German Naval Medical Institute

Kronshagen, Germany

German Naval Medical Institute

Kronshagen, Germany

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Rottger S.,Helmut Schmidt University | Vetter S.,German Naval Medical Institute | Kowalski J.T.,German Armed Forces Office
WMU Journal of Maritime Affairs | Year: 2016

This study asses the effectiveness of classroom-based bridge resource management (BRM) training for junior naval officers, in which general principles of human behaviour and performance in teams and under stress were conveyed. Although BRM training is recommended by the International Maritime Organization and is increasingly common in seafaring, very little is known about whether the adaptation of crew resource management (CRM) training from aviation to the maritime domain has been successful and what type of training is effective. A study with a quasi-experimental, two-factorial mixed design was conducted with BRM training as the between factor and time as the within factor. For 117 study participants, evaluation criteria were assessed on all levels as defined by Kirkpatrick (Train Dev J, 178–192 1979): subjective training evaluation, knowledge, attitudes and behaviour as well as performance while commanding a vessel during a real-world exercise. BRM participants showed better subjective training evaluations and more BRM-related knowledge than controls. Training did not produce differences between groups regarding BRM-related attitudes, the demonstration of non-technical skills or the overall success in the real-world exercise. Overall, BRM training effectiveness was rather low, which can most probably be attributed to the focus of training on generalizable knowledge, skills and attitudes at the expense of their specific application to the context of the real-world exercise. In the design of BRM and CRM training courses alike, the effective application of general principles to a given context must be defined, and the application must be emphasised during training delivery. © 2015, World Maritime University.


Winkler B.E.,University of Leipzig | Winkler B.E.,University of Ulm | Muth C.-M.,University of Ulm | Kaehler W.,German Naval Medical Institute | And 3 more authors.
Diving and Hyperbaric Medicine | Year: 2013

Introduction: In-water resuscitation has recently been proposed in the European resuscitation guidelines. Initiation of mechanical ventilation underwater might be considered when an immediate ascent to the surface is impossible or dangerous. The present study evaluated the feasibility of such ventilation underwater. Methods: A resuscitation manikin was ventilated using an Interspiro® MK II full-face mask or with an Oxylator® ventilator via a facemask or a laryngeal tube, or with mouth-to-tube inflation. Tidal volumes achieved by the individual methods of ventilation were assessed. The ventilation tests were performed during dives in the wet compartment of a recompression chamber and in a lake. Ventilation was tested at 40, 30, 20, 12, 9 and 6 metres' depth. Results: Ventilation was impossible with the cuffed mask and only sufficient after laryngeal intubation for a small number of breaths. Laryngeal tube ventilation was associated with the aspiration of large amounts of water and the Oxylator failed during the ascent. Efficient ventilation with the MK II full-face mask was also possible only for a short period. An absolutely horizontal position of the manikin was required for successful ventilation, which is likely to be difficult to achieve in open water. Leakage at the sealing lip of the full-face mask and the cuff of the laryngeal tube led to intrusion of water and resulted in subsequent complete failure of ventilation. Conclusions: The efficacy of underwater ventilation seems to be poor with any of the techniques trialed. Water aspiration frequently makes ventilation impossible and might foster emphysema aquosum-like air trapping and, therefore, increase the risk of pulmonary barotrauma during ascent. Because the limitations of underwater ventilation are substantial even under ideal conditions, it cannot be recommended presently for real diving conditions.


Kossler F.J.,University of Innsbruck | Nitzschner M.M.,German Naval Medical Institute
11th International Conference on Cognition and Exploratory Learning in Digital Age, CELDA 2014 | Year: 2014

In the current study, it was examined whether successful learning is related to using different types of media. We compared the comprehension of an economic concept in novices (N = 82) under three conditions: a Wikipedia article, a funny, and a serious YouTube video. The media were presented in English which is a foreign language to most of the German speaking sample. The funny video turned out to be the condition related to better success in learning while individual variables (e.g. Thinking Styles and metacognitive evaluation) were controlled. Regarding metacognition, it was further found out that answering by logical thinking correlated negatively, and that answering by processing the presented material correlated positively with the number of correct answers. © 2014 IADIS.


Winkler B.E.,University of Ulm | Winkler B.E.,German Naval Medical Institute | Eff A.M.,German Naval Medical Institute | Eff S.,German Naval Medical Institute | And 4 more authors.
Resuscitation | Year: 2013

