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Johnson WB, Young A, Goldman S, Wilson J, Alderete JF, Childers WL. Exoskeletal solutions to enable mobility with a lower leg fracture in austere environments. WEARABLE TECHNOLOGIES 2023; 4:e5. [PMID: 38487779 PMCID: PMC10936379 DOI: 10.1017/wtc.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 03/17/2024]
Abstract
The treatment and evacuation of people with lower limb fractures in austere environments presents unique challenges that assistive exoskeletal devices could address. In these dangerous situations, independent mobility for the injured can preserve their vital capabilities so that they can safely evacuate and minimize the need for additional personnel to help. This expert view article discusses how different exoskeleton archetypes could provide independent mobility while satisfying the requisite needs for portability, maintainability, durability, and adaptability to be available and useful within austere environments. The authors also discuss areas of development that would enable exoskeletons to operate more effectively in these scenarios as well as preserve the health of the injured limb so that definitive treatment after evacuation will produce better outcomes.
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Affiliation(s)
- W. Brett Johnson
- Research and Surveillance Division, Extremity Trauma and Amputation Center for Excellence, San Antonia, TX78234, USA
- Center for the Intrepid, Brooke Army Medical Center, San Antonia, TX78219, USA
| | - Aaron Young
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA30332, USA
| | - Stephen Goldman
- Research and Surveillance Division, Extremity Trauma and Amputation Center for Excellence, San Antonia, TX78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD20814, USA
| | - Jon Wilson
- Alabama College of Osteopathic Medicine, Dothan, AL36303, USA
| | | | - W. Lee Childers
- Research and Surveillance Division, Extremity Trauma and Amputation Center for Excellence, San Antonia, TX78234, USA
- Center for the Intrepid, Brooke Army Medical Center, San Antonia, TX78219, USA
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Canyoning Accidents in Austria from 2005 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010102. [PMID: 31877835 PMCID: PMC6982325 DOI: 10.3390/ijerph17010102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022]
Abstract
Canyoning has become a popular recreational sport. Nevertheless, little is known about injuries or diseases associated with canyoning. The aim of this study was to examine accident causes, injury patterns, out-of-hospital and in-hospital treatment and outcomes. For this purpose, national out-of-hospital data from the Austrian Alpine Safety Board and regional in-hospital data from Innsbruck Medical University Hospital were analysed for the period from November 1, 2005 to October 31, 2018. Nationally, 471 persons were involved in such accidents; 162 (34.4%) were severely injured, nine of whom died. Jumping (n = 110, 23.4%), rappelling (n = 51, 10.8%), sliding (n = 41, 8.7%) and stumbling (n = 26, 5.5%) were the most common causes of canyoning accidents. A large proportion of injuries were documented for the lower extremities (n = 133, 47.5%), followed by the upper extremities (n = 65, 23.2%) and the spine (n = 44, 15.7%). Death was mainly caused by drowning. Overall mortality was 1.9% (n = 9), and the absolute risk was 0.02 deaths per 1000 hrs of canyoning. Many uninjured persons required evacuation (n = 116, 24.6%), which resulted in a substantial expense and workload for emergency medical services. Increased safety precautions are required to reduce accidents while jumping and rappelling and fatalities caused by drowning.
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Abstract
INTRODUCTION Little is known about injuries in canyoning. It was the purpose of this study to determine injury rates, patterns, causes and risk factors in canyoning; and to identify targets for future injury prevention strategies. METHODS From May to October 2015, 109 participants from 17 different countries were prospectively followed via a monthly e-mail-based questionnaire. RESULTS During 13,690 h of canyoning, 57 injury-events occurred. The overall injury-rate was 4.2 injuries/1000 h of canyoning. The hand (23%) and lower leg and foot (25%) were most frequently involved. Most of the injuries were mild (n = 27, 49%) and limited to the soft-tissue. There were seven severe injuries (12%) with two lateral malleolar fractures, both necessitating surgery. The majority of injuries were due to material failure (44%) and significantly more injury-events were reported when the tour included rappelling (p = 0.037). Canyoning guides suffered from significantly less injuries compared to beginners and advanced canyoneers (p < 0.001). CONCLUSIONS The majority of canyoning injuries are mild. On the other side, roughly one-tenth suffered from severe injury. Canyoning guides are less prone to injury-events and beginners should consider performing tours with experienced guides. Notwithstanding, rappelling was the most common activity associated with an injury and the material used was deemed causative for an injury-event in almost half of all cases. Further improvement in canyoning equipment, frequent equipment service, and instructional courses to ensure adequate employment of equipment might minimize the risk of getting injured.
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Strapazzon G, Reisten O, Argenone F, Zafren K, Zen-Ruffinen G, Larsen GL, Soteras I. International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents. Wilderness Environ Med 2018; 29:252-265. [PMID: 29422373 DOI: 10.1016/j.wem.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy (Dr Strapazzon); International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras).
| | - Oliver Reisten
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Zermatt Air and Mountain Rescue, Alpine Rescue Center, Zermatt, Switzerland; Rescue Service, Solothurn Hospital, Solothurn, Switzerland (Dr Reisten)
| | - Fabien Argenone
- Helicopter Emergency Medical Service 04, ICU, Centre Hospitalier de Digne, Digne les Bains, France; French Mountain Rescue Association (ANMSM Medcom), Grenoble, France (Dr Argenone)
| | - Ken Zafren
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK (Dr Zafren)
| | - Greg Zen-Ruffinen
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Glaciers SA et GRIMM, Sion, Switzerland (Dr Zen-Ruffinen)
| | - Gordon L Larsen
- Department of Emergency Medicine, Dixie Regional Medical Centre, St. George, UT; Search and Rescue Service, Zion National Park, Springdale, UT (Dr Larsen)
| | - Inigo Soteras
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Cerdanya Hospital, Puigcerdà, Spain; Faculty of Medicine, Girona University, Girona, Spain (Dr Soteras)
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Rauch S, Dal Cappello T, Strapazzon G, Palma M, Bonsante F, Gruber E, Ströhle M, Mair P, Brugger H. Pre-hospital times and clinical characteristics of severe trauma patients: A comparison between mountain and urban/suburban areas. Am J Emerg Med 2018; 36:1749-1753. [PMID: 29395773 DOI: 10.1016/j.ajem.2018.01.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Martin Palma
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Francesco Bonsante
- Department of Anaesthesiology and Intensive Care Medicine, Bolzano Central Hospital, Bolzano, Italy
| | - Elisabeth Gruber
- Department of Anaesthesiology and Intensive Care Medicine, Bruneck Hospital, Bruneck, Italy
| | - Mathias Ströhle
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
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Ausserer J, Moritz E, Stroehle M, Brugger H, Strapazzon G, Rauch S, Mair P. Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas. Injury 2017; 48:20-25. [PMID: 27650943 DOI: 10.1016/j.injury.2016.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. RESULTS Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. CONCLUSIONS The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.
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Affiliation(s)
- Julia Ausserer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Elizabeth Moritz
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Matthias Stroehle
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Simon Rauch
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Peter Mair
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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