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救援任务:有如好莱坞电影的“南极救援行动”

更新时间:2019/5/2 11:20:52 来源:纽约时报中文网 作者:佚名

Antarctica's most extreme rescue mission
救援任务:有如好莱坞电影的“南极救援行动”

In late April 2015, Tim Nutbeam was smuggled onto a plane carrying a big bag of blood to attempt a rescue mission in Antarctica. It was the beginning of winter when the continent is draped in almost total darkness and extreme cold, not to mention frequent high winds. Due to the dangerous conditions, there are normally no scheduled flights during the six months of winter.

2015年4月下旬,努特皮姆(Tim Nutbeam)带着一大袋血浆,登上了前往南极的救援飞机。此时正值南半球初冬,整个南极大陆被黑暗和严寒笼罩,强风频频来袭。由于气候条件恶劣,在为期半年的冬季里,一般不会安排任何航班在南极起降。

But Nutbeam, a consultant in emergency medicine based in the UK, went ahead with the journey, joined by a pilot and engineer.

即便如此,英国急诊医学顾问努特皮姆还是同飞行员和工程师一起,飞赴南极。

Their mission was to save the life of a critically ill worker on an Antarctic base. Malcolm Roberts, an engineer for British Antarctic Survey, had suffered a massive gastrointestinal bleed at the Halley Research Station days before. He was thousands of miles away from the nearest hospital.

他们是为了救助基地里一位生命垂危的患者。几天前,在哈雷研究站(Halley Research Station)工作的英国南极调查局工程师罗伯茨(Malcolm Roberts)肠胃严重出血,而最近的医院却在数千英里以外。

Roberts had lost a lot of blood but had survived the first 24 hours. If they got to him in time, there was a chance that he would live – but there were many challenges that could prevent them from saving their patient.

罗伯茨失血很多,但所幸挺过了前24小时。如果救援队伍能够及时赶到,那么他还有一线生机——但是前往南极的路道阻且长,很难说罗伯茨能不能逃过一劫。

The flight to Halley would take about 24 hours with one stop to refuel in Rothera, another base on the Antarctic peninsula, before making the same journey back, meaning they would be flying for about 48 hours straight. And on the way back, they would have to deal with a medical emergency at the same time, having had little sleep or rest.

飞往哈雷研究站大约需要24小时,中途经停南极半岛的罗瑟拉基地(Rothera)加油。再加上回程,总共需要连续飞行48小时之久。返程途中还要应对患者的紧急状况,几乎没有时间休息睡觉。

Saving the patient’s life was challenge enough. But on top of that, how would Nutbeam be able to handle the mission psychologically?

单是拯救患者生命就已经不简单了,而与此同时,努特皮姆能否做好这次任务的心理准备?

Initially, he wasn’t even meant to go on the trip. Nutbeam was supposed to be the back-up doctor on the mission. When the emergency occurred he had flown into Punta Arenas, a town near the southernmost tip of Chile. The plan was that he would be stationed there to help after the plane landed.

最初并不是要派努特皮姆去,他只是后备医生,紧急救助开始后他飞到了智利最南端的蓬塔阿雷纳斯镇,按照计划是等救援飞机在那里着陆后提供协助。

But when a volcano erupted north of where he was, everything changed. The lead doctor was waiting for a connecting flight in Santiago but all flights were cancelled. At the same time, there was a rare break in weather across the Drake Passage, the body of water between southern Chile and Antarctica, where visibility is often poor. “I suddenly realised that I would be going,” says Nutbeam. “It was too good an opportunity to wait.”

但是,小镇以北的火山爆发,一切计划都被打乱。主治医生当时正在圣地亚哥等候转机,但所有航班都取消了。而智利南部与南极洲之间的德雷克海峡却出现了难得的好天气,海上能见度很理想。努特皮姆说:“我突然意识到该我去了,这是个千载难逢的好机会。”

Nutbeam admits that everything happened so quickly that he didn’t think much about the potential dangers at the time. Instead, he remembers feeling excited about getting to go to Antarctica and do the rescue.

