Evidence-based medicine in dark and alien environments

DSC_3477I like to contrast caves and their dark development to the extraordinary environments above them such as remote mountains, glaciers, deserts, unspoiled forests, and major cities like Napels as well as incredible islands like Sardinia, lying in the middle of Mediterranean sea.

I like the contrast between the darkness inside and the light outside, the pleasures of problem solving and discoveries that belong so deeply to the medical practice and medical research. As a physician, I was fascinated early on by the challenge of making clinical decisions in an evidence-based manner on mountains and under them. Lack of data make these environments a particularly difficult area to operate in.

DSC_3517I soon faced the problem of practicing medicine and its instruments in extremely adverse environmental, topographical, and logistical conditions where the human body reacts to the thin air, cold and darkness.

My job is to try to find answers to these issues, in collaboration with other emergency physicians at CNSAS, of which I am a member and for the International Commission of Mountain Emergency Medicine (ICAR MEDCOM).

I am vice director of the EURAC Institute of Mountain Emergency Medicine of Bolzano, Italy, an institution aiming to improve the diagnosis and treatment of casualties and acutely ill patients in mountainous regions by raising the standard of alpine emergency medicine to an internationally recognized evidence-based discipline.

IMG_3182The chance to take part in the world of training for space exploration missions in ESA's CAVES course offered another approach to isolation, teamwork and limited resources issues for clinical and research purposes.

Recognising human health concerns are a pressing issue for all types of exploration. Another major problem arises when conducting scientific research on space missions and before getting a patient to a hospital. Frozen equipment or a discharged battery can make all the difference!

Supporting CAVES as a medical doctor in charge of first-intervention and patient stabilisation I hope to help in improving the quality of human skills and data collection. These are of paramount importance to provide better insight into various aspects during a mission on the International Space Station and for future space exploration missions.

Giacomo Strapazzon

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Meet the Team: Giacomo Strapazzon

Giacomo Strapazzon. Credit: ESA-V.Crobu

Giacomo Strapazzon. Credit: ESA-V.Crobu

Caves are rather uncomfortable but fascinating environments, you need be aware of obstacles, directions, yourself and your teammates, as well as be alert to dangers. All this is in just the dim light of a helmet torch. And that, of course, means moving in full control of your body. A simple injury to an ankle or a wrist could make the exit unreachable without help.

Astronauts need to be cared for. So for CAVES 2013 I decided to involve a medical doctor to support the extended expedition in addition to the external support of the Sardinian branch of the Italian Cave Rescue organization (CNSAS).

As with all team members, I needed someone who could be multifunctional. Giacomo is an expert speleologist, and has supported us as a medical doctor before, but he is also as an expert in caving and roping techniques. He monitors safety with a tremendous motivation and makes sure everybody is in swinging shape.

Loredana Bessone

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Karst for astronauts lesson five: cave morphology

What types of caves exist that are explored by astronauts in CAVES? Find out in the last lecture of Karst for astronauts.

[youtube 6U6xOHjK7JI]

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Karst for astronauts lesson four: Supramonte caves

Part four of our guide to caves for astronauts focuses on the Supramonte caves in Sardinia, Italy.

[youtube czONJ1FpVW0]

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Karst lesson 3: Cave genesis

Jo de Waele continues his lecture on Karst and how caves are formed.

How do caves form by the action of water? What does the shape of a cave tell us about its formation? What are the main prerequisites for a cave to form? What are the three phases of speleogenesis (cave formation)? How long does it take to form a cave? Is a cave formed by dissolution or erosion?

[youtube SEyMwBr4xBE]

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Karst lesson two: surface morphologies

What does the ground above a carbonatic cave look like? How does a river disappear underground a blind valley? What do rillen, karren and solution pans look like?
Find out in part two of the Karst lecture:
[youtube qLfuBLWhmPg]

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Karst for non-specialists

Studying the weird aragonite helictites in Asperge Cave, France. Credit: Mirjam Widmer.

