first aid

First aid

Council directive 92/29/EEC of 31 March 1992 on the minimum safety and health requirements for improved medical treatment on board vessels

The documents are classified chronologically, starting with the oldest at the beginning of the list.

Author: J. Delosa This paper reviews the problems in performing correct volumetric or manometric mechanical ventilation inside the chamber, blood transfusions and/ or administration of vasoactive substances, control and surveillance of infectious diseases and coordination between the surgical and anaesthesiological procedures the patient may require as often happens in patients with gas gangrene. Problems concerning the medical and nursing staff are also discussed, since these persons are often obliged to stay under pressure.

Author: Unknown This document is a presentation of Cardiopulmonary resuscitation (CPR) and most 1st aid techniques that can be used to initiate personnel not familliar with such procedures.

Author: Jacek Kot All medical devices introduced into the hyperbaric chamber should be of an appropriate design and fit for use in the hyperbaric environment and the manufacturer should certify them for hyperbaric conditions. However, until now only several medical devices are CE marked for usage in hyperbaric chambers. Therefore users often need to perform themselves checking of the medical equipment needed for continuation of intensive care during hyperbaric treatment. To make this task easier, this paper presents review of reports of usage of medical devices under increased pressure.

The International Labour Organization (ILO) Maritime Labour Convention 2006 stipulates that all ships shall carry a medicine chest, medical equipment and a medical guide. The International Medical Guide for Ships supports a main principle of that Convention: to ensure that seafarers are given health protection and medical care as comparable as possible to that which is generally available to workers ashore, including prompt access to the necessary medicines, medical equipment and facilities for diagnosis and treatment and to medical information and expertise. Also consider the additional document Quantification Addendum: International Medical Guide for Ships

Authors: Martin A Croce, Louis J Magnotti, Stephanie A Savage, George W Wood, Timothy C Fabian An alternative to embolization or external pelvic fixation (EPF) in patients with multiple pelvic fractures and hemorrhage is a pelvic orthotic device (POD), which may easily be placed in the resuscitation area. Little published information is available about its effectiveness. This study evaluated the efficacy of the POD compared with EPF in patients with life- threatening pelvic fractures.

Author: John Penzo & Kirk Dobrowolski This document provides comprehensive explanations regarding drugs and their usage..

9 - International maritime health: Guidance to the International Medical Guide for Ships 3 rd edition - Interim advice regarding the best use of the medical chest for ocean-going merchant vessels without a doctor onboard.

Author: Schlaich C., Reinke A., Sevenich C., Riemer T., Oldenburg M., 5 , Baur X., Horneland A., Jaremin BM., Nielsen., Wichtmann EM., Ioannidis., Brandal., Puskeppeleit M, Denisenko I, Carter T, Nikolic N This document has been published to help the non- medical person in charge of medical care on board vessels to make the best use of the medical chest and equipment on board.

This document is the complement of the International Medical Guide for Ships. The University of Newcastle WHO Collaborating Centre for Training in Pharmaco-economics and Rational Pharmacotherapy was commissioned to develop a list of recommended quantities of medicines listed in the third edition of the International Medical Guide for Ships.

Authors: M. Beuran, S. Paun, B. Gaspar, M. Vartic, S. Hostiuc, A. Chiotoroiu, I. Negoi There are many controversies related to the trauma patient care during the pre-hospital period nowadays. Due to the heterogeneity of the rescue personnel and variability of protocols used in various countries, the benefit of the pre-hospital advanced life support on morbidity and mortality has been not established. The authors reviewed the literature in what concerns the basic and advanced life support given to the trauma patients during the pre-hospital period.

This user manual relates to the DanMedical Analysis System (D-MAS). This manual explains how to set up and use D-MAS and includes important safety information. All information in this manual is based on D-MAS and the standard factory default configuration.

This document is also availaible on DMAC’s website Note that today defibrillators should be provided in all chambers.

Author: Dr. Alan Moloff This document, published by PYNG, a medical equipement manufacturer, promotes the use of Pelvic Stabilization devices. Note that the mortality for pelvic fractures is very high due to the major hemorrhage that can occur secondary to pelvic fracture

This document is a presentation for using the EZ-IO ® from Teleflex (see above)

This document is the method of use of the EZ-IO® Power Driver, a sealed, hand-held, lithium battery powered medical device for use with the EZ-IO® Intraosseous Vascular Access System from Teleflex (https://www.teleflex.com/usa/en/index.html). This system can be used in any situation where intravenous access is difficult to obtain in emergent, urgent, or medically necessary cases. It is also described in logistics/Mediical equipment

This document is a presentation published by PYNG medical on the use of Pelvic Stabilization Devices.