事发突然,他承认当时甚至无暇思考可能发生的危险,只记得对前往南极救援激动无比。

Extreme personalities

极限探险者的品质

There have been few medical evacuations during the Antarctic winter. In 2016, an ill worker was airlifted from the South Pole mid-winter – when there are 24 hours of darkness – while another patient rescue took place from the main US research base in 2010.

在南极冬天进行的医疗撤离屈指可数。2016年曾在24小时不见太阳的极夜里用飞机接走过一名病人,另一次是2010年从美国的研究主基地接走的。

According to Nathan Smith, a psychology researcher at the UK’s University of Manchester, people who take part in extreme expeditions often are motivated by the chance to do something that not many people do. “They are often highly trained so it’s an opportunity to test their skills out and do a task they haven’t done before,” he says.

英国曼彻斯特大学的心理学研究员史密斯(Nathan Smith)表示,参加极限探险的人通常是想要尝试大多数人所做不到的事情。他说:“这些人往往训练有素,因而将这当成是一次检验技能并尝试新任务的机会。”

Certain personality types are better able to deal with the stress of extreme expeditions. Research has shown that people who are less neurotic perform better. “What we see is that people in high-risk jobs are not easily anxious and when they are, they are able to control it quite well,” says Smith.

面对极限探险的压力时,某些性格类型的人会更加自如。有研究显示,神经没那么敏感的人表现得更好。史密斯说:“我们发现,从事高危工作的人更不容易焦虑,即使焦虑也能控制好。”

Conscientiousness also play a role. A study looking at the personality traits of people willing to take a parabolic flight, for example, found that conscientiousness allowed them to cope better with extreme demands. This goes against the common notion that people who take part in extreme activities are adrenaline junkies. “What we found is that people typically spend a lot of time de-risking,” says Smith. “They do a lot to avoid having an adrenaline rush because to them that signals a threat.”

这也与负责心有关。例如,一项研究调查了愿意尝试飞机抛物线飞行的人有哪些性格特质,结果发现责任心能让他们更好地应对极端的要求。人们普遍认为敢于尝试极限活动的人玩的就是心跳,但这项研究的结论恰好相反。史密斯说:“我们发现,这些人常常会花很多时间来降低风险,会尽力避免肾上腺素飙升,因为他们觉得这是一个危险信号。”

Nutbeam and his team had to be diligent to deal with the challenges they faced during the long journey. Throughout the trip, for example, Nutbeam had to monitor the temperature of the bagged blood, ensuring that it remained within a narrow optimum range. The front of the plane, where the team was huddled, was kept warm, but it was about -10C at the back. “I had to try and find a sweet spot to put the blood and had to check on it every hour,” he says.

此次漫长的旅程中,努特皮姆和团队必须积极应对各种困难。譬如,努特皮姆需要全程监控血袋的温度,确保它处于有限的最佳温度范围之内。大家都挤在较为温暖的机头,机尾的温度则低至零下10摄氏度。他说:“我得找个合适的地方放置血袋,而且每小时都要检查一次。”

The team landed in Halley just as dawn broke and had about an hour and a half to retrieve Roberts before it would be too dark to take off again. It was -30C without the windchill factor. Nutbeam took a snowmobile to the station where he successfully performed what is thought to be the first Antarctic blood transfusion on Roberts and transferred him to the plane. Meanwhile, the engineer kept the plane’s engines functional, since if they got too cold they wouldn’t be able to start up again.

破晓时分,援救团队成功抵达哈雷基地,有一个半小时的时间将罗伯茨运上飞机,再晚天就黑得无法起飞了。气温已经到了零下30摄氏度,寒风将体感温度降得更低。努特皮姆坐着雪地摩托抵达基地,并在罗伯茨身上成功进行了南极第一例输血,随后把他转移到了飞机上。与此同时,飞行员保持发动机运转,因为引擎一旦过冷就再也发动不起来了。

Nutbeam says that nothing was meticulously planned due to the unpredictable circumstances. His strategy was to “wing it in an informed way”.

