An evaluation of the Royal Air Force helicopter search and rescue services in Britain with reference to Royal Air Force Valley 1980-1989.

The Royal Air Force (RAF) operates a helicopter Search and Rescue (SAR) service in the United Kingdom and territorial waters; it also provides a similar service in several locations abroad. A 10-year retrospective study of the SAR helicopter service operating from the RAF base at Valley on the island of Anglesey in North Wales is presented, with national SAR statistics over a similar period provided for comparison. Analysis of records kept by SAR aircrew at RAF Valley shows that their assistance had been requested on 1490 occasions during the 10-year period studied; most of these requests were the result of incidents involving holidaymakers, particularly in the mountains or along the coast. The results illustrate the versatility and life-saving potential of a highly skilled and motivated service able to work in adverse weather and dangerous locations. In the light of current debate, the value of aeromedical evacuation of seriously ill patients using helicopters is discussed.     

A Comparison of the Rates of Sickness Absence between the Male Population of Royal Air Force Waddington and the Lincolnshire Police Force During November 1980

A survey of male sickness absence notifications during the monthof November 1980 was performed at Royal Air Force Waddingtonand at the Lincolnshire Police Force Headquarters. The results,when analysed, showed a statistically significant (P<0.05)lower absence rate amongst RAF personnel, independent of theparameters used for comparison. The study points to the existence of an occupational healthservice as a major contribution to lower sickness absence ratesamongst RAF personnel. Accepted        1 January 1982 Flight Lieutenant R. Guest, Medical Centre, United Kingdom Support Unit, Ramstein Air Base, BFPO 109     

Training of aerospace medicine physicians

In the U. S. there are 23 recognized medical specialty boards. One of these is preventive medicine. Within preventive medicine there are three areas: Aerospace Medicine, Occupational Medicine, and Public Health/General Preventive Medicine. The preventive medicine specialties have a common core of required training including biostatistics, epidemiology, health services administration and environmental health. These, plus associated topics are covered during year one of training. Year two of training involves clinical rotations specifically tailored to the eye, ear, heart, lungs and brain, plus flight training to the private pilot level, and a Masters Degree research project for the required thesis. During year three the physicians in aerospace medicine practice full-time aerospace medicine in a NASA or other government laboratory or a private facility. To date, more than 40 physicians have received aerospace medicine training through the Wright State University School of Medicine program. Among these are physicians from Japan, Australia, Taiwan, Canada and Mexico. In addition to the civilian program at Wright State University, there are programs conducted by the U. S. Air Force and Navy. The Wright State program has been privileged to have officers from the U. S. Army, Navy and Air Force. A substantial supporter of the Wright State program is the National Aeronautics and Space Administration and a strong space component is contained in the program.     

Radiation exposure during air travel: guidance provided by the Federal Aviation Administration for air carrier crews

Air carrier crews are occupationally exposed to ionizing radiation, principally from galactic cosmic radiation. To promote radiation safety in aviation the Federal Aviation Administration has: issued educational material on the nature of the radiation received during air travel; recommended radiation exposure limits for pregnant and nonpregnant aircrew members; developed computer programs that estimate for a given flight profile the amount of galactic radiation received on a current flight or on one flown at any time back to January 1958; published tables that enable aircrew members to estimate possible health risks associated with their occupational exposure to radiation; and conducted research on effects of radiation during pregnancy. References for this material are given in the article. In addition, graphic and tabular data in the article show how galactic radiation levels and the composition of the galactic radiation has changed between 1958 and 1999. Also given are estimates of effective doses received by air travelers on a wide variety of air carrier flights.     

Adverse medical events in British service personnel following anthrax vaccination

The safety of the UK anthrax vaccine in British service personnel was evaluated by a retrospective cohort study of randomly selected personnel from five Royal Air Force bases by investigating adverse medical events and consultation rates for a period before and after vaccination. Vaccination acceptance rate varied from 27 to 89% (P=0.0001). In the vaccinated cohort 11.1% (n=368) reported side-effects. The number of consultations in the year prior to vaccination (P=0.04) and RAF base (P=0.0085) were associated with side-effects. Only the RAF base remained a statistically significant factor (P=0.007) after adjusting for other factors. The anthrax vaccine resulted in mild side-effects in 11%, and no serious side-effects were observed. Acceptors of vaccine did not have significantly more medical consultations following vaccination than their unvaccinated counterparts.     

