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Breath-Hold Diving Rubicon Research Repository (http://archive.rubicon-foundation.org) i Rubicon Research Repository (http://archive.rubicon-foundation.org) Rubicon Research Repository (http://archive.rubicon-foundation.org) BREATH-HOLD DIVING Workshop Proceedings June 20-21, 2006 Jointly Sponsored by the Undersea and Hyperbaric Medical Society and Divers Alert Network Peter Lindholm, MD, PhD Neal W. Pollock, PhD Claes EG Lundgren, MD, PhD i Rubicon Research Repository (http://archive.rubicon-foundation.org) Recommended Citation: Lindholm P, Pollock NW, Lundgren CEG, eds. Breath-hold diving. Proceedings of the Undersea and Hyperbaric Medical Society/Divers Alert Network 2006 June 20-21 Workshop. Durham, NC: Divers Alert Network; 2006. Copyright © 2006 by Divers Alert Network 6 West Colony Place Durham, NC 27705 All rights reserved. No part of this book may be reproduced in any form by photostat, microfilm or any other means without written permission from the publisher. This diving safety workshop and the publication of this document were jointly sponsored by the Undersea and Hyperbaric Medical Society and Divers Alert Network. Opinions and data presented at the Workshop and in these Proceedings are those of the contributors, and do not necessarily reflect those of the Undersea and Hyperbaric Medical Society or Divers Alert Network. Cover design by Alison Ma. ISBN 978-1-930536-36-4 ii Rubicon Research Repository (http://archive.rubicon-foundation.org) CONTENTS UNDERSEA AND HYPERBARIC MEDICAL SOCIETY v DIVERS ALERT NETWORK v ACKNOWLEDGMENTS vi UNIT CONVERSIONS vi 2006 UHMS/DAN BREATH-HOLD WORKSHOP: OPENING REMARKS 1 THE SCIENCE OF BREATH-HOLD DIVING: PAST, PRESENT AND FUTURE 2 Claes E.G. Lundgren NITROGEN NARCOSIS DURING NO LIMITS FREEDIVING 17 WORLD RECORD DIVE TO 160 m (525 ft) Tanya Streeter PHYSIOLOGICAL MECHANISMS INVOLVED IN THE RISK OF LOSS 26 OF CONSCIOUSNESS DURING BREATH-HOLD DIVING Peter Lindholm INCREASED LEVELS OF THE BRAIN DAMAGE MARKER S100B AFTER 32 APNEAS IN COMPETITIVE BREATH-HOLD DIVERS Johan P.A. Andersson, Mats H. Liner, Henrik Jonsson APNEA DIVERS: HYPOXYPHILIACS, ATHLETES, OR VALUABLE 36 MEDICAL RESEARCH SUBJECTS? Lynne Ridgway, Ken McFarland 'SAMBA', 'MOOGLIES' AND OTHER ACUTE EFFECTS OF APNEA 39 Lynne Ridgway, Ken McFarland, Ian B. Stewart, Andrew C. Bulmer DEVELOPMENT OF THE DAN BREATH-HOLD INCIDENT DATABASE 46 Neal W. Pollock DAN BREATH-HOLD INCIDENT DATABASE: 2004-2005 CASES 56 Sheila J. Modi, Neal W. Pollock DIVING HABITS HISTORICALLY ASSOCIATED WITH 'SHALLOW WATER 60 BLACKOUT' IN HAWAIIAN FREEDIVERS Richard W. Smerz, Frank Farm, Jr A PROPOSED 60 SECOND LIMIT FOR BREATH-HOLD DIVING 64 Frank K. Butler SHALLOW WATER BLACKOUT: THE PROBLEM AND A POTENTIAL SOLUTION 75 Terry L. Maas iii Rubicon Research Repository (http://archive.rubicon-foundation.org) SAFETY TECHNIQUES AND PROBLEM MANAGEMENT IN RECREATIONAL 82 AND COMPETITIVE FREEDIVING Kirk Krack, Martin Stepanek, Mandy-Rae Cruickshank GLOSSOPHARYNGEAL BREATHING AND BREATH-HOLD DIVING 96 ON EMPTY LUNGS Peter Lindholm LARYNGOSPASM IN BREATH-HOLD DIVING 102 Christopher W. Dueker CARDIOVASCULAR AND HEMATOLOGICAL ADJUSTMENTS 108 TO APNEIC DIVING IN HUMANS Erika Schagatay, Matt Richardson, Robert deBruijn, Johan P.A. Andersson CORRELATION BETWEEN SPLEEN SIZE AND HEMATOCRIT 116 DURING APNEA IN HUMANS Matt Richardson, Robert de Bruijn, Sofia Petterson, Jenny Reimers, Erika Schagatay DECOMPRESSION SICKNESS IN BREATH-HOLD DIVING 119 Robert M. Wong MANIFESTATION OF DECOMPRESSION ILLNESS IN JAPANESE AMA DIVERS 130 Kiyotaka Kohshi, Yoshihiro Mano, Robert M. Wong BRAIN FUNCTION IMAGING IN ASYMPTOMATIC ELITE BREATH-HOLD DIVERS 135 Ralph T. Potkin, J. Michael Uszler USE OF ELECTRONIC DATA LOGGERS WITH BREATH-HOLD DIVING 138 Karl E. Huggins, Martin Stepanek PANEL DISCUSSION 142 APPENDICES A. List of Acronyms Used 160 B. Workshop Participants 161 C. Workshop Schedule 165 iv Rubicon Research Repository (http://archive.rubicon-foundation.org) UNDERSEA AND HYPERBARIC MEDICAL SOCIETY www.uhms.org The UHMS is an international, nonprofit organization serving over 2,500 members from more than 50 countries. Most UHMS members are diving or hyperbaric scientists and physicians. Associate members are nurses, technicians, respiratory therapists and others who work in the field of diving and hyperbaric medicine. The Undersea and Hyperbaric Medical Society (UHMS) is the primary source of information for diving and hyperbaric medicine physiology worldwide. It was founded as the Undersea Medical Society in 1967 but in 1986 changed the name to Undersea and Hyperbaric Medical Society. The name change reflects the rapidly growing interest in hyperbaric oxygen physiology and therapy. The UHMS's purpose is to provide scientific information to protect the health of sport, military and