Medical kit for single-handed offshore yacht races.

BACKGROUND: The medical kit is the basis of medical support in maritime environment; it is defined by international or national regulations and guidelines. For offshore races, rules and recommendations are proposed by national or international sailing federations. Sailing and racing offshore alone presents specificities that sometimes make it difficult to apply the usual recommendations. The epidemiology of single-handed offshore race is dominated by traumatic risks. Medical events are relatively rare because competitors are high-level athletes, generally young and subject to complete medical assessments. The scarcity of available scientific data makes it necessary to choose appropriate methods for developing recommendations. The purpose of this work is to propose a medical kit adapted and applicable to these situations. MATERIALS AND METHODS: The method used was that of "Professional recommendations by formal consensus of experts" derived from the Rand/UCLA method. After a critical analysis of the literature, a panel of 19 experts having expertise in medicine in maritime environment was gathered from various medical specialties (cardiologist, internist, intensivist and emergency physician, ear-nose-throat physician and general practitioner) and from varied medical activities. They had not declared any direct conflict of interest. RESULTS: A medical kit proposal has been developed. The choice of drugs was based on the analysis of the epidemiology of medical events observed during the last offshore races. The experts' choice was to reduce the quantity of medication and medical devices in order to limit the risk of confusion of medicines and dosages. Drugs with significant side effects or requiring third party monitoring have been removed. Medical devices designed to do an intervention impossible to perform on oneself have also been eliminated. CONCLUSIONS: Solo sailing remains a marginal maritime activity with specific risks. The development of single-handed races requires an adaptation of medical support through the development of a specific medical kit and adapted training. The formalised consensus of experts seems to be an appropriate method for developing recommendations in the field of maritime medicine.

Recreational scuba diving in patients with congenital heart disease: Time for new guidelines.

The number of recreational scuba divers is steadily increasing. In its latest recommendations, the French Federation of Undersea Studies and Sports listed congenital heart disease as a formal and final contraindication to scuba diving. On the other hand, with the progress made in their management, the prognosis and quality of life of patients with congenital heart diseases have improved considerably, enabling them to engage in physical and sports endeavours, which are known to confer general health and psychological benefits. As a consequence, the ability of these patients to dive has become a regular and recurrent issue. We review the various types of scuba diving, the physical performance required for its practice, its effects on cardiovascular function and the elements that need to be considered before recommending whether it can be practiced safely at various levels of difficulty. Because of the diversity and broad heterogeneity of congenital heart diseases, a detailed evaluation of each patient's performance based on clinical criteria common to all congenital heart diseases is recommended.

Activity-based rate-adaptive pacemakers under hyperbaric conditions.

OBJECTIVES: The aim of this study was to test a variety of currently available activity-based rate-adaptive pacemakers under hyperbaric conditions. BACKGROUND: Sports divers with pacemakers can dive under certain circumstances. The rate response of activity-sensing pacing under hyperbaric conditions has rarely been evaluated. MATERIALS AND METHODS: We manufactured a miniaturized hyperbaric chamber. A pacemaker inside was kept close to the corresponding telemetry wand placed on top of the chamber. An inflation device for coronary balloon angioplasty was used to create hydraulic pressure. Group I pacemakers were exposed to a 30 msw/98 fsw/4 ATA and after a 1-month waiting period to 60 msw/197 fsw-depth/7 ATA. Group II was exposed to only one dive to 60 msw. The electrogram and event marker telemetry were used to monitor the pacing stimuli and measurements were made for case distortion. RESULTS: The baseline pacing rate did not change in 27 tests. Return to baseline was shown during 18 tests after transient sensor-driven rate. There was a sensor rate response to manual brief shaking during and following testing. A case distortion was shown in 15 of 29 tests at 60 m. CONCLUSIONS: Modern accelerometers showed no sensitivity to pressure on the pacemaker can at 30 msw/98 fsw and 60 msw/197 fsw but in some devices responded to pressure changes. There was no pacing dysfunction or suppression of the sensor response despite the high incidence of case distortion at 60 msw/197 fsw. As a general rule, diving should not be allowed at depths greater than 20 msw/65 fsw.

[General practice consultation in a hospital emergency department. History, evaluation and prospects]. / Consultation de médecine générale au sein d'un service d'accueil des urgences. Historique, bilan et perspectives.

INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to remain free and independent. The traditional system of permanent care is no longer adapted to our society, and we must rapidly find solutions. The vocation of the GMC is not to become a universal model, but this new experience opens new horizons for the future.