Introduction: Drowning is a common cause of death in young adults. The 2010 guidelines of the European Resuscitation Council call for in-water-resuscitation (IWR). There has been controversy about IWR amongst emergency and diving physicians for decades. The aim of the present study was assessing the efficacy of IWR. Methods: In this randomized cross-over trial, nineteen lifeguards performed a rescue manoeuvre over a 100. m distance in open water. All subjects performed the procedure four times in random order: with no ventilation (NV) and transportation only, mouth-to-mouth ventilation (MMV), bag-mask-ventilation (BMV) and laryngeal tube ventilation (LTV). Tidal volumes, ventilation rate and minute-volumes were recorded using a modified Laerdal Resusci Anne manikin. Furthermore, water aspiration and number of submersions of the test mannequin were assessed, as well as the physical effort of the lifeguard rescuers.One lifeguard subject did not complete MMV due to exhaustion and was excluded from analysis. Results: NV was the fastest rescue manoeuvre (advantage ~40s). MMV and LTV were evaluated as efficient and relatively easy to perform by the lifeguards. While MMV (mean 199ml) and BMV (mean 481ml) were associated with a large amount of aspirated water, aspiration was significantly lower in LTV (mean 118ml). The efficacy of ventilation was consistently good in LTV (Vt=447ml), continuously poor in BMV (Vt=197) and declined substantially during MMV (Vt=1019ml initially and Vt=786ml at the end). The physical effort of the lifeguards was remarkably higher when performing IWR: 3.7 in NV, 6.7 in MMV, 6.4 in BMV and 4.8 in LTV as measured on the 0-10 visual analogue scale. Conclusion: IWR in open water is time consuming and physically demanding. The IWR training of lifeguards should put more emphasis on a reduction of aspiration. The use of ventilation adjuncts like the laryngeal tube might ease IWR, reduce aspiration of water and increase the efficacy of ventilation during IWR. © 2013 .


Winkler B.E.,University of Ulm | Froeba G.,University of Ulm | Koch A.,German Naval Medical Institute | Kaehler W.,German Naval Medical Institute | Muth C.-M.,University of Ulm
Emergency Medicine Journal | Year: 2013

Introduction In water resuscitation has been reported to enhance the outcome of drowning victims. Mouth-tomouth ventilation during swimming is challenging. Therefore, the efficacy of ventilation utilities was evaluated. Methods Ventilation was assessed with the Oxylator ventilator, as well as the consecutive self-contained underwater breathing apparatus (SCUBA) regulators using an anaesthetic test lung: Poseidon Cyklon 5000, Poseidon XStream, Apeks TX 100, Spiro Arctic, Scubapro Air2 and Buddy AutoAir. Results Oxylator, Apeks TX 100, Arctic and Buddy AutoAir delivered reliable peak pressures and tidal volumes. In contrast, the ventilation parameters remarkably depended on duration and depth of pressing the purge button in Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2. Critical peak pressures occurred during ventilation with all these three regulators. Discussion The use of Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2 regulators is consequently not recommended for in-water ventilation. With the limitation that the devices were tested with a test lung and not in a human field study, Apeks TX 100, Spiro Arctic and Buddy AutoAir might be used for emergency ventilation and probably ease in-water resuscitation for the dive buddy of the victim. Professional rescue divers could be equipped with the Oxylator and an oxygen tank to achieve an early onset of efficient in-water ventilation in drowning victims.


Becker M.,RWTH Aachen | Roehl A.B.,RWTH Aachen | Siekmann U.,RWTH Aachen | Koch A.,German Naval Medical Institute | And 5 more authors.
Herz | Year: 2014

Seismocardiography (SCG) is a noninvasive technique for recording cardiac vibrations. Changes in these waves have been correlated with chronic and acute alterations in myocardial function. This analysis is complex and clinical integration limited. The current study aimed to simplify the utilization of SCG by fast Fourier transformation for a reliable discrimination between different intra- and postoperative causes of hypotension (i.e., myocardial ischemia or hypovolemia). We operated on nine pigs and recorded SCG at baseline, at hypovolemia (occlusion of the inferior vena cava), and at ischemia (occlusion of the right coronary artery). In conclusion, SCG enables detection and differentiation of ischemia and hypovolemia as important causes of altered myocardial function during and after surgery. Thus, this simple and noninvasive diagnostic tool may be used intra- and postoperatively to identify patients at risk. © 2013 Urban & Vogel.


PubMed | German Naval Medical Institute
Type: Journal Article | Journal: Human factors | Year: 2013

The aim of this study was to adapt the Crew Resource Management (CRM) Attitudes Questionnaire (CMAQ) to the maritime domain, to assess the ship management attitudes of junior naval officers, and to determine the extent to which these attitudes correlate with behavior and performance in a naval exercise.CRM attitudes have been shown to be associated with performance in aviation, but it is unclear whether this construct is applicable and relevant to the maritime domain.Participants were 121 active seafarers and 101 junior officers of the German Navy who completed the Ship Management Attitudes Questionnaire-German Navy (SMAQ-GN). Ratings of nontechnical skills and ratings of mission success of the junior officers were collected during a real-world naval exercise.Internal consistencies of SMAQ-GN were similar to those of the original CMAQ and retest reliability was rather high. Attitudes of junior officers toward communication and coordination were positive. Regarding command responsibility and the recognition of stressor effects, positive as well as neutral and negative attitudes were found. Overall, attitudes did not correlate with behavior and performance. Separate analysis of those participants reporting negative to neutral ship management attitudes showed substantial positive correlations of attitudes with behavior and performance.Ship management attitudes play a significant role in commanding ships. The attitude-performance linkage is not linear. Behavior and performance are less effective in officers with negative attitudes and equally effective in officers with slightly positive and very positive attitudes.Ship management attitudes can be used to assess training needs for nautical teams.


