Epidemiology and mortality of glacier crevasse accidents.

INTRODUCTION: Crevasse accidents can lead to severe injuries and even death, but little is known about their epidemiology and mortality. METHODS: We retrospectively reviewed helicopter-based emergency services rescue missions for crevasse victims in Switzerland between 2000 and 2010. Demographic and epidemiological data were collected. Injury severity was graded according to the National Advisory Committee for Aeronautics (NACA) score. RESULTS: A total of 415 victims of crevasse falls were included in the study. The mean victim age was 40 years (SD 13) (range 6-75), 84% were male, and 67% were foreigners. The absolute number of victims was much higher during the months of March, April, July, and August, amounting to 73% of all victims; 77% of victims were practicing mountaineering or ski touring. The mean depth of fall was 16.5m (SD 9.0) (range 1-35). Overall on-site mortality was 11%, and it was higher during the ski season than the ski offseason (14% vs. 7%; P=0.01), for foreigners (14% vs. 5%; P=0.01), and with higher mean depth of fall (22 vs. 15m; P=0.01). The NACA score was ≥4 for 22% of the victims, indicating potential or overt vital threatening injuries, but 24% of the victims were uninjured (NACA 0). Multivariable analyses revealed that depth of the fall, summer season, and snowshoeing were associated with higher NACA scores, whereas depth of the fall, snowshoeing, and foreigners but not season were associated with higher risk of death. CONCLUSION: The clinical spectrum of injuries sustained by the 415 patients in this study ranged from benign to life-threatening. Death occurred in 11% of victims and seems to be determined primarily by the depth of the fall.

TV taskussa - tänään ja tulevaisuudessa

The objective of my thesis was to find out how mobile TV service will influence TV consumption behaviour of the Finns. In particular the study focuses on the consumption behaviour of a well educated urban people. For my thesis, I provided a detailed analysis of the study results of a large scale questionnaire research FinPilot from the year 2005 based on an assignment of Nokia Ltd. In order to deepen the study results, I focused on the above mentioned group of young people with good education. The goal of the FinPilot research was to give answers to the following questions: what kind of programs, in what kind of circumstances, and for which reasons are they watched when using the mobile television service. The results of the research consisted mainly of data like figures, graphics etc. The data was explaned from the helicopter perspective, for it gave additional value to the research and consequently to my own thesis. My study offered complementary, unique information about their needs as it was based on questionnaires supplemented by individual interviews of the group members, their free comments as well as group discussions. The study results proved that mobile TV service did not increase the total TV consumption time. The time used for watching the mobile TV was significantly shorter than the time for watching the traditional TV. According to my study, the young urban people with good education are more interested to adapt the mobile TV service than the average Finns. Being eager to utilize the added value offered by the mobile TVs they are a potential target group in launching and marketing processes. On the basis of the outcome of the thesis, the future of mobile TV service seems very promising. The content and the pricing, however, have to match the user's needs and expectations. All the study results prove that there exists a social order for mobile TV service.

New Trends in Public Facility Location Modeling

The past four decades have witnessed an explosive growth in the field of networkbased facility location modeling. This is not at all surprising since location policy is one of the most profitable areas of applied systems analysis in regional science and ample theoretical and applied challenges are offered. Location-allocation models seek the location of facilities and/or services (e.g., schools, hospitals, and warehouses) so as to optimize one or several objectives generally related to the efficiency of the system or to the allocation of resources. This paper concerns the location of facilities or services in discrete space or networks, that are related to the public sector, such as emergency services (ambulances, fire stations, and police units), school systems and postal facilities. The paper is structured as follows: first, we will focus on public facility location models that use some type of coverage criterion, with special emphasis in emergency services. The second section will examine models based on the P-Median problem and some of the issues faced by planners when implementing this formulation in real world locational decisions. Finally, the last section will examine new trends in public sector facility location modeling.

Management of major accidents with on-site 144 dispatcher

Introduction: An excellent coordination between firefighters, policemen and medical rescue is the key to success in the management of major accidents. In order to improve and assist the medical teams engaged on site, the Swiss "medical command and control system" for rescue operations is based on a binomial set up involving one head emergency doctor and one head rescue paramedic, both trained in disaster medicine. We have recently experimented an innovative on-site "medical command and control system", based on the binomial team, supported by a dedicated 144 dispatcher. Methods: A major road traffic accident took place on the highway between Lausanne and Vevey on April 9th 2008. We have retrospectively collected all data concerning the victims as well as the logistics and dedicated structures, reported by the 144, the Hospitals, the Authority of the State and the Police and Fire Departments. Results: The 72-car pileup caused one death and 26 slightly injured patients. The management on the accident site was organized around a tripartite system, gathering together the medical command and control team with the police and fire departments. On the medical side, 16 ambulances, 2 medical response teams (SMUR), the Rega crew and the medical command and control team were dispatched by the 144. On that occasion an advanced medical command car equipped with communication devices and staffed with a 144 dispatcher was also engaged, allowing efficient medical regulation directly from the site. Discussion: The specific skills of one doctor and one paramedic both trained for disaster's management proved to be perfectly complementary. The presence of a dispatcher on site with a medical command car also proved to be useful, improving orders transmission from the medical command team to all other on- and off-site partners. It relieved the need of repeated back-and-forth communication with the 144, allowing both paramedic and doctor to focus on strategy and tactics rather than communication and logistics.

