course
expectations. Each question has a range of response from 0 to 6.
N Mean Std. Deviation
52 4.7115 .93592
How physically demanding do you think the
course will be?
How mentally demanding do you think the
course will be?
How physically fit do you think you will have to
be to complete the course?
How apprehensive are you about being
physically injured while on this course?
52 4.5000 82842
52 3.7500 81349
52 2.8269 1.65353
Post-Course Survey. At the end of the course, students’ perceptions of the level of physical
and mental demand, as well perceptions of the physical fitness requirements for the course
were re-assessed. In addition, we asked whether they felt the course was easier or tougher
than they expected it to be. For this latter question, responses ranged from 0 (A Lot Easier
Than Expected) to 6 (A Lot Tougher Than Expected), with 3 (As Expected) being a neutral
response.
As Table 5 shows, immediately after completing the course, students continued to rate the
course as physically and mentally demanding, and requiring the students to be physically fit.
When we asked whether the course was easier or tougher than they expected, 12% felt it was
easier than they expected, 33% felt it was exactly as they expected, and 55% felt it was
tougher than they expected. When asked whether their initial expectations concerning the
course were met, 94% answered “Yes.”
Table 5: Means and standard deviations for four questions assessing perceptions of the course,
asked at the end of the course. Each question has a range of response from 0 to 6.
N Mean Std. Deviation
51 5.0392 .87088
How physically demanding do you think the
course was?
How mentally demanding do you think the
course was?
How physically fit do you think students should
be in order to complete this course?
Was the course easier or tougher than you
thought it would be?
51 4.4706 1.10187
51 4.1176 73884
51 3.7255 1.21784
Six-Week Follow-Up. We asked the same questions in the six-week follow-up. As Table 6
indicates, students continued to feel that the course was physically and mentally demanding,
requiring the students to be physically fit, as evidenced by mean scores that were above the
mid-point of 3. However students’ average responses to the demand and fitness questions at
DRDC Toronto TR 2005-100
the six-week follow-up were lower than those that they reported immediately following the
course.
Responses to the question about whether the course was easier or tougher than they expected
also were somewhat different than was the case immediately after the course completion, with
24% feeling it was easier than they expected, 36% feeling it was exactly as they expected, and
40% feeling it was tougher than they expected. When asked whether their initial expectations
for the course were met, 92% answered “Yes” at the follow-up.
Table 6: Means and standard deviations for four questions assessing perceptions of the course,
asked six-weeks after the course concluded. Each question has a range of response from 0 to 6.
N Mean Std. Deviation
pcre demanding do you think the 25 424 1.300
pth demanding do you think the 25 3.60 1.258
eer) a ee
dep — or tougher than you 25 3.24 1.200
Assessing Changes in Expectations and Perceptions. To determine whether these
differences in student expectations and perceptions across the three assessment points (i.e.,
pre-course, post-course, six-week follow-up) were statistically meaningful’, we adopted a
three-stage process. First, we wanted to determine whether the students’ increased perceptions
of the mental and physical toughness, as well as physical fitness requirements, from pre-
course to post-course were statistically significant. To do this, we computed a paired-sample
t-test (pre-course vs. post-course) for each of these three questions.
Results indicated that students believed the course to be significantly more physically
demanding immediately after completing the course, as compared to their expectation just
before taking the course (Means = 4.71 vs. 5.04, respectively; (50) = -2.48, p < .05).
However, students expectations of the mental demand of the course did not significantly differ
from pre-course to post-course immediately upon their return from the training area (Means =
4.50 vs. 4.47, respectively, 1(50) = 0.28, p > .05). Lastly, students’ perceptions of how
physically fit students who take the course should be did significantly increase between their
pre-course and immediate post-course assessments (Means = 3.75 vs. 4.12, respectively; (50)
= -2.83, p < .05).
In the second stage of these analyses, we asked whether the decreases in students’ perceptions
of course difficulty from the post-course to the six-week follow-up were statistically
meaningful. Again, we computed a series of paired-sample t-tests for the same three
questions. However, because we were comparing post-course to the follow-up, these analyses
include only those 25 people who returned the follow-up questionnaire. Thus, the means used
in these analyses may be slightly different than those in Tables 5 and 6.
