scubadoc Ten Foot Stop

June 27, 2009

Problems With Moving Water

Filed under: Article — admin @ 10:47 am
Problems With Moving Water

Avoid this Disaster

Accidents caused by divers being carried away by currents have been reported since the early days of diving in the 1950’s. Most of us have heard about the horror story of the five Japanese divers, who came up after a very beautiful and enjoyable current dive off Peleliu, only to find that they had not only missed their boat but had missed the end of the island. All of these divers died after a prolonged float in what must have been a strong current. The current was not at fault, however, but poorly qualified dive operators and faulty equipment, an uncertified diving guide, a small faulty single engine vessel without a radio and novice divers -all pointed toward this disaster. See Guidelines for the Abandoned Diver

Diving in currents is easily one of the most enjoyable - but can be one of the most dangerous dives that a diver encounters. It is a low energy high speed trip that allows you to see much more of the rapidly passing reef. The flip side of this is that you miss a lot of small life, and the hazards of loss of control and any efforts to work against the currents are high energy and stress producing. Recognizing that a problem exists is the first thing a diver has to face. Divemasters usually are on top of the problem and brief you appropriately.

Signs of A Current

Each diver can detect signs of current, such as:

1). fast moving surface water;

2). which way the boat is facing (depending on whichever is the stronger, the current or the wind);

3). movement of floating material on the water or in the water;

4). movement of divers away from the boat rapidly on entry;

5). bubbles moving away from a diver at an angle underwater;

6). if the plant life and soft coral underwater are laying down.

The contour of the ocean bottom will change currents, often dramatically. A diver can adjust his speed by moving to the bottom, slowing behind coral heads and outcroppings or holding on to permanent objects, all the time presenting the smallest frontal surface area to the current. Because of a “boundary layer” condition, water molecules that are closest to a surface move the slowest due to their nearness to the surface. Other areas of calmness are areas behind obstacles and the sides of walls. Getting close to the bottom and using your finger or dive knife to stabilize you is usually all you need to hold your position.

As the diver moves through the water column he encounters resistance-and this increases by the square of the velocity of the current as it passes over the body. As a diver works against the current along the bottom, a good indication of the amount of work being performed is by monitoring the respiratory rate, this rising exponentially as exertion increases. “Bottom crawling” is a technique that may have to be used when the swimming exertion level rises. This is easily done in rocky areas but can be a real challenge in sandy bottoms-where a good dive knife comes in handy as an anchor.

If conditions exist so that exertion levels continue to rise, it’s better to surface, inflate and wait. Here is where a safety sausage comes in handy. This is an inflatable, long red plastic tube that juts above the water 6-7 ‘ and can be easily seen as much as a half a mile or more. Shining a flashlight in the bottom of the sausage at night provides a long red light that can be seen at a great distance.

Surface floats are other techniques used in diving in currents. A line attached to a float and to a diver give two advantages; the dive group is marked for the boat operator and any tired or nervous divers can hang onto the line and rest. When drifting free without a line, the boat operator relies on visualizing the diver’s bubbles for location; a surface chop can make it difficult for the boat operator to see the divers bubbles,

Strong currents can rip away a mask or snorkel when turning sideways or looking up. Snorkels do better stored in the BC or under a leg strap underwater so as to reduce drag on the mask. Place a little extra tension on mask straps if strong currents are expected.

The dive group should have a clear understanding of exiting and entering the water in conditions of current. Divers should try to let the current work for them by initiating dives into the current on the first part of the dive and planning the return with the current. Float lines are essential for an orderly entry for the divers to hold position for descent and ascent, otherwise divers will be strung out too far apart for a safe dive. Entries should be timed so that there will be no stragglers and the descent be made under control. Exits are also planned so that the float line can be used to pull against the current rather than having to swim against it.

Currents are usually generated by wind and tides or a combination of the two. Predicting what you will encounter generally depends on using information from the local weather service combined with tide information from local dive operators. In certain areas, such as “The Great White Wall” in Fiji and “Blue Corner” in Palau, the currents are almost always due to tidal action and are fairly predictable. One should always go with local experience in making decisions regarding diving into currents.


Underwater motions occur in areas where swells are forced against a barrier of some sort, such as a beach, wall, rock, or wreck. A surge is a to-and-fro action complicated by indentations such as caves, rocks or large holes in wrecks. Surges can be used to aid in your movement, carrying you forward in one direction where you can stabilize yourself as the surge retreats, and move forward again with the next surge. They are also dangerous since they create huge forces that can carry you into places that you don’t want to go. Divers should remain distant from diver-size holes in wrecks and caves and learn to use surges as a method of aid in movement, either upward to get back into the boat or to move onto a ledge.


Wrecks create special problems with currents. Frequently the boat will anchor on the wreck, playing out enough scope so that divers can easily descend on the line. A tag line is helpful placed between the anchor line and the stern of the boat, facilitating the descent from the dive platform. Divers who lose contact with the line run the risk of being swept away from the wreck and the diveboat, sometimes requiring rescue after coming up predictably exhausted from fighting the current.

Adapted from Glen Egstrom, Ph.D.
Medical Seminars, Inc

Diving In Polluted Waters

Filed under: Article — admin @ 10:46 am
Diving in Polluted Waters

The Problem
Over the past ten to fifteen years the diving population has become sensitized to the potentially hazardous presence of pollution in the sea.  The ocean has been a traditional dumping ground for many types and degrees of pollutants.  Several years ago a Los Angeles Times article indicated that 2000 U.S. beaches were closed due to sewage spills.(1993).  California, as usual a leader, had 745 closures with 588 occurring in Southern California.  Consistent and regular monitoring would have probably  fond many more contaminated beaches needing closure.  There is a definite lack of any standardized program for monitoring our waterways; particular areas of concern are harbors and similar areas which do not “flush” well, rivers, especially those with high levels of industry on the shores, sewage outfalls which go out to sea but are often overloaded and areas which have the deposits of soft, silty materials dropped as the currents reduce their velocities in dispersal areas.  It has been estimated that there are on the order of 15,000 chemical spills that enter our water areas each year in the U.S. alone.  The contaminated areas are growing and now include many recreational diving areas as well as scientific study sites and search and rescue operations.

The health consequences of the water pollution have not been quantified by careful study but many local health professionals are concerned with infectious and carcinogenic disease potential for patients who are ocean swimmers, lifeguards and divers. Until adequate epidemiologic data is available the recourse would appear to be logically focused upon conservative practices in selecting dive sites and conditions.

This increase in areas of pollution is a worldwide problem and has affected many diving operations. Diving in polluted water requires that certain precautions be taken, and, in some instances, the use of sophisticated equipment and procedures.  Avoiding diving in areas with high potential for pollution, particularly after heavy rains is fundamental in urban or industrialized areas.

