[Prophylactic medicine--a foreground direction of medical support of the air staff of aviation of the Armed Forces of Russian Federation]

The first prophylaxis of chronic not-infection diseases obtains more and more value. Level of these diseases among air staff is rather high and has a tendency of increasing. It's bounded up with defects in the system of the first medical unit, insufficient conducting of ecological and sanitarium-hygiene screening and taking steps on decreasing of the influence of noxious agent on the human organism, improvement of working conditions of air specialists, decreasing of the value of psychoemotional stress and other factors. An important factor during the conducting the first and the second prophylaxis is an early detection of changes in health by the air staff and technical-engineer staff, diagnostics of diseases on early stages, when they conduct without any symptoms, forehanded rehabilitation and treatment.

Inter-professional working in the RAF Critical Care Air Support Team (CCAST)

OBJECTIVE

To understand working relationships between doctors and nurses in the (UK) Royal Air Force (RAF).

METHODS

Qualitative, semi-structured interviews.

SAMPLE

Six nurses and five anaesthetists from the RAF Critical Care Air Support Team were interviewed.

FINDINGS

A variety of factors had an effect on inter-professional dynamics between anaesthetists and nurses within CCAST.

DISCUSSION

The military setting makes this relationship different from that which has been observed in the National Health Service (NHS) and reported in the literature. An area which had not been analysed before in terms of doctor-nurse relationships debate is the issue of personality. This research shows it to be a significant issue in this relationship, for both groups of professionals.

The role of psychiatry in U.S. Air Force primary care: research-based models for clinical consultation and education

The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and data-driven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.

Could simulated emergency procedures practised in a static environment improve the clinical performance of a Critical Care Air Support Team (CCAST)? A literature review

OBJECTIVE

The Royal Air Force Critical Care Air Support Teams (CCASTs) have a philosophy to undertake transfers of critically ill patients from anywhere in the world back to a UK medical facility in a stable or improved clinical condition. The training they receive is primarily taught by traditional didactic methods, with no standardisation of education between teams that are expected to deliver care to the same standard. Notwithstanding there being no current compromise to patient care during air transfer, it was important to consider the benefits of an alternative experiential teaching modality. Experiential learning utilised in the static environment could potentially improve the current CCAST training curriculum and, therefore, improve clinical performance during air transfer.

METHOD

In the absence of primary research evidence investigating beneficial teaching modalities for medical flight crews, a review of recent literature was undertaken to observe any potential relevance to the aeromedical specialty. This critical review examined recent quantitative research on various modalities of experiential learning and their influence on the critical thinking, higher cognitive and psychomotor skill acquisition by healthcare professionals in a static hospital environment. The main databases were interrogated using the following inclusion criteria: patient simulation, clinical competence, aeromedical, education, computer simulation, critical thinking and problem-based learning. The number of articles obtained was 13; these were coded on methodological strength to reduce the potential for inclusion bias. Nine studies were finally selected for review.

RESULTS

Many small studies have been undertaken, primarily observing benefits of experiential learning to medical students and doctors. No studies show conclusively that simulated learning improves patient outcome, but the body of evidence suggests human patient simulators to be advantageous over other modalities because of their realistic recreation of critical events. They have proven to be at least as effective as traditional teaching by didactic methods.

CONCLUSION

For CCASTs to have a standardised training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practised, on demand, in a safe environment as an augmentation to the current training programme. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care.

Collaboration in practice--assessment of an RAF CCAST

Aeromedical evacuation of critically ill patients by the Royal Air Force is undertaken in a complex healthcare environment--one which demands effective teamwork to achieve the best possible outcome for the patient. A military team cannot rely purely on rank structure to guarantee a disciplined and efficient working unit. Furthermore, personnel must acknowledge the many potential hindrances of a Critical Care Air Support Team (CCAST) working environment that can affect optimal performance. These include: fatigue as a result of extended hours of duty; effects of altitude; isolation; and entering war zones, all of which may negatively affect motivation, stress and communication. This article reviews and discusses adaptation strategies utilised by a CCAST to overcome these obstacles. The importance of role equality within a team and the subsequent feeling of value this promotes, effective communication and positive "can do" attitudes contribute to making the team work.

