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Diving medicine

April 15, 2024

Diving medicine, also called undersea and hyperbaric medicine (UHB), is the diagnosis, treatment and prevention of conditions caused by humans entering the undersea environment. It includes the effects on the body of pressure on gases, the diagnosis and treatment of conditions caused by marine hazards and how relationships of a diver's fitness to dive affect a diver's safety. Diving medical practitioners are also expected to be competent in the examination of divers and potential divers to determine fitness to dive.

A recompression chamber is used to treat some diving disorders.
Diving Medicine Physician
Occupation
NamesPhysician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, clinics

Hyperbaric medicine is a corollary field associated with diving, since recompression in a hyperbaric chamber is used as a treatment for two of the most significant diving-related illnesses, decompression sickness and arterial gas embolism.

Diving medicine deals with medical research on issues of diving, the prevention of diving disorders, treatment of diving accidents and diving fitness. The field includes the effect of breathing gases and their contaminants under high pressure on the human body and the relationship between the state of physical and psychological health of the diver and safety.

In diving accidents it is common for multiple disorders to occur together and interact with each other, both causatively and as complications.

Diving medicine is a branch of occupational medicine and sports medicine, and at first aid level, an important part of diver education.

Range and scope of diving medicine edit

Further information: Diving disorders, List of signs and symptoms of diving disorders, and List of diving hazards and precautions

The scope of diving medicine must necessarily include conditions that are specifically connected with the activity of diving, and not found in other contexts, but this categorization excludes almost everything, leaving only deep water blackout, isobaric counterdiffusion and high pressure nervous syndrome. A more useful grouping is conditions that are associated with exposure to variations of ambient pressure. These conditions are largely shared by aviation and space medicine. Further conditions associated with diving and other aquatic and outdoor activities are commonly included in books which are aimed at the diver, rather than the specialist medical practitioner, as they are useful background to diver first aid training.[citation needed]

The scope of knowledge necessary for a practitioner of diving medicine includes the medical conditions associated with diving and their treatment, physics and physiology relating to the underwater and pressurised environment, the standard operating procedures and equipment used by divers which can influence the development and management of these conditions, and the specialised equipment used for treatment.[1]

Scope of knowledge for diving medicine edit

The ECHM-EDTC Educational and Training Standards for Diving and Hyperbaric Medicine (2011) specify the following scope of knowledge for Diving Medicine:[1]

Scope of knowledge for hyperbaric medicine edit

The ECHM-EDTC Educational and Training Standards for Diving and Hyperbaric Medicine (2011) specify the following scope of knowledge for Hyperbaric Medicine additional to that for Diving medicine:[1]

  • Physiology and pathology of diving and hyperbaric exposure.
    • HBO-Basics – effects of hyperbaric oxygen – physiology and pathology
  • Clinical HBO
    • Chamber technique (multiplace, monoplace, transport chambers, wet recompression)
    • Mandatory indications
    • HBO Recommended indications
    • HBO Experimental and anecdotal indications
    • HBO Data collection / statistics / evaluation
    • HBO General basic treatment (nursing)
    • HBO Diagnostic, monitoring and therapeutic devices in chambers
    • Risk assessment, incidents monitoring and safety plan in HBO chambers
    • HBO Safety regulations

Diagnostics edit

Main article: List of signs and symptoms of diving disorders

The signs and symptoms of diving disorders may present during a dive, on surfacing, or up to several hours after a dive. Divers have to breathe a gas which is at the same pressure as their surroundings, which can be much greater than on the surface. The ambient pressure underwater increases by 1 standard atmosphere (100 kPa) for every 10 metres (33 ft) of depth.[2]

The principal conditions are: decompression illness (which covers decompression sickness and arterial gas embolism); nitrogen narcosis; high pressure nervous syndrome; oxygen toxicity; and pulmonary barotrauma (burst lung). Although some of these may occur in other settings, they are of particular concern during diving activities.[2]

The disorders are caused by breathing gas at the high pressures encountered at depth, and divers will often breathe a gas mixture different from air to mitigate these effects. Nitrox, which contains more oxygen and less nitrogen is commonly used as a breathing gas to reduce the risk of decompression sickness at recreational depths (up to about 40 metres (130 ft)). Helium may be added to reduce the amount of nitrogen and oxygen in the gas mixture when diving deeper, to reduce the effects of narcosis and to avoid the risk of oxygen toxicity. This is complicated at depths beyond about 150 metres (500 ft), because a helium–oxygen mixture (heliox) then causes high pressure nervous syndrome.[2] More exotic mixtures such as hydreliox, a hydrogen–helium–oxygen mixture, are used at extreme depths to counteract this.[3]

Decompression sickness edit

Main article: Decompression sickness

Decompression sickness (DCS) occurs when gas, which has been breathed under high pressure and dissolved into the body tissues, forms bubbles as the pressure is reduced on ascent from a dive. The results may range from pain in the joints where the bubbles form to blockage of an artery leading to damage to the nervous system, paralysis or death. While bubbles can form anywhere in the body, DCS is most frequently observed in the shoulders, elbows, knees, and ankles. Joint pain occurs in about 90% of DCS cases reported to the U.S. Navy, with neurological symptoms and skin manifestations each present in 10% to 15% of cases. Pulmonary DCS is very rare in divers.[4]

Pulmonary barotrauma and arterial gas embolism edit

If the breathing gas in a diver's lungs cannot freely escape during an ascent, the lungs may be expanded beyond their compliance, and the lung tissues may rupture, causing pulmonary barotrauma (PBT). The gas may then enter the arterial circulation producing arterial gas embolism (AGE), with effects similar to severe decompression sickness.[5] Gas bubbles within the arterial circulation can block the supply of blood to any part of the body, including the brain, and can therefore manifest a vast variety of symptoms.

Nitrogen narcosis edit

Main article: Nitrogen narcosis

Nitrogen narcosis is caused by the pressure of dissolved gas in the body and produces temporary impairment to the nervous system. This results in alteration to thought processes and a decrease in the diver's ability to make judgements or calculations. It can also decrease motor skills, and worsen performance in tasks requiring manual dexterity. As depth increases, so does the pressure and hence the severity of the narcosis. The effects may vary widely from individual to individual, and from day to day for the same diver. Because of the perception-altering effects of narcosis, a diver may not be aware of the symptoms, but studies have shown that impairment occurs nevertheless. The narcotic effects dissipate without lasting effect as the pressure decreases during ascent.[6]

High-pressure nervous syndrome edit

Main article: High-pressure nervous syndrome

Helium is the least narcotic of all gases, and divers may use breathing mixtures containing a proportion of helium for dives exceeding about 40 metres (130 ft) deep. In the 1960s it was expected that helium narcosis would begin to become apparent at depths of 300 metres (1,000 ft). However, it was found that different symptoms, such as tremors, occurred at shallower depths around 150 metres (500 ft). This became known as high-pressure nervous syndrome, and its effects are found to result from both the absolute depth and the speed of descent. Although the effects vary from person to person, they are stable and reproducible for the individual.[7][medical citation needed]

Oxygen toxicity edit

Main article: Oxygen toxicity

Although oxygen is essential to life, in concentrations significantly greater than normal it becomes toxic, overcoming the body's natural defences (antioxidants), and causing cell death in any part of the body. The lungs and brain are particularly affected by high partial pressures of oxygen, such as are encountered in diving. The body can tolerate partial pressures of oxygen around 0.5 bars (50 kPa; 7.3 psi) indefinitely, and up to 1.4 bars (140 kPa; 20 psi) for many hours, but higher partial pressures rapidly increase the chance of the most dangerous effect of oxygen toxicity, a convulsion resembling an epileptic seizure.[8] Susceptibility to oxygen toxicity varies dramatically from person to person, and to a smaller extent from day to day for the same diver.[9] Prior to convulsion, several symptoms may be present – most distinctly that of an aura.

