Thursday, June 30, 2005

Vomiting While Diving

Dr Campbell:

I just saw the quote below on your website while browsing around. I realise that you didn't write it, and it is just someone speculating, but I think the "common sense" approach would be rather dangerous if applied. An alternative method is described which I think is fine, but just seeing the "common sense" approach in print makes me feel very uneasy.

I am a divemaster and although I don't guide a lot, I have had some very novice divers vomit while guiding and know plenty of instructors and guides who have experience of this themselves and with clients (one of them always throws up at the start of every dive, and my wife has thrown up a number of times). The universal approach I have seen - which always seems to work - is to keep the regulator in while vomiting and maintain depth (airway closed; and managing a controlled ascent while retching seems unlikely anyway). Once the vomiting has stopped, you can switch to another regulator and make an ascent. When guiding someone, I face them, make eye contact, hold a BC strap or shoulder for reassurance, and place my hand lightly on their regulator (avoiding the purge), letting my fingertips extend up on to their mask so that they are comforted by seeing that I am "holding their regulator in". If someone is looking unwell on the boat, I brief them for this procedure, and I haven't had any complaints yet. Vomiting while diving happens a lot (because people get seasick a lot and tend to dive while on overseas holidays) and I haven't seen it being a big issue - people seem to be more nervous before than after.

Perhaps a doctor's view of things is coloured by dealing with patients who are incapacitated in some way (either by illnes or by being on their back with a mouthful of medical or dental equipment) and whose reflexes are therefore not working at their best. Most people seem to
(re-?)acquire good airway control very quickly when they start diving, regulators seem to clear themselves of vomit very well, and I have never had or heard of a problem with this approach. People are presumably "designed" to throw up and then resume breathing, we are in a good posture to do this when diving, and a regulator in the mouth doesn't seem to complicate things. However I once tried removing my regulator to cough (just to see what would happen) and I got a nasty shock as the breathing reflex after coughing seems strong and I got a lot of water too far back. I don't think that there is a natural reflex to put something in your mouth in order to breathe and I suspect (but haven't tried it) that a diver might have little or no chance of
getting a regulator back in their mouth (and then purging it of water ...) before they started breathing in after retching. If their breathing is under control, then my experience suggests it will almost certainly do no or little harm to have a regulator in their mouth even if it has some residual vomit in it; if their breathing isn't under control then it is _essential_ that they have a regulator in their mouth, whatever the consequences of that may be. In a worst case scenario that they inhale some vomit and have a coughing fit, then having a regulator in their mouth is probably their best bet. (As a guide, you freak if you ever see a typical customer without their
regulator in their mouth for any reason).

Obviously my opinion doesn't account for much on this - I haven't tried it either way personally except for the cough test, but I would urge you to consider the matter, asking around as necessary, and amend your website in some way - I think any suggestion of removing a regulator to vomit is just dangerous, even if offered speculatively or as "common sense". The suggestion of removing one side of the mouthpiece is just confusing the issue here - even if it worked, the sort of diver who could do that successfully would do it anyway if they were going to. I have oodles of dive experience and if I had to throw up I would do it the simple way, but would make sure my backup regulator was to hand and my buddy was aware of the situation (as step 1 not step 5!).

Best regards,

Simon Richards
www.cave-exploration.com

Wednesday, June 29, 2005

MEDICAL DIRECTOR POSITION AVAILABLE

GUTHRIE CENTER FOR WOUND CARE AND HYPERBARIC MEDICINE
( Sayre, Pennsylvania)

Guthrie's Center for Wound Care and Hyperbaric Medicine is based at the Robert Packer Hospital, a 260-bed tertiary care center located on the border of Pennsylvania and New York. RPH is one of three hospitals which are part of the Guthrie Health Care System. Guthrie Health Care System is a $330-million integrated health care delivery system with a 100-year history in this region of the Northeast. The Wound Center includes four exam rooms plus a suite with two hyperbaric oxygen chambers. Guthrie's physician-based wound management model includes multiple treatments for a wide variety of chronic non-healing wounds such as diabetic leg and foot ulcers, pressure sores, ostomy-related wounds, compromised skin grafts and more. Potential candidates will be board certified in their specialty and have experience with minor surgery wound care related debridement. Advanced wound care and hyperbaric experience is desirable but is not a prerequisite. The Center is open 5 days per week from 8:00 am to 5:30 pm. No call.