Jo studying cave formations in France. Credit: Mirjam Widmer.

Not many people in the world understand the importance of karst, or even know what karst is. ‘Karst’ does not sound particularly inviting, and it could be confused with a disease, a curse, or other bad things. In reality karst is the name of a region, between Slovenia and Northeast Italy, where rock dissolution has created a wide set of beautiful surfaces and subsurface landforms, most important of all are the caves.

The word 'caves' is more commonly known but it often evokes fear and danger. Caves are often thought to be dark (and up to here people guess right), with bad air (only when exhausted cavers pass by does it sometimes get smelly) as well as dangerous, inhabited by evil spirits and dragons, home to devils, not to mention bloodsucking vampires with terrible diseases. Poor caves, and poor bats that live in them.

Caves are wonderful places, where awesome mineral formations – stalactites and stalagmites – render speechless. Bats are lovely creatures that eat insects or fruit, a fundamental part in the biological cycle of plants and animals, including humans. Without bats we would be surrounded by clouds of mosquitos and moths!

What do astronauts think about karst and caves? Who knows, although many people may have visited a tourist cave, the formation of underground spaces and surrounding landscapes often remain a mystery including to astronauts, despite it being likely that caves will be found on other planets, and could be used as shelters for extra-terrestrial expeditions.

Karst lecture with astronaut pupils. Credits: ESA-V. Crobu

Karst lecture with astronaut pupils. Credits: ESA-V. Crobu

Since ESA’s CAVES requires astronauts to explore, map and run scientific experiments in a cave, I designed a lecture on karst that gives a quick but easy overview of the phenomena and the environment. Not all astronauts are scientists and time constraints required that I prepare a 60-minute lecture to give the background information needed to perform exploratory and scientific activities in caves.

From today we present five videos on karst, each of around 10-15 minutes, releasing one each day. The lessons cover the karst processes, the resulting surface morphologies, the genesis of caves, cave morphologies, and the caves and karst of Supramonte, in Sardinia, Italy.

[youtube pIjtWMr4Vsk]

Jo De Waele

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Speleopolis: the city of magic and a special Halloween

CAVES presentation at Casola 2013 Underground. Credits: Cervelliln Azione

CAVES presentation at Casola 2013 Underground. Credits: Cervelliln Azione

This year the ESA CAVES team was invited to celebrate a magical Halloween at the Casola 2013 Underground event.

Each year, on the days that we celebrate all saints and the dead (not Halloween really, as Halloween is not a very Italian tradition), Italian speleologists meet to celebrate those who live underground and the underground world: darkness, friendship, exploration, endurance and discovery.

This year the International Meeting of Speleologists (which is held mainly in Italian, but with many speleologists from around the world) was held in Casola Valsenio, a small town of 2000 inhabitants in the beautiful hills of Emilia Romagna. Casola was literally but peacefully invaded by a happy crowd of 2500 speleologists.

Registration office. Credits: Cervelli In Azianoe

Registration office. Credits: Cervelli In Azianoe

The event involved a few days of presentations, round tables, videos and 3D projections, exhibitions, guided tours, school labs, book presentations, cultural events, music and poetry... you name it.

In the midst of it all ESA CAVES gave a presentation which was made unforgettable by the announcement of the birth of Paolo Nespoli’s son. Later during speleonight a videoconference was organised with Paolo himself and NASA astronauts Jack Fisher and Mike Barratt.

It’s hard to describe the magic of Casola, a city that has officially been named Speleolopolis, and which for a few days has two mayors: Nicola Iseppi, mayor of Casola Valsenio and Biagio, mayor of Speleopolis.

Directions to everywhere in Speleopolis. Credits: Cervelli In Azione

Directions to everywhere in Speleopolis. Credits: Cervelli In Azione

Considering that ESA CAVES is about effective and safe teamwork, I can only applaud the organising team, led by Stefano Olivucci, for being on top of everything and having the spirit, professionalism and flexibility to handle surprises that came along and gracefully inject them into the programme.