Treatments edit

Treatment of diving disorders depends on the specific disorder or combination of disorders, but two treatments are commonly associated with first aid and definitive treatment where diving is involved. These are first aid oxygen administration at high concentration, which is seldom contraindicated, and generally recommended as a default option in diving accidents where there is any significant probability of hypoxia,[10] and hyperbaric oxygen therapy, which is the definitive treatment for most conditions of decompression illness.[11][12]

Oxygen therapy edit

Main article: Oxygen therapy

The administration of oxygen as a medical intervention is common in diving medicine, both for first aid and for longer term treatment.[12] Normobaric oxygen administration at the highest available concentration is frequently used as first aid for any diving injury that may involve inert gas bubble formation in the tissues. There is epidemiological support for its use from a statistical study of cases recorded in a long term database.[13][14][15]

Recompression and hyperbaric oxygen therapy edit

Main article: Hyperbaric medicine

Recompression treatment in a hyperbaric chamber was initially used as a life-saving tool to treat decompression sickness in caisson workers and divers who stayed too long at depth and developed decompression sickness. In the 21st century, it is a highly specialized treatment modality found to be effective for treating many conditions where the administration of oxygen under pressure is beneficial.[16]

Hyperbaric oxygen treatment is generally preferred when effective, as it is usually a more efficient and lower risk method of reducing symptoms of decompression illness, but in some cases recompression to pressures where oxygen toxicity is unacceptable may be required to eliminate the bubbles in the tissues in severe cases of decompression illness.[12]

Availability of recompression treatment is limited. Some countries have no facilities at all, and in others which have facilities, such as the US, some hospitals do not make them available for emergency treatment.[17]

Medical examination for fitness to dive edit

Main article: Fitness to dive

Fitness to dive, (or medical fitness to dive), is the medical and physical suitability of a person to function safely in the underwater environment using underwater diving equipment and procedures. Depending on the circumstances it may be established by a signed statement by the diver that he or she does not suffer from any of the listed disqualifying conditions and is able to manage the ordinary physical requirements of diving, to a detailed medical examination by a physician registered as a medical examiner of divers following a procedural checklist, and a legal document of fitness to dive issued by the medical examiner.

The most important medical examination is the one before starting diving, as the diver can be screened to prevent exposure when a dangerous condition exists. The other important medicals are after some significant illness, where medical intervention is needed there and has to be done by a doctor who is competent in diving medicine, and can not be done by prescriptive rules.[18]

Psychological factors can affect fitness to dive, particularly where they affect response to emergencies, or risk taking behaviour. The use of medical and recreational drugs, can also influence fitness to dive, both for physiological and behavioural reasons. In some cases prescription drug use may have a net positive effect, when effectively treating an underlying condition, but frequently the side effects of effective medication may have undesirable influences on the fitness of diver, and most cases of recreational drug use result in an impaired fitness to dive, and a significantly increased risk of sub-optimal response to emergencies.

Education and registration of practitioners edit

Specialist training in underwater and hyperbaric medicine is available from several institutions, and registration is possible both with professional associations and governmental registries.

Education edit

NOAA/UHMS Physicians Training Course in Diving Medicine
This course has been presented since 1977, and has been influenced by internationally accepted training objectives recommended by the Diving Medical Advisory Committee, the European Diving Technology Committee, and the European Committee for Hyperbaric Medicine. The course is designed for qualified medical practitioners, but may be useful to others who work in the field of diving safety and operations.[19] The course is to train physicians to recognize and treat diving medical emergencies. Subject matter includes:[19]
  • Basic physics and physiology of the hyperbaric environment:
    • the laws and principles;
    • the differences between hyperbaric and hypobaric pressure;
    • hyperbaric gases and their effects under pressure;
    • links between the physiological effects of the hyperbaric environment and the pathology of the disease
  • Basic decompression theory:
  • Dive computer theories and types, and comparison to dive tables
  • Introduction to commercial diving and comparison to recreational and technical diving, including differences in procedures, equipment, and diver categories
  • The clinical application of hyperbaric oxygen therapy and the treatment tables used;
  • Participation in surface-supplied diving operation and hyperbaric chamber operations;
  • Components, types, operational and safety hazards associated with hyperbaric chambers;
  • Diving-related conditions resulting from the effects of long-term effects of diving, flying after diving, altitude, thermal conditions, age and gender
  • Neurologic assessment on a diver with signs and/or symptoms of DCI
  • Medical and fitness standards for diving, including:
    • contraindications for both commercial and recreational divers
    • differences in medical standards for recreational versus occupational diving communities
    • legal implications for approving and denying fitness to dive in an occupational setting
    • approaches for determining the safety of prescription and OTC medications used by divers
Fellowship in Undersea and Hyperbaric Medicine
The Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) offer 12-month programs in undersea and hyperbaric medicine associated with ACGME or AOA accredited programs in emergency medicine, family medicine, internal medicine, occupational medicine, preventive medicine, or anesthesiology.[20][21][22]
ECHM-EDTC Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine
The standard drawn up jointly by the European Committee for Hyperbaric Medicine and the European Diving Technical Committee defines job descriptions for several levels of diving and hyperbaric physician: Education and assessment to these standards may be provided by institutions of higher education under the leadership of a Level 3 Hyperbaric Medicine Expert as defined below. Certificates of competence may be issued by a nationally accredited institution or an internationally acknowledged agency, and periodic recertification is required.[1] Level 1. Medical Examiner of Divers (MED) minimum 28 teaching hours.
  • The MED must be competent to perform the assessments of medical fitness to dive of occupational and recreational divers and compressed air workers, except the assessment of medical fitness to resume diving after major decompression incidents.
Level 2D. Diving Medicine Physician (DMP) minimum 80 teaching hours.
  • A DMP must be competent to perform the initial and all other assessments of medical fitness to dive of working and recreational divers or compressed air workers, and manage diving accidents and advise diving contractors and others on diving medicine and physiology (with the backup of a diving medical expert or consultant).
  • A DMP should have knowledge in relevant aspects of occupational health, but is not required to be a certified specialist in occupational medicine.
  • A DMP should have certified skills and basic practical experience in assessment of medical fitness to dive, management of diving accidents, safety planning for professional diving operations, advanced life support, acute trauma care and general wound care.
Level 2H. Hyperbaric Medicine Physician (HMP) minimum 120 teaching hours
  • An HMP will be responsible for hyperbaric treatment sessions (with the backup of a hyperbaric medicine expert or consultant)
  • An HMP should have appropriate experience in anaesthesia and intensive care in order to manage the HBO patients, but is not required to be a certified specialist in anaesthesia and intensive care.
  • An HMP must be competent to assess and manage clinical patients for hyperbaric oxygen therapy treatment
Level 3. Hyperbaric medicine expert or consultant (hyperbaric and diving medicine) is a physician who has been assessed as competent to:
  • manage a hyperbaric facility (HBO centre) or the medical and physiological aspects of complex diving activities.
  • manage research programs on diving medicine.
  • supervise a team of HBO doctors and personnel, health professionals and others.
  • teach relevant aspects of hyperbaric medicine and physiology to all members of staff.
Gesellschaft für Tauch- und Überdruckmedizin e. V.
Society for Diving and Hyperbaric medicine
German standards for education and assessment of diving medical practitioners are similar to the ECHM-EDTC Standards and are controlled by the Gesellschaft für Tauch- und Überdruckmedizin e. V. They include Medical Examiner of Divers, Diving Medicine Physician, Hyperbaric Medicine Physician, Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant.[23]
Schweizerische Gesellschaft für Unterwasser- und Hyperbarmedizin
Swiss Society for underwater and hyperbaric medicine.
Swiss standards for education and assessment of diving medical practitioners are controlled by the Schweizerische Gesellschaft für Unterwasser- und Hyperbarmedizin. They include Medical Examiner of Divers, Diving Medicine Physician and Hyperbaric Medicine Physician.[24]
Österreichische Gesellschaft für Tauch- und Hyperbarmedizin
Austrian Society for Diving and Hyperbaric medicine.
Austrian standards for education and assessment of diving medical practitioners are controlled by the Österreichische Gesellschaft für Tauch- und Hyperbarmedizin They include Medical Examiner of Divers, Diving Medicine Physician, Hyperbaric Medicine Physician, Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant.[25]

Registration edit

The American Medical Association recognises the sub-speciality Undersea and Hyperbaric Medicine held by someone who is already Board Certified in some other speciality.[26]

The South African Department of Employment and Labour registers two levels of Diving Medical Practitioner. Level 1 is qualified to conduct annual examinations and certification of medical fitness to dive, on commercial divers (equivalent to ECHM-EDTC Level 1. Medical Examiner of Divers), and Level 2 is qualified to provide medical advice to a diving contractor and hyperbaric treatment for diving injuries[27] (equivalent to ECHM-EDTC Level 2D Diving Medicine Physician)

Australia has a four tier system: In 2007 there was no recognised equivalence with the European standard.[28]

  • GPs completing the first tier four- to five-day course on how to examine divers for 'fitness to dive' can then add their names to the SPUMS Diving Doctors List
  • GPs completing the second tier two-week diving medicine courses provided by the Royal Australian Navy and the Royal Adelaide Hospital, or the two-week course in Diving and Hyperbaric Medicine provided by the ANZ Hyperbaric Medicine Group, qualify to do commercial-diving medicals.
  • The third tier is the SPUMS Diploma in Diving and Hyperbaric Medicine. The candidate must attend a two-week course, write a dissertation related to DHM and have the equivalent of six months' full-time experience working in a hyperbaric medicine unit.
  • The fourth tier is the Certificate in Diving and Hyperbaric Medicine from the ANZ College of Anaesthetists.

