Analysis of 2004 German general aviation aircraft accidents according to the HFACS model

INTRODUCTION: The number of aircraft accidents remains on a constant level since the late 1990s. Routine analysis in detail of the causative factors is not carried out in Germany. The analysis of flight mishaps has been demonstrated to be an important basis for flight safety. The Human Factors Analysis and Classification System (HFACS) model is best suitable for aircraft accident analysis. The aim of this study was to classify aircraft accidents in the General Aviation (GA) of Germany according to the HFACS model and to figure out the underlying causes. MATERIAL AND METHODS: The analysis was performed with the HFACS model and on the basis of the regularly published reports of the German state department for aircraft accident analysis (BFU) including accidents (but not incidents) of GA aircraft flown by German pilots in Germany and in other countries. The underlying reasons were classified as follows: pilot errors, organizational factors, ergonomic factors, aeromedical problems, and crew resource management. Additionally, the phase of the flight was classified. RESULTS: Two hundred thirty-nine GA aircraft accidents were registered in 2004 in Germany. Eighty-seven (36%) were reported in the class up to 2 tons, six (3%) in the class of 2.0 to 5.7 tons, 28 (12%) for Touring Motor Gliders (TMG), and 118 (49%) for gliders. Of these accidents, 54 (35 crewmembers and 19 passengers) aircraft occupants survived slightly injured, 35 (23 crewmembers and 12 passengers) were seriously injured, and 34 (21 crewmembers and 13 passengers) were killed. Data for uninjured aircraft occupants were not available. Most accidents happened on summer weekends during approach and landing (53%) due to pilot errors (84%). CONCLUSIONS: Our data mainly seem to be in concordance with previously published data on GA. An improvement of flight safety can be achieved only with a detailed analysis of the accident data. Therefore, more data on aircraft accidents in Germany are needed, for example, by adapting the German aircraft accident report form. Pilots should train in approaches and landings to conduct a higher level of proficiency.     

一起民航客机飞行颠簸事件的医学分析

目的 分析一起飞行颠簸事件发生经过和相关伤员的伤情并探讨现代综合医疗救护方法.方法 对一起严重飞行颠簸事件的伤员伤情及急救处理进行回顾性医学分析.结果 2007年7月6日,南方航空公司一架A330执行CZ322悉尼-广州航班任务时,在高度FL350巡航期间,距Molly(马尼拉区域)航路点约100海里(1海里=1852 m)时,遇晴空湍流发生严重颠簸,造成机上37人不同程度受伤.其中9名为机组乘务员,占机组成员60%;其余28名为旅客,占旅客人数的13%.伤情以头面部和颈部外伤最多,其次为四肢外伤,以皮肤软组织损伤为主,没有脏器损伤及骨折.直接致伤原因为晴空湍流造成飞机颠簸后的机械损伤.事件发生后,机组人员机上进行初步伤情确认及紧急处理.飞机降落在白云机场后,机场急救中心相关人员上机初步救助及转运伤员,南方航空公司航卫中心工作人员进行伤员分类转运,民航广州医院及广州当地有关医院对伤员进行进一步检查及治疗.以上所有环节完成及时,配合良好.伤员均得到及时完善的救治,现已全部痊愈或好转.结论 ①突发的晴空湍流难以发现,对飞行安全威胁很大;②紧急医疗救援的组织管理非常重要;③飞行事故医疗救护的应急组织方案和医疗救援能力非常关键;④对旅客和机组人员要加强安全和防护教育;⑤对受伤乘务员的体检鉴定应注意受伤部位的功能恢复情况;⑥应加强伤员的心理创伤的应急干预和康复工作.     

批量伤员救治中护理风险因素分析及防范对策

 目的 探讨批量伤来诊时医院急诊科的护理风险及管理对策.方法 通过对批量伤员院内急救中的风险因素进行分析,采取加强护理组织管理、完善应急预案、加强护士专业培训、针对关键环节进行重点管理等措施.结果 通过以上措施有效防范了风险事件的发生,提高了护理工作质量和伤员满意度.结论 实施风险管理,是保障批量伤急救护理质量的关键.     

