RTO MP-062 / HFM-050 - FTP Directory Listing - Nato

T-6
In principle, I think that natural, slow adaptation to altitude without the use of
pharmacological intervention is preferable in young, healthy soldiers. An interesting approach
to altitude adaptation with operational implications, by means of stepwise ascent, is presented
in paper 47. However, under special circumstances where quick adaptation is crucial, the
availability of a substance like Bemithylum, could be helpful. Obviously, NATO cannot yet
rely on the supply of a substance from Russia in order to prepare soldiers for fast high altitude
operations. However, the approach is interesting, and the HFM Panel should encourage a
competent group within the alliance to take a closer look at the described substance and
evaluate its effects and possible side effects.
A special, but relevant operational problem is to choose the right ventilators and procedures
for air evacuation of battlefield casualties in order to avoid hypoxic complications. Valuable
information on this important issue is given in paper 42.
Hyperbaric oxygen treatment
Hyperbaric oxygenation (HBO) has proven useful on many indications, although the
mechanisms of the observed HBO effects sometimes are not well understood, and may even
seem paradoxical. Most alliance nations pay attention to the guidelines given by Undersea and
Hyperbaric Medical Society (UHMS). The second Key Note speaker picked indications from
the UHMS approved list, relevant for combat situations, and unveiled important subcellular
mechanisms which explain several of the observed beneficial effects of HBO. The operational
importance of HBO is obvious, regarding the treatment of DCI in diving and aviation. This is
highlighted in papers referred to under the heading “Decompression illness (DCI)” above.
However, the benefit of mobile HBO units in the theatre of surface operations to treat injuries
not related to pressure variations, has so far not been sufficiently exploited in any of the
alliance nations. As underlined in paper 25, HBO is an important adjuvant in the treatment of
typical combat injuries, like high velocity missile wounds with a zone of ischemia, which may
progress to tissue necrosis. The relevant operational use of HBO also on indications other than
those related to pressure changes, is described in paper 28. Evacuation under increased
pressure is another aspect focussed on in paper 24. Although the indication described in paper
26 is not relevant for military operations, it describes a prognostic marker, which may be
useful also in other HBO indications.
The bottom line is that the alliance should make HBO available also for surface combat
theatres. Although it may sometimes complicate medical contingency planning, the benefit of
saved limbs and lives will probably far outweigh the inconveniences. Traditionally, HBO
units are carried on board ships related to diving operations. Very often battlefields are
located within reach of helicopters from a shoreline. Accordingly, HBO units on board ships
could be used also for treating surface combat injuries. Future hospital ships should definitely
have the capability of HBO. Plans are underway in Norway for a fast moving hospital ship
also carrying a HBO unit. This could prove a valuable asset for allied operations under or
outside article 5, like peace keeping and peace enforcing operations.
Eustachian tube function
The “bottleneck” of hyperbaric diving and some aviation operations is the Eustachian tube.
At its narrowest, isthmus, the opening is only 1 x 2 mm. It is lined by a ciliated epithelium
covering lymphatic tissue and a rich blood and lymph vasculature, which can easily become
congested from upper respiratory infections or allergic reactions, and from increased thoracic
pressure, unfavourable body positions relative to the force of gravity, or G-forces. At rest the
pharyngeal end of the tube is closed. Contracting pharyngeal muscles, mainly mm. tensor and