Technical Information Center Research Articles

Preface

Eurock has always been an important occasion for the whole rock mechanics community to exchange new ideas, for an update on the latest development in the field and, even more importantly, for meeting active people in this sector.The Italian rock mechanics community was really honored to host such an important event in Turin after more than 20 years since the last Eurock held in Italy. The organizing committee has been working hard to guarantee an event in presence, but the pandemic situation has forced us to prefer an online event to guarantee its realization and the best healthy conditions for all the attendants. The conference has been organized with live sections and downloadable recording material in order to guarantee to all the authors to present their contributions and the attendants the possibility to actively participate in the Symposium. Although having done our best it is evident that this is not comparable with an in-person event especially in Italy. Our country in addition to the well-known heritage sites, natural beauties and gastronomic delights is also a “rocky country” and numerous important works involving rock engineering aspects are ongoing and would have been of extreme interest to participants.Even in this complex condition, most of the authors have confirmed their participation sending more than 200 papers and, as organizers of Eurock 2021, we believe that this conference will further stimulate the rock mechanics community through the development of scientific knowledge and the exchange of technical information. We therefore wish to acknowledge the ISRM board and its President for giving us the opportunity to organise this event in Italy.List of Committees, Editors, Organizing Committee, Scientific Committee, CONFERENCE PICTURES, logos are available in this pdf

Combat and Operational Stress Control Interventions and PTSD: A Systematic Review and Meta-Analysis.

Military personnel must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on deployed service members who are isolated from support systems and other resources. As part of a larger systematic review on the acceptability, efficacy, and comparative effectiveness of interventions designed to prevent, identify, and manage stress reactions, we assessed posttraumatic stress disorder (PTSD) outcomes. We searched the electronic databases PsycINFO, PubMed, PTSDPubs, the Defense Technical Information Center, and Cochrane Central, as well as bibliographies of existing systematic reviews, to identify English-language studies evaluating the efficacy or comparative effectiveness of stress control interventions published since 1990. Controlled trials and cohort comparisons of interventions with military, law enforcement, and first responders were included. Two independent reviewers screened literature using predetermined eligibility criteria. Researchers individually abstracted study-level information and outcome data and assessed the risk of bias of included studies; data were reviewed for accuracy by the project leader. Changes in PTSD symptom scores from baseline to post-intervention were converted to standardized mean differences for comparison across studies. Risk ratios were calculated for PTSD case rates post-deployment. When several studies that compared an intervention group with a similar control/comparator reported the same outcome category and measure type, we conducted meta-analysis. We conducted meta-regression by adding a categorical variable, representing setting (i.e., in theater) or population (military vs. law enforcement or first responders) to the meta-analysis model to assess whether this variable was associated with the outcome across studies. The quality of the body of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers study limitations (risk of bias), directness, consistency, precision, and publication bias. Sixteen controlled trials and 13 cohort comparisons reporting PTSD outcomes met inclusion criteria. Eight controlled trials and two cohort studies had high risk of bias, primarily due to poor, differential, or unknown response rate at follow-up. Twenty-four of the 29 studies included military personnel. Interventions included Acceptance-based Skills training, Attention Bias Modification training, stress inoculation with biofeedback, Critical Incident Stress Debriefing, group psychological debriefing, Eye Movement Desensitization and Reprocessing for sub-clinical stress, embedding mental health providers in theater, Third Location Decompression, reintegration programs, and a 3-week post-deployment residential program for psychological resource strengthening.Meta-analyses of studies comparing a group that received a stress control intervention to a group that did not receive an intervention found no significant difference in reduction in PTSD symptom scores (moderate QoE) or PTSD case rate post-deployment (low QoE). A meta-analysis of studies comparing a specific stress control intervention to an active comparator (usually standard stress management education) found no significant effect on PTSD symptom scores (moderate QoE). Although combat and operational stress control (COSC) interventions may play a valuable role in decreasing stress, decreasing absenteeism, and enabling return to duty, a systematic review of 29 studies that included a control/comparison group found little evidence that COSC is effective in preventing PTSD or decreasing PTSD symptom scores in military personnel.