Respiratory ill-health in Dental Laboratory Technicians: A Comparative Study of GP Consultation Rates

Eighteen Royal Air Force dental laboratory technicians (DLTs)and 69 Service controls matched for age, sex and smoking statuswere compared by means of incidence rates of GP consultationfor respiratory, and all other, illness. By retrospectively calculating for each individual the timeserved (man-years at risk) at the RAF Station concerned, togetherwith the number of consultations that fell into each of thestudy categories, it was possible to produce an incidence rate,per man-year at risk, of consultations for both study and controlgroups. By calculating a relative risk (RR) it was observedthat DLTs were nearly three times (RR=2·95. Cl 1·69–5·13),more likely to attend their GP with respiratory problems thanmembers of the control group, and 1·7 times (RR=1·71.Cl 0·98–3·01) more likely to attend theirGP with other problems. Comparison of the numbers of individuals continuing to use bronchodilatortherapy in each of the two groups suggested that DLTs have ahigher prevalence of conditions that require this form of therapyas treatment. Requests for reprints should be addressed to: Squadron Leader R. Guest, Senior Medical Officer, Royal Air Force Kinloss, Forres, Moray IV36 0UJ, Scotland     

Simulator Sickness in an Army Simulator

Simulator sickness describes a symptom reported by aircrew duringor after flight simulator training. Some features are commonto motion sickness but others, which are unusual during realflight, are believed to result specifically from the simulatorenvironment. This paper describes the results of a questionnaire study examiningthe incidence and factors influencing simulator sickness inany army training system. Case histories are described and conclusionsdrawn with respect to health and safety, training and the effecton flight operations. One hundred and fifteen aircrew were registered in the questionnairestudy. Data were collected from a history questionnaire, a post-sortiereport and a delayed report form. Sixty-nine per cent of aircrewgave a history of symptoms in the simulator and 59.9 per centexperienced at least one symptom during the study period althoughfew symptoms were rated as being other than slight. Only 3.6per cent of subjects reported symptoms of disequilibrium. Comparativeanalysis of the results was performed after scoring symptomsto produce a sickness rating. This showed: association betweensimulator-induced sickness and greater flying experience; adaptationto the simulator environment; a history of sea sickness maypredict susceptibility to simulator sickness; and no associationof crew role and simulator sickness. Although some authorities believe simulator sickness to be apotential flight safety hazard there was little evidence fromthis study. Guidelines for the prevention of the problem are presented nowthat many factors have been identified. A general policy to‘ground’ aircrew for a period following simulatortraining is not necessary, but severe cases should be assessedindividually. Requests for reprints should be addressed to: Lt Col M.G. Braithwaite RAMC, Consultant in Aviation Medicine, 1st Armoured Field Ambulance RAMC, BFPO 30     

军事飞行人员临床航卫保障体系构建

在军队某综合医院构建军事飞行人员临床航卫保障体系实践的基础上,阐明临床航卫保障在军事飞行人员医学选拔、疾病矫治与医学鉴定等方面的核心价值,明确临床航空医学价值追求、技术要求及创新路径等方面的特殊内涵,提出创新临床航卫保障体系发展三个方面的建议,即完善医疗保障体系、选拔鉴定体系、科技创新体系,研究成果对推进我军特色临床航卫保障体系建设具有指导意义。     

Human nutrition in medical practice: the training of doctors.

Nutritional advice from doctors and other health workers is held in high regard by the general public. It is important, therefore, to ensure that the advice given is sound and safe. Historically, the training in nutrition for the health professions has been piecemeal and selective. As a first step in the development of national standards, a core curiculum on nutrition for health professionals was developed as part of the National Nutrition Task Force. Designed for undergraduates, the curriculum sought to provide a standard for training which would ensure safe practice. The curriculum, which has been accepted by all undergraduate medical schools, identifies eighteen bullet points covering: the principles of nutritional science; public health nutrition; clinical nutrition and nutritional support. Postgraduate training for doctors is the responsibility of the Royal Colleges, who have formed an Intercollegiate Group on nutrition. This group has developed an intercollegiate foundation course in nutrition which lasts for I week and is offered at different centres around the country. Using the Intercollegiate Course as a base, individual Colleges are exploring how they might best develop the next level of training by identifying the educational needs for nutrition in different sub-specialities. There is some discussion as to whether it is timely to develop a defined clinical speciality in human nutrition. Within these developments, nutritionists and dietitians are identified as a resource to be called upon by other health professionals, and therefore it is important that in their own training they are suitably equipped to take on this challenge.     

