Diving medicine

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A recompression chamber is used to treat some diving disorders. Decompression chamber.jpg
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

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.

Contents

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

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

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

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]

Diagnostics

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

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

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

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

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

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

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

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

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

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

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

Education

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

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]

Training of divers and support staff in relevant first aid

Divers

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

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

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

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

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

Timeline

Notable researchers

Research organisations

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]

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

Related Research Articles

Nitrox refers to any gas mixture composed of nitrogen and oxygen. This includes atmospheric air, which is approximately 78% nitrogen, 21% oxygen, and 1% other gases, primarily argon. In the usual application, underwater diving, nitrox is normally distinguished from air and handled differently. The most common use of nitrox mixtures containing oxygen in higher proportions than atmospheric air is in scuba diving, where the reduced partial pressure of nitrogen is advantageous in reducing nitrogen uptake in the body's tissues, thereby extending the practicable underwater dive time by reducing the decompression requirement, or reducing the risk of decompression sickness.

<span class="mw-page-title-main">Nitrogen narcosis</span> Reversible narcotic effects of respiratory nitrogen at elevated partial pressures

Narcosis while diving is a reversible alteration in consciousness that occurs while diving at depth. It is caused by the anesthetic effect of certain gases at high pressure. The Greek word νάρκωσις (narkōsis), "the act of making numb", is derived from νάρκη (narkē), "numbness, torpor", a term used by Homer and Hippocrates. Narcosis produces a state similar to drunkenness, or nitrous oxide inhalation. It can occur during shallow dives, but does not usually become noticeable at depths less than 30 metres (98 ft).

<span class="mw-page-title-main">Breathing gas</span> Gas used for human respiration

A breathing gas is a mixture of gaseous chemical elements and compounds used for respiration. Air is the most common and only natural breathing gas, but other mixtures of gases, or pure oxygen, are also used in breathing equipment and enclosed habitats such as scuba equipment, surface supplied diving equipment, recompression chambers, high-altitude mountaineering, high-flying aircraft, submarines, space suits, spacecraft, medical life support and first aid equipment, and anaesthetic machines.

<span class="mw-page-title-main">Oxygen toxicity</span> Toxic effects of breathing oxygen at high partial pressures

Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen at increased partial pressures. Severe cases can result in cell damage and death, with effects most often seen in the central nervous system, lungs, and eyes. Historically, the central nervous system condition was called the Paul Bert effect, and the pulmonary condition the Lorrain Smith effect, after the researchers who pioneered the discoveries and descriptions in the late 19th century. Oxygen toxicity is a concern for underwater divers, those on high concentrations of supplemental oxygen, and those undergoing hyperbaric oxygen therapy.

<span class="mw-page-title-main">Barotrauma</span> Injury caused by pressure

Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tension or shear, either directly by an expansion of the gas in the closed space or by pressure difference hydrostatically transmitted through the tissue. Tissue rupture may be complicated by the introduction of gas into the local tissue or circulation through the initial trauma site, which can cause blockage of circulation at distant sites or interfere with the normal function of an organ by its presence. The term is usually applied when the gas volume involved already exists prior to decompression. Barotrama can occur during both compression and decompression events.

Diving disorders, or diving related medical conditions, are conditions associated with underwater diving, and include both conditions unique to underwater diving, and those that also occur during other activities. This second group further divides into conditions caused by exposure to ambient pressures significantly different from surface atmospheric pressure, and a range of conditions caused by general environment and equipment associated with diving activities.

<span class="mw-page-title-main">Diver rescue</span> Rescue of a distressed or incapacitated diver

Diver rescue, following an accident, is the process of avoiding or limiting further exposure to diving hazards and bringing a diver to a place of safety. A safe place is often a place where the diver cannot drown, such as a boat or dry land, where first aid can be administered and from which professional medical treatment can be sought. In the context of surface supplied diving, the place of safety for a diver with a decompression obligation is often the diving bell.

<span class="mw-page-title-main">Underwater diving</span> Descending below the surface of the water to interact with the environment

Underwater diving, as a human activity, is the practice of descending below the water's surface to interact with the environment. It is also often referred to as diving, an ambiguous term with several possible meanings, depending on context. Immersion in water and exposure to high ambient pressure have physiological effects that limit the depths and duration possible in ambient pressure diving. Humans are not physiologically and anatomically well-adapted to the environmental conditions of diving, and various equipment has been developed to extend the depth and duration of human dives, and allow different types of work to be done.