Risk Factors for Postpartum Depression in Active Duty Women

Postpartum depression (PPD) is a common perinatal complication. Risk factors previously found to correlate with PPD in civilians include prenatal depression, childcare stress, limited social support, difficult infant temperament, and maternity blues. Previously identified risk factors in military spouses include spouse deployment/redeployment cycles. It is unclear if these previously identified risk factors are also a risk factor for AD women or if the additional stressors associated with being on active duty (AD) are risk factors for PPD. The purpose of this review is to determine if civilian risk factors have been found to put AD women at risk for PPD and to identify unique risk factors for PPD in AD women. A scoping literature review was performed using PubMed, Defense Technical Information Center, and PsychINFO. The searches were conducted using relevant medical subject headings and keywords. The inclusion criteria included articles published since 1948 (the year women were legally allowed to join the military) that reference risk factors for postpartum/peripartum depression in AD women serving in the U.S. military. The following exclusion criteria were also applied: in a language other than English, opinion papers, and/or not published in a peer-reviewed journal. Articles meeting criteria were evaluated and mapped to stressors previously identified in the literature for civilian and military spouses with PPD with novel stressors identified as mapping outside this framework. Only two articles met the inclusion criteria. The first study included 87 AD women. The second study, a cohort study between 2001 and 2008, included 1660 AD women. Unique risk factors identified in AD women include previous deployments, serving in the Army, smoking status, alcohol use, and low self-esteem. Few studies have investigated the risk factors for PPD in AD women. It appears that AD women share many risk factors, or variants of those risk factors, for PPD as their civilian and AD spouse counterparts, but there are also unique risks to consider. More work is needed to improve screening and prevention efforts.

Information exchange in governance networks—Who brokers across political divides?

AbstractThe exchange of information among organizations is the lifeblood of governance networks. It is a necessary condition for successful governance. Political divides between organizations often impede information exchange. We ask which organizations are most likely to broker information across political divides. We consider survey (n = 312) evidence of technical information exchange in Swiss water governance. Bayesian exponential random graph modeling results show that scientific organizations play crucial roles for cross‐divide brokerage. To a lesser extent, this also holds for higher‐level governmental agencies. Participation in policy forums is associated with a higher likelihood of brokering across political divides. There is however no clear benefit to participating in more than two or three forums. We conclude that an active role played by scientific organizations is the most promising avenue to increase information flow across political divides. Beyond this, we suggest setting up carefully constructed exchange forums and selectively engaging moderate members of subgroups.

The Defense Technical Information Center: DoD’s Foundation to Store, Manage and Share Scientific Research

ABSTRACT The Defense Technical Information Center (DTIC) celebrates its 75th anniversary in 2020. In that time DTIC has collected, preserved and provided the Department of Defense (DoD) access to its accumulated collection of scientific and technical information. Information formats have changed significantly in three quarters of a century from paper to microfilm/microfiche to electrons. Similar to other information providers, DTIC has needed to adapt and innovate to a new and continually changing technology landscape. In order to keep pace in the information arena, DTIC moved from passively collecting documents on completed research, to actively producing products that expand view of the lifecycle of research, provide collaborative tools, and enable the analysis of trends in budget and research. This article will explore the history, processes, and current services offered by this pioneering and unique information agency. As the organization reflects on its accomplishments, it looks to the future of serving DoD information needs. DTIC will continue to preserve research for use by the DoD scientific community, with an eye toward developing new ways to analyze this body of information.

The Toxicity, Pathophysiology, and Treatment of Acute Hydrazine Propellant Exposure: A Systematic Review.

