BACKGROUND: Extensive research has demonstrated that shift-work and time of day affect one’s ability to maintain alertness and vigilance. Research has also sought to determine ways to increase alertness and decrease the effects of fatigue in high vigilance environments, such as air traffic control. This study was designed to assess the effectiveness of video game play as a fatigue countermeasure in air traffic controllers.METHODS: We tested 22 military air traffic controllers to ascertain whether video game play prior to time in the air traffic control room heightened their alertness during their shift. An oculometer, which is an objective measure of physiological arousal and visual alertness, was used to measure pupillary diameter, amplitude, latency, and velocity. Perceived alertness was assessed using the Stanford Sleepiness Scale. Over a 4-wk period, the air traffic controllers participated in a counterbalanced, within-subjects design study with experimental (video gaming prior to control room) and control (no video gaming prior to control) conditions.RESULTS: We used a within-subjects, repeated measures MANOVA to compare differences in physiological and perceived alertness of individuals in the two conditions. Results indicated that video game play significantly increased physiological alertness in air traffic controllers, especially pupil diameter and velocity, and this effect was sustained for at least 30 min after they stopped playing. Perceived alertness was also increased by video game play.DISCUSSION: These results indicate that video game play could be an effective fatigue countermeasure in high vigilance occupations such as air traffic control.Fowler LA, Gustafson D. Video game play as a fatigue countermeasure in air traffic controllers. Aerosp Med Hum Perform. 2019; 90(6):540–545.