Accidents and injuries in competitive enduro motorcyclists: a prospective analysis

The Erzberg Rodeo Motor Enduro race, was analyzed over three consecutive years to analyze the risk of sustaining an accident, to determine the kind and site of injured body regions and to correlate the incidence of accidents with the site on the race track suspiring that most accidents happen at the first- and the last-third. In this prospective, field study questionnaires were used recoding fallen riders. Demographic data, the third of the race track on which the accident happened and details of the accident itself like its mechanism were noted. Each injured body region was recorded separately and rated according to the abbreviated injury scale. Two thousand nine hundred and twenty-three athletes started in 3 years in the Erzberg Rodeo; 6% of them had an accident and 94% were non-professionals. Overall, the average abbreviated injury scale was 2.8. More than 80% of all counted injuries were superficial. Most accidents happened in a curve due to the front tire sliding, affecting mostly arm and leg. Overall 67% of all accidents happened at day 1 of the race and 41% of all accidents happened in the first-third of the race track. Competitive Enduro motorcyclists have a high risk of sustaining an accident, but in comparison a low risk of sustaining a severe injury. Curves are the predominant site of accidents.     

Medical standards for mountain rescue operations using helicopters: official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.     

Are self‐reported risk‐taking behavior and helmet use associated with injury causes among skiers and snowboarders?

Over the last 10 years, ski helmet use has steadily increased worldwide. According to the “risk compensation theory,” however, studies found that up to one third of skiers and snowboarders self‐reported to engage in more risk taking when wearing a ski helmet. Therefore, to evaluate whether self‐reported risk taking and ski helmet use affect accident causes on ski slopes, more than 2000 injured skiers and snowboarders were interviewed during the 2011/2012 winter season about accident causes and potential intrinsic and extrinsic risk factors. Chi‐square tests revealed that ski helmet use did not significantly differ between self‐reported risky and cautious people (81% vs 83%). Multivariate regression analysis revealed younger age groups [odds ratios (ORs) 1.8–1.9, P < 005], male sex (OR 2.4, P < 0.001), Austrian nationality (2.2, P < 0.001), higher skill level (1.7, P < 0.001), and off‐slope skiing (OR 2.2, P = 0.060) to be predictive for a risky behavior on ski slopes. Neither the use of skis or snowboards nor accident causes were significantly associated with a riskier behavior on ski slopes. In conclusion, self‐reported risk‐taking behavior and ski helmet use seem not to be associated with accident causes leading to an injury among recreational skiers and snowboarders.     

Injury prophylaxis in paragliding

OBJECTIVES: To show trends in paragliding injuries and derive recommendations for safety precautions for paraglider pilots on the basis of accident statistics, interviews, questionnaires, medical reports, and current stage of development of paragliding equipment. METHODS: All paragliding accidents in Germany have to be reported. Information on 409 accidents was collected and analysed for the period 1997-1999. RESULTS: There was a substantial decrease in reported accidents (166 in 1997; 127 in 1998; 116 in 1999). The number of accidents resulting in spinal injuries was 62 in 1997, 42 in 1998, and 38 in 1999. The most common cause of accident was deflation of the glider (32.5%), followed by oversteering (13.9%), collision with obstacles (12.0%), take off errors (10.3%), landing errors (13.7%), misjudgment of weather conditions (4.9%), unsatisfactory preflight checks (4.9%), mid-air collisions with other flyers (2.2%), accidents during winching (2.2%), and defective equipment (0.5%). Accidents predominantly occurred in mountain areas. Fewer than 100 flights had been logged for 40% of injured pilots. In a total of 39 accidents in which emergency parachutes were used, 10 pilots were seriously injured (26%) and an additional three were killed (8%). CONCLUSIONS: Injuries in paragliding caused by unpredictable situations can be minimised by (a) using safer gliders in the beginner or intermediate category, (b) improving protection systems, such as padded back protection, and (c) improving pilot skills through performance and safety training.     