Hydrazines are highly toxic inorganic liquids that are used as propellants in military and aviation industries, such as the U.S. Air Force F-16 Emergency Power Unit and SpaceX SuperDraco Rockets. The most commonly used derivatives include hydrazine, monomethylhydrazine, and 1,1-dimethylhydrazine (unsymmetrical dimethylhydrazine). Industrial workers in close contact with hydrazines during routine maintenance tasks can be exposed to levels well above the National Institute for Occupational Safety and Health relative exposure limits. A systematic review was performed using PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration Technical Server, and Defense Technical Information Center, and data related to hydrazine exposures were searched from inception to April 2020. Publications or reports addressing hydrazine toxicity, pathophysiology, and treatment of hydrazine fuel exposure were selected. Acute toxic exposures to hydrazine and its derivatives are rare. There are few case reports of acute toxic exposure in humans, and data are largely based on animal studies. The initial search identified 741 articles, manuscripts, and government reports. After screening for eligibility, 51 were included in this review. Eight articles reported acute exposures to hydrazine propellant in humans, and an additional 14 articles reported relevant animal data. Exposure to small amounts of hydrazine and its derivatives can cause significant soft tissue injury, pulmonary injury, seizures, coma, and death. Neurologic presentations can vary based on exposure compound and dose. Decontamination is critical as treatment is mainly supportive. High-dose intravenous pyridoxine has been suggested as treatment for hydrazine-related neurologic toxicity, but this recommendation is based on limited human data. Despite recent research efforts to generate less toxic alternatives to hydrazine fuel, it will likely continue to have a role in military and aviation industries. Aerospace and military physicians should be aware of the toxicity associated with hydrazine exposure and be prepared to treat hydrazine toxicity in at-risk populations.

Digital Twins: Universal Interoperability for the Digital Age

Digital twins will provide a standardized platform for representing real-world objects, enabling a consistent, seamless exchange of technical information and interoperability across domains while reducing risk, increasing safety, and improving efficiency.

FORMS AND METHODS OF INTERSTATE EXCHANGE OF SCIENTIFIC AND TECHNOLOGICAL INFORMATION: RUSSIAN AND FOREIGN EXPERIENCE

Introduction. The purpose of this study is to analyse the forms and methods of interstate exchange of scientific and technical information (STI), in particular, to study the current status of the Russian Federation State STI System (SSTIS RF) as well as bodies responsible for the implementation of the STI system (incl. the CIS Interstate Coordination Council for Scientific and Technical Information (ICCSTI)) and the course of development of interstate cooperation in the exchange of scientific and technical information to ensure the innovative development of Russia. The analysis of international experience in the development of scientific and technical information systems, including the trends in the context of which this development takes place, can help identify possible areas for improvement and determine inconsistencies and development issues for the SSTIS RF. Methods. To assess the interstate exchange of scientific and technical information, a description of the Russian and international practices of information exchange and a general description of the features characteristic of the two systems were prepared. In the framework of the study, the methods of synthesis and analysis were used to generalise and identify the most significant characteristics of cooperation between countries in the exchange of scientific and technical information. Results and Discussion. This study analyses the peculiarities of the forms and methods of interstate STI exchange in Russia and abroad. The operation specifics of the domestic STI system and its structure, supported by the system of standards on information, librarianship and publishing (SIBID), were considered in the context of Russian experience. The peculiarities of the operation of the International Centre for Scientific and Technical Information (ICSTI), which is engaged in the development of international digital information infrastructure in many countries, including Russia, were considered. In terms of international experience of interstate exchange of STI, approaches to standardisation of information exchange are described, in particular, the Information for All programme; the programmes of the EU regional partnership were also considered. This paper also identifies the main tools for national STI systems that enter the global information space. Conclusion. An analysis of the historical aspects and the current state of STI exchange in Russia and abroad revealed shortcomings inherent in the STI system of the Russian Federation: low degree of optimisation in the system, low level of digitalisation and integration of the Russian STI system with systems of other countries. The paper proposes a number of measures for the development of interstate information exchange and cooperation in the field of STI.

災害時危機的状況下における診療基準(Standards of care under austere conditions in the catastrophic disaster setting: formation process and development of Crisis Standards of Care)

要旨【目的および対象】米国で発生，進展してきたCrisis Standards of Careについて，その形成過程を追うとともに，災害医療におけるその必要性を検討する。【結果】2001年9.11同時多発テロ発生以来，米国では通常の災害規模を超えたcatastrophic disasterに際し，圧倒的な需要と供給の不均衡のもと，いかに限られた医療資源を分配するか，という問題がCrisis Standards of Care（CSC）という言葉とともに議論され続けている。いかに判断を下すか，日常診療での判断基準や経験では困難で，その結果生じた不利益に法的制裁を科される可能性もありうる。連邦政府機関からその計画作成のための予算が供出され，現在まで様々な州，自治体でそのプロトコールが作成されている。【結語】CSCは災害医療において極めて重要な概念であり，我が国においてもその導入を検討すべきである。