Physician roles in aeromedical evacuation: current practices in USAF operations

Physicians play an increasingly important role in the critical medical process of aeromedical evacuation (AE). Incomplete or inappropriate preparation for AE can result in increased patient discomfort, and in the worst cases, potentially serious or insurmountable in-flight medical problems. During military operations and in response to natural disasters, physicians are responsible for four processes necessary for a successful AE mission. These include: 1) AE screening, including determination of appropriate classification, precedence, and special medical requirements; 2) validation; 3) medical preparation; and 4) clearance. Physicians responsible for preparing patients for AE need to understand both the patient evacuation system and the unique medical aspects associated with AE. The U.S. military patient evacuation system is comprised of three principal transportation phases: casualty evacuation; inter-theater AE; and intra-theater AE. Important elements of the USAF AE system are patient movement requirements centers, the validating flight surgeon, aeromedical staging facilities, AE liaison teams, aeromedical crews, and critical care air transport (CCAT) teams. Important medical aspects unique to AE include the effects of flight physiology on medical conditions, oxygen limitations, and distinctive medication and supplies requirements.

In-flight medical incidents in the NASA-Mir program

This paper summarizes medical experience during the six NASA-Mir flights from March 14, 1995, to June 4, 1998. There were 7 U.S. astronauts who were part of 6 Mir space crews and worked jointly with 12 Russian cosmonauts. Advances in space medicine have created a safer environment; however, experience shows that crewmembers experience traumatic injuries and illnesses of diverse etiologies during spaceflight. During these joint flights both Russian and U.S. medical kits were available to crewmembers who could access either medical kit as appropriate. The Russian medical team had primary responsibility for monitoring and care of all crewmembers and analyzing medical results. When medical incidents occurred, the appropriate Russian or U.S. medical team determined the plan for diagnosis and treatment. Each team kept the other informed regarding medical situations during the flights and strictly observed the principles of medical confidentiality. A summary of medical incidents by programmatic element is described as experienced by the crewmembers and the ground support medical teams. The most frequent medical cases were small traumatic injuries to the skin and mucous membranes and fluctuations in the cardiovascular system, manifesting primarily in the form of cardiac dysrhythmias. The ability to use both the Russian medical aids and the U.S. medical kit significantly increased the effectiveness and reliability of therapeutic and prophylactic care. The degree of medical care and cooperation established precedents for integrating these systems for the medical support of expeditions on the International Space Station.

Evolution of the Behavioral Sciences Branch of the Space Medicine and Health Care Systems Office at the Johnson Space Center

This paper presents a brief history of psychology and psychiatry roles in psychological selection and how these roles have evolved into the Behavioral Sciences Branch at the Johnson Space Center USC), Houston, TX. Since the initial selection of the Mercury Seven, the first United States astronauts, psychologists and psychiatrists have been involved in astronaut selection activities. Initially very involved in psychological selection of astronauts, the role of behavioral health specialists waned during the Gemini and Apollo years. With the onset of the NASA/Mir/International Space Station Program, the introduction of payload and mission specialists, and international collaboration, the evolving need for behavioral health expertise became apparent. Medical and psychological selection processes were revisited and the Johnson Space Center developed a separate operational unit focused on behavioral health and performance. This work unit eventually became the Behavioral Sciences branch of the Space Medicine and Health Care Systems Office. Research was allocated across groups at JSC, other NASA space centers, and the National Space Biomedical Research Institute, and was funded by NASA Headquarters. The current NASA focus on human space exploration to the Moon and beyond re-emphasizes the importance of the human-centered approach.

Operational behavioral health and performance resources for international space station crews and families

The Behavioral Health and Performance Section (BHP) at NASA Johnson Space Center provides direct and indirect psychological services to the International Space Station (ISS) astronauts and their families. Beginning with the NASA-Mir Program, services available to the crews and families have gradually expanded as experience is gained in long-duration flight. Enhancements to the overall BHP program have been shaped by crewmembers' personal preferences, family requests, specific events during the missions, programmatic requirements, and other lessons learned. The BHP program focuses its work on four areas: operational psychology, behavioral medicine, human-to-system interface, and sleep and circadian. Within these areas of focus are psychological and psychiatric screening for astronaut selection as well as many resources that are available to the crewmembers, families, and other groups such as crew surgeon and various levels of management within NASA. Services include: preflight, in flight, and postflight preparation; training and support; resources from a Family Support Office; in-flight monitoring; clinical care for astronauts and their families; and expertise in the workload and work/rest scheduling of crews on the ISS. Each of the four operational areas is summarized, as are future directions for the BHP program.

Models of research-operational collaboration for behavioral health in space

Addressing the behavioral health needs of astronauts clearly requires collaborations involving researchers, clinicians and operational support personnel, program administrators, and the astronauts themselves. However, such collaborations are often compromised by a failure to understand the needs, priorities, constraints, and preferences of potential collaborators. This failure, in turn, can lead to research of poor quality, implementation of programs and procedures that are not evidence-based, and an increased risk of morbidity and mission failure. The experiences of social marketing strategies in health promotion and disease prevention, cultural exchange between developers of evidence-based treatments and consumers, and dissemination and implementation of evidence-based practices in mental health services offer three different models of research-operational collaboration with relevance to behavioral health in space. Central to each of these models are the patterns of interpersonal relations and the individual, social, and organizational characteristics that influence these patterns. Any program or countermeasure for behavioral health in space must be both needs-based and evidence-based. The successful development, dissemination, implementation, and sustainability of such a program require communication, collaboration, and consensus among all key stakeholders. To accomplish this, all stakeholders must participate in creating a culture of operational research.

