"Aeromedical"

INTRODUCTION: Coronary artery disease (CAD) is the leading cause of denial or withdrawal of flying privileges for aircrew. Screening for CAD is therefore crucial. The present study analyzed German military aircrew with diagnosed CAD and/or acute coronary syndrome despite close medical monitoring with the intention to further optimize individual outcomes and aeromedical disposition. METHODS: The digital information systems of the German Air Force Centre of Aerospace Medicine were searched for pilots and nonpilot aircrew with CAD and/or myocardial infarction (MI)...

Lateral epicondylitis is a degenerative condition affecting the origin of the extensor tendon in the forearm. It is the primary etiology of elbow pain in adults and is also a frequently reported ailment in various occupational sectors. Herein, we present a case of lateral epicondylitis in an airline pilot. The etiology was supposed to be the frequent and prolonged use of throttle levers in the at-risk limb position, i.e., forearm pronation and wrist dorsiflexion. Despite limited treatment options due to aeromedical standards, the patient recovered after approximately one month, primarily by means of physical therapy and improving the working posture...

INTRODUCTION: Dynamic preload assessment measures including pulse pressure variation (PPV), stroke volume variation (SVV), pleth variability index (PVI), and hypotension prediction index (HPI) have been utilized clinically to guide fluid management decisions in critically ill patients. These values aid in the balance of correcting hypotension while avoiding over-resuscitation leading to respiratory failure and increased mortality. However, these measures have not been previously validated at altitude or in those with temporary abdominal closure (TAC)...

INTRODUCTION: Emergent clinical care and patient movements through the military evacuation system improves survival. Patient management differs when transporting from the point-of-injury (POI) to the first medical treatment facility (MTF) versus transporting from the Role 2 to the Role 3 MTF secondary to care rendered within the MTF, including surgery and advanced resuscitation. The objective of this study was to describe care provided to patients during theater inter-facility transports and compare with pre-hospital transports (POI to first MTF)...

BACKGROUND: Head trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma...

INTRODUCTION: This study sought to examine the efficacy of integrating medical device alarms into the intercommunication set of a simulated HH-60, allowing medics to hear the alarms over the ambient noise of the aeromedical environment. MATERIALS AND METHODS: U.S. Army critical care flight paramedics were recruited as subjects for this study. Subjects participated in two testing scenarios: One with patient monitor alarms integrated into their communication lines and one without integrated alarms (the control condition)...

INTRODUCTION: Early enteral feeding in critically ill/injured patients promotes gut integrity and immunocompetence and reduces infections and intensive care unit/hospital stays. Aeromedical evacuation (AE) often takes place concurrently. As a result, AE and early enteral feeding should be inseparable. MATERIALS AND METHODS: This retrospective descriptive study employed AE enteral nutrition (EN) data (2007-2019) collected from patients who were U.S. citizens and mechanically ventilated...

INTRODUCTION: Negative pressure wound therapy (NPWT) is utilized early after soft tissue injury to promote tissue granulation and wound contraction. Early post-injury transfers via aeromedical evacuation (AE) to definitive care centers may actually induce wound bacterial proliferation. However, the effectiveness of NPWT or instillation NPWT in limiting bacterial proliferation during post-injury AE has not been studied. We hypothesized that instillation NPWT during simulated AE would decrease bacterial colonization within simple and complex soft tissue wounds...

INTRODUCTION: Military flight surgeons evaluating aviators for flight fitness based on the cervical spine range of motion (CROM) have no operationally relevant reference with which to make a reliable determination. The published physiological limits for the general population do not necessarily apply to military aviators. CROM requirements for rotary-wing aviators would ideally be defined by measurements taken directly within their operational environment. MATERIALS AND METHODS: Nine subjects performed the same predetermined 1-hour flight mission in a UH-60 aircraft and then, at least 2 days later, in the U...

INTRODUCTION: Understanding usage patterns of current paper-based documentation can inform the development of electronic documentation forms for en route care. The primary objective was to analyze the frequency of use of each field within the 3899 L Patient Movement Record documented by en route Critical Care Air Transport Teams. Secondary objectives were to identify rarely utilized form fields and to analyze the proportion of verifiable major events documented within the 3899 L form...