It has been a pleasure to entertain kids with astronaut tales, to teach them about space oddities and the analogies of exploring underground and to listen to the stories of true explorers, their struggles and their achievements.

Thank you Casola, you kept your word, and made the myth come true!

Loredana Bessone

P.S. I would like to add a short text sent from Max, an organiser of many key events at Casola. It is in Italian but translating Max’s texts are an impossible feat. In any case, you probably needed to be there to get the spirit of his words. Enjoy!

CSA astronaut Jeremy Hansen tweeted this spooky picture of CAVES 2013. Credits: ESA-V. Crobu

CSA astronaut Jeremy Hansen tweeted this spooky picture of CAVES 2013. Credits: ESA-V. Crobu

In un luogo definito Speleopolis tutto può accadere. Eppure, sentire chiedere a una classe di bambini "chi è stato nello spazio?" va certamente oltre. E va oltre anche l'essere rimproverati perché "il Teatro Senio e' troppo piccolo per gli astronauti"...
Tutta Casola 2013 Underground è andata oltre. Gli astronauti che si allenano in grotta, le ghiacciaie che diventano location per mostrare stupende immagini d'aragonite, Diemberger che è l'unico vivente con due ottomila per primo. La narrativa per ragazzi e gli spot per la speleologia che si fanno contest con decine di autori e opere, le grotte turisticizzate, le anticipazioni del 2015. Si potevano percorrere pochi metri e attraversare orizzonti esplorativi, andare dall'ipogeo alle vette. Ascoltare parole e musica su Pollok, andare alla presentazione di un nuovo testo di Natalino Russo, fermarsi a ballare, Speleonotte o Speleobar. Presentazioni tante. Mostre tante e tante le associazioni. Materiali e discussioni sui materiali. 4000 tra speleologi e abitanti di Casola Valsenio. Un murale davanti al bagno pubblico del Parco Pertini. Viaggi nella Terra, sulla Terra e verso lo Spazio. Sogni e incontri. Grazie a ESA CAVES per essere stata presente nella Speleopolis emersa per alcuni giorni e pronta a rimanere nei ricordi.
Massimo (max) Goldoni

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The secret of friendshipIl segreto dell’amicizia

BBC documentary in Venezuala. Credits: La Venta-V. Crobu

BBC documentary in Venezuala. Credits: La Venta-V. Crobu

I started caving in 1998 without thinking that from that moment my life would change in a radical way. Since then I have enjoyed great explorations of underground Sardinian rivers, incredible discoveries abroad, participating in ESA’s CAVES side by side with astronauts and developed an overall passion for caves and nature. Caving has led me to live very intense experiences far from every-day life and meet a wide variety of people. Caves are not just a documentation exercise or an adventure but a way to meet new people and establish friendships.

Venezuela. Credits: La Venta-V. Croby

Venezuela. Credits: La Venta-V. Crobu

Sometimes people on an expedition already know each other but most of the time they are strangers. You  might have spoke over the phone or via e-mail but often you meet for the first time when you shake hands at the airport. It is funny and I am often curious to know who I will be sharing a tent with or with whom you will conduct a survey. Sometimes the collaboration goes better than with others. New companions are like uncharted territory, they are to be discovered. The affinity that grows with expedition members can decide the outcome of an expedition, the greater the spirit of adaptation, cooperation and understanding, the greater chance of achieving results and that is why when you share such an intense and exciting experience genuine friendships grow that neither time nor distance can divide.

Sardinia. Credits: V. Crobu

Sardinia. Credits: V. Crobu

Sharing the discovery of a new gallery, being brave when you try to find your way out of a cave, shaking from the cold, sharing the little food left over when you are hungry, chatting to each other during the long ascents back outside and eating with friends around the fire afterwards binds you strongly to your companions.

ESA’s CAVES manages to concentrate all that I have experienced in fifteen years of caving. When the astronauts arrive it is exciting to see the great expectations for the adventure that is about to begin. You must know how to go in the cave but you must also know how to live together for twenty days in close contact. You have to be willing to learn but also to give, you have to adapt to a frenetic pace, you have to work with people you are not familiar with and you have to communicate with people from other countries in different languages.