A postgraduate training course to prepare doctors for decision-making related to health authorities'' computing services

A training course which has been developed for doctors in public health medicine is described. Its underlying purpose was to create an appreciation of general management principles to ensure that resources would be directed to computing which supports patient care. This course could be adapted for computer training of experienced doctors in other branches of medicine.     

湖南某民航空勤人员营养状况调查研究

目的了解湖南某民航空勤人员的营养摄入状况、膳食结构,为引导其合理膳食、建立科学的食物消费观提供依据。方法对湖南某民航的全部空勤人员（369人）进行食物频率调查;膳食调查采用多阶段整群抽样抽取95人,以24 h回顾法连续3 d进行膳食营养素摄入情况的调查。结果膳食调查结果显示,民航空勤人员膳食结构为谷类22.26%、蔬菜水果类40.43%,摄入比例偏低;鱼禽肉蛋类20.24%、油脂类4.90%,摄入比例偏高。膳食纤维摄入量过低,只达到推荐摄入量的50.10%。钙、维生素B2摄入量不足,分别占推荐摄入量的79.29%和75.71%。结论湖南某民航空勤人员营养状况总体良好,食物结构基本合理,营养素摄入存在蛋白质、脂肪摄入过高,碳水化合物、钙、维生素B2和膳食纤维摄入偏低的问题。因此,需对湖南某民航空勤人员加强营养教育,树立正确营养观念,平衡膳食,合理营养。     

GPs' attitudes toward complementary medicine

The National Center for Complementary and Alternative Medicine (NCCAM) define complementary and alternative medicine as a group of 'diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine', as defined by our medical peers. Since the 1990 s the term 'integrative medicine' has gained increasing popularity and acceptance by doctors aligned with the importance of evidence based medicine and the demonstration of increasing nonorthodox therapies having a scientific basis. The RACGP-AIMA (The Royal Australian College of General Practitioners-Australasian Integrative Medicine Association) position paper on complementary medicine (CM) defines integrative medicine as 'the blending of conventional and natural/complementary medicines and/or therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole'.     

民航飞行人员骨密度和骨代谢指标的测定

目的探讨高空环境对飞行人员骨密度和骨代谢指标的影响,分析飞行人员骨密度和骨代谢水平与飞行时间的关系。方法某航空公司健康男性飞行员139名（20～60岁）和健康地面男性对照人员37名（20～60岁）,按照年龄分成4组：20～年龄组,30～年龄组,40～年龄组,50～印年龄组,分别采用单光子超远端两维骨密度测量法测量骨密度,放射免疫分析法测定血清骨钙素（BGP）水平,采用酶联免疫分析法测定血清骨特异性碱性磷酸酶（BALP）,其结果用组间t检验进行比较,各变量与飞行时间之间进行相关分析。结果飞行员各年龄段骨密度均值水平均低于正常值,P〈0．05;50～60岁年龄组尺骨BMD明显低于正常组,P〈0．05。尺骨的BMD受飞行年限的影响较桡骨敏感。飞行人员BGP水平和BALP水平均低于对照组,飞行人员BGP水平和BALP水平与对照组比较,在20～年龄组和30～年龄组均显著降低（P〈0．01）,40～年龄组之间差异无显著性（P〉0．05）,与累积飞行时间呈显著性负相关（P〈0．01）。结论高空环境能降低飞行员的骨密度,尺骨受高空环境的影响较桡骨敏感。并影响飞行人员的骨代谢水平,且与飞行时间相关。     

Helminth infections in British troops following an operation in Sierra Leone

One hundred and fifty-three British soldiers and 86 Royal Air Force (RAF) personnel were deployed on a hostage rescue operation in Sierra Leone. For 3 days they were exposed to various infection risks and 6 weeks later some of the soldiers presented with gastrointestinal complaints. Both groups were screened with structured questionnaires, blood investigations and (where indicated) faecal microscopy and charcoal culture for helminths. Definite and probable cases of helminth infection were treated with albendazole and all soldiers were screened again after 3 months. Among the soldiers investigated, 73/145 (50%) reported gastrointestinal symptoms and 70/139 (50%) had eosinophilia. Among these, 17/66 (26%) had hookworm infection, 6/66 (9%) had Strongyloides stercoralis infection and 1/66 (2%) had Giardia lamblia infection. Eosinophilia was most strongly associated with entering the enemy camp and being in the platoon that attacked the area around the camp latrines. Among RAF personnel, who were not involved in activities on the ground, 3/86 (3%) had borderline eosinophilia. Treatment of 105/153 (69%) soldiers with albendazole was well tolerated and, on follow-up screening 3 months later, 23/124 soldiers (19%) had gastrointestinal symptoms and 18/121 (15%) had eosinophilia. Faecal investigations and schistosomiasis serology tests were all negative at this stage.     