The main problem centers around the fact that bacterial, viral and chemical hazards can affect the human body by skin contact and entry through orifices.   The following list was produced in the NOAA Manual and the details were obtained from the medical literature.

Vibrio - 34 species of this family of bacteria are known and cholera and El Tor vibriones are among those known to be pathogenic to man.  Cholera vibriones have recently been found in Santa Monica Bay in California and have raised concerns although it is not known to have produced any disease. Other vibriones may be anaerobic and produce disease states such as purulent otitis, mastoiditis, and pulmonary gangrene.  V. Proteus found in human fecal material is a common cause of diarrheal disease.  V. Vulnificus is found in sea water.

Escherichia - found widely in nature, occasionally pathogenic to man, produces carotenoid pigments and can often be recognized by the orangish pus.  E. Coli,. which has some pathogenic strains is often found in fecal material: and can produce urinary tract infection and epidemic diarrheal disease.

Shigella - produces dysentery

Salmonella - 1000 serotypes, ingestion can produce gastroenteritis including food poisoning, typhoid and paratyphoid.

Klebsiella - can produce pneumonia, rhinitis, respiratory infection.

Legionella- causes Legionnaires disease and Potomac fever.  Perhaps inhibited in salt water.

Actinomycetes - causes a “ray fungus” actinomycosis, an infectious disease in man which inflames lymph nodes, develops abscesses, can drain into the mouth causing damage to the peritoneum, liver and lungs.

Pseudomonas- pathogenic to man, “blue pus” formed by some pseudomonas infections. This can lead to a wide variety of infections including wound sepsis, endocarditis, pneumonia and meningitis. It is known to flourish in dark, warm, damp places, i.e., inside hoses, bladder compartments and similar places that are not cleansed after being infiltrated by contaminants.

Viruses - infectious agents which can result in fevers (frequently severe), mononucleosis, and a wide range of disease states.

Parasites - many types with all manner of effects, all bad, can are found in polluted water.

Chemicals -  There are over 15,000 chemical spills in the U.S. waterways each year and many of these are releasing chemicals that are incompatible with man and the equipment that is worn.

As detailed information becomes available on this issue divers will become sensitized to the need for preventive measures before, during and after diving.  At present the scientific and public safety diving communities are developing techniques for isolating the diver from the potential problems and decontaminating all exposed elements of the diving equipment.  It appears eminent that the recreational community will feel the need to exert greater care in the future.

It is becoming increasingly important to develop an understanding of the variations in the local conditions to which individuals expose themselves.  Some areas become particularly hazardous following heavy rains, hot weather and windstorms.  Local health authorities can usually be called for advice regarding any tests that have been performed and the results.  They should also be able to identify areas of high concentrations of pollutants that should be avoided.

When diving in areas where pollution is suspected or expected the following issues are worthy of evaluation.

1. The individual diver should consider the need for appropriate vaccinations and inoculations.  Many of the diseases can be avoided if the individual has taken the appropriate “shots”.  A few that appear worthy of consideration:
Hepatitis A and B
Typhoid, Smallpox and Diphtheria

2. Pollution and filth are often associated. If the water contains obvious trash and garbage it is quite probably an unhealthful diving environment and another location should be selected.  If the water looks nasty it probably is nasty!!

3. Many diseases have an incubation period before they exhibit symptoms.  Medical advice is as close as the phone and early diagnosis and treatment can sometimes be improved if the Doctor understands that an individual may.have been submerged in polluted water.

4. Information on chemical spills can be obtained from the Chemical Transportation Emergency Center (1 800 424 9300 US).

5. “When in doubt- Check about”

A basic procedure if one feels they must dive in high risk water involves reducing the exposure of the diver.  NOAA has pioneered a sophisticated SOS (suit over suit) system that will virtually isolate the diver from any contact with the water.  This system is somewhat complex inasmuch as it requires complete system integrity from the times the diver dresses out until the system has been decontaminated following the dive.  Strict procedures are followed to ensure that the divers body does not contact the fluid in which it is immersed.

Previously, many public safety divers wore a  single dry suit and a full face mask during their dives. However, Stephen Barsky now states that Full-face masks only provide minimal protection and should only be used in environments where the pollutants are known, and do not pose a threat of death or permanent disability. In environments where the pollutants are not known, or where they lead to death or permanent disability, a helmet should be worn connected to a mating dry suit with mating dry gloves. This is considered the standard today.” (See Reference below)

If good seals are involved and the diver is effectively rinsed, scrubbed down and rinsed again prior to breaking any existing seals, the probability of exposure to the pollutants can be minimized.  Special care must be taken to clear hoses and fittings that interface with the life support system.  A failure to rinse bladders and hoses which may later be linked to the divers mouth or lungs could provide a path to the host days after the dive.  The use of snorkels, alternate air sources, oral inflation devices and hose connections should all be given careful attention since the can carry contaminants directly into the mouth.  Positive pressure, “self bailing” breathing systems have definite advantages in that they resist flooding.

Recreational divers maybe well advised to place their regulator in their mouth and their mask over their nose before entering suspect water and keeping it there until they have safely exited the water where they can remove the regulator without needing to replace it.

Polluted water is a fact of our lives.  The degree of pollution can only be mitigated through education and the “upstream” elimination of the sources of the contaminants.  The attitude that careful rinsing of diving gear is a waste of time “cuz its just going to get wet again next time it is used” should probably be replaced with the attitude that one should begin every dive with clean gear.

LINKS To Pollutant Testing

Utah Bureau of Environmental Chemistry and Toxicology

Adapted from Glen Egstrom, Ph.D
Medical Seminars, Inc. 1992

Other References:
Colwell, Microbial Hazards Of
Diving In Polluted Waters, Maryland Sea Grant
Publication UM-SG-TS-82-01.

Diving in High-Risk Environments, 3rd Edition
by Steven M. Barsky
Paperback - 197 pages 3rd edition (December 15, 1999)
Hammerhead Press; ISBN: 0967430518

June 15, 2009

Hyperbaric Oxygenation References from Sunny Sonnenrein

Filed under: Uncategorized — admin @ 9:54 am

A single exposure to hyperbaric oxygen increases levels of circulating nucleosomes but does not induce mononuclear cell apoptosis in divers.
MED 09-31 200919462751 NDN- 230-0973-3081-8

AUTHORS- Weber, S U; Koch, A; Siekmann, U; Neitzel, C; Stouber, F; Hoeft, A; Schroeder, S

JOURNAL NAME- Undersea Hyperb Med
PP 117-25
DOCUMENT TYPE- Journal Article; Research Support, Non-U.S. Gov’t
ISSN- 1066-2936
CORPORATE AUTHOR- Department of Anesthesiology and Intensive Care Medicine, University of Bonn Medical Center, Bonn, Germany.