5 ; ee
as opposed to reflecting random variability in responses
DRDC Toronto TR 2005-100 17
Results of these analyses revealed that students’ perceptions of how physically demanding the
course was significant decreased between the post-course and the six-week follow-up
questionnaires (Means = 5.00 vs. 4.24, respectively, (24) = 2.92, p < .05). Students’
perceptions of the mental demand of the course also significantly decreased in the six-weeks
between the post-course and the follow-up surveys (Means = 4.36 vs. 3.60, respectively; (24)
= 3.08, p < .05). Similarly, students’ perceptions of the physically fitness requirements of the
course also significantly decreased between administrations of the post-course versus follow-
up questionnaires (Means = 4.16 vs. 3.68, respectively, (24) = 2.61, p < .05).
We also asked whether there were significant differences between the post-course and the
follow-up in terms of students’ perceptions of how easy versus how tough was the course.
Again, we used a paired-sample t-test and only those students who returned the follow-up
survey are represented in these findings. The t-test showed students perceived the course to be
significantly less tough at the six-week follow-up than they had immediately after completing
the course (Means = 3.96 vs. 3.24, respectively, (24) = 2.75, p < .05).
Finally, we wanted to know whether the expectations students had for the level of course
difficulty returned to the pre-course, or baseline values at the six week follow-up. As in the
last two sets of analyses, we used a paired-samples t-test, comparing the means for the pre-
course expectations with the means for the six-week follow-up. Results of these analyses
indicated that students rated the course as significantly less physically demanding six weeks
after the course than they had expected prior to taking the course (Means = 4.24 vs. 4.88,
respectively), (24) = 2.14, p < .05. Student’ perceptions of the mental demands of the course
also were significantly lower at the follow-up than they were the pre-course assessment
(Means = 3.60 vs. 4.68, (24) = 4.55, p < .05).
Perceived Safety Concerns While on the Course
In the post-course and follow-up surveys, we asked students about their perceptions of the
their safety during the course. First, we asked about the level of physical contact used by the
enemy force during the capture, the transfer, and the tactical questioning phases. Responses to
each of these questions were made on a scale from —3 (A Lot Less Than Expected) to +3 (A
Lot More Than Expected), with “Exactly As Expected” being represented by a zero. We also
asked the students whether they felt the level of contact used by the enemy force was more,
less, or exactly as needed during each of the three phases. As with the previous questions,
responses to each of these questions were made on a scale from —3 (A Lot Less Contact is
Needed) to +3 (A Lot More Contact is Needed), with “Exactly As Needed” being represented
by a zero.
Post-Course. Post-course responses to the three questions about physical contact during the
capture, transfer, and tactical questioning phases are shown in Table 7. Interestingly, sixty-six
percent of the students expected more physical contact from the enemy force than they
received during the capture phase, while 50% expected more physical contact than they
received during the transfer phase, and 69% expected more physical contact than they
received during the tactical questioning phase.
DRDC Toronto TR 2005-100
Table 7: Means and standard deviations for three questions from the post-course survey
assessing perceptions of level of contact used by the enemy force during the capture, transfer,
and tactical questioning phases of the ASERE course. Each question has a range of response
from -3 (A Lot Less Than Expected) to +3 (A Lot More Than Expected).
N Mean Std. Deviation
How was the level of physical contact used by
the enemy force during the capture phase, 50 -1.0600 1.25210
compared to what you expected?
How was the level of physical contact used by
the enemy force during the transfer phase, 50 -.7400 1.06541
compared to what you expected?
How was the level of physical contact used by
the enemy force during the tactical questioning 48 -1.1667 1.22619
phase, compared to what you expected?
When asked to indicate the degree to which they felt more or less physical contact is needed
at each of these three phases of the course, many students felt that more contact was needed.
Average responses are shown in Table 8. In general, for the capture phase, no one thought the
enemy force needed to use less contact; 28% thought the amount of contact used was exactly
as needed, while 72% felt that more contact was needed. During the transfer phase, 35% felt
the amount of contact used was exactly as needed, while 65% felt more contact was needed.
During the tactical questioning phase, 4% felt that less contact was required, 12.5% felt that
the amount of contact was exactly as needed, while 83.5% felt that more contact was needed.
Table 8: Means and standard deviations for three questions from the post-course survey
assessing perceptions of necessary contact required by the enemy force during the capture,
transfer, and tactical questioning phases of the ASERE course. Each question has a range of
response from —3 (A Lot Less Contact is Needed) to +3 (A Lot More Contact is Needed).
N Mean Std. Deviation
Do you think the enemy force used an
appropriate amount of physical contact during
the capture phase, or does there need to be
more or less physical contact at that point?
Do you think the enemy force used an
appropriate amount of physical contact during
the transfer phase, or does there need to be
more or less physical contact at this point?
