The Provision of Prescription-Only Medicines for Use on UK-based Overseas Expeditions.

Expedition teams without accompanying medical professionals traveling overseas from the UK frequently carry medical kits containing prescription-only medicines (POMs). Access to safe, basic POMs whilst on expedition is important, as the quality and availability of medicines in-country may not be acceptable, and delay in treatment may be hazardous. At present, there is no published guidance relating to drug acquisition and administration in these situations. In the UK, a number of different practices are currently in use, with uncertainty and medicolegal concerns currently hampering safe and efficient provision of POMs on overseas expeditions. A guideline is proposed for the management of prescription-only medications in an expedition setting.

Recommendations for Updates to Emergency Medical Kits for Commercial Aviation.

INTRODUCTION: Emergency medical kits (EMK) are provided to clinicians who volunteer on commercial aircraft during a medical emergency. The contents of the EMKs are mandated by the Federal Aviation Administration in the United States and, internationally, by the International Civil Aviation Organization and the country of airline origin. The mandatory contents of the kits have not been updated by the Federal Aviation Administration since 2006, and the EMKs continue to lack key equipment such as automated blood pressure cuffs, glucometers, pulse oximeters, and epinephrine autoinjectors. Of further concern is a lack of standardized and centralized reporting for in-flight medical events that, if it existed, could better inform the contents of the kits. This commentary is intended to advocate for an update to the EMKs in the United States given the authors' experiences with in-flight medical events. Rajagopal AB, Pissaris A, Clark K, Merrill A, Glatter R, Ho A, Towle DC, Yanuck J, Lahham S, Ulin L, Fischetti C, Apisa L. Recommendations for updates to emergency medical kits for commercial aviation. Aerosp Med Hum Perform. 2024; 95(10):794-796.

Comparison of tissue oxygenation achieved breathing oxygen using different delivery devices and flow rates.

INTRODUCTION: Divers with suspected decompression illness require high concentration oxygen (O2). There are many different O2 delivery devices, with few data comparing their performance. This study evaluated O2 delivery, using tissue O2 partial pressure (PtcO2), in healthy divers breathing O2 via three different delivery devices. METHODS: Twelve divers had PtcO2 measured at six limb sites. Participants breathed O2 from: a demand valve using an intraoral mask with a nose clip (NC); a medical O2 rebreathing system (MORS) with an oronasal mask and with an intraoral mask; and a non-rebreather mask (NRB) at 15 or 10 L·min⁻¹ O2 flow. In-line inspired O2 FIO2) and nasopharyngeal FIO2 were measured. Participants provided subjective ratings of device comfort, ease of breathing, and overall ease of use. RESULTS: PtcO2 values and nasopharyngeal FIO2 were similar with the demand valve with intraoral mask, MORS with both masks and the NRB at 15 L·min⁻¹. PtcO2 and nasopharyngeal FIO2 values were significantly lower with the NRB at 10 L·min⁻¹. The NRB was rated as the most comfortable to wear, easiest to breathe with, and overall the easiest to use. CONCLUSION: Of the commonly available devices promoted for O2 delivery to injured divers, similar PtcO2 and nasopharyngeal FIO2 values were obtained with the three devices tested: MORS with an oronasal or intraoral mask, demand valve with an intraoral mask and NRB at a flow rate of 15 L·min⁻¹. PtcO2 and nasopharyngeal FIO2 values were significantly lower when the flow rate using the NRB was decreased to 10 L·min⁻¹.

Comparison of tissue oxygenation achieved breathing oxygen from a demand valve with four different mask configurations.