Recent reports that hyperbaric oxygenation (HBO2) induced apoptosis in T-cell lines raised concern about a possible immunosuppressive effect of HBO2. Nucleosomes, DNA fragments wrapped around a histone core, have been observed in the circulation in diseases with increased cell death such as sepsis. Our aim was to investigate, whether HBO2 increases circulating nucleosomes as a marker of cell death and induces apoptosis of peripheral blood mononuclear cells in vivo. After informed consent 29 healthy volunteers were exposed to a 30 minute dive at 2.8 atmospheres absolute in a pressure chamber under resting conditions, while breathing 100% oxygen. Samples were obtained before and 24 hours after exposure. Circulating nucleosomes were measured in serum. Caspase-3 activation, Bcl-2 expression and mRNA of Bcl-2, Bcl-xl and Bax were analyzed in mononuclear cell extracts. Nucleosomes were elevated markedly 24h after exposure (p<0.01), while caspase-3 was not activated significantly. mRNA levels of Bcl-2, Bcl-xl and Bax were not altered. In conclusion, while evidence of elevated levels of circulating nucleosomes was found, mononuclear cell apoptosis was not affected by a single exposure to hyperbaric oxygen


Bread mold osteomyelitis in the femur.
MED 09-31 200919472954 NDN- 230-0975-9327-4

AUTHORS- Wilkins, Ross M; Hahn, David B; Blum, Raymond

JOURNAL NAME- Orthopedics
PP 362
DOCUMENT TYPE- Journal Article
ISSN- 1938-2367
CORPORATE AUTHOR- Denver Clinic for Extremities at Risk, Presbyterian/St. Luke’s Medical Center, Denver, Colorado 80218, USA.

Rhizopus osteomyelitis is an uncommon and often fatal infection that usually occurs in immunocompromised patients. The infection is commonly referred to as “bread mold.” The usual course of treatment is Amphotericin B, debridement, and, if needed, amputation of the affected limb. This article details a rare case of postoperative Rhizopus osteomyelitis in an otherwise healthy patient. The patient originally presented at another institution for anterior cruciate ligament repair after a ski injury. Postoperatively, he developed clinical evidence of infection. He was referred to our institution with stiffness and swelling in the knee as well as weight loss and decreased range of motion. Fluid collection was visible on magnetic resonance imaging. Arthroscentesis was cultured for fungus and bacteria, and the fungal cultures were positive for Rhizopus species. An attempt at limb salvage was made. Debridement, use of a cement spacer loaded with Amphotericin B, systemic antifungal therapy, and 23 hyperbaric oxygen treatments were used to eradicate the disease. Four surgeries were needed to eradicate the disease, and 10 months after initial presentation, the patient had a distal femoral endoprosthesis placed in his leg. Laboratory tests returned to normal and frozen sections were negative for fungus. At 3-year follow-up, the patient reported a musculoskeletal functional score of 50% and had no evidence of recurrent infection.


Decision process to assess medical equipment for hyperbaric use.

Burman F, Sheffield R, Posey K.

DAN Southern Africa, Cape Town, South Africa.

Undersea Hyperb Med. 2009 Mar-Apr;36(2) :137-44.

There are very few items of medical equipment specifically designed for hyperbaric use; and little information is available about medical equipment already tested for hyperbaric use. Hyperbaricists are usually left to their own devices in making a determination about the safe and effective use of standard medical equipment in the hyperbaric setting. This article proposes a logical and systematic process to arrive at this determination. The process involves seven steps beginning with a need assessment and ending with endorsement by appropriate individuals. The discussion of decision steps includes identifying risk elements, compliance with safety standards, testing, and documentation.


Deletion of mouse MsrA results in HBO-induced cataract: MsrA repairs mitochondrial cytochrome c.

Brennan LA, Lee W, Cowell T, Giblin F, Kantorow M.

Biomedical Sciences Department, Charles E Schmidt College of Biomedical Science, Florida Atlantic University, Boca Raton, FL, USA.

Mol Vis. 2009 May 15;15:985-99.

PURPOSE: Considerable evidence indicates a role for methionine sulfoxide reductase A (MsrA) in lens cell resistance to oxidative stress through its maintenance of mitochondrial function. Correspondingly, increased protein methionine sulfoxide (PMSO) is associated with lens aging and human cataract formation, suggesting that loss of MsrA activity is associated with this disease. Here we tested the hypothesis that loss of MsrA protein repair is associated with cataract formation. To test this hypothesis we examined the effect of MsrA deletion on lens opacity in mice treated with hyperbaric oxygen, identified lens mitochondrial proteins oxidized upon deletion of MsrA and determined the ability of MsrA to repair the identified proteins. METHODS: Wild-type and MsrA knockout mice were treated or not treated with 100 treatments of hyperbaric oxygen (HBO) over an 8 month period and lenses were examined by in vivo light scattering measurements documented by slit-lamp imaging. Co-immunoprecipitat ion of MsrA was conducted against five specific protein representatives of the five complexes of the electron transport chain in addition to cytochrome c (cyt c). Cyt c in lens protein from the knockout and wild-type lenses was subjected to cyanogen bromide (CNBr) cleavage to identify oxidized methionines. Methionine-specific CNBr cleavage was used to differentiate oxidized and un-oxidized methionines in cyt c in vitro and the ability of MsrA to restore the activity of oxidized cyt c was evaluated. Mass spectrometry analysis of cyt c was used to confirm oxidation and repair by MsrA in vitro. RESULTS: HBO treatment of MsrA knockout mice led to increased light scattering in the lens relative to wild-type mice. MsrA interacted with four of the five complexes of the mitochondrial electron transport chain as well as with cyt c. Cyt c was found to be aggregated and degraded in the knockout lenses consistent with its oxidation. In vitro analysis of oxidized cyt c revealed the presence of two oxidized methionines (met 65 and met 80) that were repairable by MsrA. Repair of the oxidized methionines in cyt c restored the activity of cytochrome c oxidase and reduced cytochrome c peroxidase activity. CONCLUSIONS: These results establish that MsrA deletion causes increased light scattering in mice exposed to HBO and they identify cyt c as oxidized in the knockout lenses. They also establish that MsrA can restore the in vitro activity of cyt c through its repair of PMSO. These results support the hypothesis that MsrA is important for the maintenance of lens transparency and provide evidence that repair of mitochondrial cyt c by MsrA could play an important role in defense of the lens against cataract formation.