PubMed | Medical College of Wisconsin, Rush University Medical Center, University Hospital of Wuerzburg, German Naval Medical Institute and University of Ulm
Type: | Journal: Resuscitation | Year: 2015

Airway management, mechanical ventilation and resuscitation can be performed almost everywhere--even in space--but not under water. The present study assessed the technical feasibility of resuscitation under water in a manikin model.Tracheal intubation was assessed in a hyperbaric chamber filled with water at 20 m of depth using the Pentax AWS S100 video laryngoscope, the Fastrach intubating laryngeal mask and the Clarus optical stylet with guidance by a laryngeal mask airway (LMA) and without guidance. A closed suction system was used to remove water from the airways. A test lung was ventilated to a maximum depth of 50 m with a modified Oxylator() EMX resuscitator with its expiratory port connected either to a demand valve or a diving regulator. Automated chest compressions were performed to a maximum depth of 50 m using the air-driven LUCAS 1.The mean cumulative time span for airway management until the activation of the ventilator was 36 s for the Fastrach, 57 s for the Pentax AWS S100, 53s for the LMA-guided stylet and 43 s for the stylet without LMA guidance. Complete suctioning of the water from the airways was not possible with the suction system used. The Oxylator() connected to the demand valve ventilated at 50 m depth with a mean ventilation rate of 6.5 min(-1) vs. 14.7 min(-1) and minute volume of 4.5 l min(-1) vs. 7.6 l min(-1) compared to the surface. The rate of chest compression at 50 m was 228 min(-1) vs. 106 min(-1) compared to surface. The depth of compressions decreased with increasing depth.Airway management under water appears to be feasible in this manikin model. The suction system requires further modification. Mechanical ventilation at depth is possible but modifications of the Oxylator() are required to stabilize ventilation rate and administered minute volumes. The LUCAS 1 cannot be recommended at major depth.


PubMed | Medical College of Wisconsin, University of Leipzig, German Naval Medical Institute, University of Ulm and University of Innsbruck
Type: Clinical Study | Journal: Emergency medicine journal : EMJ | Year: 2015

Drowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS rescue concept with in-water ventilation and chest compressions was evaluated.Cardio pulmonary resuscitation (CPR) and vascular access were performed in a self-inflating Heliboat platform in an indoor wave pool using the Fastrach intubating laryngeal mask, the Oxylator resuscitator, Lund University Cardiopulmonary Assist System (LUCAS) chest compression device and EZ-IO intraosseous power drill. The time requirement and physical exertion on a Visual Analogue Scale (VAS) were compared between a procedure without waves and with moderate swell.Measurement of the elapsed time of the various stages of the procedure did not reveal significant differences between calm water and swell: Ventilation was initiated after 02:48 versus 03:02 and chest compression after 04:20 versus 04:18min; the intraosseous cannulisation was completed after 05:59 versus 06:30min after a simulated jump off the helicopter. The attachment of the LUCAS to the mannequin and the intraosseous cannulisation was rated significantly more demanding on the VAS during swell conditions.CPR appears to be possible when performed in a rescue platform with special equipment. The novel helicopter-based strategy appears to enable the rescuers to initiate CPR in an appropriate length of time and with an acceptable amount of physical exertion for the divers. The time for the helicopter to reach the patient will have to be very short to minimise neurological damage in the drowning victim.


PubMed | University of Tübingen, German Naval Medical Institute, Friedrich - Schiller University of Jena, University of Ulm and University of Regensburg
Type: Journal Article | Journal: Diving and hyperbaric medicine | Year: 2014

Full-face-masks (FFM) prevent the divers face from cold and can support nasal breathing underwater. The aim of the study was to evaluate the effect of the use of FFMs on lung function and wellbeing.Twenty-one, healthy, non-asthmatic divers performed two cold-water dives (4C, 25 min, 10 metres depth) - one with a FFM and the other with a standard scuba regulator (SSR). Spirometry was performed before and after each dive and well-being and cold sensation were assessed after the dives.Significant decreases in forced vital capacity (FVC), forced expiratory volume in one second (FEV) and midexpiratory flow at 75% of FVC (MEF) occurred after both FFM and SSR dives. Changes in FVC and FEV did not differ significantly between FFM and SSR dives. However, the mid-expiratory flows measured at 50% and 25% of FVC (MEF and MEF) were significantly lower 10 minutes after the FFM dive compared to 10 minutes after the SSR dive. The wellbeing and cold sensation of the divers were significantly improved with FFM dives compared to SSR dives.Cold-water dives during wintertime can be associated with airway narrowing. During cold-water dives, the use of a FFM appears to reduce the cold sensation and enhance the well-being of the divers. However, a FFM does not appear to prevent airway narrowing in healthy, non-asthmatic subjects.

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