Tuesday, February 28, 2006

Baptist Hospital Chamber in Pensacola Readies for Oriskany

Hospital trains for Oriskany diving injuries
Sean Smith@PensacolaNewsJournal.com

The soon-to-be-sunk aircraft carrier Oriskany is expected to become a prime divers' playground, but Pensacola hospitals and emergency officials are bracing for dive injuries. Baptist Hospital will be the only local facility with a hyperbaric chamber to treat civilian dive injuries. The chamber at Pensacola Naval Air Station is for military divers.

The Baptist chamber, currently used to treat wounds and other ailments, will be ready for dive injuries by April or May, Dr. Kelli Wells said. The treatment of dive injuries is a very involved process that requires enhanced training as well as 24-hour staff, she said. "What we're doing is increasing the level of training," she said. "We'll treat dive injuries as they occur, but my real desire is that we get information out there to prevent the injuries." Currently, emergency crews divert dive-injury patients to hospitals in Mobile and Panama City, which each see about a dozen dive-related injuries a year.

The 32,000-ton, 888-foot long Oriskany, to be sunk before June 1, is expected to rest at about 210 feet down, 22 miles southwest of Pensacola Pass. The superstructure will be at about 60 feet and the flight deck at about 130 feet -- the limit for recreational divers.

See remainder of article at http://snipurl.com/n1ge .

United Companies Brownie's Third Lung Experiences Increased Interest in Its Nitrox Maker(TM) System

Retrieved from "Market Wire"

FORT LAUDERDALE, FL -- (MARKET WIRE) -- 02/28/2006 -- United Companies Corporation Subsidiary Trebor Industries Inc. dba Brownie's Third Lung (OTC BB: UCPJ) is preparing to install another of its Nitrox Maker™ systems on a luxury yacht. In the last year, Brownie's has experienced increased interest in this onboard Nitrox generation unit as general knowledge about the advantages of diving Nitrox becomes more recognized worldwide. Divers who use Nitrox instead of standard compressed air experience many advantages including reduced post-dive fatigue and reduced risk of decompression sickness when diving conservatively.

Brownie's Nitrox Maker™ is a modular system, which aids in installation of the unit and makes it relatively easy to operate. To select a gas mixture, the operator simply uses the dials on the unit to choose the desired oxygen percentage for the final mix. The Nitrox Maker™ uses two independent oxygen analyzers to ensure the accuracy of the final mixture. The gas produced can either be used to fill scuba tanks directly or stored in a series of high-pressure tanks for future use. All of the components of the Nitrox Maker™ are encased in a King Starboard® cabinet that allows for easy installation and an attractive finish.

Brownie's custom designs each Nitrox Maker™ to accommodate personal diving needs and the vessel's available space. Many existing air compressor systems can be upgraded to include a Nitrox Maker™, offering the numerous benefits of diving Nitrox, without the need to invest in a new air compressor. Brownie's also offers a full line of air compressors systems that can be upgraded to include the Nitrox Maker™.

Brownie's designs, builds and installs diving solutions from floating recreational hookah diving systems to a full-line of state-of-the-art air compressors and mixed-gas blending stations. For more information on Brownie's Third Lung, please visit us online at www.browniedive.com and www.tankfill.com. Stock Symbol: (OTC BB: UCPJ).

Links to Nitrox on Scubadoc's Diving Medicine Online

Nitrox Diving
Basic information about nitrox diving. ... Recreational nitrox diving has in common with traditional compressed air diving the use of nearly all the same ...

Nitrox Links
I'm very interested in learning cave diving, nitrox (and other mixes) diving. ... Nitrox &&Technical diving in Coron More &&more divers are getting ...

Monday, February 27, 2006

Debate: The relative safety of forward and reverse diving profiles.

Scuba instructors and dive masters all over the world are in a quandary about the proper method to teach and do diving profiles - with conflicting recommendations by the Smithsonian Reverse Diving profile Workshop in 1999 and a recent study reported in the UHMS Journal, supporting forward diving profiles already found to be safe over many years.

We have provided the abstract of the new article by McInnes, Edmonds and Bennett reported in the Undersea and Hyperbaric Medical Journal, Nov/Dec 2005. In addition we have obtained material reflected in the references to the article that gives most of the salient features of the workshop. Finally, we have provided you with a critique of the workshop and article so that you may personally take part in the debate. This is a pragmatic debate, as it affects every dive operator in so far as the safety of the diver is concerned. I specifically ask that you read the comments of Dr. Simon Mitchell linked to the bottom of this article.

1 Department of Diving and Hyperbaric Medicine,Prince of Wales Hospital,Sydney,2 Consultant Diving Physician,3 University of NSW,Sydney,Australia
McInnes S,Edmonds C,Bennett M.The relative safety of forward and reverse diving profiles.Undersea Hyperb Med 2005;32(6):421427.

A recent workshop found that with nodecompression dives,“reversed dive profiles ”(RDP) did not increase the risk of decompression sickness (DCS).Thus in multilevel dives, the deeper part of a dive may be performed later in the dive,and repetitive dives may progress from shallow to deep.This contradicts the conventionally recommended forward dive profile (FDP) when the deeper dive, or deeper part of the dive,is performed first.The RDP Workshop recommendations were made despite the absence of adequate data. We performed two groups of experiments to test this hypothesis. We exposed two matched groups of 11 guinea pigs each to forward and reverse multilevel diving profiles to determine any substantial difference between FDPs and RDPs.There was no evidence of DCS in any of the FDP animals,while six (55%) of the RDP animals exhibited symptoms of severe DCS and died. This difference was statistically significant (P =0.01). We then compressed two groups each of 11 guinea pigs to repetitive dives to determine any substantial difference in the risk of DCS when two equivalent sets of three dives were conducted from the deepest to most shallow on the one hand (FDP),and from the shallowest to the deepest on the other (RDP). Over two such series of dives (the second extended in time and depth to increase DCS risk), there was a significantly higher incidence of severe DCS in those animals in the RDP group. Seven of 21 exposures (33%) in the RDP group resulted in severe DCS versus none in the FDP group (P =0.01). Our findings suggest that multilevel and repetitive dives performed in the established FDP manner are less hazardous than those performed in the reverse profile mode, at least for the exposures we chose. We believe the recommendations of the workshop should be reexamined.

1.Lang MA ,Lehner CE.Proceedings of theReverse Dive Profile Workshop 2930 October1999.Undersea and Hyperbaric Medical Society,


Workshop Sessions

In the first session, a discussion of the literature revealed that the prohibition against reverse profiles probably related less to safety issues than to “optimizing” bottom time over a series of dives. This comes from gas-loading considerations that allow more usable bottom time by making the deep dive first.

The next two sessions concentrated on physics, physiology, and modeling. Among the modeling approaches, bubble formation and growth models were prevalent. Although there was diversity among the bubble models, they tended to arrive at similar conclusions. For example, most call for lower allowable supersaturation gradients on the initial stops (deep stops) and shorter no-decompression limits than conventional dissolved gas models. The bubble models included David Yount’s varying permeability model (VPM), also known as the “tiny bubble” model; Bruce Wienke’s reduced-gradient bubble model (RGBM); the Duke University bubble-volume model; the DCIEM bubble evolution model based on Doppler scores; a gas-dynamics model by Valenie Flook based on Van Liew’s concepts; and Michael Gernhardt’s tissue bubble-dynamics model.

Hugh Van Liew argued that they need experimental validation to confirm the existence and role of micronuclei for bubble formation, including whether such gas nuclei can be “crushed” to the point of elimination or inactivation. Another presentation showed that, although the reverse dive profile may have a higher predicted incidence of decompression sickness (DCS), the differences were trivial for pairs of no-stop dives, and decompression using the U.S. Navy tables would be adequate. However, for dives involving decompression stops or for more than two dives in a row, these tables might not provide a reliable decompression. All of this pointed toward an urgent requirement for more information and, to this end, Alf Brubakk suggested an animal model that might at least show which profiles result in the most bubbles.