Training of divers and support staff in relevant first aid edit

Divers edit

A basic knowledge understanding of the causes, symptoms and first aid treatment of diving related disorders is part of the basic training for most recreational and professional divers, both to help the diver avoid the disorders, and to allow appropriate action in case of an incident resulting in injury.[27]

Recreational divers edit

A recreational diver has the same duty of care to other divers as any ordinary member of the public, and therefore there is no obligation to train recreational divers in first aid or other medical skills. Nevertheless, first aid training is recommended by most, if not all, recreational diver training agencies.[29][30][31]

Recreational diving instructors and divemasters, on the other hand, are to a greater or lesser extent responsible for the safety of divers under their guidance, and therefore are generally required to be trained and certified to some level of rescue and first aid competence, as defined in the relevant training standards of the certifying body. In many cases this includes certification in cardiopulmonary resuscitation and first aid oxygen administration for diving accidents.

Professional divers edit

Professional divers usually operate as members of a team with a duty of care for other members of the team. Divers are expected to act as standby divers for other members of the team and the duties of a standby diver include rescue attempts if the working diver gets into difficulties. Consequently, professional divers are generally required to be trained in rescue procedures appropriate to the modes of diving they are certified in, and to administer first aid in emergencies. The specific training, competence and registration for these skills varies, and may be specified by state or national legislation or by industry codes of practice.[27][32]

Diving supervisors have a similar duty of care, and as they are responsible for operational planning and safety, generally are also expected to manage emergency procedures, including the first aid that may be required. The level of first aid training, competence and certification will generally take this into account.

  • In South Africa, registered commercial and scientific divers must hold current certification in first aid at the national Level 1, with additional training in oxygen administration for diving accidents, and registered diving supervisors must hold Level 2 first aid certification.[27]
  • Offshore diving contractors frequently follow the IMCA recommendations.

Diver medic edit

A diver medic or diving medical technician is a member of a dive team who is trained in advanced first aid.[33]

A diver medic recognised by IMCA must be capable of administering first aid and emergency treatment, and carrying out the directions of a physician, and be familiar with diving procedures and compression chamber operation. The diver medic must also be able to assist the diving supervisor with decompression procedures, and provide treatment in a hyperbaric chamber in an emergency. The diver medic must hold, at a minimum, a valid certificate of medical fitness to operate in a pressurized environment, and a certificate of medical fitness to dive.[34]

Training standards for diver medic are described in the IMCA Scheme for Recognition of Diver Medic Training.[34]

Ethical and medicolegal issues edit

Experimental work on human subjects is often ethically and/or legally impracticable. Tests where the endpoint is symptomatic decompression sickness are difficult to authorise and this makes the accumulation of adequate and statistically valid data difficult. The precautionary principle may be applied in the absence of information allowing a realistic assessment of risk. Analysis of investigations into accidents is useful when reliable results are available, which is less often than would be desirable, but privacy concerns prevent a large mount of information potentially useful to the general diving population from being made available to researchers.

History of diving medical research edit

See also: History of decompression research and development

Timeline edit

  • November 1992: The first examination for certification in Undersea Medicine by the American Board of Preventive Medicine.[26]
  • November 1999: The first examination for Undersea and Hyperbaric Medicine qualification.[26]

Notable researchers edit

Research organisations edit

Defence and Civil Institute of Environmental Medicine
Further information: DRDC Toronto
DCIEM is a combined military and civilian research organisation to research the operational needs of the Canadian Forces in all environments.[citation needed]
Divers Alert Network
Main article: Divers Alert Network
The Divers Alert Network (DAN) is an international non-profit organization with regional branches supported by donations, grants, and membership dues, for assisting divers in need. The DAN Research department conducts significant medical research on recreational scuba diving safety, and the DAN Medicine Department provides support for divers worldwide to find answers to their diving medical questions.[35]
Diving Diseases Research Centre
Main article: Diving Diseases Research Centre

The Diving Diseases Research Centre (DDRC) is a British hyperbaric medical organisation located near Derriford Hospital in Plymouth, Devon. It is a registered charity and was established in 1980 to research the effects of diving on human physiology.

The main objective of DDRC is research into diving medicine. The Centre is also an education and training base providing diving medical, clinical and hyperbaric courses.
Diving Medical Advisory Council
Main article: Diving Medical Advisory Council
DMAC is an independent committee with the purpose of providing advice about medical and safety aspects of commercial diving. They publish guidance notes about various aspects of diving and diving medical practice, and run a scheme for approval of courses in diving medicine.[36]
European Committee for Hyperbaric Medicine
The ECHM is an organisation to study and define indications for hyperbaric therapy, research and therapy protocols, standards for therapeutic and technical procedures, equipment and personnel, and related cost-benefit and cost-effectiveness criteria. It is a representative body with the European health authorities, and works toward cooperation among scientific organizations involved in the field of Diving and Hyperbaric Medicine.[37] Membership of the committee includes doctors practicing diving medicine in Northern Europe, representatives of relevant health authorities, medical representatives from relevant navies, and a diving safety officer nominated by the International Marine Contractors Association.
European Underwater and Baromedical Society
Main article: European Underwater and Baromedical Society
The European Underwater and Baromedical Society (EUBS) is a primary source of information for diving and hyperbaric medicine physiology worldwide. The organization was initially formed as the European Underwater and Biomedical Society in 1971.[38]
National Board of Diving and Hyperbaric Medical Technology
Main article: National Board of Diving and Hyperbaric Medical Technology

The National Board of Diving and Hyperbaric Medical Technology (NBDHMT), formally known as the National Association of Diving Technicians, is a non-profit organization for the education and certification of qualified personnel in the fields of diving and hyperbaric medicine in the US.[39]

  • The Diver Medic Technician (DMT) program is designed to meet the specific medical care needs of commercial, professional and scientific divers that often work in geographic isolation.[40][41] DMT's are specifically trained for the various diving hazards found at remote work sites.[40] The curriculum covers a wide range of topics from barotrauma to treatment of decompression sickness.[42]
  • The Certified Hyperbaric Technologist (CHT) program is tailored to meet the specific safety and operational needs for biomedical devices within the department, and the necessary knowledge and skills to administer clinical treatment.[43] The curriculum covers a wide range of topics including hyperbaric chamber operations to transcutaneous oxygen monitoring.[44]
  • The Certified Hyperbaric Registered Nurse (CHRN) program is a subspecialty for registered nurses,[45] sometimes referred to as baromedical nurses.
Southern African Underswater and Hyperbaric Medical Association
Main article: Southern African Underwater and Hyperbaric Medical Association
SAUHMA is a voluntary association recognised as a Special Interest group by the Group Council of the South African Medical Association.[46]
South Pacific Underwater Medicine Society
Main article: South Pacific Underwater Medicine Society

The South Pacific Underwater Medicine Society (SPUMS) is a primary source of information for diving and hyperbaric medicine physiology worldwide. The organisation supports the study of all aspects of underwater and hyperbaric medicine, provides information on underwater and hyperbaric medicine, publishes a medical journal and holds an annual conference.[47][48]

SPUMS offers a post-graduate Diploma of Diving and Hyperbaric Medicine.
Undersea and Hyperbaric Medical Society
Main article: Undersea and Hyperbaric Medical Society
The Undersea and Hyperbaric Medical Society (UHMS) is a primary source of information for diving and hyperbaric medicine physiology worldwide.