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Dying to play video games: carbon monoxide poisoning from electrical generators used after hurricane Ike.
MED 09-32 200919482736 NDN- 230-0977-7425-4

AUTHORS- Fife, Caroline E; Smith, Latisha A; Maus, Erik A; McCarthy, James J; Koehler, Michelle Z; Hawkins, Trina; Hampson, Neil B

JOURNAL NAME- Pediatrics
PP e1035-8
DOCUMENT TYPE- Journal Article; Research Support, U.S. Gov’t, P.H.S.
ISSN- 1098-4275
CORPORATE AUTHOR- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, 6431 Fannin St, MSB 1.247, Houston, TX 77030, USA.

BACKGROUND: Carbon monoxide (CO) poisoning is common after major storms because of loss of electrical power and use of alternate fuel sources for heat and electricity. In past epidemics of hurricane-related CO poisoning, the source has typically been gasoline-powered electrical generators. Although it is typically believed that generators were used to power air conditioning and refrigeration, this report demonstrates an unsuspected reason for their use. PATIENTS AND METHODS: After Hurricane Ike’s landfall in September 2008, major power outages were associated with an epidemic of CO poisoning from electrical generators, as expected. Staff at Memorial Hermann Hospital-Texas Medical Center treated or telephone-triaged cases from the Houston area. A review of the details of those cases forms the basis of this report. RESULTS: Memorial Hermann Hospital-Texas Medical Center staff treated or triaged 37 individuals exposed to CO from gasoline-powered electrical generators in 13 incidents in the first 36 hours after landfall of the hurricane. Notably, 54% (20 of 37) of the patients were under the age of 18 years. Symptoms ranged from mild to severe, with 1 child dying at the scene. Eleven patients were treated with hyperbaric oxygen Among 9 incidents in which the reason for generator use was determined, 5 were due to generators powering video games or televisions to watch movies or programs. These 5 incidents in which video games were being powered accounted for 75% (15 of 20) of the pediatric poisonings. CONCLUSIONS: Generator-related CO poisoning is indeed common during power outages after hurricanes. However, generators are commonly being used to provide electricity to power entertainment devices for children, such as video games. Additional public education about CO risk is needed, perhaps directed at older children and teenagers through the schools in regions susceptible to hurricanes.


Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss.
MED 09-31 200919138452 NDN- 230-0975-8989-2

AUTHORS- Cekin, E; Cincik, H; Ulubil, S A; Gungor, A

JOURNAL NAME- J Laryngol Otol
PP 609-12
DOCUMENT TYPE- Journal Article
ISSN- 1748-5460
CORPORATE AUTHOR- Department of Otolaryngology, Haydarpasa Training Hospital, Gulhane Military Medical Academy, Istanbul, Turkey.

OBJECTIVE: To evaluate the effectiveness of hyperbaric oxygen therapy in the management of sudden hearing loss. STUDY DESIGN: Patients with sudden hearing loss were divided into study and control groups. The 36 patients in the study group were treated with hyperbaric oxygen therapy in addition to standard medical therapy, whereas the 21 patients in the control group were treated with only standard medical therapy. SUBJECTS AND METHODS: Both groups were treated with standard therapy, comprising prednisolone starting at a dose of 1 mg/kg and reducing over three weeks. Patients in the study group received hyperbaric oxygen therapy in addition to standard drug therapy. RESULTS: Success rates were 78.95 per cent in the study group and 71.30 per cent in the control group. However, this difference was not statistically significant (p > 0.05). CONCLUSIONS: Considering the cost of hyperbaric oxygen therapy and its inconvenience to patients, this treatment should only be considered in patients suffering sudden hearing loss if there are contraindications to standard medical treatment.


Effects of hyperbaric oxygen on intrauterine hypoxic-ischemic brain damage in neonatal rats.
MED 09-31 200919470263 NDN- 230-0974-7688-4

AUTHORS- Chen, Jing; Chen, Yan-Hui

JOURNAL NAME- Zhongguo Dang Dai Er Ke Za Zhi
PP 380-3
DOCUMENT TYPE- English Abstract; Journal Article
JOURNAL CODE- 100909956
ISSN- 1008-8830
CORPORATE AUTHOR- Department of Pediatrics, Union Hospital Affiliated to Fujian Medical University, Fuzhou 350001, China. yanhui,

OBJECTIVE: The application and the efficacy of hyperbaric oxygen (HBO) in hypoxic-ischemic brain damage (HIBD) remain controversial. This study aimed to explore the effects of HBO on brain functional outcome and possible repair mechanisms in neonatal rats with intrauterine HIBD in aspects of the number of survived neurons and the central nervous electrophysiological conduction velocityo.METHODS: A rat model of intrauterine HIBD was preparedo.Subjects were divided into four groups at randomo.HIBD, HBO-treated HIBD group, normal control and HBO-treated normal control. After 24 hrs of the operationo.the two HBO-treated groups received HBO treatment (0.02 MPao.1 hr/d) for 14 days. When the rats were 4 weeks oldo.the electrophysiological changes in the central nervous system (CNS) were observed by brainstem auditory evoked potential (BAEP) for assessing brain function. Hematoxylin and eosin (HE) staining and Nissl,s stainting were employed to observe the pathological change and the number of neurons in the hippocampus. RESULTS: The peak latency of waves II and IV and the interpeak latency of waves I-IV in the HBO-treated HIBD group were shortened compared with those in the untreated HIBD group (P< 0.05). HE staining displayed that the pathological injuries in the hippocampus were alleviated in the HBO-treated HIBD group when compared with the untreated HIBD group. Nissl,s staining showed that survived neurons in the HBO-treated HIBD group were more than the untreated HIBD group (P< 0.05). The HBO-treated control group showed increased survived neurons compared with the untreated control group (P< 0.05). CONCLUSIONS: Early HBO treatment might improve brain functional outcome through increasing synaptic transmission efficiency, improving central nervous electrophysiological conduction velocity and reducing neuron death in neonatal rats with intrauterine HIBD.


Evaluation of Artificial Dermis Neovascularization in an Avascular Wound.

Baynosa RC, Browder LK, Jones SR, Oliver JA, Van Der Harten CA, Stephenson LL, Wang WZ, Khiabani KT, Zamboni WA.

Division of Plastic Surgery, Microsurgery and Hyperbaric Laboratory, University of Nevada School of Medicine.

Soft tissue coverage for avascular wounds is necessary in reconstructive surgery. Several authors have demonstrated successful treatment of problem wounds using artificial dermis. This study evaluates in an animal model the potential for neovascularization of artificial dermis in devascularized and avascular wound beds. Forty rats were assigned to four groups: (1) control, full-thickness skin graft was replaced on the vascular wound bed; (2) Integra, Integra placed over the full-thickness wound; (3) fascia, the spinotrapezius fascia exposed and Integra placed over the wound; and (4) fascia/Parafilm, a Parafilm layer placed under the raised fascia with Integra over the fascia. Laser Doppler readings were taken at baseline over the intact skin and then over the created wound beds. Biopsies of the full-thickness skin graft and the neodermis were obtained on postoperative day 14 and histologically evaluated for neovascularization. The laser Doppler readings confirmed the nature of the surgically created, poorly vascularized and avascular wound beds. Subsequent biopsies of the artificial dermis in these wound beds, however, demonstrated active neovascularization. This study demonstrates that Integra artificial dermis can serve as an effective dermal substitute in avascular wounds. Lateral ingrowth of capillaries into the dermal substitute may explain the successful integration of this artificial dermis.


Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT
MED 09-32 200919489477 NDN- 230-0977-9227-2

AUTHORS- Baskot, Branislav; ZivkoviA., Miodrag; TepiA., Sandra; ObradoviA., Slobodan

JOURNAL NAME- Vojnosanit Pregl
PP 399-402
DOCUMENT TYPE- English Abstract; Journal Article
ISSN- 0042-8450
CORPORATE AUTHOR- Vojnomedicinska akademija, Institut za nuklearnu medicinu, Beograd, Srbija.
LANGUAGE- Serbo-Croatian (Cyrillic)

BACKGROUND: The most important predictors of long-term survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV) volume, ejection fraction (LVEF) and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC) in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. CASE REPORT: We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia). He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO) and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber , BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche) was applied deeply subcutaneously, every second day from 2000 IU to totally 16000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity abnormal motion and wall thickening for all segments. Left ventricle end-diastolic volume was 393 ml (normal < 142 ml), and LV end-systolic volume was 334 ml (normal < 65 ml). Four months after the therapy G-SPECT showed improvement in any parameters; LVEF 25%, with improvement in wall motion (normalized wall motion in the anterior, lateral area, and proximal septum) and wall thickening, LV end-diastolic volume was 390 ml, LV end-systolic volume was 289 ml. CONCLUSION: Using G-SPECT method before and after the therapy with hyperbaric oxygenation and erythropoietin we obtained objective improvement and good therapy effects in the treatment of chronic heart insufficiency.


Hemodynamic changes in rat leg muscles during tourniquet-induced ischemia-reperfusio n injury observed by near-infrared spectroscopy.

Kim JG, Lee J, Roe J, Tromberg BJ, Brenner M, Walters TJ.

Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA 92612, USA.

Physiol Meas. 2009 May 13;30(7):529- 540

In this study, we hypothesized that non-invasive continuous wave near-infrared spectroscopy (CWNIRS) can determine the severity or reversibility of muscle damage due to ischemia/reperfusio n (I/R), and the results will be highly correlated with those from physical examination and histological analysis. To test this hypothesis, we performed CWNIRS measurements on two groups of male Sprague-Dawley rats ( approximately 400 g) that underwent 2 h (n = 6) or 3 h (n = 7) of pneumatic tourniquet application (TKA). Tissue oxyhemoglobin [HbO(2)] and deoxyhemoglobin [Hb] concentration changes were monitored during the 2 h or 3 h of 250 mmHg TKA and for an additional 2 h post-TKA. Rats were euthanized 24 h post-TKA and examined for injury, edema and viability of muscles. Contralateral muscles served as controls for each animal. In both groups, [HbO(2)] dropped immediately, then gradually decreased further after TKA and then recovered once the tourniquet was released. However, releasing after 2 h of TKA caused [HbO(2)] to overshoot above the baseline during reperfusion while the 3 h group continued to have lower [HbO(2)] than baseline. We found a significant correlation between the elapsed time from tourniquet release to the first recovery peak of [HbO(2)] and the muscle weight ratio between tourniquet and contralateral limb muscles (R = 0.86). Hemodynamic patterns from non-invasive CWNIRS demonstrated significant differences between 2 h and 3 h I/R. The results demonstrate that CWNIRS may be useful as a non-invasive prognostic tool for conditions involving vascular compromise such as extremity compartment syndrome.


Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl.
MED 09-32 200918828793 NDN- 230-0979-2326-5

AUTHORS- Tarani, Luigi; Costantino, Francesco; Notheis, Gundula; Wintergerst, Uwe; Venditti, Mario; Di Biasi, Claudio; Friederici, Donata; Pasquino, Anna Maria

JOURNAL NAME- Pediatr Diabetes
PP 289-93
DOCUMENT TYPE- Journal Article
JOURNAL CODE- 100939345
ISSN- 1399-5448
CORPORATE AUTHOR- Pediatric Department, University La Sapienza, Rome, Italy.

To demonstrate that the 2-yr clinical follow-up of our patient strongly suggests that long-term therapy with posaconazole (POS) is safe and beneficial in treatment and prevention of relapses of, otherwise fatal, central nervous system mucormycosis. Mucormycosis is a very rare opportunistic mycotic infection of diabetic children. We present the 30-month follow-up of a 12-yr-old girl affected by diabetic ketoacidotic coma, complicated by rhinocerebral mucormycosis and successfully treated with POS at the initial daily dose of 5 mg/kg t.i.d. with fatty food for 3 wk, followed by a daily dose of 10 mg/kg in four doses for 2 months and then 20 mg/kg/d in four doses for 16 months and in two doses for further 5 months. The previous amphotericin B, granulocyte colony-stimulating factor, hyperbaric oxygen and nasal and left maxillary sinus surgical debridement therapy was ineffective in stopping the progression of the infection to the brain. The patient improved within 10 d with reduced ocular swelling and pain, and 6 months after therapy stop, she is in good health and cultures are sterile. This article demonstrates that POS may be a useful drug in mucormycosis in children. We also strongly draw the attention to the main preventive procedure against invasive fungal infection that is the correct management of antidiabetic therapy that prevents the predisposing temporary neutrophils activity deficit, contributing to a better survival rate of diabetic children.


Hyperbaric oxygen pretreatment according to the gas micronuclei denucleation hypothesis reduces neurologic deficit in decompression sickness in rats.

Katsenelson K, Arieli R, Arieli Y, Abramovich A, Feinsod M, Tal D.

Israel Naval Medical Institute.

J Appl Physiol. 2009 May 21.

During sudden or too rapid decompression, gas is released within supersaturated tissues in the form of bubbles, the cause of decompression sickness (DCS). It is widely accepted that these bubbles originate in the tissue from preexisting gas micronuclei. Pretreatment with hyperbaric oxygen (HBO) has been hypothesized to shrink the gas micronuclei, thus reducing the number of emerging bubbles. The effectiveness of a new HBO pretreatment protocol on neurological outcome was studied in rats. This protocol was found to carry the least danger of oxygen toxicity. Somatosensory evoked potentials (SSEPs) were chosen to serve as a measure of neurologic damage. SSEPs in rats given HBO pretreatment before a dive were compared with SSEPs from rats not given HBO pretreatment and SSEPs from non-dived rats. The incidence of abnormal SSEPs in the animals subjected to decompression without pretreatment (1013 kPa for 32 min followed by decompression) was 78%. In the pretreatment group (HBO at 304 kPa for 20 min followed by exposure to 1013 kPa for 33 min and decompression) this was significantly reduced to 44%. These results call for further study of the pretreatment protocol in higher animals. Key words: diving, gas bubbles, gas micronuclei, somatosensory evoked potentials.