努特皮姆表示,由于情况难以预料,他们的计划也很粗略。他的策略是“随机应变,恰当处理”。

After interviewing expeditioners, Smith and his colleagues found that excessive planning was less important than having confidence in one’s skills. “Then it comes down to being flexible and adaptable and being able to adjust to the situation as it unfolds,” he says. “There are lots of things you can’t control so being able to accept that is really important.”

史密斯和同事们在采访过探险队员后发现,自信要比太详尽的计划重要得多。他说:“然后就是要灵活处理随机应变,要根据事态发展相机行事。有许多事情是你无法控制的,能接受这一点也很重要。”

Sleep deprivation

睡眠严重不足

Even a combination of expertise, conscientiousness and confidence could not make up for perhaps the biggest challenge: the extreme sleep deprivation of the 48-hour flights. Nutbeam says that he slept for about four hours over the course of the mission. “I just wasn’t functioning as a human,” he adds.

训练有素、尽职尽责、满怀信心,即使具备了这三点,也无法忽略可能是救援任务中最大的挑战:飞行48小时所造成的睡眠严重不足。努特皮姆说任务中他一共就睡了四个小时,还说“他已经不是自己了”。

Microsleeps – quick bouts of shut-eye that can last between a fraction of a second and 30 seconds – can help the body recuperate. “The brain finds ways to catch up on sleep in short bouts if it can’t otherwise obtain the sleep it needs,” says Hans Van Dongen, the director of the Sleep and Performance Research Center at Washington State University in the US.

闭目养神不到半分钟的微睡眠有助于恢复体力。美国华盛顿州立大学睡眠与表现研究中心的主任凡·东恩(Hans Van Dongen)说:“不能好好睡觉的时候,大脑会通过短暂休息来补充睡眠。”

However, microsleeps cause lapses in attention that affect performance – if they occur while driving often resulting in car accidents for example.

但是微睡眠也会分散注意力,影响各种表现——一个人如果刚好在开车就很可能发生车祸。

During the long flight back to Chile, Nutbeam was so tired that he had trouble recalling medical knowledge and making choices. And that posed some serious dangers, given that Roberts’ condition required constant monitoring and there were important medical decisions to be made. Around Rothera, for example, they needed to be flying high to pass the tall mountains below. Roberts, however, had a low circulatory blood volume due to his bleed, which affects how long he could tolerate high altitude without the need for more blood.

在返回智利的长途飞行中,努特皮姆异常疲惫,甚至都忘了医学知识,也无法下医疗决断。这很危险,因为罗伯茨的情况需要时时监控,需要重要的医疗决定。例如在罗瑟拉基地附近时,飞机需要高海拔飞行以越过高大的山体,但是罗伯茨由于失血体内的血液循环量很低,要考虑如果不输血,他的血量能够承受多长时间的高海拔飞行。

“I needed to make a decision about Malcolm’s care and just could not decide,” says Nutbeam – an unfamiliar sensation for him. “I am normally pretty pragmatic in my approach and don’t struggle with decisions.”

“我需要根据罗伯茨的状况做出决断,但我没法下定决心,我通常都很讲求实效,从来都很果决。”努特皮姆说,他从未有过这样的情况。

Sleep also plays a role in regulating emotions and can affect mood: the emotional centers in the brain are less connected when a person hasn’t had enough rest so it’s harder to control one’s feelings. As a result, sleep-deprived people can be overly grumpy or giddy, says Von Dongen.

