Diving and Hyperbaric Medicine The Journal of the South Pacifi c Underwater Medicine Society (Incorporated in Victoria) A0020660B ISSN 1833 - 3516 Volume 36 No. 3 ABN 29 299 823 713 September 2006 Project Stickybeak 2001 Decompression sickness in breath-hold divers Obesity and diving Iatrogenic CAGE The diving doctor’s diary Print Post Approved PP 331758/0015 Diving and Hyperbaric Medicine Volume 36 No. 3 September 2006 PURPOSES OF THE SOCIETY 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 To convene members of the Society annually at a scientific conference OFFICE HOLDERS President Dr Chris Acott 30 Park Avenue, Rosslyn Park Email <[email protected]> South Australia 5072 PastPresident Dr Robyn Walker 12 Barrallier Street, Griffith Email <[email protected]> ACT 2603 Secretary Dr Sarah Sharkey 1243 Pittwater Road, Narrabeen Email <[email protected]> New South Wales 2101 Treasurer Dr Guy Williams P.O.Box 190, Red Hill South Email <[email protected]> Victoria 3937 Editor Assoc. Prof. Mike Davis C/o Hyperbaric Medicine Unit Email <[email protected]> Christchurch Hospital, Private Bag 4710, Christchurch, NZ Education Officer Dr Fiona Sharp 249c Nicholson Road, Shenton Park Email <[email protected]> Western Australia 6008 Public Officer Dr Vanessa Haller P.O.Box 8023, Carrum Downs Email <[email protected]> Victoria 3201 Chairman ANZHMG Dr David Smart Department of Diving and Hyperbaric Medicine Email <[email protected]> Royal Hobart Hospital, Hobart, Tasmania 7000 Committee Members Dr Christine Lee P.O.Box 862, Geelong Email <[email protected]> Victoria 3220 Dr Glen Hawkins P.O.Box 1674, Maroubra, E-mail <[email protected]> NSW 2035 Dr David Vote P.O.Box 5016, Moreland West Email <[email protected]> Victoria 3055 ADMINISTRATION Membership Steve Goble C/o ANZ College of Anaesthetists Email <[email protected]> 630 St Kilda Rd, Melbourne, Victoria 3004 Journal Sarah Webb C/o Hyperbaric Medicine Unit Email <[email protected]> Christchurch Hospital, Private Bag 4710, Christchurch, NZ Phone: +64(0)33640045, Fax: +64(0)33640187 North American Representative Jeffrey Bertsch Email <[email protected]> European Representative Position vacant MEMBERSHIP Membership is open to all medical practitioners. Associate membership is open to all those who are not medical practitioners but are interested in the aims of the Society, and/or those engaged in research in underwater medicine and related subjects. Membership applications can be completed online at the Society’s website <www.SPUMS.org.au> Further information on the Society may be obtained by writing to: SPUMS Membership, C/o Australian and New Zealand College of Anaesthetists, 630 St Kilda Road, Melbourne, Victoria 3004, Australia or email <[email protected]> or go to <www.SPUMS.org.au> The Society’s financial year is January to December, the same as the Journal year. The 2006 subscription will be Full Members A$132.00 and Associate Members A$66.00, including GST. There will be an additional surcharge of $8.00 for journal postage for all members living outside Australia. Diving and Hyperbaric Medicine Volume 36 No. 3 September 2006 121 the Society have been advocating this for many years, and The Editor’s offering I recall Guy Williams discussing this in his (unpublished) presentation at the Palau ASM back in 1993. The three latest Project Stickbeak reports, 1999 – 2001, have documented 50 more tragic stories, mostly avoidable. The Michael Bennett and his coworkers have spent many years work collecting and collating these data is considerable. gathering and critically reviewing data from randomised However, this is not the end of the story; these data deserve clinical and applied research studies of hyperbaric oxygen formal analysis. John Lippmann indicates in his letter that (HBO) in the world literature and pulling them all together in DAN AsiaPacific is soon to employ a research assistant one place at <www.hboevidence.com>. In addition, Michael to collect diving accident and fatality data, which is good has been involved in a series of a dozen or so Cochrane news. Nevertheless, this requires proper medical oversight reviews of HBO. All this work has now been documented in and it behoves the Society’s current officers to help ensure his doctoral thesis, which may be accessed electronically.2 this happens. DAN reports from the USA lack the detail that This has been a remarkable achievement. It is, of course, Dr Walker has achieved and which is possible only through a neverending task, and no doubt he is already embarked the establishment of a professional medical relationship with upon the next round of updating the Cochrane databases as the coronial system and the police. new evidence comes in. In many clinical situations where HBO is recommended, the evidence still leaves much to be Whether decompression sickness (DCS) occurs in desired. It behoves those working in the field to constantly breathhold divers has been debated for many years. Bob strive to accumulate the necessary research evidence to Wong concludes from the evidence available that indeed justify or reject this modality of care. In some areas and it does. I have seen only two convincing cases of DCS in for various reasons, the gold standard of doubleblinded, breathhold divers and both had been undertaking scuba randomised controlled trials will never be achieved. It is dives during the same period. I suspect we will see more as important to remind oneself that evidencebased medicine freedivers push the limits of time and depth to even greater involves weighing all the evidence available, and not simply extremes. The deepest breathhold dive recorded so far ignoring anything less than Level 1 evidence, as is so often was to 209.6 metres’ sea water by Patrick Musimu in 2005. the case when justifying budget restraints. Musimu floods his sinuses and Eustacian tubes beforehand so that pressure equalisation is not required during the Accompanying this issue is the registration documentation descent, which sounds most unpleasant! for next year’s Annual Scientific Meeting. For only the second time in its 37year history the Society is holding the First introduced by Carl Edmonds and John Knight, The ASM in New Zealand. Tutukaka in Northland is in the heart diving doctor’s diary has appeared intermittently as an of one of the most beautiful coastlines in the world with a educational feature of this journal. Carl has been invited to unique diving environment and the Poor Knights Islands be the first contributor to what we hope will become a regular on its doorstep. In our Guest Speaker, Neal Pollock, we feature once again. Here is a simple lesson that not all pain have an outstanding young physiologist with a wealth of in diving is decompression sickness. A number of members experience that has ranged from highaltitude physiology of the Society have agreed to present occasional casebased to diving in Antarctica. As the convenors, Simon Mitchell educational items. However, any member is welcome to and I intend to outdo the previous New Zealand meeting, contribute if they have clinical cases from which a lesson regarded by many as one of the best in recent times, with of one form or another is to be learnt or which are simply an outstanding scientific programme. It is time to break the interesting or unusual in their own right. Case histories, trend of falling ASM attendances and give the 2007 meeting photos, Xrays, etc., are all welcome. Once again, may I your strong support. remind you that this is your journal, so let’s see more in the way of contributions from the wider membership. References Goble and Acott drew attention at the Noumea 2002 ASM 1� Goble S, Acott CJ. Regulator incidents: 52 incidents to the fact that there were no data to show that standard from the Diving Incident Monitoring Study. SPUMS scuba regulators performed adequately in an ‘octopus’ J. 2004; 33: 303. configuration. They expressed concern that the majority 2� Bennett M. The evidence basis of diving and hyperbaric probably would not cope with two divers breathing from medicine – a synthesis of the high level clinical evidence a single first stage in an emergency.1 Their concerns are with metaanalysis. <http://www.library.unsw.edu.au/ borne out in the Health and Safety Executive (UK) report ~thesis/adtNUN/public/adtNUN20060808.155338/ of which the abstract and executive summary are published index.html> here. Octopus systems are still acceptable provided only Michael Davis highperformance equipment is used. Otherwise, the scubadiving industry is going to have to undergo a wind Front cover photo taken by Dr David Smart in Hobart’s change with the marketing of convenient, welldesigned River Derwent is of the rare, endangered spotted and independent alternative air sources. Some members of handfish, Brachionichyths hirsutus. 122 Diving and Hyperbaric Medicine Volume 36 No. 3 September 2006 Original article Provisional report on divingrelated fatalities in Australian waters 2001 Douglas Walker Key words Diving deaths, breathhold diving, scuba, surfacesupply breathing apparatus (SSBA), diving accidents, case reports, carbon monoxide Abstract (Walker D. Provisional report on divingrelated fatalities in Australian waters 2001. Diving and Hyperbaric Medicine. 2006; 36: 12238.) During 2001, 12 deaths in association with breathhold and snorkel use were identified in Australia from official sources. There were also 11 fatalities in association with scuba use, and three where surfacesupply air was involved. Case summaries are presented with attention to the medical, equipment and diver performance factors. Significant adverse factors are identified and discussed for each of the groups, with comments on possibilities for reducing the number of fatalities that occur.