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- Title
ALTITUDE-INDUCED DECOMPRESSION SICKNESS EVIDENCE REPORT AND PROPOSED EVALUATION PROTOCOLS.
- Authors
Wolf, Michael; Elkhatib, Wiaam; Lang, Richard
- Abstract
BACKGROUND: Evolving research suggests cockpit decompression at altitude occurs more frequently and at lower altitudes than previously reported. Aerospace decompression sickness (DCS) can present subtly and lead to morbid neurological sequelae, requiring high clinical suspicion maintained by pilots, first responders, and physicians. Current literature reflects a paucity of guidance detailing decision-making response algorithm. This report intends to address this knowledge gap by reviewing published guidelines to develop treatment decision protocols for medical providers. OVERVIEW: Aviation DCS mechanistically overlaps with its well-studied correlate in divers with a growing literature body stimulated by prior serial fatal aviation accidents within the United States Air Force U-2 community. Following narrative literature review on the occurrence of decompression injuries resulting from altitude exposure, best clinical practices were formatted as flow charts for algorithmic and universal approaches to medical care. Inflection points in decision-making incorporate both telephone/virtual and face-to-face evaluation with progressive escalations of treatment according to tiered level of care indicated. Three flow charts were developed for procedure following rapid decompression at altitude for utilization in clinical standard operating procedures, practice guidelines, or emergency response. These encompass presence of clinical symptoms at ground-level, self-assessment screening protocol for seeking care, and pre-hospital treatment guidelines for use in a Basic Life Support response system. DISCUSSION: Cockpit decompression at altitude occurs relatively infrequently, though the potential for morbid resulting injury mandates high clinical suspicion when indicated. Clinical sequelae overlap with correlates in the hyperbaric environment, which should be recognized by pilots, aircrew, relevant military personnel, air traffic controllers, and those who provide medical services to them. Established management frameworks facilitate prompt recognition of and initiation of treatment for decompression injuries at altitude. The proposed schema in this report thus serve to prevent related adverse medical incidents while guiding clinical decision making. Learning Objectives 1. The audience will understand updates about how aerospace decompression sickness (DCS) can to lead to morbid neurological sequelae, and the monitoring methods used including high clinical suspicion maintained by pilots, first responders, and physicians. 2. The audience will learn about current published guidelines in managing acute altitude decompression sickness (DCS) and their utility in developing updated treatment decision protocols for medical providers presented in this process review.
- Subjects
UNITED States. Air Force; DECOMPRESSION sickness; AIR traffic controllers; LITERATURE reviews; MEDICAL protocols; MEDICAL care; CHILDREN of military personnel
- Publication
Aerospace Medicine & Human Performance, 2024, Vol 95, Issue 8, p598
- ISSN
2375-6314
- Publication type
Article