Do you think the enemy force used an
appropriate amount of physical contact during
the tactical questioning phase, or does there 48 1.1250 91384
need to be more or less physical contact at that
point?
50 1.0800 .87691
49 .9388 .87579
Six-Week Follow-Up. Responses to the three questions about physical contact during the
capture, transfer, and tactical questioning phases provided by students six weeks after
completing the course are shown in Table 9. Seventy-six percent of the students expected
more physical contact from the enemy force than they received during the capture phase,
DRDC Toronto TR 2005-100 19
while 60% expected more physical contact than they received during the transfer phase, and
64% expected more physical contact than they received during the tactical questioning phase.
Table 9: Means and standard deviations for three questions from the follow-up survey assessing
perceptions of level of contact used by the enemy force during the capture, transfer, and tactical
questioning phases of the ASERE course. Each question has a range of response from -3 (A Lot
Less Than Expected) to +3 (A Lot More Than Expected).
N Mean Std. Deviation
How was the level of physical contact used by
the enemy force during the capture phase, 25 -1.04 .889
compared to what you expected?
How was the level of physical contact used by
the enemy force during the transfer phase, 25 -.84 1.028
compared to what you expected?
How was the level of physical contact used by
the enemy force during the tactical questioning 25 -1.08 1.187
phase, compared to what you expected?
When asked at follow-up to indicate the degree to which they felt more or less physical
contact is needed at each of these three phases of the course, many students felt that more
contact was needed. Average responses are shown in Table 10. In general, for the capture
phase, no one thought the enemy force needed to use less contact; 28% thought the amount of
contact used was exactly as needed, while 72% felt that more contact was needed. During the
transfer phase, 4% felt that less contact was needed, 36% felt the amount of contact used was
exactly as needed, while 60% felt more contact was needed. During the tactical questioning
phase, 4% felt that less contact was required, 40% felt that the amount of contact was exactly
as needed, while 56% felt that more contact was needed.
Table 10: Means and standard deviations for three questions from the follow-up survey
assessing perceptions of necessary contact required by the enemy force during the capture,
transfer, and tactical questioning phases of the ASERE course. Each question has a range of
response from —3 (A Lot Less Contact is Needed) to +3 (A Lot More Contact is Needed).
N Mean Std. Deviation
Do you think the enemy force used an
appropriate amount of physical contact during
the capture phase, or does there need to be
more or less physical contact at that point?
Do you think the enemy force used an
appropriate amount of physical contact during
the transfer phase, or does there need to be
more or less physical contact at this point?
Do you think the enemy force used an
appropriate amount of physical contact during
the tactical questioning phase, or does there 25 .80 .957
need to be more or less physical contact at that
point?
25 1.08 .909
25 .96 1.020
20 DRDC Toronto TR 2005-100
Assessing Changes in Perceptions of Physical Contact from Post-Course to Follow-Up.
Did students’ average perceptions of the amount and necessity of the physical contact used by
the enemy force during the capture, transfer, and tactical questioning stages change from the
end of the course to the follow-up survey? A series of paired-sample t-tests compared the
average responses to each of the three questions about their expectations of force and the three
questions about the necessary level of that force. There were no significant changes in those
perceptions across time.
Correlations Between Pre-Course Expectations, and Health and Well-being. Because
expectations for how difficult the ASERE course may be are an indication of the level of
anxiety people are experiencing about the course, and because that anxiety may put people at
an increased risk for adverse health outcomes (both physical health and psychological well-
being), we examined the correlations between pre-course expectations and both pre-course
and post-course health outcomes. There was a significant, moderate correlation between pre-
course psychological distress scores (measured with the K-10) and concerns about being
physically injured while on the course, 7(50) = .40, p < .05. That is, those students with
greater concerns about being injured had higher levels of distress prior to taking the course.
There was a similar trend with the SF-12 Mental Health Component Score score: more
concern about injury was associated with poorer levels of general psychological well-being
prior to taking the course, r(50) = -27, p < .06.
Next, we explored correlations between pre-course expectations and post-course health and
well-being (SF-12 Physical Health Component Score, SF-12 Mental Health Component
Score, K-10 Psychological Distress Score, the total number of injuries, and the total number
of minor injuries). None of the correlations were significant, suggesting that pre-course
expectations were not associated with health concerns immediately after completing the
course.
Finally, we explored associations between the pre-course expectations and the six week
follow-up health and well-being indices. Two significant correlations emerged. First, the more
physically demanding the students expected the ASERE course to be (at the pre-course
session), the lower their SF-12 Physical Health Component scores were at follow-up, 7(23) = -
53, p < .05. Secondly, the more physically fit the students expected they had to be to take the
ASERE course (at the pre-course session), the lower their SF-12 Physical Health Component
scores were at follow-up, 7(23) = -.47, p < .05.
