Performance of a Chemical Heat Blanket in Dry, Damp, and Wet Conditions Inside a Mountain Rescue Hypothermia Wrap.

INTRODUCTION: Casualties with accidental hypothermia are evacuated using multilayer wraps, typically including a chemical heat blanket (CHB), a vapor barrier, and an insulating outer bag. We investigated CHB performance against dry, damp, and wet fabric, in a multilayer wrap, in response to a case report indicating diminished performance when wet. METHODS: We wrapped a torso manikin in a base layer, CHB, vapor barrier, casualty bag, and vacuum mattress, recording CHB panel temperatures at intervals of up to 7 h. Experimental conditions were dry, damp, and wet clothing, with 2 blankets tested in each condition. We subsequently used a forward-looking infrared camera to assess whether the panels heated evenly and heat flux sensors to quantify heat transfer across 2 dry, 1 damp, and 1 wet fleece under CHB panels. RESULTS: Chemical heat blankets maintained heat output for >7 h inside the wraps. Median (IQR) panel steady state temperatures were 52°C (39-56°C) against dry fleece, 41°C (36-45°C) against damp fleece, and 30°C (29-33°C) against wet fleece. Peak panel temperature was 67°C. The heat flux results indicated that CHBs generated similar quantities of heat in dry and damp conditions, as the lower temperatures were compensated by more efficient transfer of heat across the moist clothing layer. Chemical heat blanket heat output was diminished in wet conditions. CONCLUSIONS: Rescuers should cut off saturated clothing in a protected environment before wrapping casualties, but damp clothing need not be removed. Because of the high peak temperatures recorded on the surfaces of CHBs, they should not be placed directly against skin, and compression straps should not be placed directly over CHBs.

Quantifying Risk in Air Sports: Flying Activity and Incident Rates in Paragliding.

INTRODUCTION: The volume, nature, and risks of paragliding are poorly quantified. More comprehensive understanding, including incident rates allowing comparison to similar disciplines, will help direct and appraise safety interventions. METHODS: Paraglider pilots were surveyed regarding experience, incidents, recordkeeping, and risk perception. The survey could not capture those who had left the sport or died, so a subset of responses from UK pilots was compared to records from an incident database. RESULTS: There were 1788 (25%) responses from 7262 surveyed. Respondents flew a total of 87,909 h in 96,042 flights during 2019. Local flying was most frequent (n=37,680 flights, 39%) but a higher proportion of hours were spent flying cross-country (n=33,933 h, 39%). The remainder were spent in competition, hike and fly, tandem, aerobatic, or instructional flight. Flying incidents led to 103 (6%) respondents seeking medical attention, attending hospital, or missing a day of work in 2019. Near misses were reported by 423 (26%) pilots. Asymmetry and rotational forces typically led to incidents, and limb and back injuries resulted. Pilots frequently failed to throw their reserve parachutes. Only 3 (0.6%) incidents involved equipment failure, with the remainder attributed to control or decision errors. Incident rates of paragliding were estimated as 1.4 (1.1-1.9) deaths and 20 (18-27) serious injuries per 100,000 flights, approximately twice as risky as general aviation and skydiving. CONCLUSIONS: Incidents usually resulted from pilot error (control and decision), rather than equipment failure. Future safety interventions should focus on improving glider control skills and encouraging reserve parachute deployment.

Paraglider Reserve Parachute Deployment Under Radial Acceleration.

INTRODUCTION: The paragliding reserve parachute system is safety-critical but underused, unstandardized, and known to fail. This study aimed to characterize reserve parachute deployment under radial acceleration to make recommendations for system design and paraglider pilot training.METHODS: There were 88 licensed amateur paraglider pilots who were filmed deploying their reserve parachutes from a centrifuge. Of those, 43 traveled forward at 4 G simulating a spiral dive, and 45 traveled backward at 3 G simulating a rotational maneuver known as SAT. Tests incorporated ecologically valid body, hand, and gaze positions, and cognitive loading and switching akin to real deployment. The footage was reviewed by subject matter experts and compared to previous work in linear acceleration.RESULTS: Of the pilots, 2.3 failed to extract the reserve container from the harness. SAT appeared more cognitively demanding than spiral, despite lower G. Participants located the reserve handle by touch not sight. The direction of travel influenced their initial contact with the harness: 82.9 searched first on their hip in spiral, 63.4 searched first on their thigh in SAT. Search patterns followed skeletal landmarks. Participants had little directional control over their throw.CONCLUSIONS: Paraglider pilots are part of the reserve system. Maladaptive behaviors observed under stress highlighted that components must work in harmony with pilots natural responses, with minimal cognitive demands or need for innovation or problem-solving. Recommendations include positioning prominent, tactile reserve handles overlying the pilots hip; deployment bags extractable with any angle of pull; deployment in a single sweeping backward action; and significantly increasing reserve deployment drills.Wilkes M, Long G, Charles R, Massey H, Eglin C, Tipton MJ. Paraglider reserve parachute deployment under radial acceleration. Aerosp Med Hum Perform. 2021; 92(7):579587.

Cognitive Function in Simulated Paragliding Flight.