See also edit

References edit

  1. ^ a b c d Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine (PDF), Joint Educational Subcommittee of the European Committee for Hyperbaric Medicine (ECHM) and the European Diving Technical Committee (EDTC), 2011, retrieved 30 March 2013
  2. ^ a b c Brubakk, Alf O; Neuman, Tom S, eds. (2003). "9: Pressure Effects". Bennett and Elliott's physiology and medicine of diving (5th Revised ed.). United States: Saunders Ltd. pp. 265–418. ISBN 978-0-7020-2571-6. OCLC 51607923.
  3. ^ Abraini, JH; Gardette-Chauffour, MC; Martinez, E; Rostain, JC; Lemaire, C (1994). "Psychophysiological reactions in humans during an open sea dive to 500 m with a hydrogen-helium-oxygen mixture". Journal of Applied Physiology. 76 (3): 1113–8. doi:10.1152/jappl.1994.76.3.1113. eISSN 1522-1601. ISSN 8750-7587. PMID 8005852.
  4. ^ Powell, Mark (2008). Deco for Divers. Southend-on-Sea: Aquapress. p. 70. ISBN 978-1-905492-07-7.
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  6. ^ Bennett, Peter B; Rostain, Jean Claude (2003). "9.2: Inert Gas Narcosis". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. p. 301. ISBN 978-0-7020-2571-6. OCLC 51607923.
  7. ^ Stanciu, Tamara; Mihai Diaconu; Mircea Degeratu (May 2013). (PDF). Annals of the Oradea university. Archived from the original (PDF) on 9 January 2016. Retrieved 15 September 2015.
  8. ^ Clark, James M; Thom, Stephen R (2003). "9.4: Oxygen under pressure". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. pp. 358–360. ISBN 978-0-7020-2571-6. OCLC 51607923.
  9. ^ Clark, James M; Thom, Stephen R (2003). "9.4: Oxygen under pressure". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. p. 376. ISBN 978-0-7020-2571-6. OCLC 51607923.
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  15. ^ . Divers Alert Network Europe. Archived from the original on 10 June 2020. Retrieved 1 October 2018.
  16. ^ Ernest S Campbell, MD, FACS. "HBO...Indications, contraindications, links references". Scuba-doc.com. Retrieved 16 March 2013.{{cite web}}: CS1 maint: multiple names: authors list (link)
  17. ^ Stewart, Ashley. "Hyperbaric Chambers Are Turning Away Divers. Will There Be One Nearby When You Need It?". gue.com. Retrieved 7 October 2023.
  18. ^ Williams, G.; Elliott, DH.; Walker, R.; Gorman, DF.; Haller, V. (2001). "Fitness to dive: Panel discussion with audience participation". Journal of the South Pacific Underwater Medicine Society. 31 (3). Archived from the original on 5 July 2013. Retrieved 7 April 2013.{{cite journal}}: CS1 maint: unfit URL (link)
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  31. ^ CMAS Rescue diver training standard, http://www.cmas.org/technique/rescue-diver-training-programme
  32. ^ The Diving Medical Advisory Committee DMAC, November 2001, Provision of First Aid and the Training of Divers, Supervisors and Members of Dive Teams in First Aid, DMAC 11 Rev. 1,
  33. ^ "International Marine Contractors Association". Retrieved 3 April 2013.
  34. ^ a b Staff (December 1999). IMCA Scheme for Recognition of Diver Medic Training – Guidance for Training Establishments (PDF). International Marine Contractors Association. Retrieved 3 April 2013.
  35. ^ Vann RD (2007). Moon RE, Piantadosi CA, Camporesi EM (eds.). "The History of Divers Alert Network (DAN) and DAN Research". Dr. Peter Bennett Symposium Proceedings. Held May 1, 2004. Durham, N.C. Archived from the original on 13 January 2013. Retrieved 11 February 2014.{{cite journal}}: CS1 maint: unfit URL (link)
  36. ^ "Diving Medical Advisory Committee". Retrieved 2 April 2013.
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  38. ^ Elliott, David (2011). "The foundations for today's future". Diving Hyperb Med. 41 (3): 118–20. PMID 21948494. Archived from the original on 1 November 2013. Retrieved 11 February 2014.{{cite journal}}: CS1 maint: unfit URL (link)
  39. ^ "National Board of Diving and Hyperbaric Medical Technology". NBDHMT. Retrieved 14 June 2009.
  40. ^ a b . NBDHMT. Archived from the original on 25 February 2009. Retrieved 14 June 2009.
  41. ^ Clarke, Dick (1985). "All about the DMT". Pressure, Newsletter of the Undersea and Hyperbaric Medical Society. 14 (6): 2. ISSN 0889-0242.
  42. ^ "Diver Medic Technician Resource Manual". NBDHMT. Archived from the original on 15 June 2009. Retrieved 14 June 2009.
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  44. ^ (PDF). NBDHMT. Archived from the original on 28 February 2013. Retrieved 14 June 2009.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  45. ^ Josefsen, L; Woodward, C; Lewis, D; Hodge, J; Camporesi, EM (1997). "The nursing role in hyperbaric medicine". Undersea and Hyperbaric Medicine (Annual Meeting Abstract). Archived from the original on 15 April 2013. Retrieved 14 June 2009.{{cite journal}}: CS1 maint: unfit URL (link)
  46. ^ "South African Undersea and Hyperbaric Medical Association home page". Retrieved 2 April 2013.
  47. ^ Knight, John (1996). "Twenty five years of SPUMS 1971–1996". South Pacific Underwater Medicine Society Journal. 26 (2). ISSN 0813-1988. OCLC 16986801. Archived from the original on 15 April 2013. Retrieved 16 June 2008.{{cite journal}}: CS1 maint: unfit URL (link)
  48. ^ South Pacific Underwater Medicine Society. "South Pacific Underwater Medicine Society Home Page". Retrieved 15 June 2008.

Further reading edit

  • Brubakk, A. O.; Neuman, T. S. (2003). Bennett and Elliott's physiology and medicine of diving (5th Rev. ed.). United States: Saunders Ltd. p. 800. ISBN 978-0702025716.

External links edit

 
Wikimedia Commons has media related to Diving medicine.
  • Scubadoc's Diving Medicine Online
  • Diving Diseases Research Centre (DDRC)
  • [usurped] Diving Medical Literature
  • SCUBA Diving and Asthma
  • Edmonds; Thomas; McKenzie & Pennefather (2010). (3rd ed.). Carl Edmonds. Archived from the original on 27 November 2010. – free download of complete text

