[D.P.Zuikhin and his contribution to the establishment and development of the system of medical maintenance of nuclear submarines personnel].

A highly qualified physician, an outstanding leader, a scientist Dmitry Zuikhin (1924-1988) was directly involved into establishment of a system of medical support for submariners in the sea and on shore, he proved the necessity of forces and means for the medical service fleet. He was a pioneer in this challenging and new field of naval medicine. His energy, perseverance and determination helped to establish in the early 1960 a system of medical support for nuclear submarines personnel, which was subsequently implemented in all associations and connections of nuclear submarines of the Northern and Pacific fleets.

An overview of the Institute of Naval Medicine.

In the time allotted to this presentation I have only been able to provide a brief outline of the type of work undertaken by INM. However, I hope I have been able to demonstrate that INM is indeed living up to its Mission Statement and motto 'e mari ad salutum'.

Evaluation of a contingency blood donor program on U.S. Navy submarines.

OBJECTIVE: Because the role of submarine warfare is shifting from strategic deterrence to littoral force projection, submarine providers will be required to manage combat trauma. Currently, submarine providers have only crystalloid available for the reversal of hemorrhagic shock. A proposal program to provide blood products on submarines was evaluated. METHODS: Existing military emergency blood transfusion protocols were reviewed. The restrictions of donation/transfusion onboard submarines were considered. RESULTS: A protocol to provide screening for, implementation of, and a reporting system for contingency blood donation and transfusion onboard submarines was created. The protocol contains all the safeguards of existing U.S. Navy contingency donor programs with the exception of pretransfusion infectious disease testing and cross-matching. However, because the program does not require laboratory capability, it can be implemented by an independent duty corpsman onboard a submarine. CONCLUSION: This protocol provides blood for the reversal of hemorrhagic shock onboard submarines in the event of traumatic injury.

The submarine service of the future?

Space missions, although now routine, are unique in terms of their environment and logistical requirements. The number of missions (man-hours) remains relatively small and planning still relies on comparisons with analogous missions, including submarine operations. Antarctic missions, which tend not to be classified, have provided more information about isolated communities because of the number of personnel per base. Space medicine has traditionally been an extension of aviation medicine with high g-forces involved in the transition from Earth to orbit and astronauts such as Neil Armstrong recruited from the test pilot fraternity. As the length of a mission increases and the space habitation relies more on regenerative systems, the environment becomes more analogous with today's nuclear submarines. As well as the air purification implications, radiation still is a significant hazard with even greater impact on future Mars missions requiring the provision of health physics monitoring, advice and countermeasures well established in the submarine flotilla. Nevertheless, the specialty space medicine will progress as a specialty in its own right, pooling expertise from other specialties such as aviation, radiation, emergency and occupational medicine taking human exploration beyond the confines of land and sea.

Submarine escape trials 1999-2001--provision of medical support.

Since the early 1960s all Royal Navy submarines have been fitted with an escape system comprising a single escape tower (SET) and submarine escape immersion suit (SEIS). This system enables escape from a submarine at a depth of 180 metres (1.9 MPa) provided that the submarine compartment is at a pressure of no greater than 1 bar (0.1 MPa). Due to a variety of causes which may include flooding and leakage of high pressure air systems it is the highly probable that the submarine compartment will be at a pressure in excess of 1 bar (0.1 MPa) at the time of the escape. To investigate and determine what constitutes a 'safe' maximum escape depth from any given compartment pressure (the safe to escape curve), a purpose built chamber complex, the Submarine Escape Simulator (SES) has been constructed at the QinetiQ, formerly the Defence Evaluation and Research Agency (DERA), Alverstoke site. Unlike escapes from a submarine where once released from the submarine the escapee's ascent can not be halted, within the SES it is possible to halt the ascent phase. This article describes the systems and procedures developed to enable medical support to be provided rapidly to a subject at any stage of the compression decompression profile. The article also provides details of the results to date that have been obtained from this work.