Authors: Emmanuel Cauchy, MD, Sandra Leal, MD, Marie-Anne Magnan, MD, and Hugo Nespoulet, Ph A hyperbaric chamber is available in most trekking and high-altitude expeditions primarily to treat and prevent altitude illness. The device reproduces a low-altitude evacuation when descent is impossible (Bartsch et al., 1993). Atmospheric pressure is increased inside the chamber using a mechanical pump. This paper does not discuss diving. However, it highlights phenomenons linked to the use of decompression chambers while at altitude

Authors: Jacek Kot This paper aims to present current controversies concerning the safety of medical devices and procedures under pressure in a hyperbaric chamber, including: defibrillation in a multiplace chamber; implantable devices during hyperbaric oxygen treatment (HBOT), and the results of a recent European questionnaire on medical devices used inside hyperbaric chambers.

Authors: Avi Shina, Erez Nissim Baruch, Amir Shlaifer, Ami Shovali, Moran Levi, Or Yosefy, David Segal, Tarif Bader, Itai Shavit, Avraham Yitzhak. The authors examined the success rate and ease-of-use ratings of an IO device, the NIO ® (New Intraosseous Persys Medical, Houston, TX, USA) in comparison to the Arrow ® EZ-IO ® (Teleflex Medical Research Triangle Park, NC, USA) by novice users.

Authors: Bistra Iordanova, Lingjue Li, Robert S. B. Clark, and Mioara D. Manole. Assessment of Cerebral Blood Flow (CBF) and oxygenation is not routinely performed after cardiac arrest. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest. Few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcomes. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.

Authors: Simon J Mitchell, Michael H Bennett, Phillip Bryson, Frank K Butler, David J Doolette, James R Holm, Jacek Kot, Pierre Lafère Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert network / Undersea and Hyperbaric Medical Society workshop in Sydney, entitled “Management of mild or marginal decompression illness in remote locations”. The Diver’s Alert Network initiated a recent review undertaken by an international committee with members from Australasia, the USA, and Europe.

Publisher: Advanced Trauma Life Support (ATLS) The American College of Surgeons (ACS) was founded to improve the care of surgical patients, establishing and maintaining a high quality of surgical practices. In accordance with that role, the ACS Committee on Trauma (COT) has worked to establish guidelines for the care of injured patients.

Authors: Gilles Guerrier, Christine Agostini, Marion Antona, Fiorella ponzini, Anne Paoletti, Isabelle Martin, Jean- Michel Ekherian, Christophe Baillard. I-gel® is a second generation supraglottic airway device from Intersurgical and predsented in our website through this link: https://diving-rov- specialists.com/medical-equip.htm, and through this link: https://www.intersurgical.com/ The optimal size of the I-Gel remains unclear since the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-90 kg, and size 5 for weight > 90 kg) for the laryngeal mask airway I-Gel is not evidence-based. The authors hypothesized that sex might also guide the choice of I-Gel size.

Authors: Johanna Wall, Sriveena Naganathar, Banjerd Praditsuktavorn, Oscar F. Bugg, Simon McArthur, Christoph Thiemermann, Jordi L. Tremoleda, and Karim Brohi. Cardiac dysfunction (CD) significantly contributes to mortality in trauma patients who survive their initial injuries following successful hemostatic resuscitation. This poor outcome has been correlated with elevated biomarkers of myocardial injury, but the pathophysiology triggering this cardiac dysfunction remains unknown. The authors investigated the pathophysiology of acute Cardiac dysfunction after trauma using a mouse model of trauma hemorrhage shock (THS)-induced CD with echocardiographic guidance of fluid resuscitation to assess the THS impact on myocardial integrity and function.