April 15, 2024
diving, medicine, also, called, undersea, hyperbaric, medicine, diagnosis, treatment, prevention, conditions, caused, humans, entering, undersea, environment, includes, effects, body, pressure, gases, diagnosis, treatment, conditions, caused, marine, hazards, . Diving medicine also called undersea and hyperbaric medicine UHB is the diagnosis treatment and prevention of conditions caused by humans entering the undersea environment It includes the effects on the body of pressure on gases the diagnosis and treatment of conditions caused by marine hazards and how relationships of a diver s fitness to dive affect a diver s safety Diving medical practitioners are also expected to be competent in the examination of divers and potential divers to determine fitness to dive A recompression chamber is used to treat some diving disorders Diving Medicine PhysicianOccupationNamesPhysicianOccupation typeSpecialtyActivity sectorsMedicineDescriptionEducation requiredDoctor of Medicine M D Doctor of Osteopathic Medicine D O Bachelor of Medicine Bachelor of Surgery M B B S MBChB Fields ofemploymentHospitals clinicsHyperbaric medicine is a corollary field associated with diving since recompression in a hyperbaric chamber is used as a treatment for two of the most significant diving related illnesses decompression sickness and arterial gas embolism Diving medicine deals with medical research on issues of diving the prevention of diving disorders treatment of diving accidents and diving fitness The field includes the effect of breathing gases and their contaminants under high pressure on the human body and the relationship between the state of physical and psychological health of the diver and safety In diving accidents it is common for multiple disorders to occur together and interact with each other both causatively and as complications Diving medicine is a branch of occupational medicine and sports medicine and at first aid level an important part of diver education Contents 1 Range and scope of diving medicine 1 1 Scope of knowledge for diving medicine 1 2 Scope of knowledge for hyperbaric medicine 2 Diagnostics 2 1 Decompression sickness 2 2 Pulmonary barotrauma and arterial gas embolism 2 3 Nitrogen narcosis 2 4 High pressure nervous syndrome 2 5 Oxygen toxicity 3 Treatments 3 1 Oxygen therapy 3 2 Recompression and hyperbaric oxygen therapy 4 Medical examination for fitness to dive 5 Education and registration of practitioners 5 1 Education 5 2 Registration 6 Training of divers and support staff in relevant first aid 6 1 Divers 6 1 1 Recreational divers 6 1 2 Professional divers 6 2 Diver medic 7 Ethical and medicolegal issues 8 History of diving medical research 8 1 Timeline 8 2 Notable researchers 9 Research organisations 10 See also 11 References 12 Further reading 13 External linksRange and scope of diving medicine editFurther information Diving disorders List of signs and symptoms of diving disorders and List of diving hazards and precautions The scope of diving medicine must necessarily include conditions that are specifically connected with the activity of diving and not found in other contexts but this categorization excludes almost everything leaving only deep water blackout isobaric counterdiffusion and high pressure nervous syndrome A more useful grouping is conditions that are associated with exposure to variations of ambient pressure These conditions are largely shared by aviation and space medicine Further conditions associated with diving and other aquatic and outdoor activities are commonly included in books which are aimed at the diver rather than the specialist medical practitioner as they are useful background to diver first aid training citation needed The scope of knowledge necessary for a practitioner of diving medicine includes the medical conditions associated with diving and their treatment physics and physiology relating to the underwater and pressurised environment the standard operating procedures and equipment used by divers which can influence the development and management of these conditions and the specialised equipment used for treatment 1 Scope of knowledge for diving medicine edit The ECHM EDTC Educational and Training Standards for Diving and Hyperbaric Medicine 2011 specify the following scope of knowledge for Diving Medicine 1 Physiology and pathology of diving and hyperbaric exposure Human physiology of underwater diving Hyperbaric physics Diving related physiology Hyperbaric pathophysiology of immersion Pathophysiology of decompression A brief introduction to acute dysbaric disorders Chronic dysbaric disorders Hyperbaric oxygen therapy basis Physiology and pathology Oxygen toxicity Pressure and inert gas effects Nitrogen narcosis High pressure neurological syndrome Medication under pressure Non dysbaric diving pathologies Diving technology and safety Basic safety planning Compressed air work Diving procedures Wet bells and stages Scuba diving on air and mixed gas Surface supplied diving Standard diving copper helmet Rebreather diving semi closed and closed circuit Other diving procedures Characteristics of various divers Diving equipment as used to c 50m and Chambers Diving tables and computers Regulations and standards for diving Saturation diving Saturation mode Physiology of deep exposure Compression At depth in a living chamber Bell excursions Fitness to dive Fitness to dive criteria and contraindications for divers compressed air workers and HBOT chamber personnel Fitness to dive assessment Fitness to dive standards professional and recreational Diving accidents Diving incidents and accidents Emergency medical support with no chamber on site Barotrauma ENT dental cutaneous conjunctival etc Physical injuries Decompression illness Pathophysiological basis and mechanisms of DCI Differential diagnosis of decompression illness Management of decompression incidents at the surface Immediate management recompression tables and strategies Rehabilitation of disabled divers Diving accident investigation Clinical HBO Recompression chambers Scope of knowledge for hyperbaric medicine edit The ECHM EDTC Educational and Training Standards for Diving and Hyperbaric Medicine 2011 specify the following scope of knowledge for Hyperbaric Medicine additional to that for Diving medicine 1 Physiology and pathology of diving and hyperbaric exposure HBO Basics effects of hyperbaric oxygen physiology and pathology Clinical HBO Chamber technique multiplace monoplace transport chambers wet recompression Mandatory indications HBO Recommended indications HBO Experimental and anecdotal indications HBO Data collection statistics evaluation HBO General basic treatment nursing HBO Diagnostic monitoring and therapeutic devices in chambers Risk assessment incidents monitoring and safety plan in HBO chambers HBO Safety regulationsDiagnostics editMain article List of signs and symptoms of diving disorders The signs and symptoms of diving disorders may present during a dive on surfacing or up to several hours after a dive Divers have to breathe a gas which is at the same pressure as their surroundings which can be much greater than on the surface The ambient pressure underwater increases by 1 standard atmosphere 100 kPa for every 10 metres 33 ft of depth 2 The principal conditions are decompression illness which covers decompression sickness and arterial gas embolism nitrogen narcosis high pressure nervous syndrome oxygen toxicity and pulmonary barotrauma burst lung Although some of these may occur in other settings they are of particular concern during diving activities 2 The disorders are caused by breathing gas at the high pressures encountered at depth and divers will often breathe a gas mixture different from air to mitigate these effects Nitrox which contains more oxygen and less nitrogen is commonly used as a breathing gas to reduce the risk of decompression sickness at recreational depths up to about 40 metres 130 ft Helium may be added to reduce the amount of nitrogen and oxygen in the gas mixture when diving deeper to reduce the effects of narcosis and to avoid the risk of oxygen toxicity This is complicated at depths beyond about 150 metres 500 ft because a helium oxygen mixture heliox then causes high pressure nervous syndrome 2 More exotic mixtures such as hydreliox a hydrogen helium oxygen mixture are used at extreme depths to counteract this 3 Decompression sickness edit Main article Decompression sickness Decompression sickness DCS occurs when gas which has been breathed under high pressure and dissolved into the body tissues forms bubbles as the pressure is reduced on ascent from a dive The results may range from pain in the joints where the bubbles form to blockage of an artery leading to damage to the nervous system paralysis or death While bubbles can form anywhere in the body DCS is most frequently observed in the shoulders elbows knees and ankles Joint pain occurs in about 90 of DCS cases reported to the U S Navy with neurological symptoms and skin manifestations each present in 10 to 15 of cases Pulmonary DCS is very rare in divers 4 Pulmonary barotrauma and arterial gas embolism edit If the breathing gas in a diver s lungs cannot freely escape during an ascent the lungs may be expanded beyond their compliance and the lung tissues may rupture causing pulmonary barotrauma PBT The gas may then enter the arterial circulation producing arterial gas embolism AGE with effects similar to severe decompression sickness 5 Gas bubbles within the arterial circulation can block the supply of blood to any part of the body including the brain and can therefore manifest a vast variety of symptoms Nitrogen narcosis edit Main article Nitrogen narcosis Nitrogen narcosis is caused by the pressure of dissolved gas in the body and produces temporary impairment to the nervous system This results in alteration to thought processes and a decrease in the diver s ability to make judgements or calculations It can also decrease motor skills and worsen performance in tasks requiring manual dexterity As depth increases so does the pressure and hence the severity of the narcosis The effects may vary widely from individual to individual and from day to day for the same diver Because of the perception altering effects of narcosis a diver may not be aware of the symptoms but studies have shown that impairment occurs nevertheless The narcotic effects dissipate without lasting effect as the pressure decreases during ascent 6 High pressure nervous syndrome edit Main article High pressure nervous syndrome Helium is the least narcotic of all gases and divers may use breathing mixtures containing a proportion of helium for dives exceeding about 40 metres 130 ft deep In the 1960s it was expected that helium narcosis would begin to become apparent at depths of 300 metres 1 000 ft However it