Nursing home wound care: The case for hyperbaric medicine
INF 09-22 1732112041 NDN- 258-0195-6508-8

AUTHORS- Finn, Mary Pat

JOURNAL NAME- Long-Term Living
PP 24,26-27
ISSN- 1940-9958
COPYRIGHT OWNER- Medquest Communications Inc. May 2009

Given that wound care management is an essential element of nursing home care protocols, the industry is beginning to look to technology to assist in this constant war on wounds. One technology which is not new to healthcare but emerging as a treatment modality in nursing homes is hyperbaric oxygen therapy (HBOT), a method of administering pure oxygen at greater than atmospheric pressure. HBOT is used to treat a wide variety of conditions. Currently, Medicare approves the treatment of 15 conditions to include diabetic wounds, radiation tissue damage, osteomyelitis refractory, skin grafts and flaps, necrotizing soft tissue infections, crush injuries, acute traumatic ischemias, air or gas embolisms, carbon monoxide poisoning, smoke inhalation, decompression sickness, severe anemia, and cyanide poisoning. A paradigm shift needs to take place in the nursing home industry. The technology is available to make 21st-century wound care available in the long-term care setting.


Paradoxal gazous embolism in hepatic trauma. Contribution of hyperbaric oxygenotherapy.

[Article in French]

Ann Fr Anesth Reanim. 2009 Jun 2.

Thuile C, Buys S, Idabouk L, Sanchez P, Genestal M.

Service de réanimation polyvalente, CHU de Toulouse-Purpan, place du Docteur-Baylac, TSA 70034, 31059 Toulouse cedex 9, France.

A young man was admitted for a polytraumatism associating head trauma and blunt abdominal trauma with hepatic injury. He was managed with a damage control surgery with a perihepatic packing. During the second look surgery, he developed a paradoxal gazous embolism by air aspiration in the sus-hepatic vein. This has never been described before in such traumatism. The patient presented a respiratory distress, a circulatory shock due to right infarction and an intracranial hypertension with bilateral mydriasis. He was immediately treated by hyperbaric oxygenotherapy. The evolution was good and he recovered without sequelae.

PMID: 19497704


Pharmacokinetic investigation of increased efficacy against malignant gliomas of Carboplatin combined with hyperbaric oxygenation.
MED 09-31 200919465788 NDN- 230-0973-8146-4

AUTHORS- Suzuki, Yu; Tanaka, Katsuyuki; Negishi, Daisuke; Shimizu, Makiko; Yoshida, Yasuyuki; Hashimoto, Takuo; Yamazaki, Hiroshi

JOURNAL NAME- Neurol Med Chir (Tokyo)
PP 193-7
DOCUMENT TYPE- Journal Article
ISSN- 1349-8029
CORPORATE AUTHOR- Department of Neurosurgery, St. Marianna University School of Medicine.

The efficacy of intravenous administration of 400 mg carboplatin/m(2) body surface area over 60 minutes combined with hyperbaric oxygenation (HBO) therapy (0.2 MPa for 60 min) was investigated in 6 Japanese patients (aged 36-67 years) with malignant or brainstem gliomas. Plasma ultra-filtrate samples were analyzed by high-performance liquid chromatography to evaluate the relationship between efficacy and pharmacokinetics. Brain tumor response was evaluated by magnetic resonance imaging as a function of maximum plasma concentration, area under the curve, or mean residence time (MRT) for carboplatin. The MRT for carboplatin in the complete or partial response group (mean +/- standard deviation 4.3 +/- 1.7 hrs; 6 courses in 3 patients) was significantly longer (p < 0.05) than that in the progressive disease group (2.4 +/- 0.1 hrs; 3 courses in 3 patients), but maximum plasma concentration and area under the curve showed no differences. These results suggest that HBO therapy prolongs the biological residence time of carboplatin. MRT for carboplatin may be useful for predicting continuation or modification of chemotherapy and/or clinical antitumor effects in patients with malignant gliomas.


Recent advances in the management of mucormycosis: from bench to bedside.
MED 09-31 200919435437 NDN- 230-0975-8641-9

AUTHORS- Spellberg, Brad; Walsh, Thomas J; Kontoyiannis, Dimitrios P; Edwards, John; Ibrahim, Ashraf S

JOURNAL NAME- Clin Infect Dis
PP 1743-51
DOCUMENT TYPE- Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural
ISSN- 1537-6591
CORPORATE AUTHOR- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles Medical Center, 1124 West Carson St., RB2, Torrance, CA 90502, USA.
PUBLICATION COUNTRY- United States; United States; United States

Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mucormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen , and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.


Retinal artery embolization during carotid angioplasty and carotid artery stenting.
MED 09-31 200919465793 NDN- 230-0973-8151-4

AUTHORS- Yamasaki, Hiroyuki; Matsubara, Shunji; Sasaki, Isao; Nagahiro, Shinji

JOURNAL NAME- Neurol Med Chir (Tokyo)
PP 213-6
DOCUMENT TYPE- Journal Article
ISSN- 1349-8029
CORPORATE AUTHOR- Department of Neurosurgery, Mizunomiyako Hospital.

A 69-year-old man presented with a rare case of retinal artery embolization, which occurred as a complication of carotid angioplasty and carotid artery stenting performed for recurrent cerebral infarction. Magnetic resonance imaging and angiography showed right internal carotid artery stenosis with ulceration. Carotid angioplasty and carotid artery stenting were performed using the distal protection system with the PercuSurge GuardWire. However, just after dilation, the patient complained of ocular pain and blurred vision on the right, which was subsequently diagnosed as retinal artery embolization. Heparin was given for 15 hours after stenting, and aspirin and ticlopidine medication were continued. The patient received hyperbaric oxygen therapy for 1 week. The patient’s blurred vision gradually improved, but visual field defect remained. Debris was probably flushed into the external carotid artery, and passed through an anastomosis into the ophthalmic artery, resulting in retinal artery embolization.


Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases.

Al-Waili NS, Butler GJ, Lee BY, Cary Z, Petrillo R.

Life Support Technology Groups, Chronic Wound Care and Hyperbaric Center, Mount Vernon Hospital, Sound Shore Health System; Department of Medicine, Mount Vernon Hospital; and Department of Surgery, New York Medical College, Westchester, New York, USA.

J Med Eng Technol. 2009 May 29:1-9.

