“First, Do No Harm”: Old and New Paradigms in Prehospital Resuscitation in the Aquatic Domain

The balance between benefit and risk is central to the work of all those involved in aquatic services. The Hippocratic exhortation of Primum non nocere, “First, do no harm,” has a history of over 2000 years. Superficially, all would support this dictum, but harm can result from inaction. The balance between no or little intervention on the one hand and proactive intervention with iatrogenic risk on the other is complex and enduring. Risk implies that one does not have all the information available to know the exact likelihood of an outcome, a common situation involving rescue, first aid, and resuscitation. The theme of Primum non nocere (and its congener, risk-benefit ratios) in the aquatic rescue and resuscitation domain has both ethical (e.g., Good Samaritan) and legal (e.g., tort action) implications. Recently, a reversal in intervention philosophy, “Any attempt at resuscitation is better than no attempt,” has emerged. This aphorism is in stark contrast to the traditionally conservative, “Don’t do anything for which you are untrained.” Current and continuing research audits are needed to assess whether this newer paradigm results in a risk-benefit ratio low enough to counter the traditional Primum non nocere

Paper Session I-B - The Invention, Development and Commercialization of a Non-Invasive Intracranial Pressure Monitor

Defining the Problem - Why is a non-invasive intracranial pressure monitor needed? The monitoring of intracranial pressure and pressure volume index is of significant diagnostic and post-operative importance for many patients with cranial injuries and for patients who have undergone brain surgery. Cranial injuries often affect the pressure of the subarachnoidal fluid around the brain. Abnormally elevated intracranial pressure (ICP) occurs in about 60% of patients with head trauma. When ICP increases above 20mmHg, a 95% death rate occurs. High ICP reduces blood flow to the brain, preventing oxygen and nutrients from reaching brain tissue. This starvation results in the death of brain tissue

Climate dynamics experiments using a GCM simulations

The study of surface-atmosphere interactions has begun with studies of the effect of altering the ocean and land boundaries. A ten year simulation of global climate using observed sea surface temperature anomalies has begun using the NCAR Community Climate Model (CCM1). The results for low resolution (R15) were computed for the first 8 years of the simulation and compared with the observed surface temperatures and the MSU (Microwave Sounding Unit) observations of tropospheric temperature. A simulation at higher resolution (T42) was done to ascertain the effect of interactive soil hydrology on the system response to an El Nino sea surface temperature perturbation. Initial analysis of this simulations was completed

Hypoxic Blackout: Diagnosis, Risks, and Prevention

Hypoxic blackout, also called underwater blackout syndrome, is a distinct and preventable cause of drowning. The sudden and unexpected death of a young, fit swimmer or diver, almost always male, necessitates the consideration of a differential diagnosis which includes four syndromes—preexistent cardiac disease, electrical conduction abnormalities, epilepsy, and hypoxic blackout. The pathophysiology of hypoxic blackout (overriding the carbon dioxide sensor by presubmersion hyperventilation) may be induced by autonomic conflict between cold shock diving reflexes in certain predisposed individuals. Death occurs in both public and private swimming pools and in the sea, and case series include those training for underwater hockey, synchronized swimming, free diving, and playful submersion endurance challenges. The sole preventive stratagem is advocacy for awareness of risks, suitably targeted to “at risk” groups

Fatal, unintentional drowning in older people: an assessment of the role of preexisting medical conditions

Background: The number of older people (aged 65 y and over) is increasing in Australia and chronic medical conditions are common. Aquatic activities provide physical and social benefits; however, understanding the risks related to aquatic activity is important for ongoing health and wellbeing. We explore the impact of preexisting medical conditions on unintentional fatal drowning among older people in Australia. Methods: Using coronial, forensic, and medical histories from the Australian National Coronial Information System, all cases of unintentional death by drowning (or where drowning was a factor) among older people in Australia between July 1, 2002 and June 30, 2012 were investigated. Preexisting medical conditions were reviewed to determine whether they were contributory to drowning. Results: Of the 506 older people who drowned, 69.0% had a preexisting medical condition. The leading contributory medical condition was cardiovascular disease, followed by dementia, depression, epilepsy, and Parkinson disease. All conditions except cardiovascular disease and depression were overrepresented compared with the proportion of the disease in the population. Falling into water was the most common activity immediately before drowning, especially among those with dementia, whereas those with cardiovascular disease were most likely to drown while swimming. Conclusions: Preexisting medical conditions contribute to drowning in older people but with unequal contributions. With the prevalence of medical conditions expected to increase as the population ages, targeted education for older people will be important. Risk management will enable older people to safely participate in aquatic activities

The Second Conference on Lunar Bases and Space Activities of the 21st Century, volume 1

These papers comprise a peer-review selection of presentations by authors from NASA, LPI industry, and academia at the Second Conference (April 1988) on Lunar Bases and Space Activities of the 21st Century, sponsored by the NASA Office of Exploration and the Lunar Planetary Institute. These papers go into more technical depth than did those published from the first NASA-sponsored symposium on the topic, held in 1984. Session topics covered by this volume include (1) design and operation of transportation systems to, in orbit around, and on the Moon, (2) lunar base site selection, (3) design, architecture, construction, and operation of lunar bases and human habitats, and (4) lunar-based scientific research and experimentation in astronomy, exobiology, and lunar geology

The Second Conference on Lunar Bases and Space Activities of the 21st Century, volume 2

These 92 papers comprise a peer-reviewed selection of presentations by authors from NASA, the Lunar and Planetary Institute (LPI), industry, and academia at the Second Conference on Lunar Bases and Space Activities of the 21st Century. These papers go into more technical depth than did those published from the first NASA-sponsored symposium on the topic, held in 1984. Session topics included the following: (1) design and operation of transportation systems to, in orbit around, and on the Moon; (2) lunar base site selection; (3) design, architecture, construction, and operation of lunar bases and human habitats; (4) lunar-based scientific research and experimentation in astronomy, exobiology, and lunar geology; (5) recovery and use of lunar resources; (6) environmental and human factors of and life support technology for human presence on the Moon; and (7) program management of human exploration of the Moon and space