commercial divers and to improve the scientific basis of hyperbaric oxygen therapy, promote sound treatment protocols and standards of practice and provide CME accreditation. DIVERS ALERT NETWORK www.diversalertnetwork.org Divers Alert Network (DAN®) is a 501(c)(3) nonprofit dive safety organization associated with Duke University Health Systems in Durham, N.C. Since 1980, DAN has served as a lifeline for the scuba industry by operating the industry's only 24-Hour Diving Emergency Hotline, a lifesaving service for injured scuba divers. Additionally, DAN operates a Dive Safety and Medical Information Line, conducts vital dive-related medical research and develops and provides a number of educational programs for everyone, from beginning divers to medical professionals. DAN is supported through membership dues and donations. In return, members receive a number of benefits, including access to emergency medical evacuation, travel and personal assistance for both diving and non-diving needs, DAN educational publications, a subscription to Alert Diver magazine and access to diving's premier dive accident insurance coverage. DAN currently has well more than 200,000 members worldwide. The DAN Vision Striving to make every dive, accident- and injury-free. The DAN Mission Statement DAN helps divers in need with medical emergency assistance and promotes diving safety through research, education, products and services. v Rubicon Research Repository (http://archive.rubicon-foundation.org) ACKNOWLEDGMENTS Thanks are due to UHMS and DAN for co-sponsoring the workshop, NAVSEA and Office of Naval Research for financial support, our home institutions for support of our time and all the workshop participants. Additional thanks to Cindi Easterling and Lisa Wasdin for skillful logistics management and Alison Ma and Rick Melvin for cover art production. Peter Lindholm, MD, PhD Swedish Defence Research Agency, Centre for Environmental Physiology, Karolinska Institutet, Stockholm, Sweden Neal W. Pollock, PhD Center for Hyperbaric Medicine and Environmental Physiology Duke University Medical Center Claes E.G. Lundgren, MD, PhD Center for Research and Education in Special Environments, State University of New York at Buffalo UNIT CONVERSIONS 1.0 m = 3.28084 ft 1.0 mm Hg = 0.13332 kPa 1.0 kg = 2.204623 lb °C = (°F - 32) / 1.8 1.0 ft = 0.30480 m 1.0 kPa = 7.50064 mm Hg 1.0 lb = 0.4535924 kg °F = °C * 1.8 + 32 vi Rubicon Research Repository (http://archive.rubicon-foundation.org) 2006 UHMS/DAN BREATH-HOLD WORKSHOP: OPENING REMARKS DR. LUNDGREN: I am very pleased to get this meeting started. It is 20 years since we had an international symposium or workshop on breath-hold diving on this continent, the last one being in Buffalo. A lot of things have happened in our field over those 20 years, many of which we will take a thorough look at in the next two days. We want to acknowledge that this event would not have happened without the collaboration between UHMS and DAN. We also wish to recognize the generous support from the Office of Naval Research and Naval Sea Systems Command, for which we are very appreciative. DR. LINDHOLM: We will start with a few housekeeping details. First, the compact disks provided with the registration packages include the complete proceedings from the 1965 breath-hold diving symposium. We felt this was important to provide since paper copies are becoming increasingly more difficult to find. We thank Eugene Hobbs at Duke University, the same person responsible for scanning the UHMS archives, for providing us with this material. The second piece of information is that we have a court stenographer with us to produce a verbatim record of the meeting. An edited version of the discussions will be included in the proceedings of the meeting. Finally, personal issues have demanded the withdrawal of several presenters. This list includes Dr. Andreas Fahlman, Dr. Massimo Ferrigno and Mr. Glennon Gingo. Welcome. - 1 - Rubicon Research Repository (http://archive.rubicon-foundation.org) In: Lindholm P, Pollock NW, Lundgren CEG, eds. Breath-hold diving. Proceedings of the Undersea and Hyperbaric Medical Society/Divers Alert Network 2006 June 20-21 Workshop. Durham, NC: Divers Alert Network; 2006. THE SCIENCE OF BREATH-HOLD DIVING: PAST, PRESENT AND FUTURE Claes E.G. Lundgren, MD, PhD Center for Research and Education in Special Environments, State University of New York at Buffalo, NY, USA The title of my talk may be too ambitious, especially when it comes to the future, because, after all, as the Danish humorist Storm Pedersen said many years ago, "Predictions are hard to make, especially about the future." I think what lies in the future in terms of research on breath-hold diving physiology will come out of our discussions here, so it all
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