DRDC Toronto TR 2005-100 21
Summary and Conclusions
We assessed the self-reports of health and well-being of 52 students in three consecutive
i |
ASERE courses. A three-phase assessment procedure was used, with students completing
questionnaires immediately pre- and post-course, as well as six weeks after the end of the
course. In addition to examining students’ self-reports of health and well-being, we also
assessed students’ expectations and perceptions of the course. We focused on their
expectations of how physically and mentally demanding the course would be, as well as their
expectations of how physicaliy fit ASERE students should be
Immediately after completing the course we asked students about their perceptions of how
physically and mentally demanding the course was. This was done because if students were
expecting a less demanding course than they received, they may not have been adequately
prepared for the course, which may in turn be distressing. We assessed students’ perceptions
of their safety, and their perceptions of the appropriateness of the level of physical contact
used by the hunter force during the capture, transfer, and tactical questioning stages of the
practical component of the ASERE course
We were also interested in the longer-term consequences of participation in the ASERI
course. In order to pursue this question, we contacted students approximately six weeks after
they had completed the course. The follow-up questionnaires again asked students for their
self-reported health and well-being, their perceptions about the physical, mental and fitness
demands made by the course, as well as their perceptions of their safety during the capture,
transfer, and tactical questioning stages of the practical component of the ASERE course. The
results of these analyses yielded several findings of potential interest to the Ist Canadian Air
Division Surgeon and the CFSSAT ASERE staff.
Self-reported Health and Well-being
First, the ASERE course did not appear to have any appreciable effect on the self-reported
physical health or psychological well-being of most of the students. While there was a
Statistically significant decrease in self-reported physical health scores on the SF-12 measure
from pre- to post-course, the magnitude of the effect (or the practical significance of this
finding) was small. Similarly, most students reported only minor injuries, for instance, cuts,
bruises, and muscle soreness, as a result of the practical component of the course. The most
commonly reported minor ailments were numb toes or feet (16%), sore knees (12%), sore
muscles/sore back (8%), and bruises (8%). Three students experienced a major injury during
the course, including broken or chipped bones and muscle or ligament damage. Two of these
three students were still experiencing problems at the follow-up, and one of those two people
reported that the end of their course-related health problems was “still a long ways away.”
Finally, there were no significant changes in psychological well-being across the period of the
study, suggesting that the course did not cause any immediate or prolonged psychological
distress to the students
22 DRDC Toronto TR 2
Expectations and Perceptions
With respect to the students’ expectation of how demanding the course would be, especially
compared to post-course perceptions, several interesting findings emerged. First, all but one
student expected the course would be at least moderately phy sically demanding, and all
students expected the course to be at least moderately mentally demanding. Similarly, all but
ne respondents thought that students would need to be at least moderately physically fit in
f
rder to complete the course. These findings indicate that most students are aware of the
difficult nature of the course and are expecting to be challenged, both physically and mentally
Students expected a fairly demanding, intense course, and based upon post-course
assessments, the course surpassed these expectations. Immediately after completion, students
rated the course as significantly more physically demanding than their initial expectations.
pn} ;
with 50% of the students reporting the course was tougher than they had anticipated, although
their perceptions of the mental demand of the course remained unchanged. However, those
perceptions then changed again at the six-week follow-up. At this time, they remembered the
rse as significantly less physically and mentally demanding, and requiring less physical
fitness than they thought it was immediately after the course ended. Still, even at this point,
410% of students continued to report that the course was tougher than they had expected
Even more interesting at thts follow-up assessment was the fact that the students remembered
the course as less physically and mentally demanding than they initially expected it to be. This
may be a function of the closeness of the pre-course assessment. That is, it may be that
inxiety or apprehension surrounding the ASERE course might have inflated expectations for
how physically and mentally demanding the course was going to be. If the pre-course
assessment wis made six weeks before the course, would the expectations approximate the
’
six-week follow-up perceptions? This type of question only can be answered empirically in a
future study
t
Perhaps, not surprisingly, pre-course apprehension surrounding the possibility of being
injured, was associated with initial levels of psychological distress. However, course
expectations were not associated with any of the health and well-being measures immediate!