was found that different symptoms such as tremors occurred at shallower depths around 150 metres 500 ft This became known as high pressure nervous syndrome and its effects are found to result from both the absolute depth and the speed of descent Although the effects vary from person to person they are stable and reproducible for the individual 7 medical citation needed Oxygen toxicity edit Main article Oxygen toxicity Although oxygen is essential to life in concentrations significantly greater than normal it becomes toxic overcoming the body s natural defences antioxidants and causing cell death in any part of the body The lungs and brain are particularly affected by high partial pressures of oxygen such as are encountered in diving The body can tolerate partial pressures of oxygen around 0 5 bars 50 kPa 7 3 psi indefinitely and up to 1 4 bars 140 kPa 20 psi for many hours but higher partial pressures rapidly increase the chance of the most dangerous effect of oxygen toxicity a convulsion resembling an epileptic seizure 8 Susceptibility to oxygen toxicity varies dramatically from person to person and to a smaller extent from day to day for the same diver 9 Prior to convulsion several symptoms may be present most distinctly that of an aura Treatments editTreatment of diving disorders depends on the specific disorder or combination of disorders but two treatments are commonly associated with first aid and definitive treatment where diving is involved These are first aid oxygen administration at high concentration which is seldom contraindicated and generally recommended as a default option in diving accidents where there is any significant probability of hypoxia 10 and hyperbaric oxygen therapy which is the definitive treatment for most conditions of decompression illness 11 12 Oxygen therapy edit Main article Oxygen therapy The administration of oxygen as a medical intervention is common in diving medicine both for first aid and for longer term treatment 12 Normobaric oxygen administration at the highest available concentration is frequently used as first aid for any diving injury that may involve inert gas bubble formation in the tissues There is epidemiological support for its use from a statistical study of cases recorded in a long term database 13 14 15 Recompression and hyperbaric oxygen therapy edit Main article Hyperbaric medicine Recompression treatment in a hyperbaric chamber was initially used as a life saving tool to treat decompression sickness in caisson workers and divers who stayed too long at depth and developed decompression sickness In the 21st century it is a highly specialized treatment modality found to be effective for treating many conditions where the administration of oxygen under pressure is beneficial 16 Hyperbaric oxygen treatment is generally preferred when effective as it is usually a more efficient and lower risk method of reducing symptoms of decompression illness but in some cases recompression to pressures where oxygen toxicity is unacceptable may be required to eliminate the bubbles in the tissues in severe cases of decompression illness 12 Availability of recompression treatment is limited Some countries have no facilities at all and in others which have facilities such as the US some hospitals do not make them available for emergency treatment 17 Medical examination for fitness to dive editMain article Fitness to dive Fitness to dive or medical fitness to dive is the medical and physical suitability of a person to function safely in the underwater environment using underwater diving equipment and procedures Depending on the circumstances it may be established by a signed statement by the diver that he or she does not suffer from any of the listed disqualifying conditions and is able to manage the ordinary physical requirements of diving to a detailed medical examination by a physician registered as a medical examiner of divers following a procedural checklist and a legal document of fitness to dive issued by the medical examiner The most important medical examination is the one before starting diving as the diver can be screened to prevent exposure when a dangerous condition exists The other important medicals are after some significant illness where medical intervention is needed there and has to be done by a doctor who is competent in diving medicine and can not be done by prescriptive rules 18 Psychological factors can affect fitness to dive particularly where they affect response to emergencies or risk taking behaviour The use of medical and recreational drugs can also influence fitness to dive both for physiological and behavioural reasons In some cases prescription drug use may have a net positive effect when effectively treating an underlying condition but frequently the side effects of effective medication may have undesirable influences on the fitness of diver and most cases of recreational drug use result in an impaired fitness to dive and a significantly increased risk of sub optimal response to emergencies Education and registration of practitioners editSpecialist training in underwater and hyperbaric medicine is available from several institutions and registration is possible both with professional associations and governmental registries Education edit NOAA UHMS Physicians Training Course in Diving Medicine This course has been presented since 1977 and has been influenced by internationally accepted training objectives recommended by the Diving Medical Advisory Committee the European Diving Technology Committee and the European Committee for Hyperbaric Medicine The course is designed for qualified medical practitioners but may be useful to others who work in the field of diving safety and operations 19 The course is to train physicians to recognize and treat diving medical emergencies Subject matter includes 19 Basic physics and physiology of the hyperbaric environment the laws and principles the differences between hyperbaric and hypobaric pressure hyperbaric gases and their effects under pressure links between the physiological effects of the hyperbaric environment and the pathology of the disease Basic decompression theory historical development to current concepts factors affecting decompression safety including acceptable risks and thermal issues distinguish decompression sickness from barotrauma and arterial gas embolism Dive computer theories and types and comparison to dive tables Introduction to commercial diving and comparison to recreational and technical diving including differences in procedures equipment and diver categories The clinical application of hyperbaric oxygen therapy and the treatment tables used Participation in surface supplied diving operation and hyperbaric chamber operations Components types operational and safety hazards associated with hyperbaric chambers Diving related conditions resulting from the effects of long term effects of diving flying after diving altitude thermal conditions age and gender Neurologic assessment on a diver with signs and or symptoms of DCI Medical and fitness standards for diving including contraindications for both commercial and recreational divers differences in medical standards for recreational versus occupational diving communities legal implications for approving and denying fitness to dive in an occupational setting approaches for determining the safety of prescription and OTC medications used by divers Fellowship in Undersea and Hyperbaric Medicine The Accreditation Council for Graduate Medical Education ACGME and the American Osteopathic Association AOA offer 12 month programs in undersea and hyperbaric medicine associated with ACGME or AOA accredited programs in emergency medicine family medicine internal medicine occupational medicine preventive medicine or anesthesiology 20 21 22 ECHM EDTC Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine The standard drawn up jointly by the European Committee for Hyperbaric Medicine and the European Diving Technical Committee defines job descriptions for several levels of diving and hyperbaric physician Education and assessment to these standards may be provided by institutions of higher education under the leadership of a Level 3 Hyperbaric Medicine Expert as defined below Certificates of competence may be issued by a nationally accredited institution or an internationally acknowledged agency and periodic recertification is required 1 Level 1 Medical Examiner of Divers MED minimum 28 teaching hours The MED must be competent to perform the assessments of medical fitness to dive of occupational and recreational divers and compressed air workers except the assessment of medical fitness to resume diving after major decompression incidents Level 2D Diving Medicine Physician DMP minimum 80 teaching hours A DMP must be competent to perform the initial and all other assessments of medical fitness to dive of working and recreational divers or compressed air workers and manage diving accidents and advise diving contractors and others on diving medicine and physiology with the backup of a diving medical expert or consultant A DMP should have knowledge in relevant aspects of occupational health but is not required to be a certified specialist in occupational medicine A DMP should have certified skills and basic practical experience in assessment of medical fitness to dive management of diving accidents safety planning for professional diving operations advanced life support acute trauma care and general wound care Level 2H Hyperbaric Medicine Physician HMP minimum 120 teaching hours An HMP will be responsible for hyperbaric treatment sessions with the backup of a hyperbaric medicine expert or consultant An HMP should have appropriate experience in anaesthesia and intensive care in order to manage the HBO patients but is not required to be a certified specialist in anaesthesia and intensive care An HMP must be competent to assess and manage clinical patients for hyperbaric oxygen therapy treatment Level 3 Hyperbaric medicine expert or consultant hyperbaric and diving medicine is a physician who has been assessed as competent to manage a hyperbaric facility HBO centre or the medical and physiological aspects of complex diving activities manage research programs on diving medicine supervise a team of HBO doctors and personnel health professionals and others teach relevant aspects of hyperbaric medicine and physiology to all members of staff Gesellschaft fur Tauch und Uberdruckmedizin e V Society for Diving and Hyperbaric medicine German standards for education and assessment of diving medical practitioners are similar to the ECHM EDTC Standards and are controlled by the Gesellschaft fur Tauch und Uberdruckmedizin e V They include Medical Examiner of Divers Diving Medicine Physician Hyperbaric Medicine Physician Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant 23 Schweizerische Gesellschaft fur Unterwasser und Hyperbarmedizin Swiss Society for underwater and hyperbaric medicine Swiss standards for education and assessment of diving medical practitioners are controlled by the Schweizerische Gesellschaft fur Unterwasser und Hyperbarmedizin They include Medical Examiner of Divers Diving Medicine Physician and Hyperbaric Medicine Physician 24 Osterreichische Gesellschaft fur Tauch und Hyperbarmedizin Austrian Society for Diving and Hyperbaric medicine Austrian standards for education and assessment of diving medical practitioners are controlled by the Osterreichische Gesellschaft fur Tauch und Hyperbarmedizin They include Medical Examiner of Divers Diving Medicine Physician Hyperbaric Medicine Physician Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant 25 Registration edit The American Medical Association recognises the sub speciality Undersea and Hyperbaric Medicine held by someone who is already Board Certified in some other speciality 26 The South African Department of Employment and Labour registers two levels of Diving Medical Practitioner Level 1 is qualified to conduct annual examinations and certification of medical fitness to dive on commercial divers equivalent to ECHM EDTC Level 1 Medical Examiner of Divers and Level 2 is qualified to provide medical advice to a diving contractor and hyperbaric treatment for diving injuries 27 equivalent to ECHM EDTC Level 2D Diving Medicine Physician Australia has a four tier system In 2007 there was no recognised equivalence with the European standard 28 GPs completing the first tier four to five day course on how to examine divers for fitness to dive can then add their names to the SPUMS Diving Doctors List GPs completing the second tier two week diving medicine courses provided by the Royal Australian Navy and the Royal Adelaide Hospital or the two week course in Diving and Hyperbaric Medicine provided by the ANZ Hyperbaric Medicine Group qualify to do commercial diving medicals The third tier is the SPUMS Diploma in Diving and Hyperbaric Medicine The candidate must attend a two week course write a dissertation related to DHM and have the equivalent of six months full time experience working in a hyperbaric medicine unit The fourth tier is the Certificate in Diving and Hyperbaric Medicine from the ANZ College of Anaesthetists Training of divers and support staff in relevant first aid editDivers edit A basic knowledge understanding of the causes symptoms and first aid treatment of diving related disorders is part of the basic training for most recreational and professional divers both to help the diver avoid the disorders and to allow appropriate action in case of an incident resulting in injury 27 Recreational divers edit A recreational diver has the same duty of care to other divers as any ordinary member of the public and therefore there is no obligation to train recreational divers in first aid or other medical skills Nevertheless first aid training is recommended by most if not all recreational diver training agencies 29 30 31 Recreational diving instructors and divemasters on the other hand are to a greater or lesser extent responsible for the safety of divers under their guidance and therefore are generally required to be trained and certified to some level of rescue and first aid competence as defined in the relevant training standards of the certifying body In many cases this includes certification in cardiopulmonary resuscitation and first aid oxygen administration for diving accidents Professional divers edit Professional divers usually operate as members of a team with a duty of care for other members of the team Divers are expected to act as standby divers for other members of the team and the duties of a standby diver include rescue attempts if the working diver gets into difficulties Consequently professional divers are generally required to be trained in rescue procedures appropriate to the modes of diving they are certified in and to administer first aid in emergencies The specific training competence and registration for these skills varies and may be specified by state or national legislation or by industry codes of practice 27 32 Diving supervisors have a similar duty of care and as they are responsible for operational planning and safety generally are also expected to manage emergency procedures including the first aid that may be required The level of first aid training competence and certification will generally take this into account In South Africa registered commercial and scientific divers must hold current certification in first aid at the national Level 1 with additional training in oxygen administration for diving accidents and registered diving supervisors must hold Level 2 first aid certification 27 Offshore diving contractors frequently follow the IMCA recommendations Diver medic edit A diver medic or diving medical technician is a member of a dive team who is trained in advanced first aid 33 A diver medic recognised by IMCA must be capable of administering first aid and emergency treatment and carrying out the directions of a physician and be familiar with diving procedures and compression chamber operation The diver medic must also be able to assist the diving supervisor with decompression procedures and provide treatment in a hyperbaric chamber in an emergency The diver medic must hold at a minimum a valid certificate of medical fitness to operate in a pressurized environment and a certificate of medical fitness to dive 34 Training standards for diver medic are described in the IMCA Scheme for Recognition of Diver Medic Training 34 Ethical and medicolegal issues editExperimental work on human subjects is often ethically and or legally impracticable Tests where the endpoint is symptomatic decompression sickness are difficult to authorise and this makes the accumulation of adequate and statistically valid data difficult The precautionary principle may be applied in the absence of information allowing a realistic assessment of risk Analysis of investigations into accidents is useful when reliable results are available which is less often than would be desirable but privacy concerns prevent a large mount of information potentially useful to the general diving population from being made available to researchers This section needs expansion You can help by adding to it July 2020 History of diving medical research editSee also History of decompression research and development Timeline edit November 1992 The first examination for certification in Undersea Medicine by the American Board of Preventive Medicine 26 November 1999 The first examination for Undersea and Hyperbaric Medicine qualification 26 Notable researchers edit Arthur J Bachrach Albert R Behnke Peter B Bennett Thomas E Berghage Paul Bert George F Bond Alf O Brubakk Albert A Buhlmann Carl Edmonds William Paul Fife John Scott Haldane Robert William Hamilton Jr Leonard Erskine Hill Brian Andrew Hills F J Keays Christian J Lambertsen Joseph B MacInnis Simon Mitchell Richard E Moon Frantisek Novomesky John Rawlins Charles Wesley Shilling Edward D Thalmann Richard D Vann James Vorosmarti R M Wong Robert D WorkmanResearch organisations editDefence and Civil Institute of Environmental Medicine Further information DRDC Toronto DCIEM is a combined military and civilian research organisation to research the operational needs of the Canadian Forces in all environments citation needed Divers Alert Network Main article Divers Alert Network The Divers Alert Network DAN is an international non profit organization with regional branches supported by donations grants and membership dues for assisting divers in need The DAN Research department conducts significant medical research on recreational scuba diving safety and the DAN Medicine Department provides support for divers worldwide to find answers to their diving medical questions 35 Diving Diseases Research Centre Main article Diving Diseases Research Centre The Diving Diseases Research Centre DDRC is a British hyperbaric medical organisation located near Derriford Hospital in Plymouth Devon It is a registered charity and was established in 1980 to research the effects of diving on human physiology The main objective of DDRC is research into diving medicine The Centre is also an education and training base providing diving medical clinical and hyperbaric courses Diving Medical Advisory Council Main article Diving Medical Advisory Council DMAC is an independent committee with the purpose of providing advice about medical and safety aspects of commercial diving They publish guidance notes about various aspects of diving and diving medical practice and run a scheme for approval of courses in diving medicine 36 European Committee for Hyperbaric Medicine The ECHM is an organisation to study and define indications for hyperbaric therapy research and therapy protocols standards for therapeutic and technical procedures equipment and personnel and related cost benefit and cost effectiveness criteria It is a representative body with the European health authorities and works toward cooperation among scientific organizations involved in the field of Diving and Hyperbaric Medicine 37 Membership of the committee includes doctors practicing diving medicine in Northern Europe representatives of relevant health authorities medical representatives from relevant navies and a diving safety officer nominated by the International Marine Contractors Association European Underwater and Baromedical Society Main article European Underwater and Baromedical Society The European Underwater and Baromedical Society EUBS is a primary source of information for diving and hyperbaric medicine physiology worldwide The organization was initially formed as the European Underwater and Biomedical Society in 1971 38 National Board of Diving and Hyperbaric Medical Technology Main article National Board of Diving and Hyperbaric Medical Technology The National Board of Diving and Hyperbaric Medical Technology NBDHMT formally known as the National Association of Diving Technicians is a non profit organization for the education and certification of qualified personnel in the fields of diving and hyperbaric medicine in the US 39 The Diver Medic Technician DMT program is designed to meet the specific medical care needs of commercial professional and scientific divers that often work in geographic isolation 40 41 DMT s are specifically trained for the various diving hazards found at remote work sites 40 The curriculum covers a wide range of topics from barotrauma to treatment of decompression sickness 42 The Certified Hyperbaric Technologist CHT program is tailored to meet the specific safety and operational needs for biomedical devices within the department and the necessary