Airborne Rescue Research Articles

Emergency Service Assistance for Injuries on Alpine Ski Slopes: A Cross-Sectional Study.

Injuries on alpine ski slopes have been described in cohorts of a reasonable sample size, but constant improvements in safety gear, increased use of airborne rescue, and safety measures during the coronavirus disease 2019 (COVID-19) pandemic mandate re-evaluation. Therefore, the purpose of this study was to evaluate skiing and snowboarding injuries, effectiveness of airborne rescue, and impact of the COVID-19 pandemic on a large sample size. Data on alpine injuries were prospectively collected from the state emergency services dispatch center in the state of Tyrol (Austria). A total of 10,143 patients were identified, with an average age of 33.5 years (SD = 20.36). The ski patrol was involved in 8,606 cases (84.9%) and some patients (n = 1,536; 15.1%) required helicopter rescue. A total of 10,143 patients were identified from the dataset of the emergency dispatch center. The most frequently injured region was the knee (30.2%), and it was followed by the shoulder (12.9%), the lower leg (9.5%), and the head/skull (9.5%). The present findings indicate that the most frequent site of injuries on alpine slopes is the knee, and life-threatening injuries are rare. Airborne rescue is very time-effective, however clinical studies with patient follow-up should be emphasized to determine the impact of airborne rescue on patient outcome. The present findings indicate that the duration of all rescue operations has been prolonged as a result of the introduction of safety measures during the COVID-19 pandemic.

Cortisol awakening response in the airborne rescue service.

Work-related stress may lead to mental and physical illnesses. Emergency physicians may be particularly vulnerable to developing such diseases due to their extreme emotional working environment. The purpose of the study was to analyse the hormonal stress burden of emergency physicians in the airborne rescue service to create an empirical basis for developing appropriate measures against chronic stress in the rescue service. Three salivary cortisol samples were collected after awakening in 15 min intervals-each on a flight rescue day, a clinic day and a free day-to calculate the extent of the hormonal stress load of the emergency physicians. A nested linear mixed-model analysis was used in 40 cases to investigate hormonal stress. Furthermore, professional years and gender were included in the calculations. The mixed model showed neither a main effect for measurement time nor for day but a significant interaction effect (P = 0.002). The cortisol level rises strongly on the flight rescue and the clinic day, while on the free day it shows a moderate increase. Professional years and gender also proved to be statistically significant for the cortisol level of emergency physicians (P < 0.001). The results show a significantly higher cortisol increase on working days compared with a free day, which indicates a stronger stress burden on working days of emergency physicians in the airborne rescue service. Future studies should examine the stress level of emergency physicians in more detail to prove whether the working conditions of emergency physicians need to be modified.

Aeromedical evacuation of a COVID-19 patient from a zonal hospital: A case report

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected the whole world including many healthcare workers. In this era of ongoing global pandemic, the patient surge for aeromedical evacuation is going to increase. Case Details: A 54-year, male healthcare worker with no known co-morbidities, presented with complains of fever, myalgia, and sore throat at a zonal hospital of Indian Air Force in the northeast part of India. He was diagnosed with COVID-19 related bilateral extensive pneumonia. Despite of standard treatment, his condition deteriorated. An aeromedical evacuation of the patient was carried out to a tertiary healthcare centre at Delhi which involved 4-h of flying time. The Airborne Rescue Pod for Isolated Transportation (ARPIT) isolation pod was used to minimize the risk of contamination. Discussion: This was the first time that a COVID-19 patient was air evacuated in an isolation pod in Indian Armed Forces to the best of our knowledge. Based on our experience, we recommend that air evacuation of such a patient may be resorted to only as a life saving measure. The use of an isolation pod remains an unsettled issue; whereas, it gives absolute containment to spread of infection, it poses unique challenges in terms of handling the patient in case of an in-flight emergency. Certain modifications in the isolation pod have been recommended.