乌克兰居民在切尔诺贝利核电站事故后的健康状况

本文报告了切尔诺贝利事故后受到影响的乌克兰三个人群(救援人员、30km区域内撤离人员、儿童和少年)在1990～2004年间健康状况的观察结果.受害者的总人数有22.5万人.受照剂量在0.25～0.70Gy的救援人员有7 400人.观察的指标有随机性效应(甲状腺癌、白血病、妇女乳腺癌和其他恶性肿瘤的发病率)和确定性效应(急性放射病、白内障、非肿瘤性疾病,以及儿童和少年的健康状况),证明上述人群中这些效应的危险性有所增加.报告还分析了非照射因素在这些效应发生中所起的作用,说明这些疾病在发病原因上的多样性.     

生物剂量估算技术在核与辐射事故医学救援中的应用

核与辐射事故医学救援中,对事故人员进行分类诊断可使医疗资源得以充分利用,从而大大提高救援效率。生物剂量估算技术是目前判断外照射放射损伤程度的有效方法。利用生物剂量估算技术进行受照人员的分类诊断,对核与辐射事故医学救援的高效、有序具有重要意义。该文针对现有生物剂量估算技术的特点及其在核与辐射事故医学救援分类诊断中的应用进行了分析讨论。     

Factors affecting injury severity among recreational skiers and snowboarders: an epidemiology study

Different results have been reported for skiing and snowboarding injuries worldwide. Few studies consider the injury severity score (ISS) for the evaluation of differences among injured skiers–snowboarders. The aim of this study is to identify possible risk factors that affect the severity of skiing and snowboarding injuries in three winter seasons (2002–2005) in South Tyrol. For every injured skier or snowboarder referred to our emergency department in three consecutive seasons, the following data were collected: date of birth, gender, self-declared technical skills level, place of residence (local/non-local), as well as the date, time, and place of the accident. Type of injury and ISS were retrospectively assigned. Data concerning the snowfall in the last 24 h, average snow level, and outdoor air temperature values were obtained from four weather stations that were located inside the ski resorts. A multiple linear regression model was used to evaluate the association between ISS and potential determinants. In the analyzed seasons, 2,511 injured skiers and 843 injured snowboarders were evaluated at our emergency department. There was a significant change in the ISS value for subjects with different self-reported skills levels (P < 0.001). Men and non-local residents experienced more severe injuries than women and local residents, respectively (P < 0.013, P < 0.001). The ISS was higher for people aged over 60 (P < 0.001). Snowfalls brought about a decrease in accident severity (P = 0.009). The severity of the injuries increases with age. Prevention and information programs should be targeted to people who are at high risk of severe injury. A 24-h fresh snowfall seems to reduce the severity of injuries. Very little is known about snow conditions and winter sports injury. Further studies are needed to explore this field.     

Blitzschläge auf Fußballplätzen

Lightning strikes with mass casualties are not an absolute rarity. Because of a lightning strike on a sports ground in East Westphalia in 2008 with 19 injured football coaches a literature search for lightning accidents on soccer grounds in Germany using the internet was performed. In the period 1995–2008 a total of 9 lightning accidents occurred resulting in 5 to 64 injured persons per case. A total of 179 injured persons and 1 fatality were counted. There has been a remarkable increase in lightning accidents in the last 3 years (from July 2005 to July 2008). In this period at least 7 events with 102 injured persons were observed. In conclusion, an important step for prevention or reduction of the number of injured persons due to lightning strikes is to inform people playing soccer about the potential risk of lightning strikes on sports grounds.     

乌克兰四零八军区医院抢救切尔诺贝利核电站事故伤员的经验

切尔诺贝利核电站事故发生后,先后有30万左右的军人参加事故救援.本文介绍了乌克兰四零八军区医院对切尔诺贝利核电站事故伤员救治工作的任务.介绍了医疗救援三个阶段的时间划分、任务重点、兵力的投入及其结构组成.介绍了医院内部专门科室的建立、对受照剂量为0.25～0.50Gy的594例伤员健康状况的分析,其血液学改变的发生率随受照剂量增加而增多.介绍了参与救治工作医师们研究的主要内容,强调要考虑小剂量辐射对心血管系统和胃肠道的远期效应.根据救治工作的经验,分析了救治过程中存在的问题.     