The purpose of this report is to explore possible therapeutic use of hyperbaric oxygen (HBO(2)) technology on renal and urogenital diseases. HBO(2) reduces inflammation, immunity and inflammatory cytokines, stimulates wound repair and angioneogenesis, maintains tissue oxygenation, increases antioxidant enzymes and heals tissue hypoxia and radionecrosis. A literature review of peer-reviewed articles that address HBO(2), genitourological diseases, renal disease, and dialysis was performed. The paper reviews complications of renal diseases, dialysis, clinical applications of HBO(2), and effect of HBO(2) on renal and urogenital diseases. HBO(2) was used successfully to treat calcific uraemic arteriolopathy, and in many cases of acute renal failure. This technique is particularly useful in the treatment of intractable haemorrhagic cystitis secondary to pelvic radiation therapy and Fournier’s gangrene. Clearly HBO(2) might play a role in the management of urogenital diseases, urinary bladder dysfunction and diseases, testicular pathology, renal diseases, and post-traumatic ischaemic injury and/or impaired wound healing and infections. The possible role of HBO(2) for autoimmune diseases, uraemic osteodystrophy or neuropathy due to chronic renal diseases is discussed. The clinical application of this technology is expanding and the various biological influences of HBO(2) encourage testing its possible benefit in renal and urological diseases.

PMID: 19484683 [PubMed - as supplied by publisher]


Rationale of Hyperbaric Oxygenation in Cerebral Vascular Insult.

Fischer BR, Palkovic S, Holling M, Wölfer J, Wassmann H.

Department of Neurosurgery University Hospital of Muenster, D-48129 Muenster, Germany. fischeb@mednet. uni-muenster. de.

Curr Vasc Pharmacol. 2010 Jan 1

Cerebrovascular diseases and especially ischemic stroke are a leading cause of death. They occur mostly due to an insufficient oxygen (O(2)) supply to the central neural tissue as a result of thromboembolic events and/or obstructive vessel disease. The primary damage of the brain tissue cannot be restored. However, adequate therapy could minimize secondary impairment of brain tissue and restore neuronal function in the so-called “penumbra region”. Apart from reopening occluded vessels, additional O(2) supply is essential for survival of malfunctioning neural tissue. Breathing of 100% O(2) under hyperbaric conditions, hyperbaric oxygenation (HBO), is the only method to increase the O(2) concentration in tissue with impaired blood supply. Experimental as well as clinical studies have reported a positive effect of HBO therapy. Survival rate has increased under HBO therapy and neurological outcome has improved. The optimal levels of pressure as well as duration and numbers of HBO sessions need to be specified to avoid undesirable effects. Unfortunately, many questions remain unanswered before routinely recommending HBO as additional therapy in clinical practice. In this review we consider the (patho-)physiologic al background of HBO-therapy, the latest results of experimental and clinical studies and stress the evidence in patients with cerebrovascular disease.

PMID: 19485935


June 9, 2009

Diving With Disabilities

Filed under: Article — admin @ 1:30 pm

Download pdf

A Real Diving ChallengeThis page is written and maintained by
Ernest S Campbell, MD, FACS

Have you ever been on a night dive and had your lights go out? Or, imagine yourself doing a shore dive and you find that someone has tied your feet together; just imagine the difficulty of dragging yourself in and out of the water.

These are just two of the challenges that face disabled people who want to experience the serenity and beauty of scuba diving: the blind person is forever in pitch darkness, the paraplegic faces this wall every day.

In spite of these seemingly insurmountable obstacles, there are many disabled who are participating in scuba diving programs especially designed to assist them to experience our sport safely.

Below are listed various services and contacts for disabled persons who wish to learn more about diving:


  • Dive Training for the Disabled: What is it Worth? Diver Magazine, August 1997
  • “Soaring Below”, by Vicki Stiefel.
  • ‘Alert Diver’, March/April 1996; a publication of
    DAN (Divers Alert Network)

  • “Diving With Care”,
  • Training and Medical Aspects of Diving With Disabilities,
    Kimberly P. Walker, NREMT-P, DAN Training
    Alert Diver, March-April 1996, p. 40.

  • Scuba Diving With Disabilities Robinson, Jill. & A. Dale Fox:
  • (Champagne, Illinois:  Leisure Press, a Division of Human
    Kinetics Publishers, Inc.  Box 5076 Champagne, Il 61820.  1987)
    “A valuable supplement to any diving manual or class. For the disabled diver or the instructor who wants to teach disabled divers, the book is must reading.”

Associations and Clubs and Training

Amazing Seals

St. Paul/ Minneapolis Minnesota

Masha Bowen coordinator

We have recently started this exiting new program and working with local rehabilitation centers providing scuba experience for disabled divers. We have PADI and HSA certified instructors.

Disabled Diver training in the San Diego area.

John Ellerbrock
PADI Master Instructor
Pinnacle Divers
619.997.DIVE (3483)

Eels on Wheels Adaptive Scuba Club
Aron Waisman,
12338 Limerick Ave,
Austin, Texas, 78758
(512) 873-9121

Article “Challenges of Diving With Disabilities”, by Tammie Shelton

National Instructors Association for Divers with Disabilities (NIADD), Dorothy Shrout, P.O. Box 112223, Campbell; CA 95011-2223; (408) 379-6536, (408) 244- 8652 fax
NIADD, San Jose, CA.  Contact Frank Degnan at Any Water Sports, (408)244-4433.  Frank and Dorothy Shrout organize this.

Handicapped Scuba Association, Jim Gatacre, 1104 El Prado, San Clemente, CA 92672-4637, (714) 498-6128,   HSA@HSASCUBA.COM

Houston Disabled Scuba Divers Association, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556,

Southern Wheelchair Adventurers Association of Galveston-Houston, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556, (Lytle Seibert);,

Polish Scuba Diving Club for Divers with Disabilities

  • Club Challenge, 3108 Woodland Park Drive, Burlington, Ontario L7N 1L2 Canada; (905) 634-8234 (Joan Muir; Burlington), (905) 844-4160 (Annis Dixon; Oakville), (519) 658-5838 (Margaret Sanderson; Kitchener), (416) 485-7355 (Jerry Ford; Toronto)
  • Pacific Northwest Scuba Challenge Association, 14286 72nd Avenue, Surrey, British ColumbIa V3W 2R1 Canada; (604) 525-7149 (Ron Stead)
  • Persephone Scuba Diving Club, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6 Canada; Louis Jankowski, Ph.D., (514) 848-3320 (office), (514) 630-1429 (home)

Diving With Disabilities
Bruce Van Hoorn
14960 Penitencia Creek Road
San Jose, CA 95132

Bart Schassoort
3530 Warrensville Center Road
Suite 200
Shaker Heights, OH 44122

Open Waters, Paul A. Rollins, Project Coordinator, or Steven Tremblay, Project Director, c/o Alpha One, 127 Main St., South Portland, ME 04106-2622; (800) 640- 7200 (voice or TTY) or (207) 767-2189 (voice or TTY), (207) 799-0355 fax, ,

The Australian Underwater Federation has published a booklet on teaching disabled divers.  It can be obtained from theAUF Office,
PO BOX 1006,
Civic Square, ACT, 2608, Australia.