following the course. There were some associations between initial expectations and follow
up health measures, though. Physical demand and physical fitness expectations were
associated with poorer SF-12 physical health scores at the follow-up. This result may suggest
that those students who had more concerns were in less physically fit condition wher
embarking on the course, and this may account for the higher level of reported injuries post
1, and so this
course. It is important to note that we did not directly assess this relatior
explanation of this particular result is speculative at this point
Level of Physical Contact from the Enemy Force
Another important finding of this study concerns the students’ perceptions of the amount of
physical contact used by the enemy force during the capture, transfer, and tactical questioning
phases of the practical component to the course. Only six to eight percent of the students felt
that the physical contact used by the enemy force was greater than they expected, but only one
of the 52 students felt that less contact was needed. Thus, the majority of these students
DRDC Toronto TR 23
expected the enemy force to use more physical contact during capture, transfer and tactical
questioning, and that more physical contact was needed. Of course, requirements concerning
the degree of physical contact used to illustrate and underscore teaching points in a course of
this nature are the joint decision of the CFSSAT commander, and the training, sa
medical staff. Nonetheless, this finding does suggest that the majority of these students felt
that they could have tolerated more physical contact by the enemy force
Self-Report Data
This study was based upon the self-reports of health, well-being and perceptions of ASERI
students. Although self-report data can suffer from a number of biases, including self-
presentation (e.g., Adier, Thomas, & Castro, 2005) and concerns about how answers might
affect flying status, we designed the present study specifically to minimize the potential
influence of these factors. l'irst, we introduced the study personally, and made clear that
students understood that we had with no connection to CFSSAT, students’ outcomes in the
course, or with their chain of command. Second, we worked with CFSSAT staff to limit the
number of demographic questions asked of students, so that putting three or more questions
together would not serve to identify individual respondents (e.g., we avoided questions that
would triangulate in on the only female pilot from a particular home unit). We also developed
a procedure that allowed students to create their own unique personal identification code to
further ensure that the questionnaire data were completely anonymous
We also were quite encouraged by the extremely high participation rates in this study
particularly in the pre-course and immediate post-course questionnaires, where participation
was 85 and 87 percent, respectively. Although response rates on the follow-up questionnaire
dropped to 48 percent, this is neither particularly low nor unexpected in longitudinal research
of this kind, which typically involves some level of attrition at each stage of a study. There
can be many reasons for the drop in participation, including a lack of motivation. However, it
is important to remember that aircrew travel quite often and at least some of these students
may have been away again six weeks after the course completion, either on a deployment or
on training. Finally, it is very important to note that those students who did not respond to the
follow-up questionnaire did not differ in terms of health, well-being or perceptions from those
who did complete the follow-up questionnaire. This supports the representativeness of the
follow-up sample, and, thus, the validity of the responses reported six weeks after the
conclusion of the course
Future Research
Despite our confidence in the validity of the self-reports obtained from the ASERE students,
future research of this nature might benefit from physician assessment of student health,
immediately following the course and six weeks later. Another potential measure might come
in the form of instructor assessments of student performance. Further longer-term follow-up
(e.g., Six month or one year follow-up) assessments of students health and well-being might
also be revealing. The longer-term follow-ups might be more justified had their been a higher
level of physical or psychological distress noted during the six week follow-up. Moreover, it
also should be noted that these additional assessments might well affect students’ beliefs in
the anonymous nature of the data collection, and might thus increase the students’ self-
ntegration of more of these types of more detailed
nsidered prior to implementation.
ents’ assessments in three consecutive ASERE courses. Thus,
snapshot of students’ experiences, this assessment was
n of the year. Therefore, at this point we do not have a
f seasonal factors, including temperature, weather, and insect
may wish to conduct assessments across seasons to determine
s not without some degree of risk. However, the majority
: r in nature and there were no negative effects on students’
gical distress. Moreover, students appear to be aware of the demands
urse before they embark on it. As well, their perceptions of any aspect
ute after taking the course, either immediately, or six weeks after
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28 DRDC Toronto TR 2005
Annexe 1: Tasking Memo
pee National Défense DROC TRANLIT RECORD
eee aan CR NO. DD coven |
4 Health Support Operational Training Unit File Ref, 2 26e.=1
Headquarters PASSED TO | DATE | INTWRS |
1 Canadian Air Division Headquarters } v2
Box 17000 Stn Forces Ryosrs | i .