The main campus is located on the border of NY and PA, 30 miles south of the Finger Lake Region of NY State. One of the most scenic areas of the Northeast. Excellent schools, safe communities and affordable housing. Summers on the lakes and winter sports create unparalleled 4-season recreational opportunities. Visit the website at www.guthrie.org. Competitive compensation and comprehensive benefits. Contact Kathy Murray, 800-724-1295, Email: murray_kathy@guthrie.org . FAX 570-882-3098.

Please call or email me if you have any questions. Thanks for your consideration.

Sincerely,

Patrick Q. McMahon, Director
Guthrie Center for Wound Care &
Hyperbaric Medicine
Robert Packer Hospital, 4th Floor
1 Guthrie Square
Sayre, PA 18840
Phone: (570) 882-6639
Cell: (607) 351-4760
Fax: (570) 882-6728
mcmahon_patrick@guthrie.org

News Updates, Google

Diver panics, drowns in Stoney Lake scuba diving accident
CDNN - New Zealand
by LUTHER MONROE - CDNN Safety News Editor. STONEY LAKE, Ontario (27 June 2005) -- A female scuba diver panicked and died while scuba ...

Deputy DA dies in scuba accident
Daily Democrat - Woodland,CA,USA
By SHAWBONG FOK/Democrat staff Writer. A Yolo County deputy district attorney has died unexpectedly from a scuba-diving accident near Carmel. ...

Diver hospitalised with decompression sickness
ABC Online - Australia
... Victorian man in his 30s who was cave diving off Western Australia's south-eastern coast has been flown to hospital with decompression sickness, commonly known ...

Carbon monoxide poisoning sickens 6
Baltimore Sun - Baltimore,MD,USA
... Inhaling carbon monoxide displaces oxygen in the blood, and treatment in a hyperbaric chamber is designed to restore the oxygen to a person's body, in effect ...

Letter from Lisa Wasdin, UHMS

Sent: Tuesday, June 28, 2005 11:27 AM
To: Lisa Wasdin
Subject: UHMS Gulf Coast Chapter Annual Scientific Meeting, Jacksonville, Florida

To become a member of the

UHMS Gulf Coast Chapter

CLICK HERE

For more information contact

Suzanne Pack

Secretary / Treasurer

UHMS Gulf Coast Chapter

Phone: 210-614-3688

Fax: 210-223-4864

Email: gcc@uhms.org

Registration Information

Call For Abstracts

Award & Officer Nominations

Exhibitor / Sponsors

CHT/CHRN Exam

Pre-Course

Legal Aspects of

Wound Care & Hyperbaric Medicine

2006 UHMS GCC Meeting

Biloxi, Mississippi

DATES & LOCATION TO BE ANNOUNCED

http://www.uhms.org/Chapters/GCC/GCC%202005%20Updates/GCC%202005%20Meeting%20Ad.htm

Urgent Hyperbaric Cost Data, UHMS Letter

It would seem to me that everyone associated with hyperbaric medicine -
and that includes all divers - would be interested in assuring that the
treatment modality is maintained and funded properly. Here is a request
from Tom Workman about an urgent opportunity for the huperbaric industry to increase
their reimbursement.

