Pediatric trauma in the Austrian Alps: the epidemiology of sport-related injuries in helicopter emergency medical service

Beyond "bluespace" and "greenspace": A narrative review of possible health benefits from exposure to other natural landscapes

Numerous studies have highlighted the physical and mental health benefits of contact with nature, typically in landscapes characterized by plants (i.e., "greenspace") and water (i.e., "bluespace"). However, natural landscapes are not always green or blue, and the effects of other landscapes are worth attention. This narrative review attempts to overcome this limitation of past research. Rather than focusing on colors, we propose that natural landscapes are composed of at least one of three components: (1) plants (e.g., trees, flowering plants, grasses, sedges, mosses, ferns, and algae), (2) water (e.g., rivers, canals, lakes, and oceans), and/or (3) rocks and minerals, including soil. Landscapes not dominated by plants or liquid-state water include those with abundant solid-state water (e.g., polar spaces) and rocks or minerals (e.g., deserts and caves). Possible health benefits of solid-state water or rock/mineral dominated landscapes include both shorter-term (e.g., viewing images) and longer-term (e.g., living in these landscapes) exposure durations. Reported benefits span improved emotional and mental states and medical treatment resources for respiratory conditions and allergies. Mechanisms underlying the health benefits of exposure consist of commonly discussed theories in the "greenspace" and "bluespace" literature (i.e., instoration and restoration) as well as less discussed pathways in that literature (i.e., post-traumatic growth, self-determination, supportive environment theory, and place attachment). This is the first review to draw attention to the potential salutogenic value of natural landscapes beyond "greenspace" and "bluespace." It is also among the first to highlight the limitations and confusion that result from classifying natural landscapes using color. Since the extant literature on natural landscapes - beyond those with abundant plants or liquid-state water - is limited in regard to quantity and quality, additional research is needed to understand their restorative potential and therapeutic possibilities.

Epidemiology of severe paediatric trauma following winter sport accidents

AIM

This study describes the epidemiology of severe injuries related to winter sports (skiing, snowboarding and sledding) in children and assesses potential preventive actions.

METHODS

A single-centre retrospective study performed at Pediatric or Adult Intensive Care Unit in the French Alps. All patients less than 15 years old, admitted to the Intensive Care Unit following a skiing, snowboarding or sledding accident from 2011 to 2018, were included.

RESULTS

We included 186 patients (mean age 10.6 years and 68% were male); of which 136 (73%), 21 (11%) and 29 (16%) had skiing, snowboarding and sledding accidents, respectively. The average ISS (injury severity score) was 16. The major lesions were head (n = 94 patients, 51%) and intra-abdominal (n = 56 patients, 30%) injuries. Compared to skiing/snowboarding, sledding accidents affected younger children (7 vs 11 years, P < .001); most of whom did not wear a helmet (89% vs 8%, P < .001). Severity scores were statistically different amongst winter sports (ISS = 16 (IQR 9-24) for skiing, 9 (IQR 4-16) for snowboarding and 16 (IQR 13-20) for sledding accident, P = .02).

CONCLUSION

Winter sports can cause severe trauma in children. Sledding accidents affect younger children that may benefit from wearing protective equipment.

Spinal injury in alpine winter sports: a review

Introduction

Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports.

Material and methods

The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors.

Results

There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population.

Discussion

Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study

BACKGROUND

Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.

METHODS

Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.

RESULTS

For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8-30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1-7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06-3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48-9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21-4.31, p = 0.011) to be significantly associated with neck pain.

CONCLUSIONS

The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.

Facial Trauma in Sports

Injuries resulting from facial trauma are common in all sports. Athlete-to-athlete contact, falls, and blows from equipment account for the majority of these events. Appropriate knowledge of basic science, relevant anatomy, and clinical skills is required to provide the correct medical care. While true medical emergencies are infrequent, a prompt accurate diagnosis is essential in developing targeted management and return to play options.

Ambulance helicopter contribution to search and rescue in North Norway

Background

Search and rescue (SAR) operations constitute a significant proportion of Norwegian ambulance helicopter missions, and they may limit the service’s capacity for medical operations. We compared the relative contribution of the different helicopter resources using a common definition of SAR-operation in order to investigate how the SAR workload had changed over the last years.

Methods

We searched the mission databases at the relevant SAR and helicopter emergency medical service (HEMS) bases and the Joint Rescue Coordination Centre (North) for helicopter-supported SAR operations within the potential operation area of the Tromsø HEMS base in 2000–2010. We defined SAR operations as missions over land or sea within 10 nautical miles from the coast with an initial search phase, missions with use of rescue hoist or static rope, and avalanche operations.

Results

There were 769 requests in 639 different SAR operations, and 600 missions were completed. The number increased during the study period, from 46 in 2000 to 77 in 2010. The Tromsø HEMS contributed with the highest number of missions and experienced the largest increase, from 10 % of the operations in 2000 to 50 % in 2010. Simple terrain and sea operations dominated, and avalanches accounted for as many as 12 % of all missions. The helicopter crews used static rope or rescue hoist in 141 operations.

Discussion

We have described all helicopter supported SAR operations in our area by combining databases. The Tromsø HEMS service had taken over one half of the missions by 2010. Increased availability for SAR work is one potential explanation.

Conclusions

The number of SAR missions increased during 2000-2010, and the Tromsø HEMS experienced the greatest increase in workload.

Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports

INTRODUCTION

Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations.

AIM

Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs.

METHODS

This is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall.

RESULTS

Among the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score≥4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12-L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty.

CONCLUSIONS

High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12-L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.

Psychological-behavioral characteristics and fractures in children are closely related

This work aimed to study the relationship between psychological-behavioral characteristics and fractures in children to provide a basis for development of preventive strategies. The study included 84 children hospitalized for fractures (fracture group) and 78 children without fractures (control group). The following questionnaires were utilized: temperament questionnaire, Eysenck Personality Questionnaire, and the Achenbach Child Behavior Checklist (CBCL). There were more children with problem behaviors in the fracture group than in the control group (P<0.01). Furthermore, level of activity and attention dispersion showed a significant relationship with fractures (P<0.05). Scores for the psychoticism, extroversion, and neuroticism subscales of the Eysenck Personality Questionnaire were higher for the fracture group than the control group (P<0.05 or <0.01). For the Achenbach Child Behavior Checklist, the average score for boys and/or girls was higher in the fracture group than the control group in 4-5-year and/or 6-11-year olds. In addition, in 6-11-year olds, boys in the fracture group had higher scores for restlessness, aggression, and violation of discipline and girls in the fracture group had higher scores for aggression and depression than those in the control group (P<0.05). Children with fractures had more psychological and behavioral problems. Psychological intervention measures could be adopted to reduce the occurrence of fractures in children.