Prevention of G-Induced Effects on Vision and Consciousness During Simulated Suborbital Spaceflight.

Introduction: During centrifuge-simulated suborbital spaceplane flights, launch and re-entry frequently cause visual symptoms, and G-induced loss of consciousness can occur. G-related effects may be more prominent during re-entry from microgravity on actual flights. A modified anti-G maneuver that does not involve a breath strain and is suitable for members of the public may be effective against these effects.

Biopsychosocial Health Considerations for Astronauts in Long-Duration Spaceflight: A Narrative Review.

Long-duration spaceflights beyond low-Earth orbit, including missions to the Moon and Mars, pose significant health risks. Although biomedical approaches commonly appear in the literature, considering psychological and social factors alongside physiologic health offers a more holistic approach to astronaut care. Integrating the biopsychosocial (BPS) framework into medical planning addresses complex spaceflight challenges and aids in developing mitigation strategies.

Lessons for Flying Astronauts with Disabilities Drawn from Experience in Aviation.

Accessible spaceflight may seem a distant concept. As part of a diverse European Space Agency funded Topical Team, we are working on the physiological feasibility of space missions being undertaken by people with physical disabilities. Here, the first activity of this team is presented in the form of key lessons learned from aviation to inform new work on space missions.

Erratum: 'I am afraid the news is not good' - Breaking bad news in the time of COVID: Experiences from a field hospital.

No abstract available.

'I am afraid the news is not good' - Breaking bad news in the time of COVID: Experiences from a field hospital.

Background:  The COVID-19 Pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell's Plain Field Hospital, managed many COVID patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff.

Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study.

Introduction: Previous studies deriving and validating triage scores for patients with suspected COVID-19 in Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight triage scores' accuracy for death or organ support in patients with suspected COVID-19 in Sudan.

Methods: We conducted an observational cohort study using Covid-19 registry data from eight emergency unit isolation centres in Khartoum State, Sudan.

An initiative to reduce psychiatric boarding in a Cape Town emergency department.

Background: Psychiatric boarding in Emergency Departments (ED) is a global challenge which results in long ED length of stays (LOS) with significant consequences on patient care and staff safety.

Aim: This study investigated the impact of an initiative to reduce psychiatric boarding on LOS and readmission rate, as well as explored the relationship between boarding times and LOS.

Setting: This study was conducted at Mitchells Plain Hospital, a large district-level hospital in Cape Town.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study.

Introduction: Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level.

Training and testing of a gradient boosted machine learning model to predict adverse outcome in patients presenting to emergency departments with suspected covid-19 infection in a middle-income setting.

COVID-19 infection rates remain high in South Africa. Clinical prediction models may be helpful for rapid triage, and supporting clinical decision making, for patients with suspected COVID-19 infection. The Western Cape, South Africa, has integrated electronic health care data facilitating large-scale linked routine datasets.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting.

Background: Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic.

Methods: Routinely collected data for public hospitals in the Western Cape, South Africa from the 27th August 2020 to 11th March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study.

Background: Tools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa.

Methods: An observational cohort study using routinely collected data from EDs across the Western Cape, from 27 August 2020 to 11 March 2022, was conducted to assess the performance of the PRIEST (Pandemic Respiratory Infection Emergency System Triage) tool, NEWS2 (National Early Warning Score, version 2), TEWS (Triage Early Warning Score), the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS (Pandemic Medical Early Warning Score) in suspected COVID-19.

The firearm pandemic: time to act and flatten the curve.

N/A.

Navigating Pregnancy for Employees in Civilian Rotary-Wing Aeromedicine.

Women of child-bearing age make up an ever-increasing element of the aeromedical workforce in Australia and the UK. However, policy relating to the management of risk for pregnant employees in this sector is often missing or inadequate, with many women facing detrimental impacts on their career progression and financial well-being. For women who choose to continue flying, there is a lack of transparent guidance about the risks of flying within a helicopter in an aeromedical role.

Physiological Effects of Centrifuge-Simulated Suborbital Spaceflight.

High-G acceleration experienced during launch and re-entry of suborbital spaceflights may present challenges for older or medically susceptible participants. A detailed understanding of the associated physiological responses would support the development of an evidence-based medical approach to commercial suborbital spaceflight. There were 24 healthy subjects recruited into 'younger' (18-44 yr), 'intermediate' (45-64 yr) and 'older' (65-80 yr) age groups.

Cabin Pressure Altitude Effect on Acceleration Atelectasis After Agile Flight Breathing 60% Oxygen.

A flight trial was conducted to determine whether breathing 60% oxygen during high performance flight maneuvers using contemporary pilot flight equipment induces atelectasis and to explore whether cabin altitude had any influence on the extent of atelectasis identified. On 2 separate days, 14 male aircrew flew as passengers at High [14,500-18,000 ft (4420-5486 m)] and Low [4000-6000 ft (1219-1829 m)] cabin pressure altitude in a Hawk T Mk1 aircraft breathing 60% oxygen. Sorties comprised 16 maneuvers at +5 G, each sustained for 30 s.

Cardiorespiratory Responses to Voluntary Hyperventilation During Normobaric Hypoxia.

Unexplained physiological events (PE), possibly related to hypoxia and hyperventilation, are a concern for some air forces. Physiological monitoring could aid research into PEs, with measurement of arterial oxygen saturation (So₂) often suggested despite potential limitations in its use. Given similar physiological responses to hypoxia and hyperventilation, the present study characterized the cardiovascular and respiratory responses to each.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting.

Background: Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic.

Methods: Routinely collected data for public hospitals in the Western Cape, South Africa from the 27 August 2020 to 11 March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19.

Rescue Activity of a Civilian Helicopter Emergency Medical Service in the Western Cape, South Africa: A 5-Year Retrospective Review.

Introduction: Helicopter search and rescue (SAR) in Africa is conducted primarily by military organizations. Since 2002, the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial, and aquatic rescue. To our knowledge, this is the first description of the operations of an African helicopter rescue service.

Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey.

Objective: Emergency care can address over half of deaths occurring each year in low-income countries. A baseline evaluation of the specific needs and gaps in the supply of emergency care at community level could help tailor suitable interventions in such settings. This study evaluates access to, utilisation of, and barriers to emergency care in the city of Kinshasa, Democratic Republic of Congo.

A descriptive study of trauma patients transported by helicopter emergency medical services to a level one trauma centre.

Background: KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable prehospital asset for the transport of time sensitive trauma. This study reviews the impact of HEMS in the management of trauma at Inkosi Albert Luthuli hospital (IALCH) which is the only public accredited level one trauma centre in the province.

A COVID-19 field hospital in a conference centre - The Cape Town, South Africa experience.

Background: The coronavirus pandemic has put extreme pressure on health care services in South Africa.

Aim: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.

Setting: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility.

Managing acute abdominal pain in the emergency centre: Lessons from a patient's experience.

Pain is one of the most common reasons people present to the emergency centre with 7-10% of presentations being due to acute abdominal pain. However, pain is also often neglected by clinicians in emergency centres. The well validated South African Triage Score (SATS) incorporates pain assessment in the prioritising of patients with the aim of guiding clinicians.