scubadoc
************************

"Dear UHMS Member, As you recall from a recent urgent email notification, the Society has been contacted by Sue DeSantis, Executive Director of the Hyperbaric Oxygen Therapy Association (HOTA) regarding an urgent opportunity. As you know, HOTA, along with legal counsel, consultants, and key Society personnel, have been working extremely hard over the past year with CMS to further delineate an appropriate and fair reimbursement rate for hyperbaric treatment. One of the primary factors which reflected very favorably on the hyperbaric community when we last jointly met with CMS was the number of facilities that reported their cost data on short-suspense survey that was distributed. Approximately 30% of the facilities billing for federal reimbursement during 2002-2003 participated -- resulting in the clear recognition of community working toward a common goal. This response was phenomenal.
We need your help again. The community continues to communicate with CMS on this issue and we have another opportunity to provide cost data to the Lewin Group for analysis. The CFO and Program Director of your facility should have received by now another survey requesting information regarding how you allocate your costs and charges. It is critical to our future that each and every one of you participate in this effort. We received responses from 30% of you last year.........we now need input from at least 60% of you! Yes, that is right, 60%! With your help, the Lewin Group can produce a more powerful analysis with these sorts of numbers. The stronger the case, the more likely we will receive a fair assessment and equitable resolution from CMS.
Please follow up with your Program Director and CFO to make sure that the survey was received. As a backup, please go to the UHMS website (www.uhms.org) to download a copy. We need each facility to provide a quick turn on it and provide the necessary information no later than July 15, 2005. Submittal instructions will accompany the survey. Each of you can have a direct impact on our future by responding..........please make the time to do so.
Thank you for your attention to this most important effort.

Regards, Tom Workman"
W.T. Workman, MS, CAsP, CHT
Director, Quality Assurance & Regulatory Affairs
Undersea and Hyperbaric Medical Society Satellite Office
18111 Copper Ridge Drive
San Antonio, Texas 78259-3612
Tel: +1(210) 404-1553
Fax: +1(210) 404-1535

Sunday, June 26, 2005

Diving Medicine Update - 2005 -Great Lakes Chapter --- Undersea and Hyperbaric Medical Society


Discussions on:

Drugs and Diving
Computers and Technical Diving
Addictions in Diving
Hyperbaric Update
Saturday Oct. 22, 2005
Where Diving and Medicine Meet

We have outstanding speakers, interesting topics, our traditional Myths of Diving Panel and opportunities to make new friends in the diving and diving medical community. Lunch is provided, with refreshments after the meeting.

Who is this for?
Recreational and Tech Divers
Professional Divers
Dive Masters & Instructors
Diving & Hyperbaric Professionals
For info & to register
Check our website www.uhms-glc.ca
Contact Ron Nishi glc-r.nishi@sympatico.ca
0800 Register & Coffee
0830 to 1730 Symposium
Cost
$45.00 Cdn / $40.00 US before Oct. 7
$60.00 Cdn / $50.00 US after Oct. 7
Location
Again this year, we are in Burlington at the Canada Centre for Inland Waters.
Sponsors
Environmental Tectonics Corporation http://www.etcbiomedical.com/
Hyperbaric Medical Unit - Toronto General Hospital http://www.uhn.ca/programs/hyperbaric/
Ontario Underwater Council http://www.underwatercouncil.com/
Sechrist Industries http://www.sechristind.com/

DAN and International ATMO Offer Scholarships

The DAN America Recompression Chamber Assistance Program (RCAP) and International ATMO, a leader in hyperbaric medical education, have joined together to offer scholarships to send candidates to the International ATMO/Hyperbaric Safety Director Course in San Antonio, Texas.

The course scholarship is available to all staff members of remote chambers affected by RCAP; the course is held twice a year, the dates for the next class is Oct. 19-22.

To promote the appropriate education of recompression chamber personnel, DAN RCAP will provide at least two scholarships for attendance at the course. Assistance will be in the form of transportation, housing and subsistence. International ATMO, Inc. will provide the fee for course attendance.

This 30-hour program, which is offered at the Nix Medical Center in downtown San Antonio, is designed to provide necessary tools and resources to fulfill the responsibilities of the hyperbaric safety director as defined by the National Fire Protection Association (NFPA 99, Standard for Health Care Facilities). This course is appropriate for hyperbaric technologists, respiratory therapists, nurses and physicians. The curriculum includes classroom instruction and practical exercises.

The selection of a suitable candidate will be based on a number of requirements. For scholarship selection criteria and an application form, check the DAN website.

Through its Recompression Chamber Assistance Program, DAN assists recompression chambers in the DAN America region in areas of equipment, training and emergency assistance or helps those chambers maintain or reach levels DAN America believes appropriate. DAN also assists those chambers that may otherwise not be able to financially provide what is needed.

Founded in 1979 under the guidance of Dr. Jefferson C. Davis, International ATMO is one of the oldest continuous providers of hyperbaric medicine services. It has provided technical, nursing, and management services for comprehensive wound care programs at two hospital-based locations in San Antonio, Texas. Corporate President, Paul J. Sheffield, Ph.D., is an original founder of the organization.

