Safety in Alpine Helicopter Rescue Operations—Minimal Requirements of Alpine Skills for Rescue Personnel

Objective: There is a lack of data to establish minimal requirements for technical alpine climbing skills needed by rescue teams involved in alpine helicopter rescue operations to perform such operations safely. Methods: A year of rescue operations (N = 2731) were investigated for the technical difficulties of the terrain. The difficulties were graded according to the Union Internationale des Associations d'Alpinisme (UIAA) scale for rocky terrain and steepness for ice slopes. Results: For 99.7% of the operations, the terrain could be accurately evaluated. In at least 30.7% of all rescue operations, personal advanced alpine climbing skills were required for the rescue personnel, and in 6.0%, the difficulties of the rocky terrain correspond to UIAA scale grade III with another 2.4% to UIAA grade IV or above. About 1.5% of all operations took place in ice faces steeper than 50°. Conclusions: To be able to manage 90% of all operations safely, all crew members, except the pilot, must be competent at climbing rock terrain of UIAA scale grade IV and ice of 50° steepness using appropriate rescue, rope, and belaying techniques. These recommendations include a technical safety margin for adverse conditions, such as bad weathe

Physiological Effects of Training in Elite German Winter Sport Athletes: Sport Specific Remodeling Determined Using Echocardiographic Data and CPET Performance Parameters

Nine ski mountaineering (Ski-Mo), ten Nordic-cross country (NCC), and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance and pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, a multicenter retrospective analysis of two-dimensional echocardiographic data including speckle tracking of the left ventricle (LV-GLS) and CPET performance analysis was performed in 31 elite world winter sports athletes, which were obtained during the annual sports medicine examination between 2020 and 2021. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18-32 years) were compared for different CPET and echocardiographic parameters, anthropometric data, and sport-specific training schedules. Significant differences could be revealed for left atrial (LA) remodeling by LA volume index (LAVI, p = 0.0052), LV-GLS (p = 0.0003), and LV mass index (LV Mass index, p = 0.0078) between the participating disciplines. All participating athletes showed excellent performance data in the CPET analyses, whereby significant differences were revealed for highest maximum respiratory minute volume (VE (maximum)) and the maximum oxygen pulse level across the participating athletes. This study on sport specific physiological demands in elite winter sport athletes provides new evidence that significant differences in CPET and cardiac remodeling of the left heart can be identified based on the individual athlete's training schedule, frequency, and physique

Модернизация информационно-измерительной системы исследовательского реактора

Актуальность разработки проекта определяется важностью информационной измерительной системы(ИИС) для реализации функций обеспечения безопасности любого ядерного реактора, включая реактор ИВГ.1М. Наличие точной оперативной информации о работе реактора является одним из важнейших условий разумной и адекватной реакции операторов и систем автоматического регулирования на любые ситуации, возникающие как в условиях нормальной эксплуатации, так и в аварийных ситуациях. Поэтому разработка и реализация проекта способствует становлению современной культуры безопасной и надежной эксплуатации не только исследовательского ядерного реактора ИВГ.1М, но и других исследовательских реакторов в Республике Казахстан.The urgency of project development is determined by the importance of an information measuring system (IIS) for the implementation of the safety functions of any nuclear reactor, including the IVG.1M reactor. The availability of accurate operational information on the operation of the reactor is one of the most important conditions for a reasonable and adequate response of operators and automatic control systems to any situations that arise both in normal operation and in emergency situations. Therefore, the development and implementation of the project contributes to the development of a modern culture of safe and reliable operation of not only the research nuclear reactor IVG.1M, but also other research reactors in the Republic of Kazakhstan

High-resolution ultrasound tendon-to-bone distances in partial and complete finger flexor A2 pulley ruptures simulated in human cadaver dissection: toward understanding imaging of partial pulley ruptures

Introduction: The A2 pulley tear is the most common injury in rock climbing. Whereas complete A2 pulley ruptures have been extensively researched, studies focused on partial A2 pulley ruptures are lacking. A2 pulleys rupture distally to proximally. High-resolution ultrasound imaging is considered the gold-standard tool for diagnosis and the most relevant ultrasound measurement is the tendon-to-bone distance (TBD), which increases when the pulley ruptures. The purpose of this study was to establish tendon-to-bone distance values for different sizes of partial A2 pulley ruptures and compare these values with those of complete ruptures.Material and methods: The sample consisted of 30 in vitro fingers randomly assigned to 5 groups: G1, no simulated tear (control); G2, simulated 5 mm tear (low-grade partial rupture); G3, simulated 10 mm tear (medium-grade partial rupture); G4, simulated 15 mm tear (high-grade partial rupture); and G5, simulated 20 mm or equivalent tear (complete rupture). A highly experienced sonographer blinded to the randomization process and dissections examined all fingers.Results: The tendon-to-bone distance measurements (medians and interquartile ranges) were as follows: G1, 0.95 mm (0.77–1.33); G2, 2.11 mm (1.78–2.33); G3, 2.28 mm (1.95–2.42); G4, 3.06 mm (2.79–3.28); and G5, 3.66 mm (3.55–4.76). Significant differences were found between non-torn pulleys and simulated partial and complete pulley ruptures.Discussion: In contrast, and inconsistent with other findings, no significant differences were found among the different partial rupture groups. In conclusion, the longer the partial pulley rupture, the higher the tendon-to-bone distance value. The literature is inconsistent regarding the tendon-to-bone distance threshold to diagnose a partial A2 pulley rupture. The minimum tendon-to-bone distance value for a partial rupture was 1.6 mm, and tendon-to-bone distance values above 3 mm suggest a high-grade partial pulley rupture (15 mm incision) or a complete pulley rupture

Does Modern Helicopter Construction Reduce Noise Exposure in Helicopter Rescue Operations?