Another session included a discussion by several dive-computer manufacturers. Many older computers on the market use conventional dissolved-gas (Haldanian) algorithms that take into account only gas loading and supersaturation limits (M-values) and do not specifically consider the order in which dives are conducted. In these cases, the user manuals accompanying the computers may recommend against reverse dive profiles. Some of the latest dive computers incorporate algorithms based to varying degrees on bubble models. These computers have specific warning features or penalties for dive patterns associated with increased risk (bounce, yo-yo, repetitive dives with excessive pressure differentials, etc.).

Many horror stories have been associated with reverse profiles, the classic one being the instructor making a short, deep dive to release the anchor chain after a day of diving and getting severe DCS. Such situations are hard to interpret because the number of subjects is very small and buddy divers doing the same profile may be unaffected. Other data show that studies of 100 dives may be insufficient for statistical analysis, but one comment put this issue into perspective: “We are better off having that 100 dives than no observations at all.” Many participants reviewed data from the U.S. Navy, commercial diving records, decompression chambers, DAN records, and various recreational dive sources.

An argument can be made that the present lack of data proving whether reverse profiles are dangerous could be due, in part, to the arbitrary prohibition against such profiles for many years — in other words, not many of these dives have been done.

Although there were some problems with reverse dive profiles in isolated examples, the conclusion drawn from the analysis of actual diving data was that reverse profiles have not shown a higher risk for DCS than forward profiles. However, this holds most confidently when the differential pressure for the reverse profile is not too great — one cannot get big differentials without having significant depth. It appears that decompression tables, algorithms, and dive computers adequately handle the issue of reverse dive profiles.

Another observation is that this subject may be a matter of repetitive diving and, in general, this is handled differently across the many decompression algorithms.

The discussion turned to the participants to arrive at findings and conclusions, and the discussion got heated. Several people who work with bubble models had serious reservations about a “complete retraction” of warnings against reverse dive profiles since the bubble models suggest that you might get into trouble on an improperly planned or executed reverse dive profile. Many were concerned that divers, especially inexperienced sport divers, would get the wrong message about reverse profiles and think that it was okay to do them without any special consideration.

The bubble modelers obtained a couple of key concessions. Practical diving experience showed few problems with reverse profiles, but bubble models showed there could be. Thus, they adjusted some wording to make it clear that it was only in the diving experience that there had been few problems, not that there’s a lack of evidence that reverse profiles are or could have a higher DCS risk. The sentiment prevailed also that there should be a pressure differential limit, noting that most of the safely executed reverse profiles were in 40 fsw or less between the repetitive dives. Another point of agreement was that the sport diving limit of 130 fsw should apply to any relaxation of current prohibitions on reverse profile diving.

Findings and Conclusions

Neither the U.S. Navy nor the commercial sector has prohibited reverse dive profiles, and they are performed in recreational, scientific, commercial, and military diving. Since the prohibition of reverse dive profiles cannot be traced to any definite diving experience that shows an increased risk of DCS and no convincing evidence was presented that reverse dive profiles within the no-decompression limits lead to a measurable increase in the risk of DCS, the workshop participants found no reason to prohibit reverse dive profiles for no-decompression dives less than 130 fsw and depth differentials less than 40 fsw.


* Historically neither the U.S. Navy nor the commercial sector have prohibited reverse dive profiles.
* Reverse dive profiles are being performed in recreational, scientific, commercial, and military diving.
* The prohibition of reverse dive profiles by recreational training organizations cannot be traced to any definite diving experience that indicates and increased risk of DCS.
* No convincing evidence was presented that reverse dive profiles within the nodecompression limits lead to a measurable increase in the risk of DCS.

Conclusions: We find no reason for the diving communities to prohibit reverse dive profiles for nodecompression dives less than 40 msw (130 fsw) and depth differentials less than 12 msw (40 fsw).

2.Albano G.Principles and Observations on the
Physiology of the Scuba Diver .ONR Dept of Navy.

I was unable to find this reference.

3.Vik A,Jenssen BM,Eftedal O,Brubakk AO. Relationship between venous bubbles and haemodynamic responses after decompression in pigs.Undersea Hyperb Med 1993;20(3):233248.

We present a new pig model for studying relationships between venous gas bubbles and physiologic effects during and after decompression. Sixteen pigs were anesthetized to allow spontaneous breathing. Eight of them underwent a 30min exposure to 5 bar (500 kPa) followed by a rapid decompression to 1 bar (2 bar/min); the remaining eight served as controls. The pigs were monitored for intravascular bubbles using a transesophageal echocardiographic transducer, and bubble count in the twodimensional ultrasound image of the pulmonary artery was used as a measure of the number of venous gas bubbles. Effects on physiologic variables of the pulmonary and the systemic circulations were either measured or estimated. We detected venous bubbles in all pigs after decompression, but the interindividual variation was large. The time course of changes in the mean pulmonary artery pressure, in the pulmonary vascular resistance, in the arterial oxygen tension, and in the pulmonary shunt fraction followed the time course of the bubble count. In contrast, such a relationship to the number of venous gas bubbles was not found for the immediate increase in mean arterial pressure and for the changes in the other variables of the systemic circulation. We conclude that the number of venous gas bubbles, as evaluated by the bubble count in the ultrasound image of the pulmonary artery, is clearly related to changes in the variables of the pulmonary circulation in this pig model.


4.Boycott AE,Damant GCC,Haldane JS.The prevention of compressed air illness .J Hyg

5.Berghage,TE,David TD,and Dyson CV.Species differences in decompression.Undersea Biomed
Res 1979;6:113.

In an effort to bring together the diverse laboratoryanimal decompression studies, a literature review and statistical evaluation were undertaken. Although 22 different species that had been used in decompression studies were identified, systematic data were available for only 7 of these species: man, goat, dog, guineapig, rat, hamster, and mouse. Mathematical functions using physiological data on these seven species were developed to estimate 1) saturation time (the time for the body to equilibrate after an increase in hydrostatic pressure), and 2) nodecompression saturationexposure limits (the maximum saturationexposure pressure from which an abrupt return to 1 ATA can be tolerated). Data from man, rat, and mouse were used to develop physiological relationships for two additional decompression variables: change in pressurereduction limits associated with increased exposure pressure and time to onset of decompression symptoms. Finally, data on rats for two other decompression variables, gas elimination time and optimum decompression stop time, are discussed in the hope that this will stimulate additional animal laboratory research in other mammalians. The general functional relationships developed in this paper provide a preliminary and rough means for extrapolating among species the decompression results obtained during animal laboratory experiments.


6.Flynn,ET,and Lambertsen CJ.Calibration of inert gas exchange in the mouse.In:Proceedings of the
Fourth Symposium on Underwater Physiology , edited by Lambertsen CJ..New York:Academic, 1971,p.179191.

7.Hills B.Decompression Sickness,Volume 1 .1977.John Wiley and Sons.p.141.

8.Bert,P.La Pression Barométrique .Paris:Masson, 1878.Appendix I.[English translation by M.A.Hitchcock and F.A.Hitchcock ].Columbus, OH:College Book,1943.

9.Lillo RS Parker EC Evaluation of oxygen and pressure in the treatment of DCS in guinea pigs.
Undersea Hyperb Med .1998;25(1):5157.

These experiments examined whether increasing the partial pressure of oxygen (PO2), hydrostatic pressure, or both were responsible for the improvement in effectiveness of recompression treatment previously observed in guinea pigs with increasing depths of air. Unanesthetized male guinea pigs (600700 g) were subjected to 8.6 atm abs (871 kPa) air dives for 60 min and then decompressed at 1.82 atm (184 kPa)/min to the surface. Subsequently, animals usually displayed hypotension, cardiac arrhythmia, and tachypnea, indicative of a fatal bout (> 95% death rate) of decompression sickness (DCS). Animals that developed DCS were treated by recompressing to depths ranging from 2.5 to 11.6 atm abs (2531175 kPa), with 14, 28, 42, or 100% O2/balance N2. This design produced PO2's at treatment depth ranging from 0.4 to 3.6 atm abs (41365 kPa). Upon recompression, recovery of blood pressure, heart rate, and breathing rate generally occurred. The area under the breathing rate vs. time curve was used to examine the effectiveness of treatment over a period of 60 min. A dramatic improvement in recovery over time was observed with increasing recompression depth for all gas mixtures. Analysis indicated that the positive response to depth was related to increasing hydrostatic pressure, increasing PO2 had no statistically significant beneficial effect.


10.St Leger Dowse M,Gunby A,Moncad R,Fife C, Bryson P.A prospective Field study of reverse dive profiles in UK female recreational divers.South Pacific Underwater Medical Society Journal .2004; 34(4):183188.

Reverse dive profiles– Dr Phil Bryson quoted from the UKSDMC

Current understanding of decompression physiology suggests that diving the deepest dive first is safer. In the UK the principal recreational dive training organisations recommend deepest dive first but anecdotally divers do not follow this recommendation. In 2000 the Smithsonian Reverse Dives Profiles workshop concluded “We find no reason for the diving communities to prohibit reverse dive profiles for nodecompression dives less than 40msw and depth differentials less than 12msw. The primary question posed is whether reverse dive profiles (RDP) incur a higher risk of DCS than nonRDP dive profiles. In a review of the literature there was no convincing evidence to indicate that a repetitive dive must be shallower than the dive that precedes it. The exception was in a direct ascent from deep repetitive dives that have been shown to produce a high incidence of DCI. Scientific and diving medicine litera ture is not always consistent with current grass roots thinking and recommendations have grown from anecdotal data.

We observed the every day diving habits of female recreational divers and compared our data with the recommendations of the Smithsonian workshop. The divers were asked to keep diving diaries for three consecutive years but did not know the aims of the project and therefore made no changes to diving habits as a result. Volunteers were asked to record basic dive information including maximum depth, total dive time, and if a decompression stop was added. Symptoms and complications of diving were recorded as described in page 11. We categorised the multiple dive day data as follows: ·The 2nd dive is deeper than the first and the depth differential was more than 12m ·The 2nd dive is deeper than the 1st and is more than 40m ·The 2nd dive is deeper than the 1st, deeper than 40m, and the differential is more than 12m. We did not restrict the definition to nodecompression dives since there was insufficient granularity in the data to do this. We also looked at a further three categories substituting 30m for the 40m described above. 570 women divers returned diving records for up to three consecutive years. The basic characteristics are described in page 11. 532 (93%) women recorded 16,706 multiple dive days (36,487 dives). 479 (84%) women recorded 4,972 days (9,944 dives) with second dives of the day with reverse dive profiles. 36% of women logged 576 days with the 2nd dive deeper than 30m. A breakdown of the frequency of untreated selfassessed symptoms is shown in tables 1 and 2. Using the stricted interpretation only 29 (5%) of women recorded 41 RDP days (94 dives) outside of the workshop recommendations, which is only 0.2% of all multiple dive days. The relationship between RDP’s and maximum depth ever dived is shown in figure 1 and figure 2 shows the relationship with the total number of dives. Both correlate significantly (p=0.0013 and 0.0012 respectively). This study supports anecdotal observations that the practice of RDP’s in one form or another is taking place widely. Around 30% of multiple dive days within the study involved some combination of RDP although only between 0.2% and 1.5% of multiple dive days fall outside the recommenations of the Smithsonian Reverse Dive Profiles workshop. Symptom rates are higher (but not statistically) when analysing data outwith the recommendations.


11.Edmonds C,McInnes S,Bennett M.Reverse dive profiles.The making of a myth:South Pacific Underwater Medical Society Journal ,2005; 35(3):139143.

Background to the article (see above)
In 1999 the Smithsonian Institute held a workshop on RDPs which produced the following statement that many of you have heard of: "we find no reason for the diving communities to prohibit RDPs within the the no-decompression limits for dives less than 40 metres and with depth differentials less than 12 metres".

The authors in the above article have nicely critiqued the workshop findings and also presented some new data refuting the recommendations supporting RDP.

Some key points include:

1) All at the workshop agreed that there was an absence of hard data to make recommendations either way but then went on to make recommendations.

2) At the workshop, there was a disparity of opinion between those who favoured inert gas tissue models (felt that RDPs and forward dive profiles (FDPs) should be equal); and those who favoured bubble models (eg VPM and RGBM) who felt that RDPs would be less favourable for safe decompression. It was Bruce Wienke (RGBM) who suggeted the 40m and 12m caveats to the final recommendation. He didn't extend the concept to 3 or more dives or mutilevel dives.

3) There was some evidence of increased adverse outcomes with RDPs presented at the workshop (USN and Catalina Island) which was not brought out in the findings.

4) "The belief that FDPs were introduced only to obtain more bottom time is a myth that seems to have been developed at the workshop". The authors of this paper support the claim that the initial concept of avoiding RDPs (in the 1960's) was a safety issue.

5) The 40m depth and 12m differential is not clearly enough explained in the workshop findings, and that it can be manipulated in a number of ways to make deompression less effective. This was a recommendation put forward at the last minute without support and will most likely be forgotten.

6) Finally the authors present some new animal work they have performed which nicely shows a significantly worse outcome in their model using RDP.

There is an excellent discussion of this debate by Dr. Simon Mitchell at http://snipurl.com/mzx2.
He takes issue with Dr. Edmonds in the following quote: "However, the argument about reversing two profiles without adjusting either of them is to some extent an anachronistic throw-back to the days when all dives were planned with tables. It seems an academic exercise in the modern world of diving where virtually all dives are controlled by computers that derive adjusted no decompression algorithms in real time based on recent previous exposure. Almost by definition, computer users cannot perform true reverse profile dives. Another problem is that the reverse dive profile ban had reinvented itself over time as a total ban on any dive deeper than another during any single day of diving, regardless of any measures the diver was prepared to take to make the second deeper dive safe. Hence we were subjected to ridiculous practices like divers being banned from further diving just because a second dive was slightly deeper than the first, or worse, divers finding some deep hole to bounce down into on their first dive just to have "the number on their computer" which kept their depth options open for subsequent dives.

You can sum all this up by saying that divers want to do "reverse depth dives" with appropriate adjustment to the subsequent deeper dives to make them safe, NOT reverse profile dives in the strict sense."

It would be my personal (ESC) recommendation that "if it ain't broke - don't fix it". Forward diving profiles have a good track record. In addition, no decompression diving using computers would seem to be controlling, as stated by Simon Mitchell.

Let me know what you think!

Related links on our web site

Reduced Gradient Bubble Model
... except for repetitive and reverse profile diving maybe. 9) the RGBM bootstraps parameters to diving data (DCS rate) using maximum likelihood, ...

reverse profile exposures are tracked and impacted by critical phase volume reductions over appropriate time. scales. 7. Adaptation. Divers and caisson ...

[PDF] DiveMedTFS Newsletter, Dec. 30, 2001
... Page 13. DiveMedTFS Newsletter, Dec. 30, 2001 agencies for all divers to use in their dive profiles. One would need to balance the ...

[PDF] Ten Foot Stop Newsletter, July 31, 2004
... Ascents follow the same procedures as descents, in reverse. Our preferred dive profile follows multi-level diving outlines, with several minutes spent at 40 ...

For reverse profile diving, the gradient is restricted by the ratio (minimum value) of ... ambient pressure difference between reverse profile dives, ∆P, ...

An Advanced and Practical Course on the Physiology & Medicine of Professional Diving,

The Southern African Undersea and Hyperbaric Medical Association (SAUHMA) is proud to present the 2nd Bennett & Elliott’s Physiology and Medicine of Diving Course

Bennett & Elliott’s Physiology and Medicine of Diving

An Advanced and Practical Course on the Physiology & Medicine of Professional Diving,
Including Air, Mixed Gas & Saturation Procedures

12-19 August 2006

For any further information contact
Ms Antoinette Walters
Tel +27(0)12 335-1577
Fax +27(0)12 335-9994
B&E; P O Box 30880;
Wonderboom-Poort; 0033; SOUTH AFRICA

See the brochure at http://scuba-doc.com/Bennett & Elliott Brochure.pdf

Diving Medicine Courses in Thailand.

Here is a letter from Rowan Sanderson re Diving Medicine Courses in Thailand.

Dear Ernest,

I have attached below information about new diving medicine courses being
run by the Diving Disease Research Centre (DDRC from the UK) in Thailand.
This will be the second time these courses will be run over here.