睡眠也能调节情绪,影响心情:如果睡眠不足,大脑里情绪中心的联系就不那么紧密,自我情绪控制能力就会下降。凡·东恩说,睡眠不足的人可能会特别暴躁,或是昏昏沉沉。

And this would be an additional challenge to Nutbeam’s decision making when, at a later point in the flight, Roberts suffered a stroke. Nutbeam had to give him more blood as well as fluid and medication to stabilise him. “I remember feeling quite emotionally overwhelmed,” says Nutbeam. “He must have been feeling terrible but was incredibly stoical.”

在航程后段,罗伯茨中风了,这也给努特皮姆增加了挑战。为了稳定病人的身体状况,努特皮姆要给他加大输血,也增加了输液和用药。他回忆说:“当时我情绪上有些承受不住了。罗伯茨一定很难受,但他很坚强。”

Understanding the effects of sleep loss can help people cope, says Smith. “People can prepare for it and think about how it might shape their decision-making,” he says. Nutbeam says that he knows that he is much less tolerant when he’s tired, which might have helped.

史密斯说,知道缺乏睡眠的后果就能更好地应对。他说:“可以对此有所准备,想想这些后果会如何影响自己做决定。”努特皮姆说他疲惫时很没有耐心,如果知道这一点可能会有所帮助。

Teamwork

团队合作

Nutbeam was also fortunate to have a dedicated team that helped to keep his sleep-deprived mind in check. In addition to the team aboard the plane, there was a remote support network keeping a close eye on their journey from afar.

所幸有一个专门的团队帮助努特皮姆控制睡眠不足时的情绪。除了同行的团队外,还有一个远程支援网络密切关注他们的情况。

During stopovers, when they were able to communicate, colleagues abroad informed the team of weather conditions to help ease the logistical decision making.

中转停留期间能够进行通讯,远程团队会向飞机救援小组通报天气情况,帮助他们进行后勤安排。

Nutbeam also had regular debriefs with his boss in the UK about treatment and what to do in various circumstances.

努特皮姆还会定期向英国的上司汇报治疗情况,以及在不同境况下要如何应对。

When the plane landed in Rothera, for example, Roberts had another gastrointestinal bleed. There was a doctor there to help. But Nutbeam didn’t want to leave Roberts, even though he was exhausted.

飞机在罗瑟拉基地降落时,罗伯茨再次肠胃出血。基地有位医生可以帮忙,虽然努特皮姆已经精疲力竭,但还是寸步不离罗伯茨。

A call from his boss in the UK put things in order. She told Nutbeam to let the local doctor take over so he could get some sleep: he was the only one that could look after Roberts during the remaining flight. “It was the best advice in the world,” says Nutbeam. “Otherwise I think I would have stayed with him and been even more tired and psychologically broken for the final leg of the journey.”

努特皮姆的上司从英国打来电话,将一切布置得井井有条。她让努特皮姆交给基地医生暂时接管,自己休息一下,毕竟在接下来的航程中,能照看罗伯茨的就只有他一个人了。努特皮姆说:“没有比这更好的建议了。不然我会一直陪着他,最后一段航程身心都会更加疲惫。”

Tense situations can be easier to handle when there are others around. “Being in a dangerous environment surrounded by competent people who are supportive is a good way of mitigating stress,” says Smith.

周围有其他人时紧张情况会比较容易处理。史密斯说:“人在危险中如果能得到有能力人的支持,可以有效缓解压力。”

It all depends on the team dynamics, though: if people aren’t able to work well together it can have a negative impact on the functioning of the group. Personality traits – in particular agreeableness - can often predict who will be a good team player. “People that have to work in small groups in risky settings tend to be good at getting on with people,” says Smith. “They are good at communicating effectively and maintaining group function.”