IAHD, is a non-profit organization for disabled divers. and

Norges handikapfellesskap in Norway,
Dive Training for the disabled.


June 2, 2009

Secrets of the Deep

Filed under: Article, Publication — admin @ 1:24 pm

Here is an interesting article in the New York Magazine about diving along the waterfront of New York City. The entire article can be seen at

What lies beneath the surface of New York Harbor? For starters, a 350-foot steamship, 1,600 bars of silver, a freight train, and four-foot-long cement-eating worms.

Commercial diver Lenny Speregen and NYPD detective John Drzal.
Illustrations by Mark Nerys

(Photo: Matt Hoyle)

The steady transformation of New York’s waterfront from wasteland to playground means more of us are spending time along the city’s edge. That can lead a person to wonder: What, exactly, is down there? Until recently, we had patchy knowledge of what lies beneath the surface of one of the world’s busiest harbors. What we did know came largely from random anecdotes, and depth soundings done the way Henry Hudson did them—by rope and lead sinker. This first GPS-era picture comes from the team at Columbia University’s Lamont-Doherty Earth Observatory, who have methodically swept the lower Hudson with state-of-the-art sonar. LDEO’s Dr. Frank Nitsche stitched together their data, along with several other researchers’ work, into this elegant color-keyed map, which we’ve supplemented by talking with sea captains, historians, and the divers pictured above. There’s a whole other city down there. Here and on the following pages is your guide.


DAN Announces New Vice President of Medical Services

Filed under: Article, News — admin @ 11:43 am

Dr. Nicholas Bird Joins DAN Staff as New Head of Medicine Department

Anyone who has called the DAN® 24-Hour Diving Emergency Hotline or used the non-emergency Medical Information Line knows the outstanding caliber of those who comprise DAN’s medical department. That legacy now continues with the addition of Dr. Nicholas Bird, DAN’s incoming vice president of medical services.

Dr. Bird joins the DAN staff in June. He comes to DAN from the Dixie Regional Medical Center in St. George, Utah, where he currently serves as the medical director of hyperbaric medicine. His acceptance of his new position at DAN follows an intensive and exhaustive months-long search by the organization to find the right candidate for the job.

“We knew the incoming VP would have some large shoes to fill,” said Dan Orr, president and CEO of DAN. “Our retiring VP of Medical Services, Joel Dovenbarger, has served this organization for almost all of its 30 years, and his contributions to its success cannot be measured. We knew it would take a special person to succeed him, and Dr. Nick Bird is that person. He’s a highly qualified and capable physician with extensive experience in hyperbaric medicine. He’s a great fit for our culture and the needs of our medical department, and he’s an active diver who understands and enthusiastically supports our mission and philosophy. We couldn’t have asked for more.”

Dr. Bird’s qualifications include a medical degree from the Royal College of Surgeons in Ireland and the completion of his family medicine residency at the University of Washington at Vancouver, as well as a fellowship in diving and hyperbaric medicine at the University of California at San Diego. He is board certified in Family Practice and Undersea and Hyperbaric Medicine. He served in the U.S. Air Force as a Flight Surgeon and was honorably discharged with the rank of Major, but not before serving as the final Commander of the Base Hospital in Jordan during Operation Iraqi Freedom.

In addition to extensive credentials, Dr. Bird’s character was also highly admired and praised by the candidate selection committee. Said Dr. Brett Hart, a member of DAN’s Board of Directors and the selection committee: “[Our] decision to support Dr. Bird’s selection as DAN’s new Vice President of Medical Services came down to three things: honor, courage and commitment. Beyond being a capable physician, he consistently demonstrated the moral character necessary to ‘do the right thing’ in terms of supporting DAN and its mission.”

Added Dick Clarke, president of National Baromedical Services and another member of the selection committee: “Dr. Nick Bird brings to DAN solid medical credentials, excellent interpersonal skills and great enthusiasm. DAN’s membership will be that much better off as a result of Dr. Bird’s close coordination of emergency evacuation and related medical care with all those who work globally on behalf of the injured diver.”

Although the start of Dr. Bird’s tenure at DAN is still a few weeks away, his enthusiasm for his new position is unmistakable. “DAN [is] integral to the diving community,” he said. “As a resource for information, a lifeline for injured divers, a conduit for research and a pioneer of safety training, DAN has distinguished itself as an industry leader.

“I am honored to have been chosen as the new VP of Medical Services and look forward to advancing DAN’s mission of dive safety. As a hyperbaric physician, I am especially interested in DAN’s goal both to establish and enhance the quality and integrity of medical care for divers in remote areas. I have joined DAN at an exciting time in the organization’s development and look forward to rolling up my sleeves and diving in.”

Dr. Bird’s addition to the DAN staff is certainly one reason it is an exciting time at DAN, and we hope you’ll join us in welcoming him both to DAN and the dive industry.


June 1, 2009

Arterial gas embolism: a review of cases

Filed under: Article, Publication — admin @ 12:20 pm

Arterial gas embolism: a review of cases

There is an article in Anaesth Intensive Care. 2008 Jan;36(1):60-4, “Arterial gas embolism: a review of cases at Prince of Wales Hospital, Sydney, 1996 to 2006″ by Trytko BE, Bennett MH that is well written and reports on the experience of a hyperbaric facility that utilizes evidence based guidelines for HBO treatment. 

Arterial gas embolism may occur as a complication of diving or certain medical procedures. Although relatively rare, the consequences may be disastrous. Recent articles in the critical care literature suggest the non-hyperbaric medical community may not be aware of the role for hyperbaric oxygen therapy in non-diving related gas embolism. This review is part of an Australian appraisal of experience in the management of arterial gas embolism over the last 10 years. We identified all patients referred to Prince of Wales Hospital Department of Diving and Hyperbaric Medicine with a diagnosis of arterial gas embolism from 1996 to 2006. Twenty-six patient records met our selection criteria, eight iatrogenic and 18 diving related. All patients were treated initially with a 280 kPa compression schedule. At discharge six patients were left with residual symptoms. Four were left with minor symptoms that did not significantly impact quality of life. Two remained severely affected with major neurological injury. Both had non-diving-related arterial gas embolism. There was a good outcome in the majority of patients who presented with arterial gas embolism and were treated with compression.

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