INTRODUCTION: High concentration normobaric oxygen (O2) is a priority in treating divers with suspected decompression illness. The effect of different O2 mask configurations on tissue oxygenation when breathing with a demand valve was evaluated. METHODS: Sixteen divers had tissue oxygen partial pressure (PtcO2) measured at six limb sites. Participants breathed O2 from a demand valve using: an intraoral mask (IOM®) with and without a nose clip (NC), a pocket face mask and an oronasal mask. In-line inspired O2 (FIO2) and nasopharyngeal FIO2 were measured. Participants provided subjective ratings of mask comfort, ease of breathing and holding in position. RESULTS: PtcO2 values and nasopharyngeal FIO2 (median and range) were greatest using the IOM with NC and similar with the IOM without NC. O2 measurements were lowest with the oronasal mask which also was rated as the most difficult to breathe from and to hold in position. The pocket face mask was reported as the most comfortable to wear. The NC was widely described as uncomfortable. The IOM and pocket face mask were rated best for ease of breathing. The IOM was rated as the easiest to hold in position. CONCLUSION: Of the commonly available O2 masks for use with a demand valve, the IOM with NC achieved the highest PtcO2 values. PtcO2 and nasopharyngeal FIO2 values were similar between the IOM with and without NC. Given the reported discomfort of the NC, the IOM without NC may be the best option.

Preparing for International Travel and Global Medical Care.

Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries. Consideration should also be given to other high-risk travel scenarios, including the provision of health care overseas, adventure and extreme sports, water environments and diving, high altitude, and terrorism/unstable political situations.

A technical diving-related burns case: treatment in a remote location.

Injuries suffered as a result of a rebreather oxygen explosion and fire occurred to a diver on vacation in the island state of Chuuk, Micronesia. The medical and logistical management of the diver in a remote location are described. The mechanism of both the fire and the subsequent blast and burn injuries are discussed. Prevention of and preparation for such incidents are discussed in the context of the increasing frequency of dive and adventure travel to remote areas.

A comparison of the tissue oxygenation achieved using different oxygen delivery devices and flow rates.

INTRODUCTION: High-concentration normobaric oxygen (O2) administration is the first-aid priority in treating divers with suspected decompression illness. The best O2 delivery device and flow rate are yet to be determined. AIM: To determine whether administering O2 with a non-rebreather mask (NRB) at a flow rate of 10 or 15 L·min ⁻¹ or with a demand valve with oronasal mask significantly affects the tissue partial pressure of O2 (PtcO2) in healthy volunteer scuba divers. METHODS: Fifteen certified scuba divers had PtcO2 measured at six positions on the arm and leg. Measurements were taken with subjects lying supine whilst breathing O2 from a NRB at 10 or 15·L·min⁻¹, a demand valve with an adult Tru-Fit oronasal mask and, as a reference standard, an oxygen 'head hood'. End-tidal carbon dioxide was also measured. RESULTS: While none of the emergency delivery devices performed as well as the head hood, limb tissue oxygenation was greatest when O2 was delivered via the NRB at 15 L·min⁻¹. There were no clinically significant differences in end-tidal carbon dioxide regardless of the delivery device or flow rate. CONCLUSION: Based on transcutaneous oximetry values, of the commonly available emergency O2 delivery devices, the NRB at 15 L·min ⁻¹ is the device and flow rate that deliver the most O2 to body tissues and, therefore, should be considered as a first-line pre-hospital treatment in divers with suspected decompression illness.

Managing scientific diving operations in a remote location: the Canadian high Arctic.

Global climate change is expected to alter the Arctic bioregion markedly in coming decades. As a result, monitoring of the expected and actual changes has assumed high scientific significance. Many marine science objectives are best supported with the use of scientific diving techniques. Some important keystone environments are located in extremely remote locations where land-based expeditions offer high flexibility and cost-effectiveness over ship-based operations. However, the extreme remoteness of some of these locations, coupled with complex and unreliable land, sea and air communications, means that there is rarely quick access (< 48 h) to any specialized diving medical intervention or recompression. In 2009, a land based expedition to the north end of Baffin Island was undertaken with the specific aim of establishing an inventory of the diversity of seaweeds and their pathogens that was broadly representative of a high Arctic marine environment. This account highlights some of the logistical considerations taken on that expedition; specifically it outlines the non-recompression treatment pathway that would have been adopted in the event of a diver suffering decompression illness.