Diving and Hyperbaric Medicine The Journal of the South Pacific Underwater Medicine Society (Incorporated in Victoria) A0020660B and the European Underwater and Baromedical Society Volume 38 No. 4 December 2008 Best wishes to our readers for 2009 DCS – Heat shock and exercise may work in different ways DAN provides fresh insights into diving deaths German guidelines for dive accident care Why divers take long breaks from diving NMDA receptors and the HPNS Pulmonary bullae and CAGE ISSN 1833 3516 Print Post Approved ABN 29 299 823 713 PP 331758/0015 Diving and Hyperbaric Medicine Volume 38 No. 4 December 2008 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 SOUTH PACIFIC UNDERWATER EUROPEAN UNDERWATER AND MEDICINE SOCIETY BAROMEDICAL SOCIETY OFFICE HOLDERS OFFICE HOLDERS President President Mike Bennett <[email protected]> Alf Brubakk < a l f . o . b r u b a k k @ n t n u . n o > PastPresident Vice President Chris Acott <[email protected]> Peter Germonpré <[email protected]> Secretary Immediate Past President Sarah Lockley <[email protected]> Noemi Bitterman <[email protected]> Treasurer Past President Guy Williams < s p u m s @ f a s t m a i l . n e t > Ramiro Cali-Corleo < i r o c a l i @ d a n e u r o p e . o rg > Education Officer Honorary Secretary David Smart <[email protected]> Joerg Schmutz < j o e r g . s c h m u t z @ h i n . c h > Public Officer Member at Large 2008 Vanessa Haller <[email protected]> Dr Peter Knessl <[email protected]> Chairman ANZHMG Member at Large 2007 David Smart <[email protected]> Phil Bryson < p h i l . b r y s o n @ d d r c . o r g > Committee Members Member at Large 2006 Glen Hawkins <[email protected]> Maide Cimsit <[email protected]> Scott Squires <[email protected]> ADMINISTRATION Membership ADMINISTRATION Steve Goble <[email protected]> Honorary Treasurer & Membership Secretary Patricia Wooding MEMBERSHIP 16 Burselm Avenue, Hainault, Ilford For details of the different types of SPUMS membership: Essex, IG6 3EH, United Kingdom Full, Associate, Student, Corporate and Retired Phone & Fax: +44-20-85001778 and further information on the Society, or to complete a E-mail: <[email protected]> membership application, go to the Society’s website: <www.SPUMS.org.au> For further information on EUBS and to complete a or Email: <[email protected]> membership application go to the Society’s website: The official address for SPUMS is: <www.eubs.org> c/o Australian and New Zealand College of Anaesthetists, or E-mail: <[email protected]> 630 St Kilda Road, Melbourne, Victoria 3004, Australia DIVING and HYPERBARIC MEDICINE The Journal of the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society Editor: European Editor: Mike Davis, Dr Peter Mueller, Germany c/- Hyperbaric Medicine Unit E-mail: <[email protected]> Christchurch Hospital, Private Bag 4710 Editorial Board: Christchurch, New Zealand Mike Bennett, Australia Phone: +64(0)33640045 Alf Brubakk, Norway Fax: +64(0)33640187 Peter Germonpré, Belgium E-mail: <[email protected]> Neal Pollock, USA David Smart, Australia Diving and Hyperbaric Medicine Volume 38 No. 4 December 2008 181 diving deaths over the past decade or more. About a quarter The Editor’s offering of these divers had concomitant medical problems that, had they been identified, in many cases might have precluded Much of the epidemiological literature on sports injury involvement in scuba activities or that may have contributed suffers from insufficient information or poor study design or in some way to the diver’s death. analysis. Such studies try to answer a series of questions. • What is the incidence of injury? In diving, this has often Divers who have had a long layoff from diving then return been hampered by lack of reliable data on the size of are thought to be over-represented in diving fatality statistics. the population at risk. Figures have been available for A postal survey is reported in this issue that attempts to look only a few specific at-risk groups and for scientific at the reasons for such layoffs. Unfortunately its value is divers in the USA.1 limited by a low response rate (always a problem with such • What are the nature and circumstances of injury? surveys), but a few useful indicators are provided that could Descriptive studies such as Project Stickybeak and the also be worth addressing by the recreational industry. More Diving Incident Monitoring Study (DIMS) are good data are needed in this area. examples of the analysis of individual diving accidents and incidents.2,3 Such studies do not provide incidence Two established diving research laboratories, in Norway and rates, but focus on the process of error, and in the case Israel, add to the slowly growing list of basic science research of incident