Background Maritime first responders frequently perform manual overboard lifting during rescue operations, placing them at high risk for musculoskeletal injury, particularly in the lumbar spine. Conventional ergonomic guidelines, including the Revised National Institute for Occupational Safety and Health (NIOSH) Lifting Equation (RNLE), were developed for controlled, symmetrical lifting and do not adequately capture the biomechanical and environmental demands of overboard recovery. Purpose This study aimed to quantify biomechanical demand during overboard lifting from vessels with 1.8- to 3.0-m freeboard and to evaluate injury risk under conditions exceeding standard RNLE assumptions. Methods The RNLE was adapted to estimate Recommended Weight Limit (RWL) and Lifting Index (LI) for overboard lifting tasks. Scenario-based analyses examined object masses (0–140 kg), horizontal reaches (25–50 cm), and vertical lifting distances (0–175 cm). LI values were calculated at both lift origin and destination to capture phase-specific biomechanical risk. Results Under idealized conditions, LI exceeded the recommended safety threshold (LI > 1) at loads as low as 15.6 kg for a horizontal reach of 25 cm. For a human-sized load of 90 kg, LI ranged from 3.9 to 7.8 depending on horizontal reach and vertical displacement, indicating substantial biomechanical overload. Increasing horizontal reach from 25 to 50 cm increased LI by 40 to 60% across all load conditions. LI exceeded 1 at both the lift origin and destination for all modeled loads ≥20 kg and vertical displacements ≥50 cm, highlighting the elevated risk inherent in these tasks. Conclusion Manual overboard lifting imposes significant biomechanical strain that frequently exceeds conventional ergonomic limits. Task-specific metrics derived here provide quantitative guidance for injury prevention, including pre-employment functional screening, progressive task-specific conditioning, and the use of mechanical assistive devices. These findings support evidence-based occupational health strategies for maritime first responders and other personnel performing high-risk lifting tasks in dynamic environments.
Introduction Frostbite injuries cause disfigurement and loss of functionality. The role of early imaging in management remains unclear because most modalities require infrastructure that prevents field application. Providers use point-of-care ultrasound to assess a range of soft tissue and musculoskeletal pathologies. The primary objective of this study is to determine the accuracy with which emergency physicians can identify frozen tissue on ultrasound. Methods Three emergency medicine physicians evaluated whether porcine tissue was frozen or unfrozen by viewing standardized ultrasound clips. The team recorded clips of tissue thawing in a water bath from −10 to +10°C using a handheld ultrasound device. Each physician independently reviewed randomized clips and recorded their assessments. A 2 × 2 table was used to calculate the pooled sensitivity and specificity. Results Emergency medicine physicians reviewed 75 clips. They achieved a pooled sensitivity of 76% (95% CI 0.60–0.87) and a specificity of 87% (95% CI 0.68–0.96) for detecting frozen tissue compared with the tissue thermometer as the standard. Their results showed an overall accuracy of 80% (95% CI 0.69–0.88). Conclusions In this pilot study, emergency medicine physicians with advanced point-of-care ultrasound training identified frozen tissue on ultrasound 80% of the time. Future research should explore the sonographic features of frozen tissue in cases of frostbite and the test characteristics for sonographers with varying skill levels.
Background Accidental hypothermia is an unintentional drop in core temperature below 35 °C, typically resulting from exposure to cold environmental conditions. Clinical presentations may vary widely depending on the severity of hypothermia and the presence of coexisting conditions complicating diagnosis and treatment. We report a case of accidental hypothermia caused by environmental exposure and associated with cardiogenic shock from a myocardial infarction with complete heart block. Case Presentation A group of ski tourers found a 62-y-old male skier at 3000 m in severe distress with abdominal pain, shivering, and profound exhaustion. On arrival at a mountain hut, he was agitated, then became unconscious and bradycardic with a weak femoral pulse. Once advanced medical equipment reached the hut, a 12-lead electrocardiogram showed an inferior ST-elevation myocardial infarction (STEMI) with complete third-degree atrioventricular block and a ventricular escape rhythm. The first measurable axillary temperature was 32.2 °C. Consciousness progressively improved, but bradycardia persisted during rewarming. The patient was evacuated 6 h after the diagnosis of acute STEMI. He underwent percutaneous coronary intervention and was successfully treated with a stent. Conclusions This case illustrates that hypothermia and environmental factors can complicate the diagnosis of atypical presentations of life-threatening conditions, such as STEMI, and how unexpected clinical findings not fully explained by hypothermia may indicate the presence of an underlying condition. In such situations, hypothermia staging systems should be used with caution. Early electrocardiography, awareness of cognitive biases, and the use of safe rewarming practices are essential to ensure timely diagnosis and prevent complications.
