The occupational hazards of health workers (HWs) in standard work environments have been well defined in both the developed and developing world during routine working conditions. Less defined are the hazards to HWs during pandemics, epidemics, natural disasters, wars, conflicts, and other crises. How do crises affect the infrastructure of medical systems? What are the distinct needs of the patient population during crises? What are the peculiarities of the Crisis Health Worker (CHW)? What are the known CHWs’ occupational risks? What are the protective factors? By means of a PubMed search, we synthesized the most relevant publications to try to answer these questions. Failures of healthcare infrastructure and institutions include CHW shortages, insufficient medical supplies, medications, transportation, poorly paid health workers, security concerns, and the absence of firm guidance in health policy. Healthcare needs affecting the patient population and CHWs include crisis-induced injury and illness, hazardous exposures, communicable diseases, mental healthcare, and continuity of care for pre-crisis medical conditions. CHWs’ occupational hazards include supply deficiencies, infectious disease transmission, long working hours, staff shortages, financial reimbursements, mental fatigue, physical exhaustion, and inconsistent access to clean water, electricity, and Internet. CHWs suffer from injuries and illnesses that range from immediate, debilitating injuries to chronic, unforeseen effects like mental fatigue, physical exhaustion, anxiety, burnout, and even post-traumatic stress syndrome (PTSD). Protective factors include personal traits such as adaptability and resilience as well as skills learned through structured education and training. Success will be achieved by constructively collaborating with local authorities, local health workers, national military, foreign military, and aid organizations.

Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare, aggressive, poorly differentiated form of squamous cell carcinoma caused by a chromosomal rearrangement of the NUT gene on chromosome 15. These tumors have a predilection for midline and paramidline structures of the upper aerodigestive tract and mediastinum and can affect patients across a broad age range, including children. In the current example, a 53 year old male presented with a mass originating in the left nasal cavity. The clinical, radiographic, and morphologic features of NMC are discussed.Keywords NUT midline carcinoma Á Undifferentiated carcinoma Á Nasal Á Nasal cavity Á Sinonasal Á Nuclear protein of testis Á Radiology HistoryA 53 year old male presented with a 9 month history of left nasal congestion, rhinorrhea, and sinus tenderness. The patient also noted recurrent epistaxis lasting longer than 30 min 6 months prior to presentation. Additionally, patient reported recent onset of left facial numbness in the V 2 distribution of the trigeminal nerve. He denied fevers and weight loss, but did note drenching night sweats. Radiographic FeaturesSinus CT examination revealed a soft tissue mass which completely obstructed the left nasal cavity. Coronal views delineated osseous expansion with erosion and destruction of the nasal septum and medial wall of the left maxillary sinus (Fig. 1a). There was opacification of left ethmoid air cells and the left maxillary sinus. Corresponding MR images demonstrated an 8.4 9 3.3 9 2.3 cm mass centered in the left nasal cavity (Fig. 1b). The mass was heterogeneously enhancing on postcontrast T1-weighted images and displayed predominantly isointense signaling with T2-weighted studies. The mass measured 8.4 cm in anterior-posterior dimension, including a pedunculated component that extended past the choana into the nasopharynx (Fig. 2). No intracranial extension or erosion into the orbits or cribriform was present. Brain and neck MRI evaluation revealed no evidence of brain metastasis or cervical lymphadenopathy. TreatmentFollowing an incisional biopsy, the patient underwent functional endoscopic sinus surgery including a left maxillary antrostomy, total ethmoidectomy, sphenoidotomy,

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The goal of Pressurized Submarine Escape Training (PSET) is to prepare future submariners for the physical and mental challenges of escaping a disabled submarine and promote proper handling of the Beaufort Ltd Mk 11 Submarine Escape and Immersion Equipment suit. Training participants are only permitted to enter PSET after strict health screening protocols have been met to optimize trainees’ safety. Before PSET, trainees are given detailed, one-on-one instruction on proper ascent mechanics by specially trained Navy Dive instructors. Since the reinstatement of PSET by the U.S. Navy, four incidents of arterial gas embolism (AGE) have occurred in submarine trainees with a 10-year period (2009-2019). Of these four incidents, three were observed within a couple months of each other from 2018 to 2019. A comprehensive review of AGE history, epidemiology, dive physiology, pathophysiology, and management was completed. Prompted by the recent incidents relative to the low reported incidence rate of AGE in historical PSET training, reported potential risk factors were compared with better understand potential etiologies of AGE in already medically screened individuals. Risks and benefits of PSET were listed, compared, and analyzed. The relative safety and cost effectiveness of this rigorous form of training was reconfirmed.

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