Effects of hypobaric hypoxia on respiratory and motor function in spinal cord injury rats / 解放军医学杂志

Objective To investigate the effect of hypobaric hypoxia on the respiratory function of C5 spinal cord injury rats by simulating the environment of low pressure and low oxygen in air transport. Methods 20 male SD rats were randomly divided into 3 groups: sham operation group (n=4), spinal cord injury group (n=8) and spinal cord injury + low pressure group (n=8). Spinal cord injury model was made by compression method. These rats in the three groups were treated with carotid artery catheterization, and were fed for 24 hours. Spinal cord injury + low pressure group was put into 2500 m low pressure environment for 4 hours. Arterial blood gas, blood routine test, HE staining of the spinal cord and lung tissue were detected to evaluate respiratory function, and BBB score was used to evaluate motor function of rats. Results There was no significant difference between the three groups in pH, oxygen partial pressure, carbon dioxide partial pressure, oxygen saturation, glucose, lactate, alkali surplus, buffer alkali and other indicators (P>0.05). The percentage of reticulocyte in spinal cord injury group was lower than that in sham operation group (2.05%±0.69% vs. 2.88%±0.20%, P=0.034), there was no significant difference between spinal cord injury + low pressure group and other two groups (2.37%±0.59% vs. 2.88%±0.20%, P=0.178; 2.37%±0.59% vs. 2.05%±0.69%, P=0.282). There was no significant difference among the three groups in the leukocyte counts and percentage of neutrophils, lymphocytes, monocytes, erythrocytes, hemoglobin and hematocrit (P>0.05). HE staining showed that there was no obvious bleeding and exudative changes in spinal cord in sham operation group, and the tissue structure was intact. The histological integrity of spinal cord injury group and spinal cord injury + low pressure group was significantly different from that of sham operation group, but there was no significant difference between the two groups. There was no significant difference in bleeding, exudation and edema between the three groups, and the alveolar structure was intact. BBB score showed no significant difference between spinal cord injury group and spinal cord injury + low pressure group (P=0.440). Conclusion The respiratory and motor function of C5 spinal cord injury rats would not be significantly affected by 4 hours of low pressure and hypoxia.

Evacuación aeromédica de pacientes COVID-19. Reporte de casos / Case reports: Aeromedical evacuation of patients COVID-19

BACKGROUND: The aeromedical evacuation in the Chilean Air Force has had an important development in the last 15 years. The coronavirus disease declared as a global pandemic by the WHO has generated the challenge of transferring highly infectious patients to centers of greater complexity. The objective of this article is to report our experience in the transfer of COVID ­ 19 patients in constant attention and medical monitoring. CLINICAL CASE REPORTS: The aeromedical evacuation of 2 COVID-19 patients was performed from the Hanga Roa Hospital, Rapa Nui, to the National Thorax Institute, Metropolitan Region, in a Lockheed Hercules C-130, which corresponds to a pressurized fixed-wing airplane. The transfer was carried out with the corresponding personal protection elements and in individual isolation capsules with advanced negative pressure life support (ISO ­ POD), in order to reduce the level of contagion to the aero sanitary crew and minimize the impact on the flight material used. DISCUSSION: The transfer was carried out achieving all the objectives set out under a strict security protocol and the two COVID-19 patients were transferred successfully. The negative pressure isolation capsule system was safe and reliable, since no crew member presented symptoms or was infected by COVID -19, and also allowed the transfer of highly contagious patients during an 8-hour flight operation.

INTRODUCCIÓN: La evacuación aeromédica en la Fuerza Aérea de Chile ha tenido un importante desarrollo en los últimos 15 años. La enfermedad por coronavirus declarada como pandemia mundial por la OMS ha generado el desafío de trasladar pacientes altamente infecciosos a centros de mayor complejidad. El objetivo de este artículo es reportar nuestra experiencia en el traslado de pacientes COVID ­ 19 en constante atención y monitorización médica. REPORTE DE CASOS CLÍNICOS: Se realizó la evacuación aeromédica de 2 pacientes COVID ­ 19 desde el Hospital de Hanga Roa, Rapa Nui, hacía el Instituto Nacional del Tórax, Región Metropolitana, en un Lockheed Hércules C-130, que corresponde a un avión de ala fija presurizado. El traslado se realizó con los elementos de protección personal correspondientes y en capsulas de aislamiento individual con soporte vital avanzado a presión negativa (ISO ­ POD), con la finalidad de reducir el nivel de contagio a la tripulación aero sanitaria y minimizar el impacto en el material de vuelo utilizado. DISCUSIÓN: El traslado se desarrolló logrando todos los objetivos planteados bajo un estricto protocolo de seguridad y los dos enfermos COVID-19 fueron trasladados de manera exitosa. El sistema de cápsulas de aislamiento a presión negativa fue seguro y confiable, ya que ningún miembro de la tripulación presento sintomatología o resultó contagiado por COVID -19, y además permitió trasladar pacientes altamente contagiosos durante una operación de vuelo de 8 horas.

Simulation training of aeromedical evacuation under international perspective / 医疗卫生装备

The history of aeromedical evacuation was reviewed in the world.Database inquiry was executed to explore the present situation of aeromedical evacuation simulation training from the aspects of the contents, tools and environmental design.The problems were summarized in aeromedical evacuation simulation training in China,and some suggestions were put forward accordingly.It's pointed out that the researches on simulation training is of great significance for the development of aeromedical evacuation in war or non-war conditions.

Study on type selection of ambulance helicopter / 医疗卫生装备

To lay a foundation for the type selection of the ambulance helicopter. The type selection was explored from the aspects of platform selection, rescue environment and service requirements, analyzing the rescue in the helicopter and the tendency of the ambulance helicopter in foreign countries and China. The types of the am-bulance helicopter were determined as the specific and modified ambulances, with the considerations such as operation environment, flight performance, cabin structure, onboard equipment, cabin configuration, fixation device and protection. Specific ambulance helicopter is supposed to be based on small- or mediate-sized platform, while the modi-fied ambulance helicopter is supposed to be based on large or heavy platform.

The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea

OBJECTIVE: Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. METHODS: This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. RESULTS: Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). CONCLUSION: In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.

Aeromedical evacuation of injured hikers in Hong Kong / 世界急诊医学杂志（英文）

@#BACKGROUND: Hiking is a very popular sport in Hong Kong. Serious injuries can sometimes occur in the remote areas not accessible to roads. Aeromedical evacuation service is run by the Government Flying Service (GFS) with emergency physicians and nurses as volunteers in Hong Kong. In this paper we describe the profile and outcome of injured hikers rescued by the GFS. METHODS: In this retrospective review, nature of the complaints, medical team composition, vital signs, clinical assessment and diagnosis on site were collected from the GFS medical record. Demographic data, final diagnoses and outcomes of the patients were retrieved from emergency department (ED) and hospital discharge records. RESULTS: A total of 275 cases were recruited for the 3-year period from January 2003 to December 2005. The mean age of the group was 39 years (range 1-83) with more males (159, 58％) than females. Heat illnesses, injuries and medical problems each constituted about one third of the cases. Lower limb injuries accounted for nearly half of the injuries. About 30％ of the rescued hikers did not register to be seen at the ED. Only 48 hikers (17.5％) required admission and four were admitted to intensive/coronary care units for heat stroke and acute coronary syndrome. Five cases of pre-hospital cardiac arrest were recorded. CONCLUSION: Most hikers evacuated by the GFS did not suffer from serious conditions. GFS should still be prepared for the occasional cases that require advanced life support.