INTRODUCTION: Paragliding is an emerging discipline of aviation, with recreational pilots flying distances over 100 km. It remains risky. Accidents typically relate to pilot error rather than equipment failure. We measured cognition and physiological responses during simulated flight, to investigate whether errors might be due to pilot impairment, rather than misjudgment.METHODS: There were 10 male paraglider pilots (aged 19-58 yr) who undertook a simulated flight in an environmental chamber from sea level (0.209 FIo2) to 1524 m (0.174 FIo2), 2438 m (0.156 FIo2), and 3658 m (0.133 FIo2), over approximately 2 h. They experienced normobaric hypoxia, environmental cooling and headwind, completing logical reasoning, mannikin, mathematical processing, Stroop Color-Word and Tower Puzzle tasks; as well as measures of risk-taking (BART), mood (POMS), and subjective experience.RESULTS: Results were compared to ten controls, matched by age, sex, and flying experience. Physiological measures were oxygen consumption, carbon dioxide production, ventilation, heart rate, oxygen saturation, rectal and skin temperatures, blood glucose, blood lactate, and urine production. There were no significant differences between pilots and controls at any altitude. Results were heterogenous within and between individuals. As altitude increased, oxygen consumption and minute volume increased significantly, while oxygen saturations fell (98.3% [baseline] to 88.5% [peak]). Rectal temperatures fell by a statistically (but not clinically) significant amount (37.6°C to 37.3°C), while finger skin temperatures dropped steeply (32.2°C to 13.9°C).DISCUSSION: Results suggest cognitive impairment is unlikely to be a primary cause of pilot error during paragliding flights (of less than 2 h, below 3658 m), though hand protection requires improvement.Wilkes M, Long G, Massey H, Eglin C, Tipton MJ. Cognitive function in simulated paragliding flight. Aerosp Med Hum Perform. 2019; 90(10):851-859.

Beach lifeguards: visual search patterns, detection rates and the influence of experience.

PURPOSE: Lifeguard surveillance is critical to any water safety program. This study determined the rates of detection of a 'drowning' individual by beach lifeguards, and whether scanning patterns differed between groups of lifeguards (experienced/less experienced, male/females, surf/non-surf). It was hypothesized that (1) Experienced lifeguards would perform better and produce less fixations of longer duration than inexperienced; (2) A greater detection rate would be seen in a 'biased' compared to a 'non-biased' condition; (3) There would be no differences between the surf compared to non-surf lifeguards, and male compared to female lifeguards with regard to scanning patterns or detection rates. METHOD: A mobile eye tracker was worn by each lifeguard (n = 69, 52 males, 17 females) as they watched 12 min of animated beach footage projected onto a screen in two conditions: a. 'Non-biased' (uniform scene). b. 'Biased' (uniform scene with presumed 'rip' on right side of screen). The lifeguards were informed that at any point during the 12 min a person may or may not disappear and to highlight if and where, a person disappeared. Unknown to the participants, a person always disappeared after 10 min at the same position within, but not between, conditions. Data were analysed using anova, t-tests and binary logistic regression. RESULTS: Experienced lifeguards were five times (p < 0.05) more likely to detect the drowning individual than inexperienced lifeguards. There were no significant differences between the visual search patterns of the groups between 2 and 10 min. The detection rates averaged 16% in the non-biased condition and 29% in biased conditions (p < 0.1), probably because lifeguards searched more on the right of the water. Furthermore, 40% (biased) and 42% (non-biased) did not detect the person disappearing, even though they fixated in the correct location in the 3.5 s before the person completely disappeared. This suggests that some lifeguards may have fixated on, but not processed, relevant visual data ('looked at but not seen'). 25% (biased) and 36% (non-biased) of the lifeguards did not fixate in the location of the person disappearing, but were able to identify their disappearance. CONCLUSIONS: Visual search patterns used by lifeguards can be altered by instruction and detection rates improve as a consequence. Peripheral vision is used effectively by some lifeguards, but cue extraction may be problematic for others.

Performance of emergency underwater breathing systems in cool (25 degrees C) and cold (12 degrees C) water.

INTRODUCTION: The shortfall between breath-hold time on cold-water immersion and the time required to make an underwater escape from a helicopter provides the rationale for emergency underwater breathing systems (EUBS) for passengers flying over cold water. This study compared three types of EUBS: a compressed gas system (CG); a rebreather system (RB); and a hybrid system (H). METHODS: Each EUBS was examined during water deployment (W(dep)) and over 90 s in cool (25 degrees C) and cold water (12 degrees C) immersion to the neck (Imm) and submersion (Subm). Subjects wore standardized clothing, including dry suit. Measures included: W(dep) time, stay time (Imm and Subm), dyspnea rating, O2 and CO2 remaining in rebreather bags [H and RB (partial pressure mmHg)], and gas volume used (CG). RESULTS: Mean data show W(dep) was slowest in the H (17.7 s) compared to the RB (10.0 s) and CG (8.1 s). Stay time was greatest in the H (90.0 s) compared to the RB (68.3 s) and CG (87.0 s); stay time in CG was also greater than RB. Dyspnea ratings were greater in RB trials (6.5 cm) compared to the CG (2.4 cm) and H (1.9 cm). Across devices, stay time in cold water was shorter during submersion than immersion (85.9 s vs. 70.1 s). During submersion stay time was shorter in cold compared to cool water (12 degrees C: 62.8 s; 25 degrees C: 77.5 s). DISCUSSION: The data suggest that the CG and H devices outperformed the RB device, but the H device required longer to deploy.

Functional tricuspid regurgitation secondary to aortic annular abscess: An unusual presentation of infective endocarditis.

An unusual case of aortic annular abscess is presented, in which the patient presented with features of gross tricuspid regurgitation. There was no direct involvement of the tricuspid valve. Tricuspid regurgitation disappeared following surgical repair of the annular abscess. The present case also illustrates the utility of trans-oesophageal echocardiography in establishing the diagnosis and planning surgical intervention.