Monday 3 April 2023

Subtle Incapacitation

Subtle incapacitation means gradual, initially imperceptible impairment of physical or mental function, whether reversible or not, which is likely to result in safety, performance and/or conduct issues that may undermine the agency's commitment to maintaining a safe working environment for all employees and others.
Cornell Law School

Subtle incapacitation is most commonly caused by hypoxia (low oxygen levels), hypoglycemia (low blood sugar), extreme fatigue, alcohol, drugs or other toxic substances. Neurological problems, such as stroke or brain tumour, may also be a cause. Transport Canada

In watching an episode of Mayday: Air Disaster, which is a program that shows the investigation process involved in various airplane accidents, I became aware of the condition known as subtle incapacitation. If you Google it, you'll find that it is only used to apply to pilots/air crew. I'm not sure why because the factors contributing to the development/manifestation of subtle incapacitation can be found in other situations as well. 
Last week, I was in Edmonton for an occupational therapy functional assessment. Because of my anxiety about driving (the assessment was in a very busy area of the city and the driving would be during rush hour), the disability company paid for a driver to take me in and return me home. During one of our trips, the driver informed me that he had been driving at 130 kph (speed limit is 110, by the way) on his way to pick me up and had been passed by a truck, obviously doing more than 130 (80 mph) and the truck driver lost control of the truck, which started weaving dangerously, until he was able to get it under control again. It made me wonder if the truck driver was a victim of subtle incapacitation. Having been married to a truck driver, I know the crazy hours they keep, and the poor lifestyle they often have, including lack of physical exercise and erratic and improper eating. Transport Canada has this to say about the symptoms of subtle incapacitation:

  • Skills or judgement may be lost with little or no outward sign.
  • The victim may not respond to stimulus, may make illogical decisions, or may appear to be manipulating controls in an ineffective or hazardous manner.
  • Failure to respond normally to two consecutive challenges or one significant warning ("You're 100 feet below decision height") should trigger action.
  • Symptoms may be evident only in moments of high stress or workload.
So, who's to say that subtle incapacitation can not apply to transport drivers? The causes can be present and the symptoms can be the same. And what about shift workers? Or even people like myself, who suffer from mental health issues and chronic and often severe insomnia? I know that my decision-making ability, my memory, my organization skills have all been negatively impacted. Even my ability to type. I also know that there are times when I'm so tired that I get clumsy. Is that not subtle incapacitation? 
I don't honestly know if "subtle incapacitation" is even an official medical diagnosis or if it can be found in the DSM (Diagnostic and Statistical Manual of Mental Disorders), but I think it should be recognized and acknowledged that it can apply to more than just airline pilots. And I have no doubt that stress can contribute to it as well. 
And nursing can be a very stressful occupation. And I guess maybe that's where I'm going with this. There is little doubt that there are likely many nurses suffering from subtle incapacitation. And maybe they've been called in by their managers for a performance review and told to do better. And they try to do better, but the situations that have produced the symptoms don't go away. There is altogether too much blame placed on nurses instead of acknowledging the factors that may be directly contributing to "poor performance". I don't know what can be done about it, but I think recognizing its existence is a step in the right direction. 
We're losing nurses faster than we can replace them. And something needs to be done. And I think exploring and dealing with why is far more important than finding replacements. Otherwise, we'll just continue to lose them. 

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