RESUMEN
OBJECTIVES: Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. MATERIAL AND METHODS: Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. RESULTS AND CONCLUSIONS: The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft - or with the doors opened while the engines are running - must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.
Asunto(s)
Ambulancias Aéreas , Ruido/prevención & control , Exposición Profesional , Monitoreo del Ambiente/métodos , Monitoreo del Ambiente/estadística & datos numéricos , Humanos , Medicina del TrabajoRESUMEN
Physicians who take a role as flight physicians in a Helicopter Emergency Medical System (HEMS) will encounter more frequently certain emergencies - such as multiple trauma, mass casualties etc. - compared to physicians in a ground based Emergency Medical System (EMS). Furthermore EMS teams already present on scene have a variance of expectations towards HEMS-Physicians. Therefore HEMS-Physicians not only must have the capabilities to treat patients properly, especially under difficult circumstances. Particularly with regard to leadership and Crew Resource Management (CRM) they will be demanded. Not least HEMS-Physicians need to have knowledge of safety and technical aspects of rescue helicopters and of operation tactics as well. Since there has been no uniform or standardised training for physicians, who will take a role in a HEMS, a course concept has been developed to improve and standardise the preparation for this challenging task.
Asunto(s)
Educación Médica Continua , Ambulancias Aéreas , Aeronaves , Ambulancias , Curriculum , Urgencias Médicas , Servicios Médicos de Urgencia , Medicina de Emergencia/educación , Humanos , Puntaje de Gravedad del Traumatismo , Centros TraumatológicosRESUMEN
AIM: Cardiopulmonary resuscitation is a team endeavour. There are only limited data on whether team performance during cardiopulmonary resuscitation is influenced by behavioural issues. The aim of the study was to determine whether and how human factors affect the quality of cardiopulmonary resuscitation. METHODS: 16 teams, each consisting of three health-care workers, were studied in a patient simulator. A scenario of witnessed cardiac arrest due to ventricular fibrillation was used. Ventricular fibrillation could be converted into sinus rhythm by two countershocks administered during the first 2 min or by two countershocks administered during the first 5 min provided that uninterrupted basic life support was started in under 60 s. Teams were rated to be successful if ventricular fibrillation was converted into sinus rhythm. Behavioural rating included leadership, task distribution, information transfer, and conflicts. RESULTS: Only six out of 16 teams were successful. Compared with successful teams, teams that failed exhibited significantly less leadership behaviour (P=0.033) and explicit task distribution (P=0.035). All teams shared among them sufficient theoretical knowledge to successfully treat the simulated cardiac arrest. CONCLUSIONS: In a scenario of simulated witnessed cardiac arrest almost two thirds of teams composed of qualified health-care workers failed to provide basic life support and/or defibrillation within an appropriate time window. Absence of leadership behaviour and absence of explicit task distribution were associated with poor team performance. Failure to translate theoretical knowledge into effective team activity appears to be a major problem.