Authors: Maritime & coast guard agency Application of the Merchant Shipping and Fishing Vessels (Medical Stores) Regulations 1995 (SI 1995/1802) and the Merchant Shipping and Fishing Vessels (Medical Stores) (Amendment) Regulations 1996 (SI 1996/2821) Notice to all Shipowners, Agents, Masters, Skippers of Fishing Vessels and all Seafarers

Authors: James Eric Neal, Brett Lewellyn The primary purpose of this study was to compare intraoperative and postoperative complication rates for upper extremity surgical cases performed on a standard operating room (OR) table with similar cases done on a typical hospital stretcher. Secondary measures reviewed included surgical time, turnover, total OR time, blood loss, tourniquet time, and postoperative complications.

Authors: Muhammad Husaini Rahmat, Ruhaizin S, Rosalam CM, Hassan A, Khairul Manami K and Indastri S. This study aims to determine efficient ways of lifting the body based on rescuers' preferences. From the results, new stretcher design parameters were established.

37 - Effects of an automated external defibrillator with additional video instructions on the quality of cardiopulmonary resuscitation

Authors: Florian Ettl, Eva Fischer, Heidrun Losert, Dominik Stumpf , Robin Ristl, Kurt Ruetzler, Robert Greif, and Henrik Fischer This study aimed to compare the cardiopulmonary resuscitation (CPR) quality of an automated external defibrillator (AED) with and without additional video instruction during basic life support (BLS) by laypersons.

38 - Emergency Medicine Cases in Underwater and Hyperbaric Environments: The Use of in situ Simulation as a Learning Technique

Authors: Matteo Paganini, Giulia Mormando, Sandro Savino , Giacomo Garetto, Giulia Tiozzo, Enrico M. Camporesi , Fabrizio Fabris, and Gerardo Bosco. Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established worldwide. In healthcare, simulation is an effective learning technique. However, few peer- reviewed articles have been published in the medical literature describing its use in diving and hyperbaric medicine.

Authors: Álvaro Astasio-Picado, Paula Cobos-Moreno, Beatriz Gómez-Martín, María del Carmen Zabala-Baños, and Claudia Aranda-Martín. The objective of this systematic bibliographic review is to update the theoretical and practical knowledge and strategies for the insertion and proper management of the intraosseous route as an emergency vascular access for nursing professionals.

NCCD is a compact, lightweight chest compression device to be used as a substitute to manual chest compression during CPR. NCCD is powered by compressed gas, and designed for use in hyperbaric environments. This equipment is described in logistics/medical equipment/NUI - Compact Chest Compression Device (NCCD https://diving-rov-specialists.com/medical-equip.htm

Authors: Ronal Surya Aditya, Ah Yusuf, Fitriana Kurniasari Solikhah, Setyo Budi Kurniawan, Siti Rozaimah Sheikh Abdullah This document discusses research aimed at understanding nurses' experience assisting patients on stretchers using commercial flights in Indonesia.

Authors: Yu Liu, MD, Yanshu Zhang, Lei Zhang, Hongliang Bai, Gang Wang, MD, Litao Guo The purpose of this study was to analyze the role of SimMan in resident training of emergency skills. Fortyfive 1st year medical residents were selected for this study. All participants were divided into groups and each participant performed different roles during training. Clinical cases were selected using the tutor mode/auto mode in the SimMan computer system in order to train and assess each group. A pre-test was administered to the 45 residents before emergency medical technician (EMT) skill training. Finally, a post- test was conducted with SimMan after training. Tutors scored the student’s performance and recorded the overall time for the procedure.

Authors: Jianxun Li, Haoxin Fu, Kin Keung Lai, and Bhagwat Ram The mobile emergency system is a new emergency mode that provides a solution to deal with increasingly frequent sudden disasters by reasonably allocating mobile emergency facilities and optimizing the allocation of mobile emergency materials. The authors consider mobile emergency cost and mobile emergency time as two objective functions. This paper establishes a multi-objective mobile emergency material allocation model, and transforms the multi-objective.

Authors: Kara D. Wyatt, Neha N. Goel, and Jessica S. Whittle High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases the work of breathing, improves the tidal volume, and modestly increases positive end-expiatory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, the authors review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients.

Authors: M Abdollahi, A Hosseini This document describes the generation of H2S, its mechanisms of toxicity, and the recommended treatment procedures and precautions to be implemented at work.

Authors: Jeroen Seesink, Stella Nieuwenburg, Theo van der Linden, Joost J.L.M. Bierens Little is known regarding the circumstances, outcomes, and quality of operational lifeboat crews perform cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs). The authors aim to evaluate the circumstances, outcomes, and quality of CPR performed by the Royal Dutch Lifeboat Institution (KNRM) in out-of-hospital cardiac arrest (OHCA).