Winnipeg MB R3J 3Y5 Cm sa
4500-1 (AMP FS) Ai
{ January 2004
Distribution List
PHYSICAL AND PSYCHOLOGICAL SURVEY
OF ADVANCED SERE COURSE
References: A. Email Megan Thompson/Major Downes 23 soe masheaned
B. Draft Student Survey (enclosed)
C. Advanced SERE Course Schedule as of 12 November 2003 (enclosed)
D. Perscon Maj Downes/Maj Power 15 December 2003
1. The Advanced Survival Evasion Resistance and Escape (SERE) Course is very
physically and psychologically demanding for the students. The short and long-term
health consequences of the program run by the Canadian Forces School of Survival and
Aeromedical Training (CFSSAT) have never been evaluated. Thus it is requested that
the Experimental Psychological Stress and Coping Group from Defence Research and
Development Canada ~ Toronto (DRDC-T) formally evaluate the impact on the students.
z Initial discussions have taken place (refs A and B) to determine the type of study
to be conducted and the cost estimate. The students will be surveyed three times (start
of course, end of course and 6 weeks post course). This office will cover the cost of 3
trips to Winnipeg for one person and DRDC-T will cover the other costs associated with
the study. Ref C lists the tentative dates for the upcoming advanced SERE courses but
it is recommended that confirmation be made with CFSSAT prior to finalizing travel
arrangements.
3. it ls requested that DRDC-T conduct this study and provide a report to this office
prior to 1 Dec 04. Any questions can be directed to Major Downes, CFSSAT SERE
Medical Advisor, at (204) 833-2500 extension 5430. :
GR. aun Dd peg -
Lieutenant Colonel
p :
1 Canadian Air Division Surgeon
Distribution List (page 2)
Canadit
DRDC Toronto TR 2005-100
Annexe 2: Information Sheet
Purpose
In January 04, | Can Air Div Surg tasked the Stress and Coping Group at Defence R&D Canada--
Toronto to assess the short and longer-term health impacts of the ASERE course on students, especially
with respect to injuries that could have implications for flying status.
The Present
Study
The study involves completing a questionnaire before the course begins, a second questionnaire at the
course end, and a final evaluation 6 weeks afterwards. Each questionnaire asks two demographic
questions so that we can better describe our group of participants in general terms, some questions
about your expectations and appraisals of the course, and two short, standard general health and well-
being questionnaires. If you have any questions while completing the evaluation, please do not hesitate
to speak with the DRDC representative.
Your participation is completely voluntary. You may end your participation at any time and your
completed questionnaires will be destroyed. You may skip individual questions that you do not wish to
answer. The survey should take 10-30 minutes to complete.
Importance of
Your
Participation
The findings from this evaluation will be presented to the | CAD Surg and the CO of CFSSAT. The
accuracy and quality of the findings we present is entirely dependent on the openness of our
participants. Thus, should you choose to participate, it is important that you answer the questions as
honestly as possible.
Guarantee of
Anonymity
Your anonymity is guaranteed. Your name will not be included anywhere in our data files. Your
information will be combined with those from other participants and only group data will be presented.
We ask for your name and contact information only to mail you the 6-week follow-up evaluation.
This contact information will be kept separate from your data and will be destroyed at the end of the
study
We will link your three evaluations using an anonymous PIN that is generated by your response to
four questions that are unique to you and are unrelated to your physical identity.
Guarantee of
Confidentiality
The confidentiality of your responses is guaranteed. DRDC researchers are guided by, and adhere
to, professional and ethical guidelines concerning behavioural research that involves people. Only
DRDC-authorized researchers will have access to the information from this evaluation. DRDC is
responsible for confidential storage of the data in a secure area.
Benefits
This research will benefit the CF in helping to quantifying the health and well-being outcomes
associated with taking the Advanced SERE course.
Risks
Mild eyestrain, fatigue, and boredom and a temporary focus on physical symptoms such as joint pains
or headaches are possible short-term risks of completing this questionnaire. If any questions trigger
intense or persistent discomfort, you should contact study personnel at the end of the session or contact
medical personnel at 17 Wing for further assistance. a eal
Contact
Information
For any further questions or concerns about this evaluation, or if you wish a copy of the report, please
contact Dr. Don McCreary, Stress & Coping Group, DRDC Toronto, 416-635-2008, 634-2008 (CSN),
or [email protected];
This project has been reviewed and approved by, the Research Ethics Board at DRDC Toronto. If you
would like to speak with the Chair of the DRDC Research Ethics Board, please contact Dr. Jack
Landolt, 416-635-2120, 634-2120 (CSN), or [email protected]
DHRRE authorizes the administration of this survey within DND/CF in accordance with
CANFORGEN 145/02 ADMHRMIL 079 UNCLASS 131028Z DEC 02. Authorization number:
340/04.
