Objective: To evaluate the cold exposure of the personnel involved in helicopter rescue operations in an alpine environment to quantify the risk for frostbite or hypothermia. Methods: The weather conditions, the locality and its altitude and the sojourn on scene of the rescue operations of 15 months in the region Oberwallis, Switzerland were analyzed. The equivalent chill temperature was estimated with two independent models. "Mean exposure" and "worst case situation" were calculated. The results are evaluated according to the "classic" Siple-Passel-Model, the more recent model of Danielsson, ISO 11079, ISO 9920, the German industrial standard DIN 33403.5, and the German government regulations for work in cold environment ("G21"). Results: There were only marginal differences in chill temperature between both temperature models. Assuming "worst case conditions" the Siple-Passel-model showed 87.1% of the operations at chill temperatures >-30°C, 12.1% in the range of-30 to-45°C, and 0,8% <-45°C. The lowest temperature was-54.6°C. The Danielson model resulted in 77.6% without the risk of frostbite, 20.1% with >5% risk, 6% >50% risk, and 1.8% >95% risk. According to DIN 1.5% of the operations were performed at chill temperatures higher than cold class 1. 2.3% are class 1, 13.3% class 2, 34.7% class 3, 34.6% class 4, and 13.7% class 5. The maximal exposure times of DIN 33404.5 are exceeded in at least 0.5% of the missions. According to ISO 11079 clothing with 2.0 clo is sufficient in 40.2% rsp. 23.9% of the operations (summer, IREQ min. and IREQ neutr.). In winter the corresponding results are 0.3% and 0.0%. Duration of limited exposure is exceeded in 9.1% (IREQ min.) rsp. 19.8% (IREQ neutr.) of the operations in summer and in 10.3% rsp. 19.8% in winter. According to ISO 9920 ICL min. as well as ICL neutr. is exceeded in 100% in summer and winter operations. Conclusions: Alpine rescue operations are a typical place of work in cold-sometimes extreme cold-environment. Because of the limited time of exposure during the majority of the operations the most important danger for rescue personnel is frostbite although hypothermia cannot be excluded in cases of prolonged operations. Special advice to avoid the specific risks must be given to the crews and an examination by occupational medicine, e.g. according to "working in cold environment, G21" of the German Berufsgenossenschaften, is recommended. Recommendations for adequate clothing are given.

Objectives: Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. Material and Methods: Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. Results and Conclusions: The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft -or with the doors opened while the engines are running -must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.

<p><b>Background: </b>Occupational physicians work directly with individual employees regarding diseases that has been caused or exacerbated by workplace factors. However, employees are increasingly required to travel for their work, including to tropical countries where they risk exposure to diseases they would not normally encounter at home (i.e., malaria). Such disease/s may also take days to months to incubate before becoming symptomatic, even after their return home, thus delaying and complicating the diagnosis. Proving this was an occupational disease with respective sick leave entitlement or compensation can be challenging. There is a lack of data concerning occupational diseases caused by tropical infections. <p> <b>Material and methods: </b>Employee case records for the period 2003-2008 from the State Institute for Occupational Health and Safety of North-Rhine Westphalia in Germany were analysed and assessed within Germany’s regulatory framework. These records included Germany’s largest industrial zone.<p> <b>Results: </b>From 2003-2008the suspected cases of “tropical diseases and typhus”, categorized as occupational disease “Bk 3104” in Germany, have decreased significantly. A high percentage of the suspected cases was accepted as occupational disease, but persistent or permanent sequelae which conferred an entitlement to compensation were rare. <p><b>Conclusion: </b> There is scope to improve diagnosis and acceptance of tropical diseases as occupational diseases. The most important diseases reported were malaria, amoebiasis, and dengue fever. Comprehensive pre-travel advice and post-travel follow-ups by physicians trained in travel and occupational health medicine should be mandatory. Data indicate that there is a lack of knowledge on how to prevent infectious disease abroad.

Alpine rescue operations are typical of a place of work in a cold--sometimes extremely cold--environment. Because of the limited time of exposure during the majority of the operations, the most important danger for rescue personnel is frostbite, although hypothermia cannot be excluded in cases of prolonged operations. Special advice to avoid the specific risks must be given to the crews and an examination by occupational medicine, e.g. according to "Working in cold environments, G21" of the German Berufsgenossenschaften, is recommended. Recommendations for adequate clothing are given.

Background: During helicopter rescue operations the medical personnel are at high risk for hearing damage by noise exposure. There are two important factors to be taken into account: first, the extreme variability, with some days involving no exposure but other days with extreme exposure; second, the extreme noise levels during work outside the helicopter, e.g. during winch operations. The benefit of modern, less noisier constructions and the consequences for noise protection are still unknown.Objectives Results and conclusions: Depending on modern technologies the situation for the personnel has been improved significantly. Nevertheless noise prevention, which includes noise intermissions in spare time, is essential. Medical checks of the crews by occupational medicine (e.g. 'G20' in Germany) are still mandatory.