Two courses will be on offer - Remote Emergency Medic, and a Basic
Hyperbaric Medicine CHT prerequisite course. Both courses are approved by
the NBDHMT and will be run in conjunction with the Royal Thai Navy and the
Badalveda Diving Medicine Network.

Hopefully you will be able to read this file. If you have any problems let
me know.



http://scuba-doc.com/Diving Medicine Course Schedule2006.pdf

Sunday, February 26, 2006

American College of Hyperbaric Medicine invitations

We received the following information from the UHMS and are transmitting it forward to anyone to whom it applies:

"On behalf of the American College of Hyperbaric Medicine, we would like to extend an invitation to the physicians in fellowship programs to attend (TUITION FREE) a satellite symposium of the DFCon Global Conference in Los Angeles, California entitled Expanding Your Wound Care Practice: Should You add Hyperbaric Therapy? March 22nd 2006. This is being provided in recognition of their commitment to the field of Hyperbaric Medicine.

A letter from the American College of Hyperbaric Medicine and the conference brochure are attached to this e-mail.

If you have any questions or concerns please feel free to contact me directly.


American College of Hyperbaric Medicine
Conference Coordinator
Ph# 414-385-8723
Fax# 414-385-8721
mverhage@hwca-inc.com "

Oxygen and Stroke, Benefit?

An interesting article about O2 and stroke

Oxygen Shows Promise as a Stroke Treatment - Forbes

This article touts the use of oxygen by mask as an early adjunct to treatment of stroke (not HBOT).

A recent Cochrane review is as follows:
"Little evidence that stroke patients benefit from hyperbaric oxygen therapy.

Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to the part of the brain affected by stroke and reduce the extent of irreversible damage. HBOT involves people breathing pure oxygen in a specially designed chamber (such as those used for deep sea divers with the bends). Our review found only three randomised trials with a limited number of participants. Too few patients have been studied to say whether or not HBOT decreases the chance of dying and only one trial suggested any improvement in the ability to do everyday tasks. Overall, there is currently little evidence to support the use of HBOT for stroke patients."

Tympanosclerosis and Diving?

Question re diving with tympanosclerosis.
Can someone with tympanosclerosis ( no tubes) dive. He has some white hardness. And slow to equalize. No problems or infection for years.

Ron Durheim instructor

Alaska Aquatics

We sent the query to our ENT consultant, Dr. Allen Dekelboum. Here is his answer:

Mr. Durheim:

You question was referred to me for comment.

Tympanosclerosis is scarring in the tympanic membrane (ear drum) as you noted. It is the end result of infections in the middle ear with possible rupture. Since the diver has not had problems with his ears for many years (how many years?), and no tubes were placed, it is generally of no consequence, as long as he can adequately and timely equalize his ears. The ear trouble in the past was due to obstruction of the Eustachian tubes, which, if it only incurred in childhood, has probably resolved. I would recommend that he be examined by an ear doctor who can also evaluate his ability to equalize with a valsalva tympanogram. If he is slow to equalize, he should take his time and not be intimidated by his diving buddies.

These comments are for information only and did not consist of an examination of the patient.

Allen M. Dekelboum, M.D.

Immersion Hypothermia and Near-drowning

Good Morning Dr. Campbell.

I am writing a nursing article and would very much like to quote/use part of your article: Immersion Hypothermia and Near-drowning . Is this acceptable to you?? Of course, I would reference your work. Thank you very much. Please let me know.

Best Regards, Ann Milroy

Nancy Ann Milroy RN,MSN,M Ed Director, Pediatric Services International Medical Center Cairo, Egypt

Hello Ann:

Certainly, you may use my article with appropriate credit. If it is translated into another language (such as Egyptian, for example), I will need a copy of the article translated back into English - due to the frequent changes in syntax that completely alter the meaning of a phrase. I would like to see the article, in any event.

Best regards;

Ernest Campbell, MD, FACS
Scubadoc's Diving Medicine Online


Dr. Campbell, thank you for your gracious (and timely) response. This article will be in English (my Arabic is quite basic). I would be happy to forward you a copy after publication. Best Regards, Ann

Nancy Ann Milroy RN,MSN,M Ed Director, Pediatric Services International Medical Center Cairo, Egypt


Great and good luck with the article.


Other resources about hypothermia
Another Look at Hypothermia, by Jolie Bookspan, PhD

Acclimatization to Cold Water, by Joile Bookspan, PhD

Saturday, February 25, 2006

UHMS Pressure, Jan/Feb 2006

Click the links and go to a PDF of the article in Pressure.

MESSAGE FROM OUR PRESIDENT .............................. 1
Lindell K. Weaver, MD writes about the removal of the UHMS library to Duke University; a new UHMS web site soon; the search for a new Executive Director; Annual Scientific Meeting at the Hilton, Disney World Resort, Orlando, Florida; the decision to summarize Board decisions and activities, and send the synopsis to all members by email; the arbitrary, poorly informed changes made by three statew BC-BS in payment schedules for HBOT.

DON’S PERSPECTIVES ................................................... 2
From Don Chandler, Executive Director, UHMS

QUALITY ASSURANCE CORNER ................................. 3
Tom Workman reveals that the 2006 Accreditation survey Schedule is filled!

ASSOCIATES NEWS ....................................................... 4
Kaye McClue, RRT, RCP, CHT Associates Chair www.uhmsassociates.org


Officer in Charge of the Institute of Naval Medicine................. 5

BOARD OF DIRECTORS SYNOPSIS.............................. 6






2006: Hilton, Walt World Disney Resort

Orlando, Florida

June 22-24

Breath-hold Diving Pre-Course: June 20-21

post-course: June 25


2007: Ritz-Carlton

June 14-16

pre-courses: June 13

post-course: June 17

Maui, Hawaii

Friday, February 24, 2006

Deeper Into Diving, Second Edition

John Lippmann, Executive Director and Director of Training DAN-SE Asia-Pacific has sent us a copy of the revised book, "Deeper Into Diving" - which I have been avidly reading for the past several weeks. It is an update of the previous book first published in 1990 but this one includes writing by Dr. Simon Mitchell, an active physician who is certified in diving and hyperbaric medicine by the Australian and New Zealand College of Anaesthetists. The book is delightfully written so as to appeal to the every day diver, the instructor and to the medical professional needing to delve deeper into a particular subject about the medical aspects of diving. For an excellent addition to your library for diving physiology and medicine, I heartily recommend that you look into getting this book.

The book is published by J.L. Publications, a Division of Submarine Publications,
P.O. Box 387,
Ashburton, Victoria 3147, Australia.
Tel/Fax:+61-3-9886 0200.
Email: jlpubs@bigpond.net.au
Website http://www.submarinerpublications.com

Wednesday, February 15, 2006

National Board of Diving and Hyperbaric Medical Technology

February 14, 2006

To all members and potential members,

The National Board of Diving and Hyperbaric Medical Technology (NBDHMT) recently made some changes to our website, www.nbdhmt.org, that I would like to bring to your attention. A potential Certified Hyperbaric Technologist (CHT), Certified Hyperbaric Registered Nurse (CHRN) or Diving Medical Technician (DMT) will now find “Resource Manuals” tailored specifically to helping them to achieve their certification/recertification available on that site. These manuals provide the requirements, guidelines, listing of approved courses and forms necessary to achieve certification and recertification. Those individuals seeking to obtain such information should “download” their particular manual from this site.

Thank you for assisting us in “spreading the word”.

Sincerely Yours,

Paul C. Baker, CHT
NBDHMT, President

Tuesday, February 14, 2006

UHMS Gulf Coast Chapter Meeting

Please Mark Your Calendars!

for the

UHMS Gulf Coast Chapter Meeting

Mobile, Alabama

November 2-4, 2006


Riverview Plaza Hotel

64 South Water St., Mobile, AL 36602

Tel: (251)438-4000, (866)749-6069
Mobile, Alabama


Abstracts Due Sep 15, 2006
Pre-Course Nov 1, 2006
CHT/CHRN Exam Nov 1, 2006
GCC Meetiing Nov 2-4, 2006
Banquet Nov 4, 2006

Room Rates
Riverview Plaza Hotel
Single/Double: $109 (+14% hotel tax)

Triple: $119 (+14% hotel tax)

Call for Papers & Registration Forms will go out soon!