OBJECTIVE: To assess timeliness, efficiency, health outcomes and cost-effectiveness of the 2018 redesigned Central Australian aeromedical retrieval model. DESIGN: Pre- and postimplementation observational study of all patients receiving telehealth consultations from remote medical practitioners (RMPs) or Medical Retrieval and Consultation Centre (MRaCC) physicians between 1/1/2015 and 29/2/2020. Descriptive and inferential statistics measuring system efficiency, timeliness, health outcomes and incremental cost-effectiveness...

AIM: This retrospective review examined the introduction of bubble Continuous Positive Airway Pressure (bCPAP) in resuscitating neonates in a rural hospital environment. METHODS: A retrospective audit of all emergent neonatal presentations to a rural emergency department (ED) over a 5-year period prior to (pre) and a 3.5-year period following the introduction of bCPAP (post). RESULTS: Sixty-seven neonatal resuscitations (31 pre- and 36 post-introduction of bCPAP) were reviewed, having an average gestation of 37...

Combat penetrating brain injury (PBI) differs significantly from PBI in civilian environments. Differences include technical factors such as the weapons involved, strained resource environments, and limited medical materials and human resources available. Ethical issues regarding the management of PBI in military settings may occur. This case study examines the case of a 20-year-old member of the French Armed Forces that suffered a penetrating brain injury in a combat situation. The four-quadrant method along with the four principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) was used to analyze this case and to apply ethics to the practice of military medicine...

INTRODUCTION: Excessive daytime sleepiness (EDS) is often associated with decreased work performance and fatigue in civil pilots. However, aeromedical recommendations for the evaluation of EDS are associated with suspicion of obstructive sleep apnea (OSA). Currently, many studies have found an association between obesity and EDS, regardless of OSA. This study aims to determine whether there is a relationship between obesity and EDS in Indonesian civilian pilots, as well as its risks for developing OSA. METHODS: This study used a cross-sectional design and was carried out at the Directorate General Civil Aviation Medical...

BACKGROUND: Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. METHODS: The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study...

BACKGROUND: For critically ill and injured patients, timely access to definitive care is associated with a reduction in avoidable mortality. Access to definitive care is significantly affected by geographic remoteness. To overcome this disparity, a robust critical care transport (CCT) or retrieval system is essential to support the equity of care and overcome the tyranny of distance. While critical care transport or retrieval systems have evolved over the years, there is no universally accepted system or standard, which has led to considerable variation in practices...

Operations in the Middle East have slowed, and near-peer tensions escalate. The U.S. Military has directed its attention from combating insurgencies toward preparedness for large-scale combat operations (LSCOs). The threat of LSCO demands a dramatic shift in strategy and resource and has raised questions about how the military will pivot from the counter-insurgency operations of the previous two decades. Innovation and change are needed to adequately receive, treat, hold, and transport the high volume of anticipated casualties in LSCO...

INTRODUCTION: Fatigue is a major contributor to aviation accidents. Sufficient sleep may be difficult to achieve under operational conditions in military aviation. Countermeasures include caffeine, however, studies evaluating its effects often do not represent daily practice with regular caffeine consumption. This study aims to establish the effect of caffeine on psychomotor performance in a realistic scenario (i.e., after a limited period of extended wakefulness). METHODS: This randomized, double-blind, crossover, placebo-controlled trial included 30 aeromedically fit subjects...

INTRODUCTION: Organizational proficiency increases with experience, which is known as a learning curve. A theoretical peacetime effect occurs when knowledge and skills degrade during peacetime. In this study, the intertheater evacuation system was examined for evidence of a military learning curve and peacetime effect. MATERIALS AND METHODS: Data on medical evacuations from U.S. Central Command occurring between January 1, 2003, and December 31, 2022, were acquired from the TRANSCOM Regulating and Command & Control Evacuation System...

INTRODUCTION: The War in Afghanistan ended in August 2021. Evacuation from the country was a large effort during the last days of the conflict. During evacuation efforts at Kabul Hamid Karzai International Airport, a suicide bombing occurred necessitating emergent medical care for many injured troops and civilians. The U.S. Air Force Critical Care Air Transport Teams (CCATTs) played a role in the medical care provided during the operations in Afghanistan. We report on in-flight events and interventions that took place during the final days of the Afghanistan withdrawal...