Field Hazards and Remote Operations - asmameeting.orgasmameeting.org/asma2013_mp/pdfs/asma2013_present_073.pdf · Introduction • Red Bull Stratos: • Remote field operations •

Aerospace Medical Association 84th Annual Scientific MeetingMay 13, 2013

Red Bull Stratos Medical Operations

Field Hazards and Remote Operations:

Providing Medical Care for the Red Bull Stratos Project

James Pattarini, MD Alejandro Garbino, MD, PhD Jennifer Law, MD, MPH Sean Norton, EMT-PRebecca Blue, MD, MPH Matthew Turney, MDSharmila Watkins, MD, MPH Jonathan Clark, MD, MPHErik Antonsen, MD, PhD

Disclosure InformationJames Pattarini, MD

I have no financial relationships to disclose.

I will not discuss off-label use and/or investigational use in my presentation

Introduction

• Red Bull Stratos:• Remote field operations• Hundreds of support personnel

• Unique environment (Roswell, New Mexico)• Limited level of medical care

• Remote location

• Desert environment

• Identification of risks• Steep learning curve from MBF1 - MBF3• Significant obstacles for the medical team to overcome.

Overview

• Flight Line Hazards

• Field Hazards

• Remote Operations

Flight Line Hazards: Nighttime Operations

• Nighttime operations

• Reflective gear while on the flight line at all times

• Trip hazards: power lines and data cables

• Heavy machinery

Flight Line Hazards:Balloon Awareness

• Balloon Awareness

• Gloves for handling

• Fragility – • No stepping over

train

• Only balloon team members to handle the balloon

• Helium Truck Hazards

Field Hazards: Capsule Awareness

• Capsule Awareness

• Falling objects (capsule suspended by crane until launch)

• Rapid crane acceleration

• Power umbilicals

• LOX, pressurized

nitrogen, batteries

Field Hazards

• Manmade Obstacles– Barbed wire fencing– Few inroads to remote territory – Private land with few, widely-

separated gates

• Automobile Hazards– Divided attention

• Balloon tracking, situational awareness

– Gravel/dirt roads the norm– Off-road driving– Geographic familiarity, or lack

thereof

Field Hazards

• Desert terrain• Field personnel hydration

requirements• Areas inaccessible by car

• Possibility of prolonged exposure

• Heat exposure• Distance to Level 1 Trauma

Center

• Indigenous wildlife• Rattlesnakes• Scorpions• Black Widows

Field Hazards

Remote Operations

• Communication

• Primary method of communication by text message

• Loss of coverage – Dependent on location,

cellular network• Group text useful• Coordination

– Medical back room trailer

• Radios primary while on site

Remote Operations

• Limited Resources• Field clinic: minor care to field personnel• Situation awareness and medical preparations

• Major obstacles during MBF1• No video feeds of MCC, flight line • Crew often unaware of medical capabilities, clinic

locations

• Limited clinical capabilities

Field Clinic EvolutionMBF1MBF1 MBF3MBF3

Final Clinic Capabilities

• Clinic– Stethoscope– Sphygmomanometer– Thermometer– Oto/ophthalmoscope

• MCC– AED

– O2 single bottle with NRB mask

OTC medications• Analgesics, antihistamines,

decongestants, PPIs• Sunblock, insect repellants

Rx medications:• Ondansetron,

prochlorperazine, prednisone, lidocaine, epinephrine

Basic wound care: • Dressings, gauze, splints• NS IVF 3-5 Liters• Suture supplies

Results

• Clinic Utilization• Encounters related to hazards outline previously

• Soft tissue injuries

• Medical illness• Upper respiratory infections

• Gastroenteritis

• Headache

• Exhaustion

Encounter Summary

Encounter Summary

Summary

• MBF 1 - 21 total encounters • MBF 2 - 14 total encounters• MBF 3 - 25 total encounters• Most common: URI complaints• Most avoidable: Headache from dehydration• Most serious:

– Lightheadedness in 75 yo M with atrial fibrillation • s/p cardioversion x3 prior to event

– Referred to local emergency department

Lessons Learned

• URI cases expected – Weather, stress, close quarters, night operations with sleep

shifting

• Multiple headache complaints– Dehydration, caffeine consumption

• Most undocumented health issues: exhaustion from prolonged nighttime operations– 15+ hour days for most crew– 10PM briefing, reset following scrubbed launch by noon.– Rest days built into schedule a necessity– Clinic requested as a nap site by crew, utilized most during

MBF2

Discussion

• Medical providers face unique challenges in a remote environment.

• Nighttime operations introduce further risk in reduced visibility and circadian disruption

• Despite resource limitations, the medical support team for the Stratos project was able to respond well to all field medical concerns

Acknowledgements

• The authors acknowledge the invaluable contribution to the spaceflight scientific community that Felix Baumgartner is making by releasing his data obtained throughout the Red Bull Stratos Project.

• The authors also acknowledge the invaluable support of the following:

– Red Bull N.A.– The Red Bull Stratos team– Col. Joe Kittinger, USAF (ret)– Art Thompson and the Sage Cheshire Aerospace Team– Jim Bagian, MD– University of Texas Medical Branch– Baylor College of Medicine– Jeffrey Sutton, MD, PhD– National Space Biomedical Research Institute through the NASA cooperative

agreement NCC 9-58– Space Medicine Clinical Research Training Program