The neonatal resuscitation training project in rural South Africa

A paediatrician trainer from Australia (JT) spent 3 months in South Africa to assist with the development of neonatal resuscitation training in rural areas, particularly in district hospitals. The project was initiated by the Rural Health Unit at the University of the Witwatersrand and coordinated through the Family Medicine Education Consortium (FaMEC). The Rural Workforce Agency of Victoria together with General Practice and Primary Health Care Northern Territory covered the salary and international travel costs of the trainer, while local costs were funded by provincial departments of health, participants and a Belgian funded FaMEC project. The trainer developed an appropriate one-day skills training course in neonatal resuscitation (NNR), using the South African Paediatric Association Manual of Resuscitation of the Newborn as pre-reading, and a course to train trainers in neonatal resuscitation. From July to October 2004 he moved around the country running the neonatal resuscitation course, and, more importantly, training and accrediting trainers to run their own courses on an ongoing basis. The neonatal resuscitation course involved pre- and post-course multiple-choice question tests to assess knowledge and application, and, later, pre- and post-course skills tests to assess competence. A total of 415 people, including 215 nurses and 192 doctors, attended the neonatal resuscitation courses in 28 different sites in eight provinces. In addition, 97 trainers were trained, in nine sites. The participants rated the course highly. Pre- and post-course tests showed a high level of learning and improved confidence. The logistical arrangements, through the departments of family medicine, worked well, but the programme was very demanding of the trainer. Lessons and experiences were not shared between provinces, leading to repetition of some problems. A clear issue around the country was a lack of adequate equipment in hospitals for neonatal resuscitation, which needs to be addressed by health authorities. A process of ongoing training has been established, with provincial coordinators taking responsibility for standards and the roll-out of training. A formal evaluation of the project is planned. The project serves as a model for skills training in rural areas in South Africa, and for collaboration between organisations. A number of specific recommendations are made for the future of this NNR training project, which offer lessons for similar programmes.     

Clinical judgement: evidence in practice.: RS Downie, Jane Macnaughton, with Fiona Randall. (213 pages, {pound}19.95.) Oxford University Press, 2000. ISBN 0-19-263216-7.

Evidence-based medicine (EBM) is rapidly becoming the dominantmedical paradigm throughout the world. Many medical school andpost-graduate programmes instruct doctors in training in theuse of these techniques, and faculty development courses     

Disorientation in Army Helicopter Operations

A brief summary of orientation error accidents during the period1962–79 is made with particular relevance to aircrew experienceand training, cockpit design and workload, and environmentaland operational factors. The present situation regarding aircrewtraining in service aircraft and operations is reviewed. The use of modern avionics in light helicopters is discussedand recommendations are made regarding the reduction of orientationerror accidents in Army helicopter operations. In particular,the helicopter disorientation training sortie currently in useon the Army Pilots Course is described in detail. Accepted        1 October 1981 Lt Col. K. Edgington RAMC, Headquarters, Director Army Air Corps, Middle Wallop, Stockbridge, Hants, SO20 8DY ^*Paper presented at the Joint Services and Faculty of OccupationalMedicine Conference held at the Institute of Naval Medicine,Alverstoke     

湖南某民航空勤人员营养KAP现状调查

目的了解湖南某民航空勤人员的营养KAP现状和营养知识获得途径,为引导其建立科学的食物消费观提供依据。方法对湖南某民航的全部空勤人员（369人）进行问卷调查。结果湖南某民航空勤人员营养知识总体得分为（14.12±3.17）分,合格者、良好者分别占55.06%和27.08%。营养的态度总体得分为（14.20±1.31）分,95.53%的民航空勤人员表示＂希望＂获得有关健康饮食方面的知识。空勤人员获得营养知识的主要途径是报纸杂志和网络。50.89%的人希望通过宣传手册和相关书籍来获得营养知识。结论民航空勤人员营养态度较为积极,但营养知识存在不足,部分被调查者有不良的饮食行为。因此需对湖南某民航空勤人员加强营养教育,树立正确营养观念。     

Integrating human factors into the medical curriculum

Background  The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay.
CRM training  One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion  Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment.