Print Post Approved
ISSN 1833 3516
ABN 29 299 823 713
Volume 42 No. 1 March 2012
The Journal of the South Pacifi c Underwater Medicine Society (Incorporated in Victoria) A0020660B
and the European Underwater and Baromedical Society
Diving and Hyperbaric Medicine
Perfl uorocarbon emulsion for severe DCS
Direct effect of Co2 on apnea-induced haemoglobin increase
how consistent are doctors in assessing ‘fi tness to dive’?
The health of recreational dive masters and instructors
Risk factors for rapid ascent and buoyancy problems
Scuba diver’s pulmonary oedema can be fatal
ultrasound under pressure
SOUTH PACIFIC UNDERWATER
application,?go?to?the?Society’s?website: <www.spums.org.au> ?
EUROPEAN UNDERWATER AND
PURPOSES OF THE SOCIETIES
To promote and facilitate the study of all aspects of underwater and hyperbaric medicine
To provide information on underwater and hyperbaric medicine
To publish a journal and to convene members of each Society annually at a scientific conference
Immediate Past President?
Member at Large 2011?
Member at Large 2010
Member at Large 2009
Honorary Treasurer & Membership Secretary
Phone & Fax:?+44-(0)20-85001778
DIVING and HYPERBARIC MEDICINE
Diving and Hyperbaric Medicine is published jointly by the South Pacific Underwater Medicine Society
and the European Underwater and Baromedical Society
Submissions to the Journal should be sent to: <firstname.lastname@example.org>
Diving and Hyperbaric Medicine Volume 42 No. 1 March 20121
The Editor’s offering
Undertaking research is a challenge, and never more so than
in primary health care. Whilst general practitioners may see
opportunities for clinical investigation amongst the range
of pathologies they deal with in their everyday practice and
have potential opportunities to contribute to epidemiological
studies, there are major barriers to turning these into a project
that can be seen through successfully. This is yet more so in
a narrow field such as diving medicine. Amongst the barriers
they face are lack of time (research for most must be done
in their own time), minimal resources, both financial and
professional, limited training in research methodology and
the ever present conflict with needing to earn a living for their
staff and themselves. You have to be either totally dedicated
or mad, perhaps a little of both. One way around the obstacles
is to enlist outside help from ‘experts’, both as mentors and
active participants in a project. Such arrangements may
be formal (e.g., supervising a project for a post-graduate
qualification) or an informal collegiate relationship.
A few years ago, Mike Bennett and I presented a session at
a Hyperbaric Technicians and Nurses Association Annual
Scientific Meeting on how to set about a research project.
As part of it, Mike discussed how to do a literature search
and what sorts of research might be achievable (Table 1),
whilst I discussed the components that make up a research
project (Table 2). These apply, in general, to all research.
Few people appreciate how many preparatory steps must
be taken before actually doing the research, and a common
reason for failure or for a less than satisfactory outcome is
lack of sufficient attention to these preliminaries.
In this issue, we have two good examples of research in
a primary health setting. Greg van der Hulst started his
project (towards a distance-learning Postgraduate Diploma
in Medical Science – Diving and Hyperbaric Medicine from
the University of Auckland) whilst he was a junior resident
in emergency medicine at Whangarei Hospital, completing it
subsequently whilst in a busy general practice in Northland,
New Zealand.1 In the process, he enlisted the help of David
Doolette, a physiologist at the US Naval Experimental
Diving Unit, Panama City, and whose methodology he
employed, and Peter Buzzacott, who at the time was a
doctoral candidate at the School of Sports Science, the
University of Western Australia. Whilst Chris Sames holds
a small part-time appointment at the Slark Hyperbaric Unit,
he is predominantly employed as a general practitioner (GP)
in the Naval Health Unit in Auckland, and his project was
conducted in his own time.2
Other examples of general practitioners publishing
independent research in the pages of Diving and Hyperbaric
Medicine within the past few years are Cathy Meehan, a GP
in Cairns (who enlisted Mike Bennett’s help) and Douglas
Walker with Project Stickybeak (now incorporated into the
DAN Dive Fatality Reporting Project).3,4 We encourage GPs
to pursue diving medicine topics of interest to them; there are
plenty of people within our two societies keen to help.
What types or classes of projects are achievable?
Magnitude – how big is the problem?
Therapy or intervention – what works?
Diagnosis – what is the best way to tell if someone has...?
Equipment – does this ‘thingy’ do what it should?
Quality – what works within our system, and why?
Cost – how much does it cost to achieve what we can do
in our system?
Teaching – how effective is the instruction process?