Don't forget...GCC Members receive discounted meeting rates.

2006 Program Director

Stephen Rydzak, MD

UHMS GCC President-Elect


President - Helen Gelly, MD

Secretary - Suzanne Pack

Member-At-Large - Laura Josefsen, RN

To contact the UHMS Gulf Coast Chapter please call 210-614-3688 or email gcc@uhms.org

Monday, February 13, 2006

World shark attacks dipped in 2005, part of long-term trend

UF study: World shark attacks dipped in 2005, part of long-term trend
Filed under Research, Environment, Florida, Sciences on Monday, February 13, 2006.

George Burgess, director of the International Shark Attack File housed at UF’s Florida Museum of Natural History finds that assertive and even aggressive human behavior may explain why shark attacks worldwide dipped last year, continuing a five-year downward trend in close encounters with the oceanic predators. The total number of attacks reduced from 65 in 2004 to 58 in 2005 and fatalities from seven to four, findings noted by new University of Florida research. Although the cause may be due to better safety precautions and fewer sharks, it could also be because of in-your-face human responses to confrontations with the predators.

In 2000, the all-time high record year for attacks since statistics were kept, there were 78 shark attacks — 11 of them fatal. There also were simply fewer sharks to attack people, a result of a decline in populations caused by overfishing of the carnivorous creature, which generally is slow to reproduce.

Burgess says that “It appears that humans are doing a better job of avoiding being bitten, and on the rare occasion where they actually meet up with a shark, are doing the right thing to save their lives.” In one such case, a surfer bitten by a great white shark off the Oregon coast on Dec. 24 had the presence of mind to drive it away with a well-timed punch to the nose, he said. “That gentleman did precisely what he should do under those circumstances,” Burgess said. “A person who is under attack should act aggressively toward the shark."

Despite the worldwide decline, the number of attacks in the United States rose slightly, from 30 in 2004 to 38 in 2005. But that is still considerably lower than the recorded high of 52 in 2000, he said. The same pattern emerged in Florida, the U.S. shark attack capital, where the number of attacks increased from 12 to 18 but was still well below the 2000 record of 37, he said. The 2004 numbers were the lowest in more than a decade, however, and were probably due to Florida’s unusually active hurricane season, which kept people out of the water.

In addition to last year’s 38 U.S. attacks, Burgess tracked 10 in Australia, four in South Africa and one each in the Bahamas, St. Martin, Mexico, Fiji, Vanuatu and South Korea. Compared with previous years, the number of attacks in Australia was relatively high last year and in 2004, when there were 12, prompting some people to call for the installation of nets to barricade sharks from beaches, Burgess said. But the per capita rate of shark attacks has not risen over the past century, with apparent increases coinciding with a rise in population and Australia’s growing attraction to tourists in recent decades, he said.

The number of shark attacks at any particular time depends on a variety of factors, including oceanographic and meteorological conditions, abundance of prey items, and very important, the amount of time people spend in the water, he said. “We need to remember there have been huge changes in how humans use the water over the last 20 to 30 years,” Burgess said. “When our parents and grandparents went into the water, they maybe wiggled their toes, or if they were very daring, jumped in and swam. People of our generation are surfing, diving, sail boarding, scuba diving, skin diving and engaging in all kinds of activities.”

Of this year’s four fatalities, two were in Australia, one in the Indo-Pacific island of Vanuatu and one in the United States. The U.S. attack occurred June 25 along Florida’s Gulf Coast, when 14-year-old Jamie Daigle was attacked by a bull shark while swimming off Sandestin. It was the state’s first death from a shark attack in four years. Two days later, also in the Florida Panhandle, 16-year-old Craig Hutto lost his right leg to a shark while fishing in waist-deep water off Cape San Blas. Five of the state’s 18 shark attacks last year occurred along Florida’s Gulf Coast, which is a greater proportion to the Atlantic coast than previous years, Burgess said. “It’s unusual to have only 13 attacks on the state’s eastern coast,” he said.

Elsewhere in the United States, five attacks occurred in South Carolina, four each in Texas and Hawaii, three in California, two in North Carolina and one each in New Jersey and Oregon. Surfers were the most frequent victims, accounting for 29 incidents, followed by swimmers and waders, 20, and divers, four.


Cathy Keen, ckeen@ufl.edu, (352) 392-0186
George Burgess, gburgess@flmnh.ufl.edu, (352) 392-2360

References to Sharks on Diving Medicine Online

Management of Shark Attack Injuries


15th International Diving, Diving-Medicine Program, Socorro Islands, Mexico

February 10, 2006

To: Diving Enthusiasts

Subject: "Dive Away" Socorro Islands, Mexico
2006 Live Aboard Diving and
Diving Medicine Program
April 22-30, 2006


We cordially invite you to join us for our 15th International Diving, Diving-Medicine Program. This year the course is being held aboard a state of the
art live aboard diving vessel at the Socorro Islands and Isla Revillagigedos, off the coast of Mexico.

The Socorro Islands are a premier dive area in the same league as Palau, Cocos Islands, and the Galapagos. In fact, the islands are often times referred to as "The Galapagos of Mexico". The diving at Socorro Islands is famous for extraordinary
interactions with gentle giant manta rays, with which you can anticipate having numerous close encounters!

The medicine program and related travel expenses qualifies as a medical education expense with 24 hours category 1 CME credit reviewed and approved by the Undersea and Hyperbaric Medical Society. Our faculty is second to none with Jeff Bozanic, PhD author of Mastering Rebreathers, Michael B. Strauss, MD co-author of Diving Science, Alan Lewis, MD fellowship trained in Undersea and Hyperbaric Medicine, and Arian Nachat, MD contributor to the newest edition of Auerbach's Wilderness Medicine. In addition to a comprehensive diving medicine curriculum, special seminars will be given analyzing diving activities as seen in the entertainment media, Anarctic diving, and new developments in technology.

Our dive platform, the Nautilus Explorer, ranks with the top of the recreational diving fleet. The Nautilus Explorer is a ship custom designed for divers to the
highest possible level of comfort and safety. There are much too many details about the ships features and amenities to be covered in a brief email. Please visit
http://nautilusexplorer.com/default_content.html to take a visual tour of the ship and find lots more information.

For more information about this program, please open the attached brochure and registration form. If you would like a brochure and registration form mailed to
you, please call (562) 933-6950 or
e-mail: milles02@yahoo.com

We look forward to having you attend this very exciting program.

Best wishes and safe diving,

The "Dive Team"
Long Beach Memorial Medical Center
Long Beach, CA

Jeff Bozanic, PhD, Michael Strauss, MD, Alan Lewis, MD, Arian Nachat, MD,
Stuart Miller, MD

Highly Regarded London Hyperbaric Medicine Course

From Steve McKenna regarding the London Hyperbaric Medicine Course 6th March to 10th March 2006

HYPERBARIC MEDICINE - A Course for Health Care and Diving Professionals

This is held at

London Hyperbaric Medicine Ltd
Whipps Cross University Hospital
London E11 1NR

Telephone: (+44) 0208 539 1222

Fax: (+44) 0208 539 1333
Duty Supervisor: (+44) 07740 251635

Duty Doctor: (+44) 07736 898066

The objectives of the course are to provide educational experience in the fundamentals of Hyperbaric Medicine for Health professionals with an interest in the specialty. The course encompasses the British Hyperbaric Association Core Curriculum for hyperbaric facility staff and includes practical experience in chamber operation and attendant duties to achieve a multi-skilled approach. This course will include The British Hyperbaric Association (BHA) syllabus "The Training & Education of Hyperbaric Unit Personnel”. Our courses have been developed to cope with an increasing international demand for high quality education in a professional environment. This is an NBDHMT APPROVED COURSE (National Board of Diving and Hyperbaric Medicine Technology). London Hyperbaric Medicine working in partnership with the Whipps Cross University Hospital now offers a course for interested individuals from all over the world which is including

• Hyperbaric technical staff
• Doctors with an interest in diving medicine
• Military Hyperbaric Staff from other countries
• Hyperbaric nursing staff (including ICU nurses)
• Hyperbaric tunnelling and professional diving specialists

For further details look at our website at



6th March to 10th March 2006.

