Sixty Years of Manned Spaceflight—Incidents and Accidents Involving Astronauts between Launch and Landing

Introduction: Since Gagarin became the first human to travel into space and complete one orbit around the Earth, on 12 April 1961, the number of manned spaceflights has increased significantly. Spaceflight is still complex and has potential risk for incidents and accidents. The aim of this study was to analyze how safe it is for humans to travel in space. Objectives: This paper, therefore, summarizes incidents and accidents covering the six decades of manned spaceflight (1961–2020). Material and methods: Extensive PubMed, Cochrane, and Google Scholar searches were made with search strings of “incidents”, “accident”, “spaceflight”, and “orbit”, and including all vehicles so far. Search terms were combined by AND or OR in search strings. Of the results obtained, studies which evaluated manned spaceflight were included in the study. Data from the National Aeronautics Space Agency (NASA), the Russian Space Agency (ROSCOSMOS), the European Space Agency (ESA), and the Chinese Space Agency (CNSA), as well as from the Virgin Galactic and the SpaceX databases, were searched to complete data and to identify all the accomplished manned spaceflights, as well as all incidents and accidents that have occurred in the specific period. Search results were compared to findings on Wikipedia, Encyclopedia Astronautica, and other public webpages. Reference lists of included articles/homepages were also included for further potential data. Results: From 1961–2020, our data revealed an increasing number of manned space flights, n = 327. The number of times an astronaut has been sent to space, n = 1294, resulted in an accumulated n = 19,414 days spent in space. The number of days spent in orbit has constantly increased from 1961 until today. The number of incidents (altogether n = 36) and accidents (altogether n = 5) has constantly decreased. The number of astronauts who have died during spaceflight is represented by n = 19. The current statistical fatality rate is 5.8% (deaths per spaceflight) with the highest fatality rate in the 1960s (0.013 deaths/day spent in space), and the lowest rates in the 1990s and the period from 2010 until the present (no deaths). The most dangerous phases of spaceflight are launch, landing and staying in orbit. Altogether, n = 12 incidents (incident rate per spaceflight: 0.04) and one accident (accident rate: 0.003) during launch have been reported, n = 9 incidents (incident rate: 0.03) and two accidents (accident rate: 0.006) have been reported during landing and n = 10 incidents (incident rate: 0.03) have been reported in orbit. Discussion: Manned spaceflight over the last six decades has become significantly safer. Since 2003, no astronaut fatality has been reported. With greater international cooperation and maintaining of the International Space Station (ISS), the number of manned spaceflights and days spent in space has constantly increased, with constantly lower rates of incidents and accidents

Evaluation of an online colour vision assessment tool

With increasing use of digital display technology in aircraft cockpits, the importance of reliable assessment of color vision in the context of aeromedical examinations continues to grow. Digital test methods are increasingly used, which can be used in a space-saving manner and (spatially) independently of ambient light conditions. In addition to professional and validated software, free apps are also available for mobile devices that can be used by private consumers. The present study reviewed such an app of a Farnsworth-Munsell Hue-100 and compared it with the original analogue testing. It found poor comparability of results, so the use of the online tool in a professional setting must be discouraged

Lightning accidents worldwide: regional analysis and medical therapy

The total number of lightning related accidents is unevenly distributed around the world. Coastal and mountainous regions as well as the tropics and subtropics are predisposed to the formation of thunderstorms due to their climatic conditions. According to respective prognoses and climate models the situation of danger concerning lightning accidents will rise in almost every part of the world due to climate change. A sufficient protection against lighting accidents is primarily provided by stable buildings and adequate educational advertising regarding risks and safety measures. Lightning related risk assessment is of particular importance in the context of outdoor sports, large open-air events, farming, air traffic, military operations, and trainings as well as travel activity

Telemedicine and space

Medical procedures during space missions require a high degree of planning in terms of operability of established procedures on earth. Human physiology is different in microgravity. Due to changes in gravitation and radiation, the human body needs to adapt to a different environment. Especially in terms of long-term missions to moon or mars, when immediate contact to earth is not possible, preventive planning is essential. Nevertheless, telemedical support has high importance to ensure best medical care in case of an emergency in space

Evaluation of new methods for airway secure during long-term space missions

Long-term missions with the construction of Lunar Orbital Platform-Gateway and manned Mars missions will be within reach in the upcoming years. An emergency evacuation will not be feasible, thus the crew must handle a lot of possible medical events, presumably without a physician onboard. Including emergencies with a need for airway secure and general anesthesia, recent data shows, that using supraglottic airway is the method of choice in microgravity. If endotracheal intubation is necessary, the usage of videolaryngoscopy is recommended, due to the swelling caused by cardiovascular changes under influence of microgravity. Whenever possible, the patient should be restrained on a stretcher, while securing the airway

Performance of the laryngeal tube for airway management during cardiopulmonary resuscitation

INTRODUCTION: Sudden cardiac arrest is one of the leading causes of death in Europe and the whole world. Effective chest compressions and advanced airway management have been shown to improve survival rates. Supraglottic airway devices such as the laryngeal tube (LT) are a well-known strategy for patients with cardiac arrest during both basic (BLS) and advanced life support (ALS). This systematic literature review aimed to summarize current data for using the LT when performing BLS and ALS. EVIDENCE ACQUISITION: Recent data on the use of the LT during cardiopulmonary resuscitation (CPR) was gathered by using the Medline database and a specific search strategy. Terms were used in various order and combinations without time restrictions. A total of N.=1005 studies were identified and screened by two experienced anesthesiologists/emergency physicians independently. Altogether, data of N.=19 relevant papers were identified and included in the analysis. EVIDENCE SYNTHESIS: Using the LT showed fast and easy placement with high success rates (76% to 94%) and was associated with higher short-term survival as compared to other strategies for initial airway management (2.2% vs. 1.4%). Quality of CPR such as chest compression fraction (CCF) before and after LT-insertion is improved (75% vs. 59%). For long-term survival, the LT showed lower survival rates. CONCLUSIONS: Especially as initial device of airway management (for inexperienced staff), the use of a LT is easy and results in a fast insertion. The advantages of the LT as compared to bag mask ventilation and endotracheal intubation are inhomogeneous in recent literature

Procedural sedation outside the operating room

Purpose of review The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA. Recent findings Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, remifentanil, propofol, and ketamine. These traditional and well known drugs are commonly used for PSA. The combinational use of multiple drugs seems to have benefits for both the provider and patient. Furthermore, there is growing interest into specific protocols and adaption for special circumstances. The preferred medications used for PSA should be both effective and well tolerated. Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient