The metrics used to define U.S. Air Force crew rest and flight duty limitations were not designed to manage surge operations such as Operation Desert Shield. Desert Shield provided an opportunity to obtain inflight data on acute and cumulative fatigue and the effect of other stressors during over-the-shoulder observations on 24 C-5 airlift crew members. Findings emphasize how sleep history, recent duty day cycles, subjective fatigue, scheduling patterns, nutrition, and billeting facilities contribute to fatigue and lower levels of alertness. The results of this fairly insignificant observational study attempt to preserve some of the aeromedical lessons of Desert Shield. The flight surgeon authors integrate their experience to outline development of a fatigue management and alertness enhancement doctrine.