DAN News and Events

DAN Speaks to Insurance Issue
DAN ensures that all members with dive accident insurance are covered for recompression.

DAN Will Conduct Dive Safety Seminars at Shows
Join DAN staff in 2006 when they conduct dive safety workshops at two dive shows. The two shows are Our World Underwater, in Rosemont, Ill. Feb. 24-26 and Beneath the Sea 2006, in Secaucus, N.J., March 24-26.

DAN DMT Course Coming in March
Spots are still open for March DMT program There are a couple spots still available for the March Diver Medical Technologist course, offered by DAN and Duke University. Read on to find out more.

» Join DAN at Long Beach Scuba Show 2006
» DAN and WCC Offer Free Satellite Phone Rentals
» 56th Diving & Hyperbaric Medicine Course Set for April 2006
» DAN and Espacio Profundo Announce Partnership

Friday, February 10, 2006

From the UHMS - "A Few Important Things"

This is a letter from Don Chandler, Executive Director, UHMS.

To All--

In this issue of my occasional mass email to our members you will find information on the following important UHMS issues:

1. UHMS Response to the Blue Cross/Blue Shield Challenges.
2. Synopsis on Actions of the UHMS Board of Directors Meeting of 28 January.
3. Fitness to Dive Course Very Helpful to Those Who Take the Specialty Board Exam in Undersea & Hyperbaric Medicine.
4. U.S./Japan Panel on Diving Physiology, Diving Technology, and Aerospace Medicine Meeting Scheduled for Kauai, Hawaii.
5. Nominations for UHMS Officers
6. Nominations for UHMS Annual Awards.
7. Good news from New Orleans.
8. A Marine Expedition prior to the June 2007 40th Anniversary Meeting in Maui.

1. UHMS Response to the Blue Cross/Blue Shield Challenges. First, let me refer you to our website www.uhms.org for a complete rundown on what we are doing about the BC/BS issues. This will be a brief of that action. As many of you know, some of the state "Blues" organizations have again changed their minds about the conditions for which they will reimburse the cost of hyperbaric oxygen treatment (shades of the 80's! - or was it the 90's?). We first heard about such shenanigans in Idaho, then Hawaii, then....and on it went. Several state "Blues" organizations are jumping ship on some conditions and moving them to their "investigational" category. We have learned from one BC/BS representative (yes, UHMS representatives have met with some of the BC/BS representatives) who opined that the "Blues" are not necessarily opposed to hyperbaric medicine, but what they did was purely a business decision to cut costs somewhere and hyperbaric medicine just happened to be what was chosen. The UHMS was quick to react to this looming potential crisis by establishing a task force to gather information and develop a strong response to what the "Blues" are doing. Dr. Bob Warriner is Chair of the UHMS Task Force and he informs us that he expects to have enough information to approach the BC/BS national leaders with said response. HOWEVER, he and our Task Force members can't do everything alone...they need your help. If you read the complete explanation on what we are doing, you will see that we need you to fax every letter of denials for hyperbaric oxygen treatment based on non-coverage to Tom Workman at (210) 404-1535. Tom will tabulate them into the report that our Task Force will give to the BC/BS national leaders. ALSO, we need you to send Tom the name of your BC/BS associated insurance company medical director and his/her contact information. You help us and together we'll get this rather arbitrary BC/BS business decision reversed.

2. Synopsis on Actions of the UHMS Board of Directors Meeting of 28 January. The following synopsis represents the action of our latest Board of Directors meeting in Copper Mountain, Colorado:
The BOD recognizes the importance of recruitment and retention of new UHMS members. We will re-structure the Membership Committee with these goals as their imperative. We also outline some facets of membership that the home office will try to assist with regarding membership recruitment. If any members have ideas or energy to assist with recruiting new members, please let me know.
Stimulated by Mike Mueller, our President will assign a task force to look into training standards and assisting with identifying physicians and other hyperbaric medicine personnel for hyperbaric medicine.
The BNA has a robust membership of 187 members. In addition they now can offer CEUs for approved courses.
The Associate membership has grown by 9% in the last year.
The BNA and Associates are planning a pre-course at our next Annual Scientific Meeting dealing with the complex patient.
Bret Stolp President-elect reported that the applications for the Executive Director search closes June 1, 2006.
Please send nominations for UHMS Awards to Dr. Sanchez (cuau57@hotmail.com), copy to Don Chandler (execdir@uhms.org).
Please submit nominations for UHMS Officers to Bret Stolp (stolp002@mc.duke.org), copy to Don Chandler.
Ron Bangasser submitted a draft for Attachment B of our By-laws. This Attachment outlines criteria for Fellowship designation by the UHMS. The draft will be disseminated to interested members and we anticipate a vote to accept the Attachment at our next BOD meeting.
Bob Warriner plans to complete recommendations about whether the UHMS should have a Virtual v. Physical office by April 1, 2006. The Board will meet by teleconference to review Dr. Warriner’s recommendations.
We recognize the lack of an appropriate, FDA-approved intravenous infusion pump for hyperbaric medicine. The Associates are working on this issue and I have contacted administrators of various IV pump companies to stimulate interest in this regard. In addition, we will try to solve the JACHO issue of lack of back-flow protection of existing hyperbaric IV pumps.
3. Fitness to Dive Course Very Helpful to Those Who Take the Specialty Board Exam in Undersea & Hyperbaric Medicine. Recently, I have heard from several physicians who have attended our Fitness to Dive course and who have told me that taking the course helped them a lot when they took the ABPM Specialty Board exam in Undersea and Hyperbaric Medicine. One physician who did not pass the Board exam said that the Fitness to Dive course was nevertheless a great help. This is good news and I encourage all physicians in our fields of medicine to register for the course. We do two classes each year; one in the spring and one in the fall. Our next course is in Charleston, SC on March 16-19, and, yes, we do still have room for more. The 2006 fall course will be at the NOAA training center in Seattle, Washington on October 5-8. We have had nothing but outstanding reviews of those who have taken the course. We also invite Nurse Practitioners and EMT's to join us but we cannot certify them as we do physicians, albeit they do get attendance certificates to prove they were exposed to the course content. Go to our website www.uhms.org and sign up, you'll not be sorry!

4. U.S./Japan Panel on Diving Physiology, Diving Technology, and Aerospace Medicine Meeting Scheduled for Kauai, Hawaii. This U.S./Japan panel has been in existence for over a quarter century and has provided an excellent forum for presenting scientific papers and papers of general interest from Japan and the United States. It is a three day meeting and has historically been well attended with about an even split of Japanese and American attendees. Recent meetings have also included some presentations from persons who hail from other countries, which we welcome. Two years ago we expanded the topics of interest to include Aerospace Medicine and we are expecting several papers this year from that field of medicine in addition to the usual diving medicine topics. We have a meeting every two years, one in Japan and the next in the U.S. The next meeting is scheduled for October 19-21, 2006 at the Sheraton Resort on the beautiful, and very laid back, island of Kauai. We will post the registration form and other information on our website within a few days. I encourage you to plan on attending this interesting panel and to present a paper if you are so inclined. All we need to get things started is for you to send me an abstract at donchandler@uhms.org I will take this and add it to the others and will inform you by late summer whether your paper is accepted. We also welcome anyone who wants to just come and listen to others present their papers.

5. Nominations for UHMS Officers. There is still time to nominate one or more of our members for officer vacancies, but time is short. In order to comply with our Constitution and By-Laws, we must close the officer nominations by Friday, February 17th. In case you don't have a calendar in front of you, that's day six of next week. We do have at least one nominee for each of our vacancies, but it would be good to have more several choices for each position. See our website www.uhms.org for a nominating form.

6. Nominations for UHMS Annual Awards. We have several nominees for awards this year, but could take more. The award nominations will remain open until April 1, 2006. At that time I will send all the nominations to our Chair, Dr. Cuau Sanchez and we will meet in committee (via telephone) to vote on those we will recommend to our Board of Directors. Unless there are unplanned delays, we must have our selections made by May 1st and can then inform the interested parties of the outcome.