Elements of a research project
1. Asking a question
2. Doing a literature search
3. Understanding the literature
4. Making a plan
5. Finding somewhere to do it
6. Finding people to provide advice and help
7. Finding people/animals/stuff to do it on
8. Finding/costing equipment and materials
9. Writing a proposal
10. Obtaining ethical approval
11. Getting the money
12. Doing the work
13. Analysing the data
14. Presenting the results
15. Keeping everyone “sweet as”
1 van der Hulst GA, Buzzacott PL. Diver Health Survey
score and probability of decompression sickness among
occupational dive guides and instructors. Diving Hyperb Med.
Sames C, Gorman D, Mitchell S. Postal survey of fitness -
to- dive opinions of diving doctors and general practitioners.
Diving Hyperb Med. 2012;42:24-9.
Meehan CA, Bennett MH. Medical assessment of fitness to
dive – comparing a questionnaire and a medical interview-
based approach. Diving Hyperb Med. 2010;40:119-24.
Walker D, Lippmann J, Lawrence CL, Fock A, Wodak T,
Jamieson S. Provisional report on diving-related fatalities in
Australian waters 2005. Diving Hyperb Med. 2010;40:131-
The front page photo of Cairns professional musician
and diver Kirtley Leigh was taken by Bob Halstead, well
known to many members for his entertaining writings
in the diving magazines. In 2008, Bob was inducted into
the International Scuba Diving Hall of Fame.
Diving and Hyperbaric Medicine Volume 42 No. 1 March 20122
The Presidents’ pages
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In 2002, during the course of the Cooperation in Science
and Technology (COST) B14 Action, we had the opportunity
to develop and start a multicentre research protocol on the
treatment of idiopathic sudden sensorineural hearing loss
(ISSHL), more commonly called ‘sudden deafness’. The
COST Action was a European Commission-sponsored
consorted action, and the funds allowed us not to run
the trial itself but to coordinate this and other hyperbaric
oxygen therapy (HBOT) evidence-based and quality-related
issues (for a full overview of the COST Action, visit the
website <www.oxynet.org> or the European Committee for
Hyperbaric Medicine website: <www.echm.org>).
Only three hyperbaric centres (out of five involved) actually
enrolled patients in this study, which had a very ambitious
protocol. Current practice for treating ISSHL consists of
high-dose cortisone, a treatment that, together with the
spontaneous recovery rate within the first 10 days, results
in return of useful hearing in about 70% of cases. The
remaining patients have a poor likelihood of recovery, and
that was precisely our target group. Retrospective studies
had indicated that in this subgroup of patients, HBOT could
result in further improvement in about 40–50%.
The study was probably too ambitious. We recognised
that ISSHL has multiple causes, from vascular to viral
to auto-immune to trauma, and that what is considered
‘sudden deafness’ may only manifest itself as a minor
tonal audiogram change. We wanted to standardise our
study population as much as possible by maintaining strict
inclusion criteria. Then, patients were randomised to a
10-day course of ‘HBOT’ or ‘no HBOT’. Providing sham
hyperbaric treatments was technically and logistically not
possible in four out of the five centres, and, furthermore,
it was considered that sham compression would result in
possible side effects.
By 2007, it had become evident that less than 1% of cases
labelled as ISSHL were eligible for the study, making the
general applicability of the results questionable. Most
patients were presenting too late to be enrolled, but many
were excluded by their ENT surgeon on the basis of a
subjective feeling that the patient ‘should get all chances
possible’. Over the course of almost nine years, about 100
patients will be analysable, a task which will be undertaken
now. The results will be heavily criticised, no doubt – a pity,
because many were awaiting them anxiously.
A Sydney group, driven by the current SPUMS President,
Mike Bennett is now engaged in a similar study, with sham
compression and inclusion criteria that are much wider;
more importantly, they have a unique cooperation with the
ENT surgeons from the region, making inclusion of patients
possibly much easier.
In the meantime, the Hyperbaric Oxygen Committee of the
Underwater and Hyperbaric Medical Society (UHMS) has
officially recognised ISSHL as an indication for HBOT. I
am not quite sure whether to be happy or sad at this news.
On the one hand, many patients will now probably be
able to benefit from this treatment and add to the already
substantial database of retrospective studies. On the other
hand, I can already see the difficulties in convincing ENT
surgeons to participate in randomised prospective trials on
ISSHL: ‘Has it not been recognised as an indication? Is not
the UHMS one of the major players in the field of HBOT and
its evidence base?’ I fear the good intentions of the UHMS
Committee may make our task – to prove that HBOT can
contribute significantly to the treatment of ISSHL – more
difficult than before.
As you read this message, it is time to send your abstracts
and register for our Annual Scientific Meeting. This year,
the location is Belgrade (Serbia), and it will be preceded
by an ECHM Consensus Conference. The location and
organisation look excellent, and the registration fees and
accomodation prices are as low as we have not seen in years
– so there is no excuse not to attend (www.eubs2012.org).