MedEd Online

Dick Clarke writes and advises about a new web site, MedEd Online, that can be seen at the above web address. Presented at this time only as a skeleton prevue - it appears all encompassing and if done popperly, will be an excellent addition to diving and hyperbaric education.

Thursday, June 23, 2005

DAN Press Release - Second Annual “Dive Industry Bash” at DEMA!

BACK BY POPULAR DEMAND…the Second Annual “Dive Industry Bash” is coming to Las Vegas! Celebrate the end of the first day of the DEMA show by joining your fellow industry members at the Second Annual “Dive Industry Bash” on Tuesday, October 4 from 6 to 8 pm, courtesy of your friends at the Bahamas Diving Association, DAN, Dive Center Business Magazine, and NAUI. <>Enjoy food, fun, and some great door prizes - plus, the first 1,000 persons get two free drink tickets for beer or wine! Your DEMA badge gets you in the door. Present your business card at the door and get a chance to win great door prizes like dive trips, equipment and accessories generously donated courtesy of Abaco Dive Adventures, DAN, Dive Center Business Magazine, NAUI, The Islands of the Bahamas and many others.

Make sure to attend the Second Annual “Dive Industry Bash” on Tuesday, October 4 at the Las Vegas Hilton Hotel (Grand Ballrooms A & B on the ground floor). Visit the Bahamas Pavilion (#940 - 950 isle), Dive Center Business / Dive Training Magazines (booth #2835), DAN (booths #1539 & #1639) or NAUI (booth #1729) for more information. Remember, bring your DEMA badge and business cards - you must be present to win. Don’t miss the fun! We’ll see you in Vegas, baby!

Mark this date on your calendar.

Wednesday, June 22, 2005

Google Alert for scuba accidents

Google Alert for: scuba accident

UK scuba diver rushed to hospital after wreck diving accident
CDNN - New Zealand
CORNWALL, UK (20 June 2005) -- In yet another scuba diving accident at the wreck of the James Egan Layne, a scuba diver has been hospitalized with the bends. ...

SCUBA DIVER MISSING
Westerly Sun - Westerly,RI,USA
... According to Old Mystic Fire Department Chief Ken Richardson, Jr., the woman was scuba diving off of ... The incident is being treated as an accident, Stewart said ...

Unsafe at any Depth: PADI Scuba Diver
CDNN - New Zealand
... OW depth limits, so too PADI "Scuba Diver(s)" will be diving deeper, probably much deeper, than 12m/40ft. Not that it matters. Accident reports provide ...

Dutch police call off search for missing scuba diver
CDNN - New Zealand
... in the search for the 25-year-old male scuba diver. The diver was from Apeldoorn. No other details were available about the diver or the accident that caused ...

Hyperbaric Therapy Helps Patients Heal
KFMB - San Diego,CA,USA
... Now a device used by scuba divers is offering these patients some relief. ... this year, the 31-year-old was severely injured in a moto-cross accident, leaving him ...

Links to dive accident management on 'Scubadoc's Diving Medicine'
http://snipurl.com/fr48


Monday, June 20, 2005

Press release about a Scuba Diving Book

Here is an interesting press release about a Scuba Diving Book written and offered by Eric Douglas, the Director of Training at DAN.

Check out the website at www.booksbyeric.com
Press Release

New dive adventure novel published

Diving adventure, action and beautiful locations come together in the new novel by Eric Douglas called Cayman Cowboys.

Set around Grand Cayman, the story follows photographer Mike Scott as he notices a series of unusual occurrences including the unexplained death of a girl, a protest of a new development and the systematic destruction of coral reefs. It all comes together when armed men warn him away from a dive site.

Investigating, he witnesses a specially-equipped submarine destroying the reef. Before he is able to report the destruction to the authorities, he and his dive buddy, Kelly, are kidnapped – along with Kelly’s girlfriend, Tanya. Friends rescue Mike and Tanya, but the kidnapper gets away with Kelly, taking him to an underwater diving bell to die.

From there, it is a race against time to save Kelly and bring down the greedy developer putting his own wealth before the beauty of the island and the welfare of the people.

