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עמוד בית
Mon, 17.06.24

September 2021 (Issue 51)

Shachar Shapira, MD, MHA, MA, Guy Davidson, MA
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Leadership is the ability of an individual or a group of people to help others
advance towards a common goal with minimal exercise of authority. The COVID-19
pandemic resulted in a health crisis that emphasized the link between crisis
management and different types of leadership. Learning from military leadership
can improve leadership capabilities among health care workers.
We can assume that every leader, regardless of their leadership style, has
most of the following qualities: the ability to form a vision and create change,
decisiveness, courage, the ability to delegate while still taking responsibility for the
consequences, and more.
In this article, we review the similarities and differences between military leadership
and medical leadership. Both require the ability to lead in times of uncertainty, to
create cooperation and to be flexible. However, there is a big difference in the
training process. In recent years, awareness of the strategic need to develop
medical leadership has been increasing.
Medical leadership has the potential to improve the Israeli health system, and
there is a similarity between the characteristics of leaders in this system and in
the Israel Defense Forces.

Keywords: Medical leadership, Military leadership, COVID-19
Yehuda Zadik, DMD, MHA, Hadas Azizi, DMD, Eran Ziv, DMD, Moshe Wojakowski, DM, Idan Nakdimon, MSc
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Flight surgeons (aviation medical examiners) and military dentists may encounter
flight-related oral conditions requiring proper diagnosis and treatment. Moreover,
dental practitioners seek to prevent the occurrence of in-flight incapacitation when
treating aircrew members. The aim of this article is to introduce the basic concepts
of aviation dentistry, including facial barotraumas (barotitis media and externa,
barosinusitis and dental barotrauma), barodontalgia (barometric pressure-related
dental pain), and dental care for aircrews. Special considerations have to be made
when planning restorative, endodontic, prosthodontic and surgical treatment of an
aircrew patient. This article supplies the practitioners with some diagnostic tools
as well as treatment guidelines. Principles of prevention, periodic examination,
dental-related flight restriction and dental documentation (for forensic purposes)
are described.

Keywords: Aviation medicine; Barodontalgia; Barotrauma.
Idan Nakdimon, M.Sc, Daniela Algranati, B.Sc, Ori Shriki, Anna Levkovsky, B.Sc, Oded Ben-Ari, MD, MHA
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Introduction: Insufficient sleep leads to fatigue, which increases the likelihood of
safety incidents in various fields, including aviation. Due to this risk, air forces have
developed several methods for reducing fatigue-related accidents. In the Israeli
Air Force, a specific workshop (the "Dead Tired" workshop) was developed with
the purpose of presenting aircrew with their objective performance under sleep
deprivation conditions.

Methods: All Israeli aircrew and Unmanned Aerial Vehicle (UAV) operators must
participate in a "Dead Tired" workshop. The workshop's duration is 4 days. On the
first night the participants do not sleep at all, on the second night they only sleep
for 3 hours and on the third night they get a full night's sleep for recovery. During
the workshop, the participants perform the Psychomotor Vigilance Task (PVT), a
task that tests their attention abilities. The PVT data at different points in time
during the workshop were analyzed.

Results: The PVT was performed by 210 participants, of whom 114 were UAV
operators and 96 were aircrew. A significant decline in task performance began
after 20 hours without sleep, and a full recovery in performance back to the baseline
was observed only after a full night's recovery sleep. UAV operators demonstrated
higher resistance to sleep deprivation both in their inherent capabilities and in all
other parameters that were examined throughout the workshop.

Conclusions: Sleep deprivation negatively impacted the abilities of both groups of
participants. UAV operators were found to be more resistant to the effects of sleep
deprivation in comparison to aircrew.

Keywords: Aircrew, "Dead Tired" workshop, Fatigue, PVT, UAV operators.
Regina Pikman Gavriely, MD, Eliad Aviram, MD, Shachar Shapira, MD, MHA, MA
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Introduction: Intraosseous (IO) access is a possible route for fluid and drug
administration to pre-hospital and emergency department patients in urgent
cases. It is implemented in scenarios in which intravenous (IV) access is not
feasible. There are several devices used for IO access, both manual and semiautomatic.
EZ-IO is a semi-automatic drill with various size IO needles. Data on
the use of this device show it to be safe and effective. EZ-IO has been in use in
the 669 search and rescue unit since 2017.