Hormonal and Subjectively Perceived Stress of the Emergency Physicians of the Airborne Rescue Service

Due to their work activities, emergency physicians are regularly exposed to exceptional mental and physical situations. In order to prevent stress-related illnesses, the triggers of hormonal and subjectively perceived stress must be understood better. On a sample of emergency physicians from two air rescue services (N = 80), the cortisol awakening response (CAR) was determined on flight rescue days, clinic days, and days off. Pearson correlations showed significant connections between the CAR on flight rescue days and individual scales of the Trier Inventory for Chronic Stress (TICS) and the Perceived Stress Scale (PSS). The results indicate that a lower subjective stress level is associated with higher levels of hormonal stress. Stepwise regression analyses showed a significant influence of the number of professional years, subjectively perceived stress, pressure to succeed, and social isolation. The results suggest that the hormonal stress burden of emergency physicians is in a complex relationship with perceived strain.

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study

BackgroundFlight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.MethodsAmong a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.ResultsFor helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8–30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1–7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06–3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48–9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21–4.31, p = 0.011) to be significantly associated with neck pain.ConclusionsThe 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.

Military Medicine Needs Reliable Clinical Signs and Tests to Guide Prognosis and Management

During missions abroad, military physicians face very special circumstances to provide care for wounded and ill comrades. These circumstances are defined by the need to provide the best possible, state-of-the-art care, which is undoubtedly the main goal of their duty. However, the clinical setting situated in or near the combat zone has several limitations, all of which must to be taken into account. This is especially relevant to military medicine as working with notoriously scarce resources has always been one of the main challenges since its beginnings. However, this burden is not unique to military physicians. Limited resources, especially in developing countries and rural areas, affect medical personnel around the world in various manners. The diagnostic possibilities in a military medical facility are limited. For example, the German role 3 field hospital in Mazar-e-Sharif, International SecurityAssistance Force (ISAF), is comparably well equipped with 1 computed tomography unit in addition to standard X-ray devices. However, when it comes to soft-tissue diagnostics, the borders of radiological capabilities are quickly reached. Magnetic resonance imaging as the accepted gold standard for most of these entities (e.g., muscle trauma) is not available. This limitation also affects the local population, which is a major stakeholder for the mission’s success and in many cases dependent on the care of ISAF-medical facilities. In smaller combat care units, such as forward surgical teams or airborne rescue stations, the situation is sharpened because these facilities are even less equipped attributable to tactical demands. German patrols in the deep hinterlands, e.g., in ISAF Observation Post North, are mostly covered by an embedded emergency physician. This physician is responsible for the provision of combat care as well as the provision of care to the local population in areas that are sometimes unattended by a modern physician for decades. Thus, the physical examination skills of the modern military physician must be broad and well trained. This means that the military medical community is desperately in need of reliable and accurate clinical signs and tests, which can compensate the aforementioned limitations to the highest possible degree. However, it is not enough to introduce and train a variety of clinical tests and signs. To provide the best possible care for military personnel and the local population, tests and signs have to be evidence-based and should be developed and validated with a data-driven and statistically sound, highquality approach.Well-designed diagnostic studies are needed to validate the current set of clinical tests and signs and to further develop and introduce new tests. Surprisingly, the manner of carrying out these studies is still a matter of controversy. In 2003, Bossuyt et al introduced a set of well-chosen approaches, which are summarized as the “STAndards for the Reporting of Diagnostic Accuracy Studies” (STARD)-guidelines. These guidelines provide useful advice for the analysis and publication of data, but the biostatistical “tool-box” is not clearly outlined. This is perhaps one of the reasons why a recent investigation revealed no changes in the reporting of diagnostic accuracy studies since the introduction of the STARD-guidelines. Hess et al recently published a recommended summary focusing primarily on biostatistical methods. The authors presented strategies to determine the sample size or study population that are necessary for critical prospective power (more than 90%) and presented methods for the evaluation of new diagnostic tests in the absence of a gold standard. Taken together, the main key factors which have to be considered before starting a diagnostic study are as follows:

Prehospital Injury Severity of Children Evacuated by Helicopters from Combat Zones: A Retrospective Report