Eric Douglas began diving in 1990 and became a dive instructor in 1998. He is currently the Training Director for Divers Alert Network in Durham, North Carolina, an international dive safety association. His duties with DAN include developing new first aid programs for divers and teaching scuba diving instructor trainers to teach them. Before going to work for DAN, Eric worked for PADI/DSAT, and served as the Assistant Editor of The Undersea Journal. Trained as a journalist, he has written and photographed thousands of stories and has traveled the world with his cameras in hand.

For more information, excerpts from the story and purchasing information, visit the author’s website at www.booksbyeric.com.

New Web Site, MedEdOnline

Dick Clarke writes to inform us of a new web site, MedEdOnline.

scubadoc

DAN News Releases, June 20, 2005

DAN Launches Dive Emergency Hotline for Korea

DAN South East Asia-Pacific (SEAP) has launched a separate dedicated 24-Hour Diving Emergency Hotline to serve divers in Korea and nonEnglish-speaking Korean DAN Members. The number is (010) 4500-9113.

DAN SEAP has organized hyperbaric chambers and diving physicians throughout the Southeast Asia-Pacific region into a 24-hour dive emergency network similar to the DAN referral networks in the United States, Europe and elsewhere.

The main purpose of this line is to provide instant dive medical advice to injured divers within Korea. However, this service may be useful for Korean-speaking divers who are unable to communicate in English through the other available DAN hotlines. The doctors who will answer the telephones speak Korean and English.

The Coordinator of the Hotline in Korea is Dr. Young Choen Kang , who lives in Daegu, Korea. Dr. Kang will be supported by several other doctors who will provide assistance with answering hotline calls.

DAN America and DAN SEAP recently sponsored dive medical seminars in Korea to provide some ideas and support for the on-call doctors, as well as for other physicians in Korea who may receive dive-related calls.

Headed by DAN America, DAN public service dive safety organizations DAN SEAP, DAN Europe, DAN Japan and DAN Southern Africa operate a global network of dive safety and medical assistance services linking the world's hyperbaric chambers and diving physicians to provide 24-hour, seven-day-a-week expert consultation on the treatment and prevention of diving injuries.

All DAN organizations are nonprofit institutions dedicated to helping injured divers and improving safety through their emergency services, research and education programs.

For additional information on dive safety and dive medical issues, see www.danseap.org <http://www.danseap.org/> or www.diversalertnetworkorg <http://www.diversalertnetworkorg/> . You can also contact the DAN medical department at +1-919-684-2948, extension 222; via email at medic@diversalertnetwork.org; via fax +1-919-493-3040; or write DAN, Attn: HOTLINE, 6 West Colony Place, Durham, NC 27705, USA.

----------


David J. Doolette Ph.D. Takes Dual Paths; It’s All Research

David J. Doolette Ph.D., a researcher in diving physiology and hyperbaric medicine from Australia, has joined Duke University Medical Center as assistant research professor in the department of Anesthesiology. As such, he will be attached as a research physiologist to the U.S. Navy and the Navy Experimental Diving Unit (NEDU) in Panama City, Fla.

For a research scientist like Doolette, this arrangement allows him to step away from basic science to real-world applications of research into the nature of decompression sickness.

At NEDU he will work in the unit’s decompression research program, collecting dive profiles and using U.S. Navy field data. “This time we will use a mathematical model, from actual measures of data; our results will not be a theoretical guess,” he said. DAN will help the Navy to develop its field data collection program based on DAN’s experience with Project Dive Exploration.

Said Richard Vann, Ph.D., Vice President for DAN Research: “We at DAN look forward to working with Dr. Doolette on problems of common interest to both DAN and the Navy.”

In June of this year, he presented a paper to the Undersea and Hyperbaric Medical Society in which he discussed exchange of gases across tissues of the muscles and brain in sheep from his native Australia. Doolette said the physiology of sheep tissues is similar to that of humans, and such research applies to human tissues too.


Interestingly, his foray into the depths of decompression science began in the United States before he pursued his Ph.D. in Adelaide. “I came to the states in 1985 and worked for a dive shop in Washington, D.C.,” he said during an interview at DAN Headquarters. “I worked as a diving instructor and divemaster.