reporting, regardless of outcome. papers coming to Diving and Hyperbaric Medicine. The idea • What risk factors contribute to injury? As well as that vigorous exercise roughly a day before diving may Stickybeak and DIMS, the reports of the Divers Alert reduce the risk of decompression sickness has been rather Network (DAN) and the British Sub-Aqua Club (BSAC) over-enthusiastically taken up by the diving community, have provided much information on those factors that long before the scientific basis for this observation is contribute to diving accidents, and some clear patterns fully understood. Since heat shock proteins are produced have emerged over the years.4,5 Another example is by both stresses, Medby and colleagues hypothesise that a report from the Professional Association of Diving prior heat stress works in the same way as exercise in a rat Instructors (PADI) looking at the incidence of arterial model, but find that this may not be so. The high-pressure gas embolism during emergency ascent training, leading physiology group at Ben-Gurion University of the Negev to PADI abandoning buoyant ascents.6 continue their work elucidating the neuropharmacological • What are the effects of preventive measures to minimize mechanisms involved in the high pressure nervous syndrome injury? By introducing changes, the efficacy of new (HPNS) associated with helium breathing by examining medical screening, training methods, equipment the expression of the glutamatergic N-methyl-D-asparate or diving practices can be assessed prospectively. receptor, which is thought to be linked to the development Because the main end points for scuba diving – death, of HPNS symptoms. decompression illness and drowning – are rare events, large numbers are required for this type of interventional References investigation, and no such studies have been reported. 1 Lang MA. The USA scientific diving medical and safety DAN has been collecting USA data since about the late experience.SPUMS Journal. 2005; 35: 145-53. 1980s, after the contract held by the University of Rhode 2 Walker D. Report on Australian diving deaths 1994-1998. Island with the Undersea Research Program expired. Whilst Ashburton, Victoria: Divers Alert Network (DAN) S.E. Asia- Pacific Ltd; 2002. annual reports have been published, DAN has been criticised 3 Acott CJ. Human error and violations in 1,000 diving incidents: in some quarters for the lack of in-depth analysis of the a review of data from the Diving Incident Monitoring Study data collected. Now, with a denominator of over a million (DIMS). SPUMS Journal. 2005; 35: 11-7. membership years, DAN have been able to reliably analyse 4 Pollock NW, Vann RD, Denoble PJ, Freiberger JJ,Dovenberger their database, giving a fatality rate for their recreational JA, et al. Annual diving report − 2007 edition. Durham, NC: diving membership of 16.4 per 100,000 divers per year. Divers Alert Network; 2007. A number of factors that have long been suspected are 5 Cumming B. NDC diving incidents report 2007. British Sub- confirmed for DAN divers, namely that men are at greater Aqua Club (BSAC) website. http://www.bsac.org/page/1062/ risk than women and that the fatality rates for both sexes incident-report-2007.htm (accessed 30 November 2008) 6 Richardson D, Cummings T. A training agency perspective increase with age. Some interesting additional figures of emergency ascent training. SPUMS Journal. 1993; 23: emerge for elderly divers that suggest several factors are 225-30. at play here, not only cardiac risk. This raises important Michael Davis issues regarding on-going assessment of physical fitness and retention of diving skills in the older diver that need to be addressed by the recreational diving industry. The front-page photo was taken in Fiordland, New Zealand by Dr Martin Sayer; red coral, Errina Studies from Australia, New Zealand, the UK and USA, have novaezelandiae, and serpulid (tube) worm, probably now reported little or no change in the annual numbers of Protula bispiralis. 182 Diving and Hyperbaric Medicine Volume 38 No. 4 December 2008 Original articles Scuba injury death rate among insured DAN members Petar J Denoble, Neal W Pollock, Panchabi Vaithiyanathan, James L Caruso, Joel A Dovenbarger and Richard D Vann Key words Accidents, age, cardiovascular, deaths, diving accidents, DAN – Divers Alert Network, epidemiology Abstract (Denoble PJ, Pollock NW, Vaithiyanathan P, Caruso JL, Dovenbarger JA, Vann RD. Scuba injury death rate among insured DAN members. Diving and Hyperbaric Medicine. 2008; 38: 182-188.) We calculated the annual rates of diving-related deaths among DAN-insured members in the period from 2000 to 2006 and investigated the effects of age and sex on death rate by logistic regression.