BackgroundIn Israel, the Airborne Rescue and Evacuation Unit (AREU) provides prehospital trauma care in times of peace and during times of armed conflict. In peacetime, the AREU transports children who were involved in motor vehicle collisions (MVC) and those who fall off cliffs (FOC). During armed conflict, the AREU evacuates children who sustain firearm injuries (FI) from the fighting zones. ObjectiveTo report on prehospital injury severity of children who were evacuated by the AREU from combat zones. MethodsA retrospective comparative analysis was conducted on indicators of prehospital injury severity for patients who had MVC, FOC, and FI. It included the National Advisory Committee for Aeronautics (NACA) score, the Glasgow Coma Scale (GCS) score on scene, and the number of procedures performed by emergency medical personnel and by the AREU air-crew. ResultsFrom January 2003 to December 2009, 36 MVC, 25 FOC, and 17 FI children were transported from the scene by the AREU. Five patients were dead at the scene: 1 (2.8%) MVC, 1 (4%) FOC, and 3 (17.6%) FI. Two (11.7%) FI patients were dead on arrival at the hospital. MVC, FOC, and FI patients had mean (±SD) NACA scores of 4.4 ± 1.2, 3.6 ± 1.2, and 5 ± 0.7, respectively. Mean (±SD) GCS scores were 8.9 ± 5.6, 13.6 ± 4, and 6.9 ± 5.3, respectively. Life support interventions were required by 29 (80.6%) MVC, 3 (12%) FOC, and 15 (88.2%) FI patients. ConclusionsIn the prehospital setting, children evacuated from combat zones were more severely injured than children who were transported from the scene during peacetime.

Aero-Medical Evacuation From the Second Israel—Lebanon War: A Descriptive Study

The second Lebanon war started as a limited operation and progressed to a large-scale campaign. Most of the fighting took place in mountainous villages and small towns inhabited with civilians. The Israeli Defense Forces (IDF) Airborne rescue and evacuation unit is charged with air evacuation of soldiers and civilians in times of peace, limited conflict, and war. We describe this unit's activities in the second Lebanon war, analyzing injury, treatment, and evacuation characteristics Data were collected from flight medical reports, debriefings of aero-medical team members (usually immediately upon return from mission), ground units medical reports and debriefings, and hospital records. 725 IDF soldiers were injured and 117 killed either in Lebanon or near the Israeli-Lebanese border during the war. A total of 338 (46%) were evacuated in 95 airlifts (averaging 4.5 evacuees per airlift) from the fighting zones or the border. Air evacuation used dedicated helicopters with advanced care capacities, and most victims were evacuated straight from the battlefield, as the fighting was ensuing. Many wounded first received advanced medical care upon the arrival of the aero-medical teams. In military operations within civilian populated areas with threats to ground transport, air evacuation can sometimes be the only readily available option. Providing timely ground advanced medical care proved difficult in many instances. Thus, for many, the rescue helicopter was the first point of access to such care. Aero-medical aircrafts and personnel faced threats from gunfire and missiles, causing both delays in evacuation and a high average number of evacuees per airlift. This article proposes ways of coping with situations in which similar rescue and evacuation problems are likely.

Katrina, the Tsunami, and Point-of-Care Testing: Optimizing Rapid Response Diagnosis in Disasters

We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.

Katrina, the Tsunami, and Point-of-Care Testing

We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.

Bedside blood gas analysis in airborne rescue operations

The alveolar partial oxygen pressure (P ao 2) recorded from 20 ventilated patients was found to decrease by 16 mm Hg during airborne rescue helicopter transport at an average altitude of 1780 feet mean sea level. The initial departure altitude was 192 feet, and the flight ascended to 2200 feet above ground level. Hence, the P ao 2 drop in patients was exclusively attributable to cruising altitude (atmospheric pressure = -42 mm Hg). Pathophysiological alterations include drops in the oxygenation index (-50 mm Hg), arterial partial oxygen pressure (-34 mm Hg), and heart rate (+7 beats per minute) and are attributable to growing disproportions in ventilation and perfusion. The absolute P ao 2 level does depend largely on the F io 2 value.