Background: During helicopter rescue operations the medical personnel are at high risk for hearing damage by noise exposure. There are two important factors to be taken into account: first, the extreme variability, with some days involving no exposure but other days with extreme exposure; second, the extreme noise levels during work outside the helicopter, e.g. during winch operations. The benefit of modern, less noisier constructions and the consequences for noise protection are still unknown. Objectives: We estimated the noise exposure of the personnel for different helicopter types used during rescue operations in the Alps and in other regions of the world with special regard to the advanced types like Eurocopter EC 135 to compare the benefit of modern constructions for noise protection with earlier ones. Methods: The rescue operations over 1 year of four rescue bases in the Alps (Raron and Zermatt in Switzerland; Landeck and Innsbruck in Austria, n = 2731) were analyzed for duration of rescue operations (noise exposure). Noise levels were measured during rescue operations at defined points inside and outside the different aircraft. The setting is according to the European standard (Richtlinie 2003/10/EG Amtsblatt) and to Class 1 DIN/IEC 651. With both data sets the equivalent noise level Leq8h was calculated. For comparison it was assumed that all rescue operations were performed with a specific type of helicopter. Then model calculations for noise exposure by different helicopter types, such as Alouette IIIb, Alouette II ‘Lama', Ecureuil AS350, Bell UH1D, Eurocopter EC135, and others were performed. Results and conclusions: Depending on modern technologies the situation for the personnel has been improved significantly. Nevertheless noise prevention, which includes noise intermissions in spare time, is essential. Medical checks of the crews by occupational medicine (e.g. ‘G20' in Germany) are still mandator

Evaluation of a Diagnostic-Therapeutic Algorithm for Finger Epiphyseal Growth Plate Stress Injuries in Adolescent Climbers

Background: Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending. Purpose: To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers. Study Design: Case series; Level of evidence, 4. Methods: On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d’Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score. Results: Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3. Conclusion: The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future

Does Modern Helicopter Construction Reduce Noise Exposure in Helicopter Rescue Operations?

Background: During helicopter rescue operations the medical personnel are at high risk for hearing damage by noise exposure. There are two important factors to be taken into account: first, the extreme variability, with some days involving no exposure but other days with extreme exposure; second, the extreme noise levels during work outside the helicopter, e.g. during winch operations. The benefit of modern, less noisier constructions and the consequences for noise protection are still unknown. Objectives: We estimated the noise exposure of the personnel for different helicopter types used during rescue operations in the Alps and in other regions of the world with special regard to the advanced types like Eurocopter EC 135 to compare the benefit of modern constructions for noise protection with earlier ones. Methods: The rescue operations over 1 year of four rescue bases in the Alps (Raron and Zermatt in Switzerland; Landeck and Innsbruck in Austria, n = 2731) were analyzed for duration of rescue operations (noise exposure). Noise levels were measured during rescue operations at defined points inside and outside the different aircraft. The setting is according to the European standard (Richtlinie 2003/10/EG Amtsblatt) and to Class 1 DIN/IEC 651. With both data sets the equivalent noise level Leq8h was calculated. For comparison it was assumed that all rescue operations were performed with a specific type of helicopter. Then model calculations for noise exposure by different helicopter types, such as Alouette IIIb, Alouette II ‘Lama', Ecureuil AS350, Bell UH1D, Eurocopter EC135, and others were performed. Results and conclusions: Depending on modern technologies the situation for the personnel has been improved significantly. Nevertheless noise prevention, which includes noise intermissions in spare time, is essential. Medical checks of the crews by occupational medicine (e.g. ‘G20' in Germany) are still mandator

Exercise Field Testing in Children: A New Approach for Age-Appropriate Evaluation of Cardiopulmonary Function

Abstract Based on the wide range of problems to effectively perform cardiopulmonary testing in young children, this study strives to develop a new cardiopulmonary exercise test for children using a mobile testing device worn in a backpack in order to test children during their natural movement habits, namely, running outdoors. A standard cardiopulmonary exercise ramp test on a cycle ergometer was performed by a group of twenty 7–10-year-old children. The results were compared with a self-paced incremental running test performed using a mobile cardiopulmonary exercise measuring device in an outdoor park. The children were able to reach significantly higher values for most of the cardiopulmonary exercise variables during the outdoor test and higher. Whereas a plateau in V˙O2 was reached by 25% of the children during the outdoor test, only 75% were able to reach a reasonable VT2, let alone V˙O2peak, during the bicycle test. The heart rate at VT1, the O2-pulse, and the OUES were comparable between both tests. OUES was also positively correlated with V˙O2peak in both tests. Testing children outdoors using a mobile cardiopulmonary exercise unit represents an alternative to standard exercise testing, but without the added problems of exercise equipment like treadmills or bicycles. It allows for individualized exercise testing with the aim of standardized testing durations instead of standardized testing protocols. The running speeds determined during the outdoor tests may then be used to develop age-adapted testing protocols for treadmill testing