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Medical Care of Divers in the Antarctic

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Medical Care of Divers in the Antarctic Arctic Medical Research vol. 53: Suppl. 2,pp. 320-324, 1994 Medical Care of Divers in the Antarctic A. H. Milne and L. F. Thomson British Antaretic Survey Medical Unit, RGIT Survival Centre Ltd, Aberdeen, Scotland Abstract: 'The provision of medical care for divers in the Antarctic presents a number of spcciil occupational health problems. For example, diving safety practices must take into account the cxlltmC nature of the environment with sea temperatures of -1.7° C and ambient temperatures .o~ -25'C with die attendant risks of hypothermia. Affliction with any of the disorders associated with d1vmg. an: likely'° have serious consequences because of the remoteness of both the dive site and the base. Tius has led die British Antarctic Survey Medical Unit to focus on the specialist training of doctors and dive tezns to 1 prepare them for medical emergencies, the facility of twin lock recompression chambe~ and to ensure high level of medical fitness pre-dive. In spite of these precautions researc:~ has been earned out to:: that high standatds of safety are maintained. Previous research in Antarctlc waters has shown thal the core tcmperatun: was maintained during the dive a significant after drop was a~~t 40 mmutes ix: dive. These findings are now being re-examined in the light of increased diving activity throughout year and changes in protective suits. Diving is conducted throughout the year at the Brit­ There are 2 groups of dysbari~ illn.ess, namely the ish Antarctic Survey (BAS) station on Signy (60° barotraumata and Decompression Sickness (DCSl. 43'S, 45° 36' W), one of the South Orkney group of Barottauma results from tissue damage cOOSfllUClll islands. Signy is one of the 5 permanently manned on a change of volume of gas, aJn:adynormall~3 BAS stations, and is a centre for terrestrial, freshwa­ as gas (eg in lung, middle ear, smuses), as dcscett ter and marine biological research. change ofpressure. It is a phenomeno~ ofbolh aol . di . (" . pressure 00creasmgvolume) The diving facility is important in support of the m vmg mcreasmg • . · volulllCl. research programmes. In recent years, BAS diving ascent (decreasing press.ure, mcreasmg ofBoyle's Barotramna is the pathological consequence · · activity has extended to other locations. 15 The care of divers in the remote, inaccessible and Law which states that the volume of !he ~ ; potentially hostile environment of the Ant.arctic is versely proportional to its abs?lute pressure given its absolute temperature remams constant . IJ1IO' based on: 15 I. Safe diving practices. The most serious form of barotrauma pu 3lld 2. Pre-dive and peri.odk medical examinations to nary of a.scent with its resultant Iun~ ~and establish conclusion on medical fitness or unfit­ 'b th tmP.umo-med1astm possl le pneumo orax, r·- ond'1 tionS. ast:· ness to dive. the most serious of all dive-related c . tpjnCd 3. Training in diving me.dicine for dive site doctor rial gas embolism (AGE). In AG~. gas is en the left 1 and n~-medical members of the diving team. into the pulmonary vein, whence it tra~els. to ulafioO. 4. On-site treatment capability, in particular a side of the heart and into the systemic c~ to the recompression chamber. Usually, but not invariably, such ·~gasnav;~bolism 5. 24 hour UK-based emergency and less urgent brain, resulting in cerebral arten pidl fatal: cc;>ve~ for advice is facilitated by satellite commu­ (CAGE). Thiscondition~~st~be; uJ: mos' mcations. the most urgent treatment is mdica • ion ro. 6. Research progtamme& to iracase knowledge of important component of.. wbich is,;eco:=; of ps pocential haz.ards ancl to enable, ifindicated, addi­ following Boyle's Law, squeeze the . tional safety measures to be undertaken. into solution. group; ot 1. Alertness to maintain. husband and develop the DCS, the second of the 2. dysooi:,~ solutiOD w overall and specific~ to diver care. illnesses, is caused by gas conung out ssion fOI· Each of~ above is~ furtlicr later in this form gas phase on and/or ~- dec~oading cl communication under "C - The Cate of 1he Diver." lowing, as a result of the di_ve, tne~e with }!efl­ tissues with gas in solution tn acco unt of ga.i The Diving..._ ry's Law. Henry's Law sta~ that the ~s di1t1-1l~ ~re are 3 groups of disorder which may befall the dissolved in a given ~uanttty of fl~~at gas U{ll111 diver (many refm:nces., inchKting I, 2, 3): proportional to the partial pressure 0 non re511lt5 l. The dysbaric illnesses. which are those due to a the fluid. 