39 - Performance of Basic Life Support by Lifeboat Crewmembers While Wearing a Survival Suit and Life Vest: A Randomized Controlled Trial.

Authors: Allart M. Venema, Marko M. Sahinovic, Albert J. D. W. R. Ramaker, Yvette N. van de Riet, Anthony R. Absalom and J. K. Götz Wietasch. Crewmembers of the “Royal Netherlands Sea Rescue Institution” (KNRM) lifeboats must wear heavy survival suits with integrated lifejackets. This and the challenging environment onboard (boat movements, limited space) might inﬂuence Basic Life Support (BLS) performance. The primary objective of this study was to assess the impact of the protective gear on single- rescuer BLS-quality.

Authors: Malay Sarkar, Irappa Madabhavi, & Nagaveni Kadakol Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may also lead to various adverse effects. Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia during supplemental oxygen therapy, particularly if uncontrolled. The risk of hypercapnia is not restricted to COPD only; it has also been reported in patients with morbid obesity, asthma, cystic fibrosis, chest wall skeletal deformities, bronchiectasis, chest wall deformities, or neuromuscular disorders.

Authors: S. Nogue, R. Pou, J. Fernandez, and P. Sanz- Fatal hydrogen sulphide poisoning usually occurs in confined spaces. However, this report discusses two fatal accidents in unconfined spaces. The first accident caused the death of three workers who entered an unconfined room in a silo of sludge at the same time that a truck dumped several tons of sludge from water purification stations. The hydrogen sulphide that had accumulated inside the silo spilled out into the interior of the room due to a ‘splashing effect’ caused by the impact of the dumped sludge. The second accident occurred when the foreman of a wastewater treatment plant entered one of the substations to perform routine checks.

25 - European regulation 2017 on medical devices, amending Directive 2001/83/EC, Regulation No 178/2002 and Regulation No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC

This Regulation aims to ensure the smooth functioning of the internal market as regards medical devices, taking as a base a high level of protection of health for patients and users, and taking into account the small and medium-sized enterprises that are active in this sector. At the same time, this Regulation sets standards of quality and safety for medical devices in order to meet common safety concerns as regards such products.

Authors: Surg Cdr Kamal Mishra, Surg Capt Gokul Krishnan This document describes the effects of carbon monoxide through historical examples. It also provides suggestions for a better comprehension of the impact of this gas and the methods to prevent them.

Authors: Seong-Yong Jeong, Young Kook Moon, Joseph Wang, & Jong-Heun Lee Accurately detecting and identiﬁcation of volatile aromatic hydrocarbons, highly toxic pollutants, are essential for assessing indoor and outdoor air quality and protecting humans from their sources. However, real-time and on-site monitoring of aromatic hydrocarbons has been limited by insufficient sensor selectivity. Addressing the issue, bilayer oxide chemiresistors are developed using Rh–SnO2 gas- sensing films and catalytic CeO2 overlayers for rapidly and cost-effectively detecting traces of aromatic hydrocarbons in a highly discriminative and quantitative manner, even in gas mixtures.

Author: N. K. I. McIver This document provides an historic of the decompression procedures since the observations of Robert Boyle to today. This description includes the therapeutic procedures.

Publisher: Undersea & Hyperbaric Medical Society This document is a compilation of pratices made by UHMS and published in April 2011. It is based in part on the USN Diving Manual Revision 6; April 200 with Advance Change Notices 15-102 , the Manual of the Medical Department (ManMed) Change 126 - August 2005, the U.S. Air Force Guidelines for Treating Altitude Decompression Sickness (USAF Instruction 48- 112), and Association of Diving Contractors International (ADCI) Return to Diving Guidelines after DCS - 2011. Note that it could also be logged in “Diving & ROV procedures” however the treatment side of the document justifies to publish it in 1st aid.

Authors: Richard E. Moon, Simon Mitchell This document details procedures to implement for treating decompression accidents. This document is not specific to commercial diving.

Publisher: US Federal Aviation Administration This document from the US Federal Aviation Administration was initially designed for personnel working in airline companies. Commercial diving companies and divers can use it to understand which formation this personnel may have or may not have.