DRDC Toronto TR 2005-100
Annex 3: Consent Form
ADVANCED SERE COURSE HEALTH AND SAFETY EVALUATION
DRDC Toronto Human Research Ethics Committee Protocol Number (L-478)
Principal Investigator: Dr. Don McCreary
Co-Investigator: Dr. Megan M. Thompson
The DRDC Toronto Human Research Ethics Committee requires all research participants to
sign a consent form. This form and all identifying personal information will be kept separate
from your questionnaire data and stored by the DRDC Toronto Human Research Ethics
Committee.
ee (name), volunteer to complete the
Advanced SERE Health and Safety Evaluation. I have read the accompanying information
sheet, and I understand that I will asked to complete the evaluation at three points: before the
beginning of the course, at the end of the course, and 6 weeks after the course. I have been
given the e-mail and mail addresses at which | can contact the principal investigator
concerning the survey.
| understand that my data will be stored at DRDC Toronto and that my answers will be treated
as confidential. My data will not be revealed to anyone other than authorized study
investigators without my consent, except as part of group results. | understand that any
information that may be used to identify me specifically (i.e., my name and address so that the
follow-up survey can be mailed to me) will not appear with my data at any time, and will be
destroyed upon completion of the study.
| understand that mild eyestrain, fatigue, and boredom and a temporary focus on physical
symptoms such as joint pains or headaches are possible short-term risks of completing this
questionnaire. | consider these acceptable.
I understand that | may withdraw from this study at any time without prejudice, and that | may
skip any question that | would prefer not to answer.
PLEASE Name: - ee
COMPLETE
AND RETURN Signature: RFa OPE ee
WITH YOUR
QUESTIONNAIRE Date: _ ee ne
DHRRE authorizes the administration of this survey within DND/CF in accordance with
CANFORGEN 145/02 ADMHRMIL 079 UNCLASS 131028Z DEC 02 Authorization
number: 340/04
DRDC Toronto TR 2005-100 31
Annexe 4: SF-12 Health Questionnaire
SF-12 HEALTH SURVEY
Please answer every question by circling the answer that best describes how you feel.
If you are unsure about how to answer a question, please give the best answer you
can.
1. In general, would you say your health is: Excellent VeryGood Good Fair Poor
l 2 3 4 5
. The following items are about activities you might do during a typical day. Does your
health now limit you in these activities? If so, how much?
Limited a Limited a Not limited at
lot little all
. Moderate activities, such as moving a table, pushing 1 2 3
a vacuum cleaner, bowling, or playing golf:
. Climbing several flights of stairs: | 2 3
. During the past four weeks, have you had any of the following problems with your work
or other regular daily activities as a result of your physical health?
. Accomplished less than you would like: Yes No
. Were limited in the kind of work or other activities: Yes No
. During the past 4 weeks, have you had any of the following problems with your work or
other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)?
. Accomplished less than you would like: Yes No
. Didn’t do work or other activities as carefully as usual: Yes No
. During the past 4 weeks, how much did pain interfere with your normal work (including
both work outside the home and housework)?
All of Most of Some of A little of None of
the time the time the time the time the time
2 3 4 5
. These questions are about how you feel and how things have been with you during the
past 4 weeks. For each question, please give the one answer that comes closest to the
way you have been feeling. How much of the time during the past 4 weeks:
Allof Most Agood Some A little None
the of the bit of ofthe ofthe of the
time time the time time time time
. Have you felt calm and peaceful? I 2 3 : 5 6
DRDC Toronto TR 2005-100
b. Did you have a lot of energy? l 2 3 4 5 6
nn
c. Have you felt downhearted and blue? 1
7. During the past 4 weeks, how much of the time has your physical health or emotional
problems interfered with your social activities (like visiting with friends, relatives, etc.)?
All of Most of Some of A little of None of
the time the time the time the time the time
2 3 4 5
DRDC Toronto TR 2005-100 33
Annexe 5: K-10 Psychological Distress Questionnaire
K10+ General Health Survey
The following questions ask about how you have been feeling during the past 30 days.
For each question, please circle the number that best describes how often you had this
feeling.