Climate change perceptions and the adoption of low-carbon agricultural technologies: Evidence from rice production systems in the Yangtze River Basin

Using a sample of 1115 rice farmers, we explored climate change perceptions, adoption of agricultural low-carbon technologies (LCTs), and the determinants influencing rice farmers' climate change adaptation in the Yangtze River Basin (YRB), central China. We built a theoretical framework based on the Theory of Planned Behavior and performed both binary and count estimations to explore the determinants affecting farmers' adoption of LCTs. Our results indicated that most rice farmers strongly agreed they observed shifting local weather conditions (52.74% of respondents) and irregular rainfall patterns (52.56%) within the last year. Further, over two-thirds of the respondents perceived that agricultural production contributes to climate variability (26.73% strongly agreed, and 40.54% agreed with that statement). In terms of the adoption intensity of LCTs, we found that about 96% of rice farmers implemented at least one low-carbon technology. Importantly, farmers' perceptions of climate change were positively associated with climate change adaptation. Other significant predictors of climate change adaptation included gender, years of experience, access to agricultural training through extension services, exchange of technical information among farmers, and access to mobile networks and postal services. We underlined policy recommendations that may accelerate climate change adaptation in rice production and complement current agricultural low-carbon programs in China.

Airway Clearance Using Suction Devices in Prehospital Combat Casualty Care: A Systematic Review.

Airway management is at the forefront for combat medics dealing with battlefield trauma. For military service members, compromised airways are the second leading cause of potentially survivable death on the battlefield, accounting for one in ten preventable combat deaths. Effective suction is a critical component of airway clearance. However, currently available devices are too heavy and bulky to be carried by combat medics and are insufficiently powered. The industry has not responded to the need, with companies continuing to produce models using 1970s technology. A literature review was completed with the assistance of a librarian. The databases searched included: Biomedical Research Database (BRD), Computer Retrieval of Information of Scientific Projects (CRISP), Federal Research in Progress (FEDRIP), Defense Technical Information Center (DTIC), Pub Med/Medline, and OVID. Additionally, a Google Scholar search was performed to identify nonstandard sources. After screening, a total of 40 articles were used. There were no randomized controlled trials or other high-quality evidence that addressed the issues; there was limited peer-reviewed literature on the use, effectiveness, adverse effects, and safety of suction for use in combat casualty care. A review of the available literature revealed no standards, either proposed, validated, or accepted, for the safety or avoidance of adverse effects for portable suction device use in combat casualty care. Similarly, there are no accepted standards to guide the safe use and anticipated adverse effects of suction for use in prehospital combat or emergency care. Nevertheless, there are meaningful data that can be extracted from the few studies available combined with non-clinical studies, narrative reviews and case reports, and expert opinions.

FOREIGN TRADE RELATIONS AND INNOVATION IN THE UNITED STATES

A trend has been identified that reflects a close correlation between the main indicators of US foreign trade and innovation activities carried out in the modern American economy. The article shows the essence of the national innovation system established in the United States and its international significance in the implementation of foreign trade relations of the country in terms of the exchange of scientific and technical information and documentation, the sale of products with a high innovative component, determined by a comparative analysis of relevant indicators. Based on the results of the study noted the positive dynamics of the active foreign trade balance of the USA in the field of exchange of scientific and technical information and documentation, with a high positive balance, the conclusions about the qualitative dominance of the leading industries of the U.S. economy in terms of aggregate innovation and foreign trade activity in ten leading countries of the world.

Welding Fumes, a Risk Factor for Lung Diseases.

(1) Background: Welding fumes (WFs) are composed of fine and ultrafine particles, which may reach the distal airways and represent a risk factor for respiratory diseases. (2) Methods: In vitro and in vivo studies to understand WFs pathogenesis were selected. Epidemiological studies, original articles, review, and meta-analysis to examine solely respiratory disease in welders were included. A systematic literature search, using PubMed, National Institute for Occupational Safety and Health Technical Information Center (NIOSHTIC), and Web of Science databases, was performed. (3) Results: Dose, time of exposure, and composition of WFs affect lung injury. Inflammation, lung defense suppression, oxidative stress, DNA damage, and genotoxic effects were observed after exposure both to mild and stainless steel WFs. (4) Conclusions: The detection of lung diseases associated with specific occupational exposure is crucial as complete avoidance or reduction of the exposure is difficult to achieve. Further studies in the area of particle research may aid the understanding of mechanisms involved in welding-related lung disease and to expand knowledge in welding-related cardiovascular diseases.