7. Good news from New Orleans. I saw Keith VanMeter at our Board of Directors meeting and was able to talk with him briefly before he was off to return to NO to continue his quest to get Charity Hospital re-opened. He told me that they were getting "very close" to getting Charity opened again and, in the meantime, they were continuing to provide medical services from tents that have been erected on the plaza just outside Charity. Great work Keith! We'll be pulling for you and let us know if we can be of help.

8. A Marine Expedition prior to the June 2007 40th Anniversary Meeting in Maui. Just recently I signed papers to engage the Agressor Fleet for a week-long live-aboard dive expedition out of Kona, Hawaii that will be from Saturday afternoon on June 2nd through Saturday, June 9th. From there, the divers who sign on for this trip of a lifetime will be within the "3 days before and 3 days after" rule for our annual meeting venue and will be able to travel direct to Maui and get the reduced room rate that we have negotiated for our annual meeting attendees. Dr. Richard Smerz, Medical Director at the Hyperbaric Treatment Center in Honolulu is our primary contact for this expedition and will be providing some professional level medical lectures during the week. We at the home office will be submitting a request to our Education Committee for CME approval...if our Education Committee approves the lectures for CME hours, each physician who goes with the expedition will not only have a week of unequalled diving, but will also take away some CME hours. There are only fourteen (14) bunks on the Kona Agressor II with ten two-bunk rooms and one four-bunk room. The cost for the two bunk rooms is $2,195 and the cost for the four-bunk room is $1,995. If you are interested in joining this happy crew, please telephone Dick Smerz at 808-587-3425 and reserve your spot. Dick will send you a packet of information and inform us here at the home office. We will send you a form which you will need to fill out and send back to us with the payment information. We would prefer getting the total amount up front, but we are willing to permit payments and can accept 1/2 down with two remaining payments, the first due on 1 September, 2006 and the second and last one due on 1 April 2007. This will permit us to make the payments we have agreed to make with the Agressor Fleet. I think these slots will fill up fast. We will arrange for a "wait list" just incase some who sign on must cancel out for one reason or another. Sign up now to guarantee a slot!

That's it for now. The best to all of you.


Thursday, February 09, 2006

Dr. Jolie Bookspan's Neck and Back Pain Sports Medicine has reopened

Neck and Back Pain Sports Medicine
has reopened after closing for 4 months for a family emergency.

I'm working on the backlog of emails. If you ordered The Ab Revolution third edition, it's on the way.

For class dates and registration, and books to stop pain and injury see the web site

Dr. Jolie Bookspan,
named "St Jude of the Joints" by Harvard Medical School clinicians

"Movie music is noise. It's even more painful than my sciatica." - Sir Thomas Beecham

NEW- The Ab Revolution 3rd edition
No More Crunches No More Back Pain

Third edition, completely reorganized and expanded. Easier to follow and use.
eBook 131 pages- size 4.7 megs - PDF format, full color photos. ISBN 0-9721214-1-2

Dr. Jolie Bookspan's Ab Revolution is a groundbreaking method to use abdominal and core muscles functionally for daily activity and back pain relief. Used by athletes, military, law enforcement, and top spine docs and rehab centers around the world.

To order, use
send $14.95 cover price to scientist@erols.com
No credit cards. PayPal balance or bank account only.
I will mail your eBook the same day I get PayPal verification.

Tuesday, February 07, 2006

Important Stuff from UHMS About Blue Cross-Blue Shield

Here is some interesting material sent out by the UHMS. BC-BS is apparently limiting the scope of insurance coverage for hyperbaric treatment - unilaterally and possibly arbitrarily.

As you might be aware, several of the regional BlueCross BlueShield affiliated insurance companies have responded to a change in the national coverage policy for use of hyperbaric oxygen treatment recommended by the BlueCross BlueShield Association. We do not know the full extent to which local BlueCross BlueShield companies have adopted these recommendations which are summarized below.

Those conditions moved to the investigational category include:

Radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis)
Refractory mycoses (mucormycosis, actinomycisis, canidiobolus coronato)
Cerebral edema
Chronic refractory osteomyelitis and acute osteomyelitis refractory to standard medical management
Acute peripheral arterial insufficiency
Necrotizing soft tissue infections
Carbon monoxide poisoning (see statement below)

This is the current (03.2005) nationally recommended coverage guidelines for adjunctive hyperbaric oxygen treatment…

Systemic hyperbaric oxygen pressurization may be considered medically necessary in the treatment of the following conditions:

1. non-healing diabetic wounds of the lower extremities in patients who meet the following 3 criteria:

a. Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;

b. Patient has a wound classified as Wagner grade 3 or higher*; and

c. Patient has no measurable signs of healing after 30 days of an adequate course of standard wound therapy.

2. acute traumatic ischemia;

3. decompression sickness;

4. gas embolism, acute;

5. cyanide poisoning, acute.

6. gas gangrene (i.e., clostridial myonecrosis);

7. profound anemia with exceptional blood loss: only when blood transfusion is impossible or must be delayed;

* The Wagner classification system of wounds is defined as follows: grade 0 = no open lesion; grade 1 = superficial ulcer without penetration to deeper layers; grade 2 = ulcer penetrates to tendon, bone, or joint; grade 3 = lesion has penetrated deeper than grade 2 and there is abscess, osteomyelitis, pyarthrosis, plantar space abscess, or infection of the tendon and tendon sheaths; grade 4 = wet or dry gangrene in the toes or forefoot; grade 5 = gangrene involves the whole foot or such a percentage that no local procedures are possible and amputation (at least at the below the knee level) is indicated.

Hyperbaric oxygen pressurization is considered investigational in the treatment of acute carbon monoxide poisoning. Note: While evidence for the treatment of acute carbon monoxide poisoning with hyperbaric oxygen pressurization has failed to demonstrate improved health outcomes, this technology is accepted in medical practice as a standard medical therapy for the treatment of carbon monoxide poisoning.


Hyperbaric oxygen pressurization is considered investigational in the treatment of the following conditions:

compromised skin grafts or flaps;
chronic refractory osteomyelitis and acute osteomyelitis, refractory to standard medical management;
necrotizing soft-tissue infections;
acute thermal burns;
spinal cord injury;
traumatic brain injury;
severe or refractory Crohn’s disease;
brown recluse spider bites;
bone grafts;
carbon tetrachloride poisoning, acute;
cerebrovascular accident, acute (thrombotic or embolic);
fracture healing;
hydrogen sulfide poisoning;
intra-abdominal and intracranial abscesses;
lepromatous leprosy;
Pseudomembranous colitis (antimicrobial agent-induced colitis);
radiation myelitis, cystitis enteritis, or proctitis;
sickle cell crisis and/or hematuria;
demyelinating diseases, e.g., multiple sclerosis, amyotrophic lateral sclerosis;
retinal artery insufficiency, acute;
retinopathy, adjunct to scleral buckling procedures in patients with sickle cell peripheral retinopathy and retinal detachment;
pyoderma gangrenosum
acute arterial peripheral insufficiency
acute coronary syndromes and as an adjunct to percutaneous coronary interventions
acute ischemic stroke
idiopathic sudden sensorineural hearing loss
radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis);
refractory mycoses: mucormycosis, actinomycosis, canidiobolus coronato;
cerebral edema, acute;
in vitro fertilization; and
cerebral palsy.


The UHMS is taking the following actions regarding this critical issue:

We need to understand the extent of the problem. Since commercial insurance companies are not required to make their internal medical policies public, the only way we will know the extent of the problem is to have our member physicians report to us any notices of policy changes under consideration or actual denials for hyperbaric oxygen treatment based on non-coverage. To do that, we are requesting that you fax any BlueCross BlueShield communication (claim denial letter, etc., after removing patient specific identifying information) to Tom Workman, Director, Quality Assurance & Regulatory Affairs, at 1-210-404-1535. We will tabulate this information to give us a better idea of the scope of this problem. Also, your communication with Tom will help us identify member physician contacts to assist the Society in meeting with individual BlueCross BlueShield medical directors. Please also provide for us the name of your BlueCross BlueShield associated insurance company medical director and his contact information.

The Society will provide you over the next few weeks (on request) a sample letter for each of the primary denied coverage indications summarizing the critical clinical information supporting the use of hyperbaric oxygen treatment and a brief bibliography of pertinent references with commentary if needed.