Location models in the public sector

The past four decades have witnessed an explosive growth in the field of networkbased facilitylocation modeling. This is not at all surprising since location policy is one of the mostprofitable areas of applied systems analysis in regional science and ample theoretical andapplied challenges are offered. Location-allocation models seek the location of facilitiesand/or services (e.g., schools, hospitals, and warehouses) so as to optimize one or severalobjectives generally related to the efficiency of the system or to the allocation of resources.This paper concerns the location of facilities or services in discrete space or networks, thatare related to the public sector, such as emergency services (ambulances, fire stations, andpolice units), school systems and postal facilities. The paper is structured as follows: first,we will focus on public facility location models that use some type of coverage criterion,with special emphasis in emergency services. The second section will examine models based onthe P-Median problem and some of the issues faced by planners when implementing thisformulation in real world locational decisions. Finally, the last section will examine newtrends in public sector facility location modeling.

La chaîne des secours: le modèle vaudois [An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model].

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

Transportation choices and the value of statistical life

This paper exploits an unusual transportation setting to estimate the value of a statistical life(VSL). We estimate the trade-offs individuals are willing to make between mortality risk andcost as they travel to and from the international airport in Sierra Leone (which is separated fromthe capital Freetown by a body of water). Travelers choose from among multiple transportoptions ? namely, ferry, helicopter, hovercraft, and water taxi. The setting and original datasetallow us to address some typical omitted variable concerns in order to generate some of the firstrevealed preference VSL estimates from Africa. The data also allows us to compare VSLestimates for travelers from 56 countries, including 20 African and 36 non-African countries, allfacing the same choice situation. The average VSL estimate for African travelers in the sample isUS$577,000 compared to US$924,000 for non-Africans. Individual characteristics, particularlyjob earnings, can largely account for the difference between Africans and non-Africans; Africansin the sample typically earn somewhat less. There is little evidence that individual VSL estimatesare driven by a lack of information, predicted life expectancy, or cultural norms around risktakingor fatalism. The data implies an income elasticity of the VSL of 1.77. These revealedpreference VSL estimates from a developing country fill an important gap in the existingliterature, and can be used for a variety of public policy purposes, including in current debateswithin Sierra Leone regarding the desirability of constructing new transportation infrastructure.

Concept de first responders en Suisse romande: état des lieux et perspectives [Concept of first responders in Western Switzerland: current situation and future perspectives].

The notion of "First Responder" (FR) refers to the system of first-aid volunteers who act to initiate the first-aid care before the classical emergency help arrives. In 2011, the French-speaking Switzerland counts 19 groups, divided up between four cantons (Fribourg, Vaud, Neuchâtel, Valais). The geographical distribution of those FR shows the stakes of these peripherical areas, with the accessibility difficulties for the emergency services, and a low demography of ambulances and doctors. The number of interventions carried out by the FR has significantly increased during the last years. The association of a quality formation, an excellent knowledge of the ground and a quick intervention has a positive impact on the survival of the patients with vital emergency or traumatic conditions.

Multi-level modeling of aspects associated with poor mental health in a sample of prehospital emergency professionals.

BACKGROUND: The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers. METHODS: 333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment. A two-level multiple regression was performed between mental health (the dependent variable) and the effort-reward ratio, the overcommitment score, weekly number of interventions, percentage of non-prehospital transport of patients out of total missions, gender, and age. Participants were first-level units, and ambulance services were second-level units. We also shadowed ambulance personnel for a total of 416 hr. RESULTS: With cutoff points of 2/3 and 3/4 positive answers on the GHQ-12, the percentages of potential cases with poor mental health were 20% and 15%, respectively. The effort-reward ratio was associated with poor mental health (P < 0.001), irrespective of age or gender. Overcommitment was associated with poor mental health; this association was stronger in women (β = 0.054) than in men (β = 0.020). The percentage of prehospital missions out of total missions was only associated with poor mental health at the individual level. CONCLUSIONS: Emergency medical services should pay attention to the way employees perceive their efforts and the rewarding aspects of their work: an imbalance of those aspects is associated with poor mental health. Low perceived esteem appeared particularly associated with poor mental health. This suggests that supervisors of emergency medical services should enhance the value of their employees' work. Employees with overcommitment should also receive appropriate consideration. Preventive measures should target individual perceptions of effort and reward in order to improve mental health in prehospital care providers.