Methods: Our goal was to describe the cases in which this device was used and
learn from them.

Results: To date, physicians and paramedics in the unit have used EZ-IO 17 times
on 15 different patients. The insertion location in about half of the cases was the
tibia, while the humeral head was the entry point in the rest.

Conclusions: Our experience supports the use of EZ-IO as an IO access device.
It has proved to be effective and easy to use after a short session of instruction
and demonstration.

Keywords: Intraosseous (IO) access, EZ-IO, Rescue Unit.
Idan Nakdimon, M.Sc, Oded Ben-Ari, MD, MHA, Uri Eliyahu, PhD, Barak Gordon, MD, MHA
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Introduction: Hypoxia may be induced by either cabin pressure failure or oxygen
system malfunction during flight. Personal tolerance to hypoxia will determine if an
aircrew member will succeed in handling the situation, or their symptoms will lead
to cognitive impairment and eventually unconsciousness. Tolerance to hypoxia can
be examined in altitude chamber training sessions designed to expose aircrew to
hypoxic conditions in a controlled setting. There are several personal factors that
may influence hypoxia tolerance. In this study, we examined whether gender was
one of them.

Methods: During altitude chamber training, the participants were exposed to a
simulated altitude of 25,000 feet (7,620 meters). At this altitude they took off their
oxygen masks, in order to recognize their personal symptoms. During this time,
heart rate and hemoglobin saturation were measured. These measurements were
taken at 10 seconds intervals.

Results: In this retrospective study, the records of 22 women and 145 men were
analyzed. Significant differences in hemoglobin levels were found between men
and women. Women were found to have a significantly higher heart rate during all
stages of the exposure. There were no significant gender-associated differences in
oxygen saturation during hypoxia exposure.

Conclusions: No significant differences were found in oxygen saturation levels
between men and women during hypoxia exposure. Lower hemoglobin levels and
higher heart rates were not associated with changes in oxygen saturation among
women. We conclude that gender does not affect hypoxia tolerance.

Keywords: Blood oxygen saturation, Depressurization system failure, Heart rate, Hypobaric chamber,
Hypoxia, Oxygen system failure.
Bar Lossos, B.Med.Sc, Daniel Gabbai, MD, Aya Ekshtein, MPE, Gal Hay, BSc, Oded Ben-Ari, MD, MHA, Shachar Shapira, MD, MHA, MA
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Background: Vitamin D is an essential component in maintaining calcium
homeostasis, adequate bone health, immunity, and other biological processes.
Vitamin D deficiency is prevalent even in sunny countries such as Israel. Aircrew
members are required to be physically fit and healthy, and vitamin D deficiency
in this population might adversely affect pilots' performance and lead to health
In this study, we aimed to evaluate the prevalence of vitamin D insufficiency and
deficiency among Israeli Air Force personnel.

Methods: During routine health inspections at the Israeli Aero-Medical Center
between November 2020 and December 2020, data was collected on the serum
25(OH)D levels of 209 Air Force soldiers.

Results: Serum vitamin D (25(OH)D) levels were normally distributed around a
mean value of 26.67 ng/mL, ranging from 6.4 to 48.4 ng/mL for the entire cohort.
69.86% of the participants were vitamin D-insufficient and 3.35% were deficient.
There were no statistically significant differences in vitamin D levels across
genders, different Air Force arrays, and professions.
Vitamin D insufficiency was not correlated to orthopedic disorders, upper
respiratory tract infections, or COVID-19.

Conclusions: In our study, which included healthy, fit, and mostly young people,
a high prevalence of vitamin D insufficiency was found, although vitamin D
deficiency was rare.

Keywords: Air Force, vitamin D, insufficiency, deficiency.
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