CAVES team. Credits: ESA-V. Crobu

ARXO with CAVES 2013 astronauts team. Credits: ESA-V. Crobu

Any difficulties are felt more a team that has to live in symbiosis for 24 hours a day during the whole course, so we must have a strong understanding at first glance. We have to be prepared to give our best in the dark because it is important to film or photograph the course. It is not easy to coordinate the lighting and filming at the exact moment you need it without disturbing the astronauts’ activities. I think the secret of the ARXO team is friendship and trust. After the third edition of CAVES we have become a more and more close-knit group. Each year wonderful friendships are born and every year we wait anxiously for the arrival of the astronauts. The course is long and tiring but it is also an opportunity to have fun and joke together. After twenty days, certificate ceremony is fraught with emotion. The astronauts offer compliments but everyone knows the course is finished. Time to pack up and with many nostalgic memories to retell. The time has come to say goodbye to all our friends. A hug and hello to everyone! We will meet again in September for the next edition!

Carla Corongiu

BBC documentary in Venezuala. Credits: La Venta-V. Crobu

BBC documentary in Venezuala. Credits: La Venta-V. Crobu

Ho iniziato a fare speleologia nel 1998 un po’ per caso senza pensare che da quel momento la mia vita sarebbe cambiata in modo radicale. Le grandi esplorazioni dei fiumi sotterranei della Sardegna, le incredibili scoperte all’estero, la partecipazione a ESA-CAVES fianco a fianco con gli astronauti e in generale la passione per le grotte e per la natura mi hanno portato a vivere delle esperienze molto intense lontano dalla vita di tutti i giorni e a incontrare e confrontarmi con una grande varietà di persone. La grotta per me non è solo

Venezuela. Credits: La Venta-V. Croby

Venezuela. Credits: La Venta-V. Crobu

documentazione e avventura ma è un modo per conoscere nuova gente e per instaurare delle amicizie. Quando parti per una spedizione conosci già alcuni partecipanti ma la maggior parte di loro sono degli sconosciuti, ci hai parlato per telefono o via mail ma ci si vede in faccia e ci si stringe la mano per la prima volta solo in aeroporto. E’ un aspetto molto divertente e curioso perché non sai con chi dividerai la tenda, con chi farai un rilievo, con chi andrai più d’accordo, i nuovi compagni e compagne sono come i territori inesplorati, tutti da scoprire. L’affinità con i partecipanti può decidere l’esito della spedizione, maggiore sarà lo spirito di adattamento, di collaborazione e di comprensione maggiore saranno le possibilità di avere grandi risultati insieme ed è per questo che quando si condividono delle esperienze così intense ed emozionanti nascono sincere amicizie che né il tempo né la lontananza riescono a dividere.
Guardarsi negli occhi commossi quando si scopre una nuova galleria, farsi coraggio quando una piena non ti permette di uscire dalla grotta, abbracciarsi quando tremi dal freddo, dividere il poco cibo rimasto quando hai fame, chiacchierare nelle lunghe risalite verso l’esterno e mangiare con gli amici intorno al fuoco dopo un’esplorazione faticosa ti lega in maniera fortissima ai tuoi compagni.

ESA-CAVES sembra il concentrato di tutto quello che ho vissuto in quindici anni di attività in grotta. L’arrivo degli astronauti è emozionante come quando incontri all’aeroporto i nuovi compagni di spedizione, ci si presenta, ci si scruta negli occhi con grandi aspettative per l’avventura che sta per iniziare. Devi saper andare in grotta ma devi anche saper convivere per venti giorni a stretto contatto con gli altri, devi essere disponibile a imparare ma anche a dare, ti devi adattare ai ritmi frenetici, devi collaborare con persone con cui non sei abituato a lavorare e devi comunicare con chi parla una lingua diversa dalla tua e con chi viene da un altro paese.