Personal experience of aeromedical evacuation of patients in the Balkans

Nurses in the Princess Mary's Royal Air Force Nursing Service (PMRAFNS) undertake a variety of different roles in providing nursing care to Armed Forces personnel wherever they may serve. One such role is the evacuation by air of sick or injured personnel. This article discusses the experience of a nurse lecturer in the PMRANS who undertook the role of aeromedical evacuation liaison officer in the Balkans for a 4-month period during winter. The role is described and details of how the aeromedical evacuation of patients was organized is presented. The benefits of evacuating patients by air are discussed along with some of the potential problems that were encountered in the Balkans, including logistical problems and the vagaries of the weather. Finally, several examples of the types of patients evacuated are presented.

A pivotal role in international rescue

As more British people travel abroad, international co-operation between health-care services has evolved. One of the key professionals involved in repatriating British travellers who are ill or injured are in-flight nurses, who need to have a wide range of nursing knowledge as well as good communication skills. In-flight nurses are generally in sole charge of a patient and they need to be able to deal independently and confidently with foreign health systems and officials, and be prepared to travel to dangerous areas such as war zones.

A concept of operations for contingency medical care on the International Space Station

The U.S.-based health care system of the International Space Station (ISS) provides the resources to care for an in-flight medical contingency. The current system was designed for use in conjunction with a return vehicle possessing medical capabilities that would allow rapid and safe transport of an ill or injured crew member to a terrestrial medical facility. Because plans for such a vehicle have been indefinitely delayed, a mismatch has been created between the limited onboard medical capabilities and the current mission profile. This has driven the medical concept of operations to one in which as many medical conditions as possible must be treated on orbit, with return to Earth delayed or avoided. This article describes this proposed new plan, the implementation of which will require numerous changes to the medical system, including modifications to training practices, treatment guidelines, diagnostic and therapeutic resources, and informatics.

Ludolph Brauer, German aeromedical pioneer

Ludolph Brauer (1865-1951) played an influential role in the history of aviation medicine in Germany. The Treaty of Versailles had put a stop to the development of German aviation and associated medical activities at the end of World War I. Brauer deserves credit for restarting civilian aviation medicine in Germany in the 1920s, paving the way for it to flourish in the 1930s. As Medical Director of the Hamburg-Eppendorf General Hospital, Brauer established the first German Institute of Aviation Medicine (GIAM) in 1927 in affiliation with the Tuberculosis Research Institute with its two large pneumatic chambers. The GIAM was active in altitude research and the selection of pilots, as well as educating medical students in aviation medicine, training Aviation Medical Examiners, and exploring clinical applications of hypobaric and climatic therapy. Brauer was forced to retire in 1934 for political reasons as the GIAM came under the influence of the military; in 1939 it was made part of the Aeromedical Research Institute of the "Reichsluftfahrt" Ministry. Brauer was a co-editor of the journal Luftfahrtmedizin in the 1930s and 1940s. He died in Munich on November 25th, 1951.

[Characteristics of morbidity, loss in man-hours, medical disqualification from flight duties and improvement of the medical flight certification process at the modern phase]

Examined and analyzed was dynamics of morbidity, losses in man-hours, medical discharge and attrition of the flying personnel in various types and branches of aviation of the Russian Federation Military Forces over the recent 10 years (1991-2000). Results of the review of the RF MF medical flight certification process (MCP) laid the ground for developing guidelines and scientifically substantiated proposals for MCP improvement in line with the present-day reform of the RF MF aviation.

An information flow analysis of a distributed information system for space medical support

In this study, we applied the methodology grounded in human-centered distributed cognition principles to the information flow analysis of a highly intensive, distributed and complex environment--the Biomedical Engineer (BME) console system at NASA Johnson Space Center. This system contains disparate human and artificial agents and artifacts. Users and tasks of this system were analyzed. An ethnographic study and a detailed communication pattern analysis were conducted to gain deeper insight and better understanding of the information flow patterns and the organizational memory of the current BME console system. From this study, we identified some major problems and offered recommendations to improve the efficiency and effectiveness of this system. We believe that this analysis methodology can be used in other distributed information systems, such as a healthcare environment.