A 10-year study of snowboard injuries in Lapland Sweden

Snowboard injuries in a Swedish ski area were evaluated from 1989 to 1999. All injured skiers (alpine, telemark, snowboarders) who sought medical attention at the local Medical Center within 48 h of the accident, were asked to answer an injury form. Physicians assessed and treated the injured skiers. There were a total of 1775 injured skiers; 568 injured snowboarders mean age 19 years. The female/male ratio was 34/66%, the injury rate 3/1000 skier days, three times higher than that of alpine skiers. The skill level of the injured snowboard riders improved during the period. The fall/run ratio of the beginners was higher (1.0) and their risk behavior lower (3.9 on visual analogue scale 1-10) in comparison to the advanced riders (0.4 and 6.6, respectively). Injuries were in 54% located to the upper extremity, 35% were wrist/lower arm injuries. Beginners had significantly higher frequency of lower arm/wrist injuries (46%), than average (32%) and advanced riders (20%). The most frequent single diagnosis was wrist/lower arm fracture (20%). Advanced riders tend to have more head/neck injuries than beginners, 17% vs. 13% (NS). Thus, with elevated skill level the injury pattern changed. For injury prevention, wrist guards and helmets are recommended for snowboard riders.     

Früherkennung von Lungenkrebs bei asbestexponierten Arbeitnehmern

Despite the fact that working with asbestos and placing it on the market have been banned in Germany since 1993 according to the Ordinance on Hazardous Substances, asbestos-related diseases of the lungs and pleura are still the leading cause of death in occupational diseases. The maximum industrial usage of asbestos was reached in former West Germany in the late 1970s and in former East Germany the late 1980s. Occupational diseases, mainly mesotheliomas and lung cancer emerging now are thus caused by asbestos exposure which occurred 30–40 years earlier. It is known that the combination of smoking and asbestos exposure results in a superadditive increase in the risk to develop lung cancer. No suitable screening methods for early detection of malignant mesothelioma are currently available and the therapeutic options are still very limited; however, the national lung screening trial (NLST) has shown for the first time that by employing low-dose computed tomography (LDCT) in heavy smokers, lung cancer mortality can be significantly reduced. According to current knowledge the resulting survival benefits far outweigh the potential risks involved in the diagnostic work-up of suspicious lesions. These results in association with the recommendations of international medical societies and organizations were pivotal as the German statutory accident insurance (DGUV) decided to provide LDCT as a special occupational medical examination for workers previously exposed to asbestos and with a particularly high risk for developing lung cancer.     

经皮椎体后凸成形术在野战综合手术救治方舱中的应用

目的 灾难救治现场,于野战综合手术救治方舱中对老年性骨质疏松性椎体压缩性骨折的受灾患者行经皮椎体后凸成形术(PKP)的近期临床疗效分析.方法 回顾性分析2013年4月-2016年8月由该院参与救治的老年性骨质疏松性椎体压缩性骨折患者43例(51椎),患者伤后立即在该院研制的野战综合手术救治方舱中行PKP手术,观察患者平均手术时间,比较手术前后痛觉视觉模拟评分(VAS)的变化和侧位X线平片上相应节段Cobb角的变化及椎体前、中、后缘高度的变化.结果 本组43例患者平均手术时间(52±15) min,术后VAS疼痛评分较术前明显降低(P＜0.01),术后伤椎相应节段Cobb角较术前有显著改变(P＜0.01),且伤椎椎体前、中缘高度较术前均由明显恢复(P＜0.01),差异均有显著统计学意义.结论 在野战综合手术救治方舱中对骨质疏松性压缩性骨折患者行PKP治疗是对老年患者紧急治疗的十分有效的方法,能早期解决患者骨折所导致的剧烈疼痛,改善患者预后.     

The injury pattern to children involved in lethal traffic accidents in Berlin

A statistical investigation of causes of death of children in Berlin, as well as in the rest of Germany shows, that 'accidents' are the most frequent causes of death in children. Nearly 50% of all child fatalities (0-15 years old) are due to traffic accidents. The reports of 30 children (19 boys, 11 girls) that were investigated in one of the three Institutes of Legal Medicine in Berlin over a period of 5 years were studied. In nearly 40% of all cases the children were pedestrians, in ten cases they died as passengers in cars, five children were bicyclists and in one case the child was a skateboarder. In 60% of all cases the principal injuries were severe injuries of the skull and brain; skull and brain trauma was the most frequent cause of death. In the group pedestrians (n=11), the cause of death in ten cases was the severe head-injury. Over 60% of all injured children died at the scene or in the first 24h after the accident, none of the children survived more than 30 days.     