“Two friends and I went diving off Morehead City in North Carolina. One of my buddies got bent, but I didn’t. I thought, ‘Why only him?’ From then on, I was fascinated about the nature of decompression sickness.”


He returned to Australia, to his native Adelaide where he took a Ph.D. from the University of Adelaide. He studied hypoxia (subnormal levels of oxygen in blood and tissue), further advancing his interest in dive physiology. His first post-doctoral research brought him — front and center — into dive practices in the tuna industry. Such research into the real world of diving helped improve training and equipment in the Australian fishing industry.

Saturday, June 18, 2005

Ten Foot Stop Newsletter discontinued, June 18, 2005

For various reasons, we will no longer publish the Ten Foot Stop Newsletter.

Our mailing list will be maintained and used for notifications and important information about meetings, conferences and publication blurbs. We will also continue to use this blogspot for similar purposes.

Thanks to our many supporters.

scubadoc

Monday, June 13, 2005

Ten Foot Stop Newsletter, June 15, 2005

Table of Contents

Note from Scubadoc
Menstruation and DCS
TAPVR risks and diving

Hyperbaric Oxygenation
Delineating an appropriate and fair reimbursement rate for hyperbaric treatment.
UHMS Associates/BNA ASM pre-course
Medical Director Position available
Hyperbaric treatment of cerebral air embolism in an infant with cyanotic congenital heart disease.
Letter from Robert Sands re 'airbag chambers'

Mailbox Potpourri
Treatment for Sea Urchin Spines
Lawler Promoted to Director of Marketing at DAN
McTaggart Named DAN Marketing Services Manager
Sea Plane Flying after Diving

Scuba Clinic Questions
Should I be diving?
Contribution of Carbonated Beverages to DCI
Possible skin bend
Hypothesis on what is triggering my heart irregularities. +
Shoulder Impingement - Should I Dive?
1st dive ear trouble / bummed
Right ear blockage
? re relationship (incl time lag) : atr fib/flutter & di
Full face mask
Diving after Metatarsal surgery ?

Questions of the Week
CADISIL and Diving?
Equalizing, sea sickness, low back pain - Good advice form Dr. Quigley
Laparoscopic anti-reflux surgery, diving?
Red Tide and Diving?

Interesting Links
Dive Site Net
World Cave Database
Environmental Problems in Karst Lands
Elasmodiver
Fishes-Gulf of Maine
Monk Seals
Whale Shark ID Project
Association of Underwater Explorers
Shark Diver
Basking Shark Project
Pacific Shark Researh Center
ReefQuest Centre for Shark Research
Aliens of the Deep
NOAA-Office of Protected Resources
X-Ray Magazine
LIKE A FISH – REVOLUTIONARY UNDERWATER BREATHING SYSTEM
The effect of endoscopic sinus surgery on symptoms of eustachian tube dysfunction.
pulmonaryfunctiontesting.pdf
Patent foramen ovale in scuba divers. A report of two cases and a brief review of the literature.
Jumbo hyberbaric chamber to open in Seattle
Quality of Breathing Gases
Find Articles
EXERCISE-INDUCED INTRAPULMONARY SHUNTING OF VENOUS GAS EMBOLI DOES NOT OCCUR AFTER OPEN SEA DIVING.
Exercise ending 30 min pre-dive has no effect on bubble formation in the rat.
Evidence for increasing patency of the foramen ovale in divers.
Delayed treatment of bubble related illness in diving--review of standard protocol.
Consensus factors used by experts in the diagnosis of decompression illness.
Bubble incidence after staged decompression from 50 or 60 msw: effect of adding deep stops.
BSAC Lowers Minimum Diving Age for Branches
Red Tide Shuts Shellfish areas in New England
Dozens of Rescuers Cannot Save Man Stuck in a Culvert
Curbs, Not Ban, Imposed on Black Coral Harvest

Links to Meetings, Courses and Conferences
International Conference on Diving and Hyperbaric Medicine
DAN Offers New Training Program in Providing Oxygen
DAN and UHMS Sponsor Diving and Hyperbaric Medicine Course
2nd Heidelberg Symposium on Diving Medicine

Humor
Diving Medicine Online blogsite