Sardinia. Credits: V. Crobu

Sardinia. Credits: V. Crobu

Le difficoltà si sentono ancora di più quando si fa parte di una squadra che vive in simbiosi per 24 ore al giorno, per tutta la durata del corso, bisogna perciò avere una fortissima intesa e capirsi al primo sguardo. Per dare il massimo se manca una luce perchè c’è un momento importante da filmare o fotografare bisogna intuire il problema e aiutarsi l’uno con l’altro. Non è facile fare tutto questo nell’esatto momento in cui ne hai bisogno, senza disturbare l’attività degli astronauti. Per questo penso che il segreto del team Arxo stia nell’amicizia e complicità.

CAVES team. Credits: ESA-V. Crobu

ARXO with CAVES 2013 astronauts team. Credits: ESA-V. Crobu

Dopo la terza edizione di ESA-CAVES siamo diventati un gruppo sempre più numeroso ma sempre più affiatato, sono nate delle splendide amicizie e ogni anno ci riabbracciamo e aspettiamo ansiosi l’arrivo degli astronauti. Il corso è lungo e faticoso ma è anche l’occasione per divertirci e scherzare insieme. Passati quei venti giorni il momento della consegna degli attestati è denso di emozione, gli astronauti si complimentano e hanno una bella frase per ognuno di noi, ma il corso è finito. Rifai le valigie e nostalgico pensi a quanti bei ricordi porterai a casa e quanto avrai da raccontare. Come in ogni spedizione che si rispetti è arrivata l’ora di salutare tutti gli amici.
Un abbraccio e ciao a tutti! Ci vediamo come sempre a Settembre alla prossima edizione!!!

Carla Corongiu

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Meet the Team: Carla Corongiu

Carla. Credits: La Venta-V. Crobu

Carla. Credits: La Venta-V. Crobu

Speleology is a mental sport as well as a technical one. Physical strength is not as important as knowing how to move or when to move. It requires patience, collaboration and organisation. Some people have wonderful gifts, and they need the support of others to put them to use. As a speleologist, you cannot work alone, you need to have multiple talents and be able to switch between different roles.

Of all the ESA outdoor expeditionary training courses, I remember the experience of the Survival training in 2010 as the most enjoyable. I had been the course coordinator and the instructional system designer for that course, and during the course I became a member of the support team. I met Carla during the training. Her boyfriend was a member of the support team, and she volunteered to help with logistic tasks.

The ARXO team Vittorio, Sirio and Carla. Credits: ESA-C. Corongiu

The ARXO team: Vittorio, Sirio and Carla. Credits: ESA-C. Corongiu

Carla joined us again during CAVES 2012, now a full member of the logistics team. She started to support the photo and video team, managing batteries and helping with lights. She is now a member of the ARXO team, and during CAVES 2013 she helped the wonderboys Vitto and Sirio, taking charge of file management, and taking pictures during the preparatory training activities.

Carla has lots of talents. She is organised, reliable and determined. Most of all, she has many skills. We could not run a course like CAVES without all team members being speleologists, but also cooks, photo operators, scientists, technical instructors, drivers, Sherpas, and most of all, extremely motivated people.

Carla is also a member of the La Venta team, and of the ASPROS association. She has joined them in fantastic expeditions in Sardinia and around the world, often documented in Vittorio’s videos and also in fantastic photographic books, for example see here and here.

Carla receives CAVES participation certificate. Credits: ESA-V. Croby

Carla receives CAVES participation certificate. Credits: ESA-V. Crobu

When we left the Sa Grutta caves this year NASA astronaut Jack Fischer saw Carla with her heavy backpack loaded with laptops Vitto and Sirio use to edit videos. When Jack saw Carla starting to climb a rope carrying the heavy backpack behind her he said: “That is not elegant!”. As Carla started moving upwards, showing no signs of stress or fatigue, with the backpack smoothly following, Jack turned to me and said: “Well, in fact that is elegant indeed!”.

Loredana Bessone

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