knowledge and skills to administer clinical treatment 43 The curriculum covers a wide range of topics including hyperbaric chamber operations to transcutaneous oxygen monitoring 44 The Certified Hyperbaric Registered Nurse CHRN program is a subspecialty for registered nurses 45 sometimes referred to as baromedical nurses Southern African Underswater and Hyperbaric Medical Association Main article Southern African Underwater and Hyperbaric Medical Association SAUHMA is a voluntary association recognised as a Special Interest group by the Group Council of the South African Medical Association 46 South Pacific Underwater Medicine Society Main article South Pacific Underwater Medicine Society The South Pacific Underwater Medicine Society SPUMS is a primary source of information for diving and hyperbaric medicine physiology worldwide The organisation supports the study of all aspects of underwater and hyperbaric medicine provides information on underwater and hyperbaric medicine publishes a medical journal and holds an annual conference 47 48 SPUMS offers a post graduate Diploma of Diving and Hyperbaric Medicine Undersea and Hyperbaric Medical Society Main article Undersea and Hyperbaric Medical Society The Undersea and Hyperbaric Medical Society UHMS is a primary source of information for diving and hyperbaric medicine physiology worldwide See also edit nbsp Underwater diving portalGeorge F Bond US Navy physician and diving medicine and saturation diving researcher Rubicon Foundation Non profit organization for promoting research and information access for underwater diving Undersea and Hyperbaric Medical Society US based organisation for research and education in hyperbaric physiology and medicine Edward D Thalmann American hyperbaric medicine specialist and decompression researcherReferences edit a b c d Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine PDF Joint Educational Subcommittee of the European Committee for Hyperbaric Medicine ECHM and the European Diving Technical Committee EDTC 2011 retrieved 30 March 2013 a b c Brubakk Alf O Neuman Tom S eds 2003 9 Pressure Effects Bennett and Elliott s physiology and medicine of diving 5th Revised ed United States Saunders Ltd pp 265 418 ISBN 978 0 7020 2571 6 OCLC 51607923 Abraini JH Gardette Chauffour MC Martinez E Rostain JC Lemaire C 1994 Psychophysiological reactions in humans during an open sea dive to 500 m with a hydrogen helium oxygen mixture Journal of Applied Physiology 76 3 1113 8 doi 10 1152 jappl 1994 76 3 1113 eISSN 1522 1601 ISSN 8750 7587 PMID 8005852 Powell Mark 2008 Deco for Divers Southend on Sea Aquapress p 70 ISBN 978 1 905492 07 7 Neuman Tom S 2003 10 5 Arterial Gas Embolism and Pulmonary Barotrauma In Brubakk Alf O Neuman Tom S eds Bennett and Elliott s physiology and medicine of diving 5th ed United States Saunders Ltd pp 557 8 ISBN 978 0 7020 2571 6 OCLC 51607923 Bennett Peter B Rostain Jean Claude 2003 9 2 Inert Gas Narcosis In Brubakk Alf O Neuman Tom S eds Bennett and Elliott s physiology and medicine of diving 5th ed United States Saunders Ltd p 301 ISBN 978 0 7020 2571 6 OCLC 51607923 Stanciu Tamara Mihai Diaconu Mircea Degeratu May 2013 Monitoriztuion and evaluation of HPNS High Pressure Nervous Syndrome PDF Annals of the Oradea university Archived from the original PDF on 9 January 2016 Retrieved 15 September 2015 Clark James M Thom Stephen R 2003 9 4 Oxygen under pressure In Brubakk Alf O Neuman Tom S eds Bennett and Elliott s physiology and medicine of diving 5th ed United States Saunders Ltd pp 358 360 ISBN 978 0 7020 2571 6 OCLC 51607923 Clark James M Thom Stephen R 2003 9 4 Oxygen under pressure In Brubakk Alf O Neuman Tom S eds Bennett and Elliott s physiology and medicine of diving 5th ed United States Saunders Ltd p 376 ISBN 978 0 7020 2571 6 OCLC 51607923 Denoble Peter Fall 2010 Oxygen as definitive treatment Alert Diver Online Diver Alert Network Archived from the original on 24 August 2015 Retrieved 15 September 2015 Bove Alfred A April 2013 Decompression sickness MSD Manual Professional version Merck Retrieved 15 September 2015 a b c US Navy 2006 US Navy Diving Manual 6th revision United States US Naval Sea Systems Command Archived from the original on 2 May 2008 Retrieved 15 June 2008 Longphre JM Denoble PJ Moon RE Vann RD Freiberger JJ 2007 First aid normobaric oxygen for the treatment of recreational diving injuries Undersea amp Hyperbaric Medicine 34 1 43 49 PMID 17393938 S2CID 3236557 Emergency Oxygen for Scuba Diving Injuries Divers Alert Network Archived from the original on 20 April 2020 Retrieved 1 October 2018 Oxygen First Aid for Scuba Diving Injuries Divers Alert Network Europe Archived from the original on 10 June 2020 Retrieved 1 October 2018 Ernest S Campbell MD FACS HBO Indications contraindications links references Scuba doc com Retrieved 16 March 2013 a href Template Cite web html title Template Cite web cite web a CS1 maint multiple names authors list link Stewart Ashley Hyperbaric Chambers Are Turning Away Divers Will There Be One Nearby When You Need It gue com Retrieved 7 October 2023 Williams G Elliott DH Walker R Gorman DF Haller V 2001 Fitness to dive Panel discussion with audience participation Journal of the South Pacific Underwater Medicine Society 31 3 Archived from the original on 5 July 2013 Retrieved 7 April 2013 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link a b Staff 2011 Underwater and Hyperbaric Medical Society Retrieved 30 March 2013 Basic Standards for Fellowship Training in Undersea and Hyperbaric Medicine PDF American Osteopathic Conjoint Committee of Undersea and Hyperbaric Medicine Retrieved 2 April 2013 Home American Osteopathic Association 2012 Retrieved 2 April 2013 Stolp Bret W Taekman Jeffery M Hobbs Gene W 2007 Simulation ACGME and the hyperbaric fellowship Undersea and Hyperbaric Medicine Archived from the original on 15 April 2013 Retrieved 3 April 2013 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link staff Gesellschaft fur Tauch und Uberdruckmedizin in German Archived from the original on 6 March 2016 Retrieved 12 March 2018 staff 2005 Swiss Underwater and Hyperbaric Medical Society in German Lengnau SUHMS Secretariat Retrieved 12 March 2018 staff Weiterbildungsordnung der OGTH fur tauch amp hyperbarmedizinische Qualifikationen von Arzten in German Retrieved 12 March 2018 a b c Knight John June 2000 Certification in diving and hyperbaric medicine in America and Australia SPUMS Journal 30 2 Archived from the original on 19 August 2022 Retrieved 3 April 2013 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link a b c d Diving Regulations 2009 of the South African Occupational Health and Safety Act 1993 Government Notice R41 Government Gazette 32907 29 January 2010 Davis Michael September 2007 The Editor s offering Diving medicine education Diving and Hyperbaric Medicine 37 3 Archived from the original on 19 August 2022 Retrieved 3 April 2013 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link Staff National Association of Underwater Instructors Scuba rescue diver specialty http www naui org specialty courses aspx 040 Archived 28 March 2009 at the Wayback Machine Staff British Sub Aqua Club First Aid for Divers http www bsac com page asp section 3606 amp sectionTitle First Aid for Divers CMAS Rescue diver training standard http www cmas org technique rescue diver training programme The Diving Medical Advisory Committee DMAC November 2001 Provision of First Aid and the Training of Divers Supervisors and Members of Dive Teams in First Aid DMAC 11 Rev 1 International Marine Contractors Association Retrieved 3 April 2013 a b Staff December 1999 IMCA Scheme for Recognition of Diver Medic Training Guidance for Training Establishments PDF International Marine Contractors Association Retrieved 3 April 2013 Vann RD 2007 Moon RE Piantadosi CA Camporesi EM eds The History of Divers Alert Network DAN and DAN Research Dr Peter Bennett Symposium Proceedings Held May 1 2004 Durham N C Archived from the original on 13 January 2013 Retrieved 11 February 2014 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link Diving Medical Advisory Committee Retrieved 2 April 2013 European Committee for Hyperbaric Medicine Retrieved 2 April 2013 Elliott David 2011 The foundations for today s future Diving Hyperb Med 41 3 118 20 PMID 21948494 Archived from the original on 1 November 2013 Retrieved 11 February 2014 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link National Board of Diving and Hyperbaric Medical Technology NBDHMT Retrieved 14 June 2009 a b Diver Medic Technician Training and Certification NBDHMT Archived from the original on 25 February 2009 Retrieved 14 June 2009 Clarke Dick 1985 All about the DMT Pressure Newsletter of the Undersea and Hyperbaric Medical Society 14 6 2 ISSN 0889 0242 Diver Medic Technician Resource Manual NBDHMT Archived from the original on 15 June 2009 Retrieved 14 June 2009 Certified Hyperbaric Technologist Training and Certification NBDHMT Archived from the original on 22 February 2009 Retrieved 14 June 2009 Certified Hyperbaric Technician Resource Manual PDF NBDHMT Archived from the original on 28 February 2013 Retrieved 14 June 2009 a href Template Cite web html title Template Cite web cite web a CS1 maint bot original URL status unknown link Josefsen L Woodward C Lewis D Hodge J Camporesi EM 1997 The nursing role in hyperbaric medicine Undersea and Hyperbaric Medicine Annual Meeting Abstract Archived from the original on 15 April 2013 Retrieved 14 June 2009 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link South African Undersea and Hyperbaric Medical Association home page Retrieved 2 April 2013 Knight John 1996 Twenty five years of SPUMS 1971 1996 South Pacific Underwater Medicine Society Journal 26 2 ISSN 0813 1988 OCLC 16986801 Archived from the original on 15 April 2013 Retrieved 16 June 2008 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint unfit URL link South Pacific Underwater Medicine Society South Pacific Underwater Medicine Society Home Page Retrieved 15 June 2008 Further reading editBrubakk A O Neuman T S 2003 Bennett and Elliott s physiology and medicine of diving 5th Rev ed United States Saunders Ltd p 800 ISBN 978 0702025716 External links edit nbsp Wikimedia Commons has media related to Diving medicine Scubadoc s Diving Medicine Online Diving Diseases Research Centre DDRC Rubicon Research Repository usurped Diving Medical Literature SCUBA Diving and Asthma infos scuba diving restrictions Edmonds Thomas McKenzie amp Pennefather 2010 Diving Medicine for Scuba Divers 3rd ed Carl Edmonds Archived from the original on 27 November 2010 free download of complete text Retrieved from https en wikipedia org w index php title Diving medicine amp oldid 1207539829 Diver medic, wikipedia, wiki, book, books, library,

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