Page 12 - Journal of Special Operations Medicine - Summer 2015

and potentiation of anticholinergics when taken concur- alerted and, after careful planning, a rescue mission was
rently. Neither is acceptable for PJs required to complete launched from Moffett Federal Airfield, California, via
dangerous and complex tasks in motion-sickness-prone C-130 with four USAF PJs aboard.
environments. Cinnarizine is a medication that acts on
the histamine receptors as well as the calcium channels Case Report
in the inner ear, and has reported side effects similar to
its antihistamine counterparts. Cinnarizine is routinely Four PJs prepped for the mission, which included a pack-
used in Europe but is not approved by the US Food and aged Zodiac raft with motor (RAMZ) (Z Marine; www
Drug Administration for use in the United States. 2 .zodiacmarineusa.com) drop and free-fall parachute from
a C-130. Consultation with the Pararescue Flight Sur-
The most common anticholinergic used for motion geon took place, and a contingency response for a sick
sickness is scopolamine, which acts upon muscarinic 1-year-old child was considered and prepared. The plane
receptors in the central nervous system that decrease flew 5 hours and deployed the RAMZ package and the
the feedback from the vestibular system. The side ef- four PJs. The air temperature was 85°F to 90°F, the water
8
fect profile for scopolamine includes dry mouth, blurry temperature was 80°F, and the sea state was 8 to 10 feet.
vision, hyperthermia, and psychosis, as with other
anticholinergics. While en route and waiting to jump, the PJs were in
their dry suits. It was warm on the plane, with poor ven-
PJs are tactical and technical rescue specialists who are tilation. During this point in the mission, one PJ began
also paramedics. PJs use all methods of insertion and to feel mildly nauseated. This team member did not use
extraction by air, sea, and land to effect the rescue mis- any medication for motion sickness at that time due to
sion. Traditionally, this goes back to the mission of res- USAF aeromedical policy, which restricts the use of such
cuing pilots or downed aircrew anywhere, anytime. PJs medications by aircrew while in flight.
may encounter varied environments (air and sea) within
a single mission, increasing their exposure to situations The drop was accomplished, a Zodiac raft was assem-
that may cause motion sickness. bled, and the PJs approached and boarded the sailboat.
The sea state still was 8 to 10 feet. An immediate check
The following is a case report of PJs who experienced of the child revealed her to be stable, alert, and respon-
severe sea sickness while on a rescue mission. This re- sive. The three other passengers were healthy.
port focuses on the use of cinnarizine, which has not
previously been used in the USAF pararescue commu- After entering the water, one of the PJs became sick im-
nity. A follow-up survey was conducted for PJs to report mediately. Two other team members became ill after
the incidence of motion sickness in the career field. boarding the sailboat. The remaining team member,
whose mission capability was not affected by seasick-
ness, evaluated the patient, instituted oral rehydration
Background
and antibiotics, and continued to monitor the child’s
An American family of four with two daughters, 1 year clinical condition. The child continued to tolerate oral
old and 3 years old, departed Mexico to sail across the feedings during this period.
Pacific Ocean to New Zealand. The prior week, the
9
1-year-old girl was diagnosed with Salmonella enteritis, In the meantime, the three other PJs were incapacitated
treated, and cleared for the trip by her pediatrician. In- at varying intervals. At 24 hours into the mission, the
cidentally, around the time the child was diagnosed, the captain offered each of the PJs one-quarter of a 75mg
mother was similarly diagnosed with the infection and cinnarizine tablet (approximated to be 18mg), explain-
fully recovered. ing that cinnarizine was the medication they routinely
used. Approximately 20 minutes after taking cinnari-
The trip was uneventful until a week into the voyage, zine, all three PJs felt better, tolerated oral fluids, and
when the child suffered a recrudescence of diarrhea and were able to relieve the treating PJ and remain mission
fever. At some point soon after this occurred, the sail- functional for the duration of the mission. Two PJs con-
boat also became disabled. Despite attempts to treat the tinued to take the medication every 12 hours.
child with conservative measures, the child’s condition
deteriorated. The mission’s team leader gathered information from the
team members about their symptoms during the mission.
The captain of the vessel, who was also the father of the Each team member was affected by motion sickness at
child, sent a distress call relaying the situation of their some point during the mission. The following is a break-
vessel and passenger. The Rescue Operations Center was down of the timeline for each member. (Note: Estimates

2 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015