Plans for the 2013 ASM are well underway too: a joint
EUBS–SPUMS Meeting, halfway between our continents
in the Indian Ocean (Reunion Island). The South African
Underwater and Hyperbaric Medical Association is keen to
join as well, so we are talking about a tri-continent meeting
on diving and hyperbaric medicine - and all are willing to
make this a big success !
Diving and Hyperbaric Medicine Volume 42 No. 1 March 20123
Another year has passed in the life of SPUMS, and that life
continues to be full of interest. Committee work seems to
involve a lot of heads down burrowing through the detail,
so it is a great pleasure to step back and try to give you all
an overview of how things are going.
You will all be aware that this year we will hold our 41st
ASM at the Madang Resort just outside the town of Madang
on the north coast of Papua New Guinea. As I write, I am
happy to say the recent political crisis seems substantially
settled and all is looking good for our arrangements. This
is our second visit to Madang, and those who were there in
2001 will remember it very fondly (hard to believe it was that
long ago!). Cathy Meehan has done a great job getting it all
together and the programme is looking full of interest to our
members. The theme is “What lies beneath: the pleasures
and perils of our diving environment”. Cathy has organised
two world-class speakers in Associate Professor Jamie
Seymour (AKA ‘the jelly dude’) and Richard Fitzpatrick
(AKA ‘the shark guy’), both from James Cook University
in Cairns. I have seen some of their presentations in other
forums, and I can thoroughly recommend them to you. The
shark wrestling videos are particularly engaging! We will
also be continuing our popular diving and hyperbaric update
workshops. All details are on the SPUMS website <www.
SPUMS.org.au> along with the links to register and book
accommodation and flights to suit your purposes. I look
forward to seeing many of you there.
On the subject of ASMs, Cathy has also agreed to head up
our new ‘future meetings’ sub-committee. This is a group
constituted at our last AGM, and given the task of seeking out
interesting destinations for the Society, along with individual
members who would be willing to convene those meetings.
At present the sub-committee consists of Cathy, Janine
Gregson and Sue Paton, but if you are willing to assist with
your time or even simply to put an idea forward, you will be
welcomed with open arms. Please contact Cathy for more
detail. (NOTE: membership of this sub-committee does not
indicate you are willing to convene a meeting!)
For the immediate future, we are planning a joint meeting
with the EUBS and SAUHMA (South African Underwater
and Hyperbaric Medical Association) in Réunion in 2013
(date to be determined). Our secretary, Karen Richardson
has put her hand up to convene this meeting for us, so watch
the website and this journal for more information on what is
sure to be a true watershed meeting for all three societies.
The great and continuing project that is joint ‘ownership’ of
the Journal with the EUBS continues. The meeting in 2013
will be a great opportunity for members of both societies to
get together and discuss all those things that are of common
interest to us. The Journal continues to go from strength to
strength and must count as SPUMS’ greatest achievement of
the last few years – largely due to the continuing efforts of
our evergreen editor. More strength to him! The successful
listing on Medline is a dispassionate recognition of just how
far we have come. An agreement to continue joint ownership
of this Journal is accepted in principle, and the editorial
contract to cover 2013 onwards is now being prepared.
On a less rosy note, the Committee (and in particular our
Education Officer, David Smart) has been doing battle
on several bureaucratic fronts. Of most direct interest to
SPUMS members is the growing practice throughout most of
Australia for dive training agencies to drop the requirement
for a medical examination prior to dive training. Such a
medical remains a firm recommendation from this society
and we are vitally interested in hearing any comments from
our members – and particularly any experiences you have
had of direct consequences from this change in policy.
We are also fighting hard on two other fronts. Firstly, David
has formulated a very lengthy reply to proposed changes to
the Work Health and Safety Diving Regulations and their
wide implications for the safety of occupational divers in
Australia – these, along with the proposed abandonment
of local Standards in the area are likely to greatly impact
the future of professional diving in our region. Secondly,
both David and I are currently embroiled in the continuing
evaluation by the Medicare Services Advisory Committee
of hyperbaric oxygen indications. At the time of writing, we
are waiting to see a draft report from the Committee on the
continuing support for non-diabetic wounds and soft-tissue
radiation injuries. Watch this space…
So it is all go here, as ‘Punter’ (former Australian cricket
captain, Ricky Ponting) scores his first ‘ton’ for two years
and our new captain (‘Pup’ Clarke) has knocked up his first
triple ton. It is good to be alive in a Sydney summer. All the
best to all of you for the New Year and I look forward to
seeing many of you in Madang. If not there, then perhaps
website is at
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