Soft Photogrammetry for Highway Engineering, HR-387, 1998

The SoftPlotter, a soft photogrammetric software and Silicon Graphics workstation, was used to evaluate the accuracy of soft photogrammetry and identify applications of this technology to highway engineering. A comparative study showed that SoftPlotter compares well with other software such as Socket and Integraph. The PC software TNTMips is inexpensive but needs further development to be comparable to SoftPlotter. The Campus Project showed that soft photogrammetry is accurate for traditional photogrammetric applications. It is also accurate for producing orthophoto and base maps for Geographic Information Systems (GISs). The Highway Project showed that soft photogrammetry is accurate for highway engineering and that the technical staff at the Iowa Department of Transportation (IA DOT) can be easily trained in this new technology. The research demonstrated that soft photogrammetry can be used with low-flight helicopter photography for large-scale mapping in highway engineering. The researchers recommend that research be conducted to test the use of digital cameras instead of the traditional aerial cameras in helicopter photography. Research that examines the use of soft photogrammetry with video logging imagery for inventory and GIS studies in highway maintenance is also recommended. Research is also warranted into the integration of soft photogrammetry with virtual reality, which can be used in three-dimensional designing and visualization of highways and subdivisions in real time. The IA DOT owns one analytical plotter and two analogue plotters. The analytical plotter is used for aerial triangulation, and the analogue plotters are used for plotting. However, neither is capable of producing orthophotos. Therefore, the researchers recommend that the IA DOT purchase soft photogrammetric workstations for orthophoto production, and if and when required, use it for aerial triangulation and plotting. In the future, the analogue plotters may become obsolete. At that time, the researchers recommend that the analogue plotters be phased out and replaced by soft photogrammetric workstations.

Interhospital aeromedical transfers: need for a specific training

Introduction: The interhospital aeromedical transfers concern mainly unstable patients presenting with multiple organ failure and among whom the intensity, as well as the difficulty of care are often underestimated. Material and method: Retrospective analysis of 2094 interhospital transfers made by the Rega helicopter of Lausanne between 2003 and 2008, with description of the pathologies, the demographic characteristics, as well as the medical and technical difficulties. Results: Male patient are overrepresented (65 vs 35%), their age being 40-80 years old. On the other hand, we note an important number (10%) of patients less than 10 years. The average time of flight is 13 minutes, with a high rate of night transfers (34%). In 73% of the cases, the transfers concern medical, especially cardiovascular and neurological situations. Trauma and surgical situations account for less than 20%. The transferred patients often require mechanical ventilation (27%), as well as invasive measure of blood pressure (11%), particularly in cases of neurological, pulmonary or cardiac diseases. In 6% of the cases, we note a haemodynamic instability, requiring the use of catecholamines. In 1% a cardiopulmonary resuscitation was initiated during the flight. The overall mortality at 48 hours is about 5%. Conclusions: In spite of relatively brief flights, the complexity and the variety of the pathologies require a specific training for the medical teams involved in the transfers, concerning the aspects of resuscitation, mechanical ventilation, and the knowledge of advanced life support in paediatrics, traumatology and cardiopulmonary intensive care.

Clinical update: suspension trauma

Objective.-Suspension trauma refers to the pathophysiologic syndrome that occurs when a victim is suspended motionless in a vertical position for an extended period of time. This can occur in sports that use a harness system as well as in various occupational activities including work on high wires or helicopter rescue operations. We reviewed the scientific evidence published to date in order to improve the prevention and treatment of suspension trauma.Methods.-Medline, PreMedline, the Cochrane Library, and Google Scholar were searched for relevant information about suspension trauma.Results.-Published data describing the pathophysiology of and the therapeutic approach to suspension trauma are sparse and consist mainly of case reports and a limited number of human experimental prospective studies. The pathophysiology of suspension trauma is related to hypovolemia induced by reduced venous return and by vagal stimulation. It is also influenced by the type of harness used. Chest harnesses may induce severe cardiorespiratory repercussions and have the lowest motionless suspension tolerance. Symptoms of suspension trauma include presyncope and can lead to a loss of consciousness.Conclusions.-Sports enthusiasts and workers who use a body harness system should never act alone and should not use a simple chest harness. If a victim shows symptoms of presyncope or is unconscious, he should be released from suspension as soon as is safely possible. There is no clear evidence to support the idea that the return to the horizontal position may contribute to the potential risk of rescue death.