'Ibe bubbling of gas out 0~ solu fai,.111fl· change of pressure. from tissue supersaroration ~ ...... rd WM & Thomson: Medical Care of Divers in the Antarctic 321 There are 2 inter-related events in DCS: 2. Pre-Dive and periodic medical examinations ,, The primary effects of the foreign body of the gas Robust physical and mental health is needed both for lllbble itself. If, for example, it presses on the the prolonged, isolated Antarctic tour and for diving. ;pinaJ cord, it may present as paraplegia, with The general, non-dive related, medical screening ~.urinary and bowel dysfunction. prior to departure for the South seeks to establish a b• A "secondary cascade" of effects as a result of view on medical fitness with a particular focus on: rubble/tissue interface cellular, biochemical and rheological events. (i) The health and safety of the individual and of lkpending primarily on the site of the "interro- his companions. pmg bubble", AGE and DCS may present clini­ (ii) Ability to perform the appointed tasks. (iii) The impact on individual and on operations were ~ in many ways -the "great mimicker" to borrow l!un !he description of syphilis. Features of either eg medical evacuation required for a foresee­ Mi ?" DCS include skin rash, joint pain, para­ able condition. t'lllleliae, numbness, breathlessness, unconscious­ (iv) The risk of adverse effects on the well-being and • paralysis, vestibular dysfunction, hypovola­ efficiency of the small, remote community. (v) Mininiising the difficulties for the Survey in * shock. and the more vague symptoms of fa­ llpc, gtneral malaise and change of affect. Urgent exercising its responsibility for the overall care ~ion is mandatory for AGE and DCS. of its employees. The medical examination for all scheduled Antarctic 2 ~re~ to diving, but not dysbaric per se. personnel comprises thorough: ~sbaric conditions caused by, or due to div­ (i) Current and past medical history, by discussion aig may be su~vided into those resulting from the with the examining doctor with reference to the P5CS that the di~er breathes (eg hypoxia, hyperoxia, exarninee's completed questionnaire. IBlrogelJ ~is. carbon monoxide contamination) (ii) Physical examination. ~llaneous ~up of disorders including (iii) Investigations: 3. ~ and ~e.anirnal injury. - Dipstix urinalysis. ldllll ~lated to di~g (conditions which may - Chest X-ray . the ~ver ~non-diver alike) which require - Blood grouping (with tests for Hepatitis Band ~ pnncipally in the context of differen- C, VDRL and HIV, conducted with the exami­ ""'6'~1S from a dive-related disorder. nee' s informed consent following modified counselling. All who journey south may be re­ 1't Carter the Diver quired to either donate or receive blood). I. 54/t diving practices - Resting ECG if aged 35 or over. - Further investigations at the discretion of the ~ Divin~ ?fficer is appointed to su- 1iiists W:, stte, all d1vmg ~vi~. He plans and examining doctor. L\s ~~ to, his SCIUor colleague in The system generally permits the time and~­ Tbccqu· 10 Cambridge. tunity for clarification over any doubt regarding -.· lplllent used and procedures followed are medical fitness, eg report from family doctor, spe­ ~~an~ -:ven tried and proven. cialist referral for assessment, correction of disorder. ~of ative divmg.is undertaken, in tenns prin- The pre-tour South and annual periodic examina­ ·~~ion requirement consequent tion of the BAS diver embraces all the above plus ~the BSA~~ and time at. depth. BAS additional aspects of history, examination and inves­ ~an: J>lanned decompression table (4). tigation reflecting the UK guidelines for the statu­ ~~to be ".OOlpleted wen within the tory examination of commercial divers (6). flrao individuaJ . ts of this Table. Repetitive diving Additional investigations are ECG (routinely all ~ 1rilb any diver is. restricted to two dives in 24 ages), sub-maximal exercise test (as an indicator of frit There· ~dive being shallower than the physical fitness), full blood count, packed cell vol­ , IS IVOldaJJce of ultiple 'tltalled~yo- .. ume and sickle-cell trait, spirometr}' by vitalograph, 0 m descents/ascents Urtis~ to divmg) during any single dive (5). and audiometry. ~ llllvel to~~ diver~tcold, this ~-. the austral the dive site (by boat 3. Training in diving medicine for d~v~ site doctor and non-medical members the diving team ~die sea ice du:::· ~ ski-doo and sledge of ' '"llglle, illness ~ . wmter). Doctors attend a 5 day course in Diving Medicine as Thcic is no d. ~ IDJury precludes diving. part of their pre-tour South preparation programme. -..ill'Ciiic~mg ~hen environmental condi­ The principal course objective is to ~ the ~­ lit\ ill'C lllaintained ~and treatment facili­ tor for a confident and effective role m the recogm­ ty. tion and management of the diving illnesses. Fol­ lowing review of the relevant physics and physiol- ~--~~~~~~~~~~~~~~~~~~- ···------ Cin:umpolar H~olth 1993 b 322 Chapter 5: Cold: Reaction and Prottc!UJI ogy, the pathogenesis, clinical features and manage­ to prevent oxygen build-up in the chamber frfll! ment of diving illnesses are considered - with exten­ exhalation. sive reference to case history discussion. The re­ (iv) Good verbal communications between ms.t quirements of routine examination (and assessment and outside the chamber.
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