111例创伤病人的监护

现代化监护手段已成为危重症救治的重要环节。但目前创伤病人监护方面的资料报道较少。我院创伤科重症监护病房（ＩＣＵ）收治了１１１例创伤病人，为创伤病人的监护积累了一些经验：１．严密观察生命体征及病情变化；２．确保呼吸道通畅，改善病人的缺氧状态；３．积极抗休克，包括采取正确体位，快速补充血容量，控制输液量和速度等。熟练掌握监护手段，是提高创伤病人救治水平的重要条件。     

Notarzteinsatz mit fataler Folge

The doctor on emergency call diagnosed an open craniocerebral trauma in the 26-year-old occupant of a crashed car. The patient was conscious and responsive. The doctor applied a pressure bandage that passed under the chin then around the heavily bleeding scalp injury and tightened the bandage several times. The injured patient consented to insufflation anesthesia which was deemed necessary for the helicopter transport but anesthesia and relaxation were only induced after the third attempt at intubation. The patient died before the rescue helicopter arrived. The autopsy findings revealed the classic picture of death from suffocation. From a morphological point of view, the iatrogenic “strangulation” by the bandage around the head was the principal feature, whereas merely a scalping injury and a femoral fracture could be found as injuries due to the accident. The final expert appraisal in the court case revealed a fatal combination of mistakes on the part of the doctor.     

A prospective study of rock climbing injuries.

OBJECTIVES: To study the rate, causes, and nature of rock climbing injuries presenting to an accident and emergency (A&E) department. METHODS: Patients presenting with rock climbing injuries to an urban A&E department were studied prospectively for one year. RESULTS: 19 rock climbers presented during the year, at a rate of one per 2774 A&E attendances. Fourteen climbers were injured on outdoor cliffs and five on the local indoor climbing wall, where the safety mats were noted to be in poor condition. Eighteen climbers had been injured during falls, 17 hitting the ground. Twelve of these climbers sustained fractures, four of which were missed on initial attendance. The remaining climber sustained the characteristic A2 pulley finger injury, which was treated conservatively with a good result. CONCLUSIONS: The risks of rock climbing in Britain would be reduced if lead climbers arranged protection at earlier stages of climbs. Sports centres with climbing walls should regularly inspect and repair their safety equipment. It is important for staff in A&E departments to appreciate the large forces involved in any climbing fall, in order that significant injuries are not missed. Those treating injured climbers should also be aware of the specific injuries to which elite climbers are predisposed.     

49例严重肢体挤压伤院前院内一体化救治

目的探讨严重肢体挤压伤的院前院内一体化救治方法和效果。方法回顾性分析2008年5月~2015年7月收治的严重肢体挤压伤患者49例的院前院内一体化救治的临床资料,男性44例,女性5例;年龄19~82岁,平均43.7岁。地震伤5例、道路交通伤20例、工矿事故伤17例、其他7例。受伤肢体:肩背上肢8例、骨盆及下肢41例。合并骨盆及肢体骨折脱位32例(闭合伤20例,开放伤12例),多发伤44例。结果院前救援时间35min~49h,现场救援建立静脉通道并输液19例,止血带使用31例。全部病例在解压后行心电监测,救援现场行小腿筋膜室切开1例,膝关节离断1例。院内救治包括清创后负压封闭引流14例,筋膜室切开减压后负压封闭引流17例,负压引流有效率96.8%(30/31),使用负压引流组无截肢者;发生挤压综合征28例(57.1%),其中合并高钾血症11例,肾功能衰竭8例;使用呼吸机辅助治疗8例,连续性肾替代治疗8例。治愈31例;好转13例;未愈5例,包括截肢3例(6.1%),死亡1例(2.0%),死因为高钾血症致心肺复苏失败。结论重视止血带和心电监测在严重肢体挤压伤院前救援中的应用,实施负压封闭引流技术可减少严重肢体挤压伤的截肢率。