Divers Alert Network (DAN) is a group of not-for-profit organizations dedicated to improving diving safety for all divers. It was founded in Durham, North Carolina, United States, in 1980 at Duke University providing 24/7 telephonic hot-line diving medical assistance. Since then the organization has expanded globally and now has independent regional organizations in North America, Europe, Japan, Asia-Pacific and Southern Africa.

<span class="mw-page-title-main">Albert R. Behnke</span> US Navy physician and diving medicine researcher

Captain Albert Richard Behnke Jr. USN (ret.) was an American physician, who was principally responsible for developing the U.S. Naval Medical Research Institute. Behnke separated the symptoms of Arterial Gas Embolism (AGE) from those of decompression sickness and suggested the use of oxygen in recompression therapy.

<span class="mw-page-title-main">Diver training</span> Processes by which people develop the skills and knowledge to dive safely underwater

Diver training is the set of processes through which a person learns the necessary and desirable skills to safely dive underwater within the scope of the diver training standard relevant to the specific training programme. Most diver training follows procedures and schedules laid down in the associated training standard, in a formal training programme, and includes relevant foundational knowledge of the underlying theory, including some basic physics, physiology and environmental information, practical skills training in the selection and safe use of the associated equipment in the specified underwater environment, and assessment of the required skills and knowledge deemed necessary by the certification agency to allow the newly certified diver to dive within the specified range of conditions at an acceptable level of risk. Recognition of prior learning is allowed in some training standards.

<span class="mw-page-title-main">Robert William Hamilton Jr.</span> American physiologist and researcher in hyperbaric physiology.

Robert William Hamilton Jr., known as Bill, was an American physiologist known for his work in hyperbaric physiology.

<span class="mw-page-title-main">Fitness to dive</span> Medical fitness of a person to function safely underwater under pressure

Fitness to dive, specifically the medical fitness to dive, is the medical and physical suitability of a diver 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 they do not have 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.

Human physiology of underwater diving is the physiological influences of the underwater environment on the human diver, and adaptations to operating underwater, both during breath-hold dives and while breathing at ambient pressure from a suitable breathing gas supply. It, therefore, includes the range of physiological effects generally limited to human ambient pressure divers either freediving or using underwater breathing apparatus. Several factors influence the diver, including immersion, exposure to the water, the limitations of breath-hold endurance, variations in ambient pressure, the effects of breathing gases at raised ambient pressure, effects caused by the use of breathing apparatus, and sensory impairment. All of these may affect diver performance and safety.

The Diving Medical Advisory Council (DMAC) is an independent organisation of diving medical specialists, mostly from across Northern Europe which exists to provide expert advice about medical and some safety aspects of commercial diving. The advice is published in the form of guidance documents, which are made available for download.

<span class="mw-page-title-main">Outline of underwater diving</span> Hierarchical outline list of articles related to underwater diving

The following outline is provided as an overview of and topical guide to underwater diving:

<span class="mw-page-title-main">Index of underwater diving</span> Alphabetical listing of underwater diving related articles

The following index is provided as an overview of and topical guide to underwater diving:

References

  1. 1 2 3 4 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. 1 2 3 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.
  5. ↑ 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.
  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). "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.
  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.
  10. ↑ 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.
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  12. 1 2 3 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.
  13. ↑ Longphre, JM; Denoble, PJ; Moon, RE; Vann, RD; Freiberger, JJ (2007). "First aid normobaric oxygen for the treatment of recreational diving injuries". Undersea & Hyperbaric Medicine. 34 (1): 43–49. PMID   17393938. S2CID   3236557.
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  25. ↑ staff. "Weiterbildungsordnung der ÖGTH für tauch- & hyperbarmedizinische Qualifikationen von Ärzten" (in German). Retrieved 12 March 2018.
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  27. 1 2 3 4 "Diving Regulations 2009 of the South African Occupational Health and Safety Act, 1993", Government Notice R41, Government Gazette (#32907), 29 January 2010
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  29. ↑ 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
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