An Analysis of After Action Reports From Texas Hurricanes in 2005 and 2017.

To review and analyze After Action Reports from jurisdictions in Texas following Hurricanes Katrina and Rita in 2005 and Hurricane Harvey in 2017 in order to assess the utility of AARs as a quality improvement measurement tool. The authors searched the Homeland Security Digital Library, the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange, and Google Scholar for any AARs that covered the response phase of at least one of the 3 hurricanes, mentioned the state of Texas, and suggested solutions to problems. The authors applied public health emergency management (PHEM) domains, as outlined by Rose et al, to frame the AAR analysis. AARs were coded by 2 reviewers independently, with a third acting as adjudicator. As an example, the problem statements in 2005 and 2017 AARs from 1 statewide agency were compared. Sixteen AARs met the inclusion criteria. There were 500 identified problem-solution sets mapped to a PHEM domain. The content was unevenly distributed, with most issues coming under PHEM 2: Policies, Plans, Procedures, and Partnerships at 45.2% in the 2005 hurricanes and 39.9% in 2017. AARs lacked consistent format and were often prepared by the response agencies themselves. Five consistent issues were raised in 2005 and again in 2017. These were volunteer management and credential verification, donations management, information sharing, appropriately identifying those requiring a medical needs shelter, and inadequate transportation to support evacuation. Because of the lack of objective data, inconsistent format, unevenly distributed content, and lack of adherence to any framework, AARs are fraught with shortcomings as a tool for PHEM. Inclusion of more objective reporting measures is urgently needed.

The interactive methods and principles of foreign language teaching

English language is very important nowadays. More and more people need English to attend universities and colleges, because now everybody have an opportunity to get higher education abroad. New ideas in science and medicine happen so quickly that it is impossible to translate everything into different languages. International relations are extended and strength­ened through the exchange of scientific, technical, and cultural information. In this situation, foreign language teaching is a matter of state significance. Teachers of foreign languages make their contribution to all aspects of education of pupils. There are some useful principles and methods of teaching foreign languages. Their role in the upbringing of the younger generation cannot be overestimated. The interactive methods of foreign language teaching is not only new or mysterious, new techniques but also new forms, new principles, new approaches, new methods in teaching process. Interactive training encourages and gives learners to create comfortable condition of learning, also learners feel their successfulness, develop creativity, intellectual and communicative abilities.

Экспортный контроль как инструмент поддержания лидерства США в меняющемся мире

В статье рассматриваются особенности американской системы экспортного контроля над товарами и технологиями двойного назначения, позволившие ей стать важным инструментом обеспечения национальной безопасности и внешней политики. Используя системно-исторический и системно-функциональный подходы, автор ставит задачу проанализировать эволюцию экспортного контроля сквозь призму изменений в американской концепции национальной безопасности США, а также исследовать, почему система, созданная в годы холодный войны, оказалась настолько востребованной в наши дни. Вокруг правил ЭК идет острая внутриполитическая борьба. Ведущие ведомства, поддерживаемые отдельными группами политической элиты, стараются навязать свои стратегические приоритеты. Деловые круги и научное сообщество рассматривают экспортный контроль как ограничительную меру, лоббируя смягчение режима. В статье обозначены три периода: период холодной войны, 1990-е – первое десятилетие 2000-х годов, современный этап. Это разделение достаточно условно. В рамках каждого этапа автор рассматривает развороты к ослаблению и ужесточению режима экспортного регулирования по соображениям национальной безопасности и внешней политики, факторы политического, военно-стратегического и экономического характера, дающие толчок к переоценке Соединенными Штатами концепции национальной безопасности. Особое внимание уделено политике экспортного контроля на современном этапе. Качественно расширяется трактовка национальной безопасности США вследствие дисперсии вызовов и угроз их глобальному лидерству. Эволюция режима экспортного контроля используется как механизм поддержания лидерства США в меняющемся мире, реорганизации мирового порядка в интересах США.

Influence of a Multitask Paradigm on Motor and Cognitive Performance of Military and Law Enforcement Personnel: A Systematic Review.