: od b None A little Some Most of All
- mung Oe past 50 cays, shout how of the of the of the the of the
often did you feel...
time time time time time
a. ... tired out for no good reason? 1 2 3 4 5
b. ...nervous? 1 2 3 4 5
¢, 77780 nervous that nothing could
: calm you down? I : 3 4 5
d. _... hopeless? 1 2 3 4 5
e. ...restless or fidgety? 1 2 a 4 5
f. -+.S0 restless that you could not 1 , 3 4 5
sit still?
g. ...depressed? 1 2 3 4 5
h. ...so depressed that nothing 1 4 3 4 5
could cheer up?
i. ...that everything was an effort? 1 2 3 4 5
j._... worthless? 1 2 3 4 5
34 DRDC Toronto TR 2005-100
List of symbols/abbreviations/acronymsi/initialisms
DND Department of National Defence
CF Canadian Forces
ASERE Advanced Survival, Evasion, Resistance, and Escape
CFSSAT Canadian Forces School of Survival and Aeromedical Training
DRDC Toronto TR 2005-100 35
UNCLASSIFIED
DOCUMENT CONTROL DATA
Self-reported Health and Well-being Outcomes of ASERE Students (U)
4 AUTHORS ¢ ame {die initial a t name ary. show rank. e.g. Ma
Donald R. McCreary; Megan M. Thompson
DATE OF PUBLICATION 6a NO. OF PAGES
July 2005 sii 30
04
?. DESCRIPTIVE NO
Technical Report Funding for this study was provided by: Canadian Forces School of
Survival and Aeromedical Training, 17 Wing/CFB Winnipeg PO BOX 17000 STN
FORCES WINNIPEG MB R3J 3Y5
8. SPONSORING ACTIVIT
Sponsoring: Canadian Forces School of Survival and Aeromedical Training
asking
.
J ‘
9a. PROJECT OR GRANT NO
wr fy whether ¢
20cg
10a. ORIGINATOR'S DOCUMENT NUMBER (1
DRDC Toronto TR 2005-100
11. DOCUMENT AVAILABII
J
Unlimited distribution
Unlimited announcement
UNCLASSIFIED
The 1st Canadian Air |
undertake an evaluation
Survival, Evasion, Resistance, and
Training
Survival and Aeromedical J
perceptions concerning the course
the end of the course, and six weeks following the course. While most students sustained some minor
( }
(e.g
(CFSSAT)
as well as self-reports of their health and well-being f
UNCLASSIFIED
DOCUMENT CONTROL DATA
fa } and indexing annotation must be entered when the overa
€ aya appear elsewhere the body of the d ne self
4 5] 4 egin with a Jicatic f the sex ty 5) fica
ry f er ecessary | ere at 4
vision Surgeon requested that the Stress and Coping Group
based on the health and well-being self-reports of students
Escape (ASERE) trai
CFB
Winnipeg
ning course conducted at Ca
Students provided their expectations a
at DRDC Toron
taking the Advan
n
rior to the
vroken bones, torn ligaments). Also, while there was a slight drop in physical health scores (using a
standardized measure) from pre-
,
a
bruises, cuts, scrapes, sore muscles), only 3 of the 52 study participants sustained a major inju
to post-course, there were no effects on the two measures of psycho
ed
adian Forces Scho¢
4
ourse
njurie
y c
ogi
well-being. Finally, questions about expectations and perceptions of the course showed that students were
expecting to take a challenging course and that those expectations were met
e médecin de lair de la 1re Div
strategies d’adaptation de RDDC Toronto procéde a une évaluation basee sur les auto ’evaluations de leur
santé et de leur bien?é@tre par les participants au cours de formation sur les procedures avancees de Survie
d’évasion, de résistance et de fuite (SERF), donné a |'Ecole de survie et de médecine de | air des F es
canadiennes (ESMAFC), BFC de Winnipeg. Les stagiaires ont exprime leurs attentes et leurs perceptions
concernant le cours, de méme qu’ils ont fourni leur évaluation de leur santé et de leur bien?étre avant le cours
a4 la fin du cours et six semaines aprés la fin du cours. Bien que la plupart des stagiaires aient subi des
blessures mineures (p. ex. ecchymoses, coupures, éraflures, douleurs musculaires), seulement trois des 52
participants etudies ont subi une Diessure grave a?d. fractures, ligaments déchirés). De plus, bien quon ait
observe (au moyen d'une mesure normalisée) des scores legérement plus faibles dans | evaluatior de la santé
physique ala fir Ju yurs COMpar ativement a ceux d jues avant ie cours, aucurl effet na ete reveile p es
deux mesures du Dien /etre psycn yique. Enfin, les questions sur les attentes et les percept < ncernant
e cours ont démontré que les stagiaires s'attendaient a suivre un cours exigeant et que ces attentes ont ete
satisfaites
Advanced Survival. Evasion, Resistance, and Escape (ASERE); Health and Well-Being; A ew
UNCLASSIFIED
sion aérienne du Canada a demandé que le Groupe du stress et des
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