Recommendations for the practice of travel medicine.

Travel Medicine has emerged as a distinct entity over the last two decades in response to a very substantial increase in international travel and is now forging its own identity, remit and objectives for care of the traveller. Crucial to the formation of any speciality is the definition of recommendations for its practice. This is particularly important and needed for travel medicine as it overlaps with and forms part of day-to-day work in a number of different medical specialities. This document defines a set of recommendations for the practice of travel medicine from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow. Their objective is to help raise standards of practice and achieve greater uniformity in provision of services, better to protect those who travel. As travel medicine moves towards applying for speciality status, these standards will also contribute to that process.

Immersion suit insulation: the effect of dampening on survival estimates.

Immersion suit leakage values were obtained from realistic testing of helicopter passenger immersion suits using eight subjects. Simulated helicopter underwater escape resulted in mean leakages of 198 +/- 103, 283 +/- 127, 203 +/- 179, and 45.7 +/- 31.6 g (mean +/- S.D.) when wearing four different immersion suits. Suit leakages obtained from a 20-min swim test to simulate vital in-water survival actions produced leakages of 213 +/- 224, 1398 +/- 691, 145 +/- 96.5, and 177 +/- 139 g (mean +/- S.D.). Dampening of undergarments during simulated helicopter travel at an elevated cabin temperature of 30 degrees C was 115 +/- 47.3 (mean +/- S.D.; n = 4) when wearing an impermeable suit and 19 +/- 16.7 g (mean +/- S.D.; n = 4) when wearing a vapour-permeable suit. The commensurate loss of insulation with the impermeable suit at the upper level of temperature could reduce clothing insulation by 17%. A reduction of less than 5% may result under similar conditions when wearing the permeable suit. The combined dampening effect of sweating, helicopter underwater escape, and performance of vital survival actions could result in a total dampening of 247-1712 g, depending on the type of suit worn. The respective loss of insulation would be 15% and 50% respectively. This could reduce, for the 10th percentile thin man, his survival time in water at 5 degrees C from 3.5 h to between 2.4 h and 1.1 h, respectively.