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Regarding Monitoring in Remote Environments
- Frank W Swinton, Julius Cranshaw (29 August 2006)
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Frank W Swinton, SPR Anaesthetics , Julius Cranshaw
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To the Editor We enjoyed the educational review by M. Cermack concerning monitoring and telemedicine support in remote environments and in human space flight(1). Regarding space-borne medical care, it was stated, “experiences from analogous terrestrial environments are used for procedure design and in psychological investigation. However…the psychological effects of remoteness… cannot be simulated.” One of us (Dr Swinton) spent one year as the doctor on the British Antarctic Survey’s Halley Research Station (75 degrees South 16 degrees West). We believe a simulation might be achievable using an Antarctic winter. In the 10 winter months, the sun did not rise for 105 days. It was not possible to go outside without protective clothing. Conditions permitting, the darkness meant stars were clearly visible at midday. During this period, it was not possible for anyone to reach the Halley team (16 men and two women). Sea-ice prevented surface rescue. Air rescue was not considered feasible because ice build-up on aircraft would prevent take-off, even if the weather were favourable. Airdrop is practiced monthly at the South Pole. Therefore, theoretically, emergency supplies might be organised on a timescale of days. E-mail up-links were made four times per day but, admittedly, a satellite phone was available in emergencies. In summer, fortuitous weather conditions permitted emergency aero-medical evacuation of two injured patients from Halley to South America for definitive care after an aircraft accident. This took 27 hours to arrange and execute. Cermack noted the difficulties of resuscitating a “free-floating patient.” It “would absorb most of the human resources in the small crew” particularly if some were needed in the “restraint of the provider and the patient”. The LUCAS™ CPR(2) machine is a pneumatic device that compresses the chest against an integral backboard. Application would be easier in microgravity than earth gravity. If successful, it would liberate one or more of the resuscitation team. The “plunger” component “sucks” the anterior chest wall and the patient might be drawn off the backboard. This would reduce the efficiency of circulatory support so additional straps might be required. Compressed air is vented under the frame, which might cause the machine and patient to drift. Therefore the machine might have to be secured as well. The manufacturer has informed us that LUCAS™ machines have not been tested in microgravity so these benefits and problems remain conjecture. Cermack speculated on the development of a “critical care autopilot”. When it is available commercially, we will be only too pleased to leave the unit at night, safe in the knowledge that the physiological trajectory of our patients will remain on target until the morning. Frank Swinton. SPR in Anaesthetics. Julius Cranshaw. Consultant in Anaesthetics and Intensive Care. Royal Bournemouth Hospital. 1 Cermack M. Monitoring and telemedicine support in remote environments and in human space flight. Br J Anaesth 2006; 97: 107-114. 2 Available at http://www.lucas-cpr.com; last accessed 24.08.06. Conflict of Interest:None declared |
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