这与团队的状态密切相关:如果一个团队无法和谐相处,那么整个团队的运作势必受到负面影响。不难从性格品质(尤其是令人愉快的品质)的角度推断谁能成为一位好队员。史密斯表示:“一般来说,在高风险下从事小组合作的人处理起人际关系更胜一筹。他们知道如何有效沟通,如何保持团队运作。”

Aftermath

后续影响

After the final flight from Rothera, the plane landed in Punta Arenas, Chile. Roberts was transferred to a hospital where he was successfully treated. But Nutbeam didn’t feel like the mission was over yet. “I really didn’t want to let Malcolm go,” he says. “I wanted to go with him to the hospital even though I could hardly string a sentence together.”

离开罗瑟拉基地后,飞机最终在智利蓬塔阿雷纳斯镇着陆,罗伯茨被转移到医院并成功接受了治疗,但努特皮姆却觉得任务尚未完成。他说:“我真的不想离开罗伯茨,我想和他一起去医院,虽然我当时已经连话都说不完整了。”

Expedition groups often have similar reaction when they return. After having lived through an intense experience together, there is a sense of empathy among those who were there, says Smith. It can also be hard to communicate what it was like to people who weren’t present so there is a tendency to be drawn to those who shared the experience.

探险队员回来后常有类似的反应。史密斯解释说,他们在高强度的环境中共同生活了一段时间,会对还留在那里的同僚产生同理心。他们也很难将这种情绪向没有类似经历的人倾诉,因此有相似经历的人会走得更近。

Nutbeam was able to visit Roberts regularly at the hospital and there was a daily meeting about his recovery which gradually helped him readjust.

努特皮姆可以定期去医院看望罗伯茨,每天都有例会讨论康复情况,他也慢慢把状态调整了回来。

According to Smith, people often reflect on what happened and what could have happened for about three weeks afterwards. After playing an important part in a mission, people may feel like they have no purpose when they return but finding something meaningful to do can ease the transition.

史密斯说,任务结束后,人们会去思考所发生的事情以及可能发生的事,这往往会持续三周时间。要是曾在任务中担当重任,之后可能会觉得丧失了奋斗目标,做些有意义的事情能够帮助心理过度。

“Writing a report or putting your experience into a story is really helpful psychologically,” says Smith.

史密斯说:“从心理学的角度来说,写工作报告,或者把自身经历写成故事都很有帮助。”

New types of training could help too. People working in extreme environments, such as astronauts or military workers, do a lot of simulations as preparation. But according to Smith, it’s rare to have training that focusses on the psychological aspects of a mission. “It seems a bit like missing a trick,” he says. “There is a lot that could be done to equip people with strategies to deal with these environments.”

新的训练方式也有所裨益。像宇航员、军人这样需要在极端环境中工作的人,准备任务时一般要进行大量的模拟训练,但史密斯表示很少有心理上的训练。他说:“这好像少了一环。指导人们适应极端工作环境有很多可以做的。”

In a sense, the rescue was just a more extreme version of what emergency room doctors encounter every day.

从某种意义上说,这场救援只是急诊室日常工作的一个极端案例罢了。

As a coping strategy, Nutbeam recommends mentally rehearsing events beforehand when well-rested. “This can prepare your mind for the insult of sleep deprivation,” he says.

努特皮姆建议,趁还能充分休息的时候先在心里演练救援。他说:“这样能为睡眠不足做好心理准备。”

Upon reflection, Nutbeam isn’t convinced that he would take part in such a mission again. He had mentally prepared himself to be the back-up doctor so hadn’t analysed the risks involved beforehand. Now he realises that there was a significant chance that they could have been stranded or suffered harm. “It’s nice to reflect on a successful rescue but there is a need to consider all the opportunities for it to go wrong and was the risk justified,” he says. “I’ve still not quite got my mind around that.”

事后再去回顾时,努特皮姆认为自己当时并不觉得会去参加救援任务,对自己的定位只是个备选医生,因此没有预先考虑那么多问题。现在他意识到,任务过程中飞机很有可能不能起飞,他们也可能受伤。他说:“回忆一次成功的救援固然让人开心。但也要去想一想有哪些地方可能会出现问题,能不能避免。我到现在还会去想这些问题。”

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