We will also be providing you with a process outline to follow in submitting your appeal and in working with the UHMS to assist you with additional information as needed.

On the national level, the UHMS is in the process of developing a detailed response to BlueCross BlueShield to be presented at the national and regional level.
The Society will keep you informed of our actions and the responses provided by various BlueCross BlueShield affiliated companies as well as the availability of the resources mentioned above. Watch the UHMS website (www.uhms.org) or your email for these updates.

* Note from scubadoc: If a treatment modality is limited to conditions where there is definite proof of efficacy in humans - how can studies ever be done that show double blinded benefit for "investigational conditions"?

Below are some related web pages on our Diving Medicine Online web site:

1. Hyperbaric Oxygen Treatment, Abstract and Full Text of JAMA Article
diving and undersea medicine for the non-medical diver, the non-diving ... Diving Medicine Online Hyperbaric Oxygen Therapy (JAMA Article) Hyperbaric Oxygen Therapy from "JAMA" "The

2. Links to HBO Therapy
diving and undersea medicine for the non-medical diver, the non ... in ambulatory care for those suffering from wounds. Our ... quality books on hyperbaric medicine, diving medicine and wound

3. HBO...Indications, contraindications, links references
and undersea medicine for the non-medical diver, the ... Diving Medicine Online Hyperbaric Oxygenation HBO Indications AMA Article on HBO ... Chambers HBO for Sudden Deafness? Disclaimer

4. Contra-indications to HBO
the use of hyperbaric oxygenation. HOME HBO HERE Scubadoc's Diving ... and undersea medicine for the non-medical diver, the ... as chemotherapeutic agents for cancer. HBO and doxorubicin

Monday, February 06, 2006

State Department Information Sheet Warns of Mexican Dive Equipment Rentals and "certifications"!

Sandwiched in an extensive write up about US residents traveling in Mexico is the following excerpt:

"Sports and aquatic equipment that you rent may not meet U.S. safety standards nor be covered by any accident insurance. Scuba diving equipment may be substandard or defective due to frequent use. Inexperienced scuba divers in particular should beware of dive shops that promise to "certify" you after a few hours' instruction."

Related web pages on Scubadoc's Diving Medicine Online:
Disease Transmission Using Scuba Gear
There are many transmissable diseases that have the capability of being passed on to another through the use of unclean equipment. These conditions are caused by viruses, bacteria and fungi - some short-lived on inanimate objects, and some lurking and living in the moist confines of the crevices and tubes of unwashed scuba gear.....

CHT and CHRN Certification Exam Review Course

Saturday, March 11, 2006
Nix Medical Center, San Antonio, Texas

This activity is an 8-hour program. The goal of the CER Course is to help participants identify their own areas of strength and weakness in test preparation. In addition to covering all topics on the CHT/CHRN exam, test taking skills and strategies are included in the CER Course.

Click here for Brochure and Registration

Hotel Space is Limited

Contact International ATMO Education Department


For More Courses in Wound Care& Hyperbaric Medicine

Go To


Friday, February 03, 2006

Case report with medical considerations for child and adolescent scuba divers.

An adolescent scuba diver with 2 episodes of diving-related injuries requiring hyperbaric oxygen recompression therapy: a case report with medical considerations for child and adolescent scuba divers.

Tsung JW, Chou KJ, Martinez C, Tyrrell J, Touger M.
Pediatr Emerg Care. 2005 Oct;21(10):681-6.

Division of Pediatric Emergency Medicine, Department of Pediatrics, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. james.tsung@med.nyu.edu

Worldwide, more than 1000 scuba (self-contained underwater breathing apparatus) diving injuries per year requiring hyperbaric recompression are documented. Approximately 80 to 90 fatalities per year are reported in North America. On average, there were 16 diving injuries requiring hyperbaric recompression therapy in scuba divers aged 19 years and younger in North America between 1988 and 2002. The youngest injured diver was 11 years old, and the youngest fatality was 14 years old during this time period. In the year 2000, certifying recreational scuba diving organizations lowered the minimum age to 8 from age 12 years for participation in the sport. We report a case of a highly trained adolescent scuba diver who, despite having advanced diving certifications, had 2 separate episodes of diving-related injuries requiring hyperbaric recompression therapy. A discussion of medical considerations in the care of the child and adolescent scuba diver is included.

See more about children divers at http://scuba-doc.com/teens.htm

Prospective study of Chironex fleckeri

Prospective study of Chironex fleckeri and other box jellyfish stings in
the “Top End” of Australia’s Northern Territory

Click Title for full article


To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri.

Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10 950 km of coastline; analysis of tidal, weather and seasonal data.

All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004.
Main outcome measures:

Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings.

Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37% of C. fleckeri stings were in children, 92% occurred during the “stinger season” (1 October to 1 June), 83% occurred in water 1 m or less deep, and 17% occured while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month’s average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30% required parenteral narcotics and 8% required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom.

Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.

New Clinic Treats Old Wounds

New Clinic Treats Old Wounds
from the Muncie Star-Press

New clinic focuses on old wounds



The wound healing center, which opened mid-January, is a stand-alone department of Ball Memorial Hospital and its main goal is to "take care of the wounds that are expected to heal, but they don't," said Judy Mansker, the center's program director.

Care for chronic wounds is time-consuming and sometimes requires advanced dressings that might not be available in non-specialty offices.

At the new center, "everything's right here and It's just more efficient," said Alex Cocco, the medical director of the center, including staff of specialty and general surgeons, a podiatrist, and trained nurses that attend the patients' needs.

Chronic wounds, which persist for more than 30 days or fail to improve with multiple treatments, result from various conditions such blood flow problems, poor diet, obesity and smoking.

Diabetes and poor circulation in lower legs contributed to Earl Bolton's persisting wound.

Chronic wounds also tend to be more common in the elderly, according to Cocco. Many of his patients are above 75 years of age, and with the area's aging population, it was only logical to designate a center that would address chronic wounds.

At the new center, patients are seen every week until the wound is 50 percent healed, and then their schedule becomes more widely spread.

This is in accordance with the guidelines from the National Healing, a comprehensive wound management service, which has developed clinical pathways and treatment protocols based on medicine, experience, research.

BMH has spent $125,000 to remodel the 27,000-square-foot building along West Jackson Street, which was a Marsh grocery store until the late 1990s. Only a portion of the building is occupied by the wound healing center.

The center also houses two hyperbaric oxygen chambers, which will be used as a special treatment for a small percentage of chronic wound patients.

Thursday, February 02, 2006

Wheelchair-bound Scuba Instructor

From The Scotsman.com news


Fraser Bathgate, of Lochend Road, has been paralysed for the last 23 years

It was a fall from a climbing wall when his safety rope was unclipped that left Fraser paralysed from the waist down. A climbing instructor in London at the time, he crashed 25ft on to a concrete floor, damaging his spine so badly he would never walk again. But the 43-year-old's disability hasn't prevented him from becoming the world's first ever wheelchair-bound fully qualified scuba diving instructor.

"Underwater you have 360 degree movement," he says.

"So I've been able to develop and refine techniques that let me use my hands for more movement rather than my legs. I'm also working with companies who have developed special propulsion mechanisms which I'm hoping to use when I train other people." The turning point in Fraser's life came when he went to Dubai in 1992. The former James Gillespie's pupil was encouraged to try scuba diving - and he found the weightlessness underwater gave him mobility.

Since becoming an instructor in 1994, Fraser has mainly been teaching other physically and mentally disabled people to dive and adds that it helps them to realise that they are not limited by their disabilities. "Diving gives people a whole new lease of life and it's amazing to see how people's confidence rockets when they realise they can do it.

"When I first started diving, it was mind-blowing because I found that I could do everything everyone else could do underwater and it suddenly gave me so much freedom that I didn't think I'd ever have again.

"I see exactly the same thing when I'm instructing. The benefits from both a physical and mental standpoint are just so huge. I still get a few people who can't believe that I could be a diving instructor, though. They see the wheelchair and just go 'you're what?' when I tell them.

"But it shows that you don't have to be held back by having a disability. I'm doing it for other disabled people now to try and show them that it's possible for them to do it too."

See also Disabled Diving at http://scuba-doc.com/divdis.htm