NH90 helikopterin moottoreiden syklilaskennan tehostaminen ja elinkaarihallinta

Tutkimustyö liittyy NH90 Helikopterin RTM-322 moottoreiden syklivaihdettavi-en osien huollonsuunnitteluun ja sen kehittämiseen. Tavoitteena oli löytää nykyi-sen käyttösyklilaskennan tilalle säästävämpi ratkaisumalli ja saada määritettyä suihkumoottorin osakokonaisuuksille lisälentoaikaa sekä huollonsuunnitteluun järkevämmät käyttöjaksot. Tähän päästiin selvittämällä käytännön lentotoiminnan avulla uudet laskentakertoimet ja -mallit moottorin eri osien eliniän määrittämi-seksi. Konkreettisena tavoitteena oli saada koneen käyttöhistoriaan perustuen kohdeorganisaatiolle esitys, miten moottoreiden käyttösyklilaskentaa tulisi muut-taa ja tehostaa. Diplomityön aihe muodostuu kolmesta tutkimusongelmakokonaisuudesta; moot-torin käyttöhistorian tutkimisesta, moottorivalmistajan hyväksymien syklilasken-tamenetelmien tutkimisesta ja moottorin syklien säästövaikutustarkastelusta tut-kimuksen määrittämillä uusilla laskentamenetelmillä. Tutkimuksen tuloksena muodostui NH90 huollonsuunnitteluun arvio mahdollisis-ta moottorisyklisäästöistä sekä moottoreiden näkökulmasta priorisoitu lista heli-kopterien moottoreiden laitevaihtohuoltojen järjestyksestä seuraavan viiden vuo-den aikana. Syklien säästötarkastelun pohjalta suoritettiin yhden koneen osalta koko käyttöhistorian ajalta takaisinlaskentatarkastelu. Tutkimuksessa selvitettiin Ilmavoimien meneillään olevien projektien valossa moottorisyklien tarkanlasken-nan toteuttamismahdollisuudet tulevaisuudessa. Tutkimuksessa saatujen tulosten avulla vältyttäisiin tulevaisuudessa RTM-322 moottorin ennenaikaisilta laitevaih-doilta koko NH90 kaluston suhteen ja näin saataisiin aikaan merkittävän suuria säästöjä vuoteen 2020 mennessä.

Ilmajohtojen laserkeilaus Suomessa 2014

Tässä kandidaatintyössä on tarkoituksena selvittää ilmajohtojen lentokuvauksen käyttömahdollisuuksia sähköverkkoyhtiöiden toiminnassa. Ilmajohtojen lentokuvaus on Suomessa ja koko maailmassa vielä varsin vähän hyödynnetty keino esimerkiksi sähköverkkojen huolto- ja kunnossapito tarkastuksissa. Lentokuvauksella tarkoitetaan vielä nykyään vuonna 2014 yleensä helikopterista tehtävää johtokadun 3D-kuvausta ja laserkeilausta. Tulevaisuudessa se voi kuitenkin olla mahdollista tehdä myös muista lentävistä aluksista. Työssä on erityisesti keskitytty lentokuvauksessa tehtävään laserkeilukseen ja 3D-kuvaus on jätetty pienemmälle huomiolle. Lisäksi työssä selvitetään lentokuvauksen taloudellista kannattavuutta sähköverkkoyhtiöille sekä pohditaan lentokuvauksen tulevaisuuden näkymiä.

Fusion of Data from Quadcopter’s Inertial Measurement Unit Using Complementary Filter

A quadcopter is a helicopter with four rotors, which is mechanically simple device, but requires complex electrical control for each motor. Control system needs accurate information about quadcopter’s attitude in order to achieve stable flight. The goal of this bachelor’s thesis was to research how this information could be obtained. Literature review revealed that most of the quadcopters, whose source-code is available, use a complementary filter or some derivative of it to fuse data from a gyroscope, an accelerometer and often also a magnetometer. These sensors combined are called an Inertial Measurement Unit. This thesis focuses on calculating angles from each sensor’s data and fusing these with a complementary filter. On the basis of literature review and measurements using a quadcopter, the proposed filter provides sufficiently accurate attitude data for flight control system. However, a simple complementary filter has one significant drawback – it works reliably only when the quadcopter is hovering or moving at a constant speed. The reason is that an accelerometer can’t be used to measure angles accurately if linear acceleration is present. This problem can be fixed using some derivative of a complementary filter like an adaptive complementary filter or a Kalman filter, which are not covered in this thesis.