If someone asked you – “what do you want to do when you become an adult?" – what would your response be?
Now, imagine me as a 14-year-old student at an art school, and one day going to a Red Cross course and recognizing that you love the idea of the First Rescue and Emergency services. My first answer was always – Astronaut! But… what should I do now? Astronaut or Doctor ...?
Solution? Helicopter flight physician!
But how can I do this thing…is it possible? Yes, it is!

I first studied medicine and became an anesthetist and intensivist. And so it was… once I graduated and then specialized in anesthesia, I began to frequent the world of Helicopter Rescue. A fantastic job that combines flight, wonderful landscapes (the Dolomites ...) and the human factor. A lot of different situations every day and in different places. The helicopter flight physician is responsible for providing casualties with emergency medical assistance at the accident site, as well as attending to patients during primary and secondary missions. The scope of activities also involves recovering patients from topographically difficult terrain by means of a rescue hoist. This applies exactly from the time the patient is put into your care until you hand them over to the medical staff responsible at the destination hospital.

I remember one early afternoon in September 2013, the Helicopter Emergency Medical Service (HEMS) Dispatching Centre of Treviso, Italy received a call from a person who told the operator that her cousin, a 53-year-old man with a previous history of inferior myocardial infarction, had suddenly fallen down while walking at home. While dispatching the nearest ambulance, the dispatcher provided CPR pre-arrival instructions to the caller, according to standard protocols. An EMS helicopter, staffed by an emergency physician (namely, me!) and a nurse, was dispatched to the scene. The first emergency unit, staffed by a nurse and an emergency technician, reached the patient within 10 minutes of the call and found the woman performing chest compressions as instructed by the dispatching center operator. My team in the helicopter reached the patient 10 minutes after the first unit started ACLS (Advanced Cardiac Life Support). The cardiac rhythm was a persistent ventricular fibrillation and the decision was made to apply a LUCAS-3 chest compressions device to the patient, who was then transported directly to the hospital and catheterization laboratory. Selective percutaneous coronary angiography was performed with ongoing continuous mechanical chest compressions. Coronary angioplasty was performed on two coronary arteries. Five days after resuscitation, the patient was extubated and was alert and oriented. After 16 days he was discharged from the Intensive Care Unit and transferred to a post-intensive care unit. The patient survived without any neurological damage despite prolonged resuscitation and a call-to-ROSC (return of spontaneous circulation) interval of nearly 2 hours. The immediate beginning of chest compressions by the caller and uninterrupted CPR by medical teams preserved the brain from ischemic damage.

​The mechanical chest compression device permitted safe and effective CPR during helicopter transportation directly to the catheterization laboratory, which permitted the removal of the coronary artery occlusions, which were preventing the ROSC.
 
This is why I think this is an amazing job…

​As well as being a certified specialist in Cardiac-Anaesthetics, Intensive Care Medicine and Aerospace Medicine, currently working as an intensivist, cardiac-anesthesiologist and HEMS doctor in northern Italy, Alessandro has a passion for space clinical medicine, which began in 2012 following a post-graduate course in Space Medicine at the San Donato Milanese University.
He has been involved in space medical research as a COSPAR (Committee on Space Research) collaborator and acted as a reviewer of many scientific articles for the journal Advances in Space Research (Elsevier). He was also Coordinator of the HEMS base in Pieve di Cadore-Italy from 2018-2020.
Alessandro is Principal Investigator for the research Mechanical Cardiopulmonary Resuscitation in Simulated Microgravity and Hypergravity Conditions: a manikin study, which took place during the 4th. parabolic flight campaign in Dübendorf (CH) in June 2020, in collaboration with the SkyLab Foundation, CNES and DLR.

Congratulations to Editor Vladimir Pletser and all the authors who contributed to this interesting open-access book entitled Preparations of Space Experiments, which was published this week. Spend a few minutes watching Vladimir as he summarises the contents of each chapter, written by world-leading researchers who have designed and prepared science experiments on microgravity platforms, including aircraft parabolic flights, in preparation for subsequent spaceflight.

For as long as I can remember, I have always been flying around. My mother was a flight attendant, my father was an Air Force mechanic and we spent most of our lives living in an Air Force base. To board, deplane and wake up with the noise of helicopters and jets was part of the routine, which did not make it less special to me.
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When I was 17 years-old, my family was transferred to Sweden and I had to decide what I wanted to do with my life. I was only sure about 2 things: I wanted to help and serve people, and I loved airplanes and the life in the air. How was I supposed to combine these two? I had no idea. Most people did not see a link between these two points, but I knew that I had to find a way, otherwise, I would never feel complete. If I would imagine myself permanently away from jets and airports or not in direct contact with people in need, a huge void would open in my chest; it just was not right, “either, or” was not an option to me.

In a Spring afternoon of 2018, I overheard some fighter pilots telling stories about accidents they had witnessed: a smashed jaw during the ejection after a period of temporal distortion, tunnelled vision, and a total blackout during the centrifuge training. Then, it hit me, those people were the link, they were the ones who connected those amazing machines to the human factor, they were the ones I wanted to help.

I started to research, and I still remember the first words that caught my eyes: “flight-surgeon”, “AsMA”, “Aerospace Medicine”. Upon reading the last mentioned, my heart dropped. I had found it. I had found an entire field and community of people as curious as me and that shared the same passions. And at the end of that year I was given the chance to get in touch with it more directly.

To graduate the International Baccalaureate (a different kind of high school), every student must carry out an independent research about a topic they would be interested in studying in university, our first research paper. I knew exactly what I wanted to do, I wanted to understand the symptoms and episodes I had heard about countless times, I wanted to understand what that so feared G. was. I read all the books about aerospace medicine fundamentals and flight physiology I could find, I started to talk to every single crew member and engineer I could reach, but the understanding of the symptoms through medical lenses was still missing. Another important thing that was missing was a supervisor, who would be willing to help me to start the research. Basically, the Science Department of my school did not understand what I was going for, how I was going to do it and no teacher was exactly thrilled with the idea of supervising a student they had no idea of how to help. It was even hard to decide whether to classify it as a Biology or Physics project!

To my heart-stopping surprise I got all of them, and they were all mostly glad to help me and to send me papers, videos, and pictures from their own centrifuge trainings (thank you so much Major Forneas and Colonel Leite). Nevertheless, to my despair the data collected contradicted my primary hypothesis! Great!

That is when my dear friend Jonas comes into scene. He worked at SAAB, the company which was developing the new Brazilian Grippen, state-of-the-art fighter jet, and offered to arrange me an interview with a test-pilot. It was by far, one of the greatest days of my life!

While we were waiting for Andreas to finish his debriefing, Jonas took me on a tour around the Flight Test Centre. I had always wanted to see the Grippen; only one was ready so far, it had flown only once and only authorised personal could see or get close to it, or at least I had been told. Jonas opened the hangar’s door and there it was! The mysterious Grippen and I was one of the few civils, who had nothing to do with the project whatsoever, who had been able not only to see it but to climb up to its cockpit! Right there, I knew I had made the right choice.
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Andreas, the test-pilot, still wearing his anti-G suit, spent a long time answering my endless questions, and by the time I finished the interview I understood where I had gone wrong and the kind of data that I needed to prove my new hypothesis right! And again, I was mesmerised by how the scientific community mobilised itself to help an enthusiast like me, who was still not even part of it.