To review the current literature investigating if performance of tactical athletes under multitask paradigms is different than performance under single-task paradigms. The authors completed a search of the literature published from January 01, 2000, to June 01, 2018, using key search terms in PubMed, Web of Science, SPORTDiscus, and Defense Technical Information Center (DTIC) databases. Studies that met inclusion and exclusion criteria were assessed for quality. Fourteen articles were identified as eligible to be included in the review. Compared with single-task, two studies reported better motor performance, six reported poorer motor performance, and three reported no difference in motor performance under multitask. Compared with single- task, two studies reported better cognitive performance, seven studies reported poorer cognitive performance, and three studies reported no difference in cognitive performance under multitask. As occupational duties become increasingly demanding, it is crucial to modify and adapt performance assessments to meet the needs required of tactical athletes to guide training and injury management programs. Motor and cognitive assessments are an integral part of performance evaluations to train, prepare, and rehabilitate tactical athletes. To meet the modern demands of tactical athletes, varying levels of difficulty in multitask paradigms that include both motor and cognitive tasks should be investigated to understand fundamental performance under operational settings to better translate across training paradigms and rehabilitation programs.

National Systems of Scientific and Technical Information Have Potential for the Development of Scientific Diplomacy in the CIS

This paper gives an assessment of the current state of national systems of scientific and technical information (NSs STI) in the categories of regulatory framework; government model; and structure. There is a general tendency for the CIS countries to the achievement of sustainable economic development by each state through the formation and implementation of state policy, including by increasing the role of science and technology and introducing innovations in accordance with the strategic and tactical tasks of the scientific and technological development of the countries. The development of national STI systems helps to improve the exchange of scientific and technical information, the formation of common scientific interests, and the expansion of international cooperation. Scientific and technical information resources that are concentrated in the national STI systems are the main potential for the development of scientific diplomacy and integration of the CIS member states into the information space. A proposal is formulated on the feasibility of creating a specialized electronic interdepartmental information and analytical system covering federal ministries, academies of sciences, scientific foundations, development institutions (with powers and finances for coordinated competitions), research institutes, universities and other organizations in the international sphere of scientific and technical cooperation in general and, in particular, in the CIS. Such a system will contribute to the coordination of planning joint projects, financing, the development of scientific state expertise, selection of promising research areas, topics of competitions and evaluation of the results of research and development. The format of bilateral international cooperation in joint scientific projects of the CIS countries is a promising mechanism for scientific diplomacy, introduction of innovations aimed at integrating the scientific and technological space of the CIS, and helping to strengthen the security of each CIS member state and the Commonwealth as a whole.

Retrospective and Prospective Look at Aflatoxin Research and Development from a Practical Standpoint.

Among the array of structurally and toxicologically diverse mycotoxins, aflatoxins have attracted the most interest of scientific research due to their high toxicity and incidence in foods and feeds. Despite the undeniable progress made in various aspects related to aflatoxins, the ultimate goal consisting of reducing the associated public health risks worldwide is far from being reached due to multiplicity of social, political, economic, geographic, climatic, and development factors. However, a reasonable degree of health protection is attained in industrialized countries owing to their scientific, administrative, and financial capacities allowing them to use high-tech agricultural management systems. Less fortunate situations exist in equatorial and sub-equatorial developing countries mainly practicing traditional agriculture managed by smallholders for subsistence, and where the climate is suitable for mould growth and aflatoxin production. This situation worsens due to climatic change producing conditions increasingly suitable for aflatoxigenic mould growth and toxin production. Accordingly, it is difficult to harmonize the regulatory standards of aflatoxins worldwide, which prevents agri-foods of developing countries from accessing the markets of industrialized countries. To tackle the multi-faceted aflatoxin problem, actions should be taken collectively by the international community involving scientific research, technological and social development, environment protection, awareness promotion, etc. International cooperation should foster technology transfer and exchange of pertinent technical information. This review presents the main historical discoveries leading to our present knowledge on aflatoxins and the challenges that should be addressed presently and in the future at various levels to ensure higher health protection for everybody. In short, it aims to elucidate where we come from and where we should go in terms of aflatoxin research/development.

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review.

Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases. PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines. The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles. The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.