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Diving and Hyperbaric Medicine The Journal of the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society Volume 43 No. 2 June 2013 Recreational technical diving Oxygen and carbon dioxide toxicity – 1944 revisited Decompression in recreational technical diving Recreational closed-circuit rebreather fatalities Stress responses during breath-hold diving Can a diver be mechanically ventilated underwater? Print Post Approved PP 331758/0015 Diving and Hyperbaric Medicine Volume 43 No. 2 June 2013 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]> Costantino Balestra <[email protected]> Past President Vice President Chris Acott <[email protected]> Jacek Kot <[email protected]> Secretary Immediate Past President Karen Richardson <[email protected]> Peter Germonpré <[email protected]> Treasurer Past President Shirley Bowen <[email protected]> Alf Brubakk <[email protected]> Education Officer Honorary Secretary David Smart <[email protected]> Joerg Schmutz <[email protected]> Public Officer Member-at-Large 2012 Andrew Fock <[email protected]> Lesley Blogg <[email protected]> Chairman ANZHMG Member-at-Large 2011 David Smart <[email protected]> Fiona Sharp <[email protected]> Committee Members Member-at-Large 2010 Peter Smith <[email protected]> Jean-Michel Pontier <[email protected]> Denise Blake <[email protected]> Liaison Officer Simon Mitchell (coopted) <[email protected]> Phil Bryson <[email protected]> Webmaster Joel Hissink (coopted) <[email protected]> ADMINISTRATION ADMINISTRATION Membership Honorary Treasurer & Membership Secretary Steve Goble <[email protected]> Patricia Wooding <[email protected]> 16 Burselm Avenue, Hainault, Ilford MEMBERSHIP Essex, IG6 3EH, United Kingdom For further information on SPUMS and to complete a membership Phone & Fax: +44-(0)20-85001778 application, go to the Society’s website: <www.spums.org.au> The official address for SPUMS is: MEMBERSHIP c/o Australian and New Zealand College of Anaesthetists, For further information on EUBS and to complete a membership 630 St Kilda Road, Melbourne, Victoria 3004, Australia application, go to the Society’s website: <www.eubs.org> SPUMS is incoprorated in Victoria A0020660B DIVING and HYPERBARIC MEDICINE <www.dhmjournal.com> Editor-in-Chief: Editorial Board: Michael Davis <[email protected]> Costantino Balestra, Belgium c/- Hyperbaric Medicine Unit Michael Bennett, Australia Christchurch Hospital, Private Bag 4710 Alf Brubakk, Norway Christchurch, New Zealand David Doolette, USA Phone: +64-(0)3-364-0045 or (0)3-329-6857 Peter Germonpré, Belgium Fax: +64-(0)3-364-0817 or (0)3-329-6810 Jane Heyworth, Australia European Editor: Jacek Kot, Poland Peter Müller <[email protected]> Simon Mitchell, New Zealand Editorial Assistant: Neal Pollock, USA Nicky McNeish <[email protected]> Martin Sayer, United Kingdom Journal distribution: David Smart, Australia Steve Goble <[email protected]> Robert van Hulst, The Netherlands Submissions to the Journal should be sent to: <[email protected]> Diving and Hyperbaric Medicine is published jointly by the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society (ISSN 1833-3516, ABN 29 299 823 713) Diving and Hyperbaric Medicine Volume 43 No. 2 June 2013 61 The European Resuscitation Council guidelines recommend The Editor’s offering in-water rescue breathing during the rescue of a drowning victim, and this was recently endorsed by the Diving “Technical diving does not contain any greater risk than Committee of the Undersea and Hyperbaric Medical traditional compressed air diving, as long as the diver is Society in the USA.5,6 The recommendations of the UHMS in command of the technology. A precondition for this is Committee will be summarised in the next issue of Diving that [s]he acquires the necessary theoretical knowledge and Hyperbaric Medicine. Taking this a step further, Winkler and is prepared to conduct the dive in accordance with and his colleagues have attempted to deliver underwater the technical requirements.” So concluded Dr Sonnhild artificial ventilation to the unconscious diver.7 Using an Schiönberg-Schiegnitz in her presentation at the 1995 immersed ventilator connected via three different devices SPUMS Annual Scientific Meeting.1 Eighteen years later, to a resuscitation manikin, their attempts were essentially a Andrew Fock concludes in his report on rebreather fatalities disappointing failure, and highlight one of the comments in in this issue “…using a CCR [closed-circuit rebreather] is the UHMS report in which they state “In particular there was associated with a four- to ten-fold increased risk of death doubt that a regulator held in place would protect the airway compared to recreational OC [open-circuit] scuba diving.”2 any more than a mouth held closed.” The German experience However, Fock points out that some of this risk is related to supports this even with more sophisticated airway protection higher-risk deep diving, which in itself is “associated with a devices, such as a full-face mask or a laryngeal tube. One of three-fold increase in risk of death” and that “two-thirds of the rationales for exploring underwater ventilation relates to the reported deaths appear to have some association with technical diving, especially in overhead environments, where high-risk behaviours.”2 Whilst CCRs are complex pieces an immediate return to the surface is not feasible. of equipment, the risks of failure appear to be more related to human errors, such as failures in pre-dive maintenance, References assembly and preparation, and to high-risk behaviours. Thus, modern CCR fatality data, whilst alarming, probably 1 Schiönberg-Schiegnitz S. Mental fitness in technical diving reinforce the simple message above from two decades ago. for sport scuba divers. SPUMS Journal. 1996;26:277-80. 2 Fock AW. Analysis of recreational closed-circuit rebreather Mixed-gas open-circuit and semi-closed and closed-circuit deaths 1998–2010. Diving Hyperb Med. 2013;43:78-85. rebreathers for both shallow and deep diving are not new 3 Doolette DJ, Mitchell SJ. Recreational technical diving part 2: decompression from deep technical dives. Diving Hyperb techniques, but have been around for decades. What has Med. 2013;43:96-104. changed is the recent, rapid growth in participation in 4 Davis M. “Technical” diving and diver performance: a recreational technical diving worldwide and the increasing personal perspective. SPUMS Journal. 1996;26:273-7. range and sophistication of equipment available, alongside 5 Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens improved gas-monitoring techniques and the advent of JJ, et al. European Resuscitation Council Guidelines for modern dive computers. In the discussion forums at the Resuscitation 2010 Section 8. Cardiac arrest in special 1995 ASM, several participants, of whom this writer was circumstances: Electrolyte abnormalities, poisoning, one, predicted recreational technical diving would bring a drowning, accidental hypothermia, hyperthermia, asthma, huge increase in severe, difficult-to-treat decompression anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81:1400-33. sickness, something that does not appear to have eventuated 6 Mitchell SJ, Bennett MH, Bird N, Doolette DJ, Hobbs GW, yet. The paper by Doolette and Mitchell helps to explain the Kay E, et al. Recommendations for rescue of a submerged 3 intricacies of deep mixed-gas decompression. As diving unresponsive compressed-gas diver. Undersea Hyperb Med. becomes deeper, longer and more challenging, one wonders 2012;39:1099-114. whether we may have seen only the tip of a clinical iceberg 7 Winkler BE, Muth CM, Kaehler W, Froeba G, Georgieff M, so far. Koch A. Rescue of drowning victims and divers: is mechanical ventilation possible underwater? A pilot study. Diving Hyperb “Because it’s there” applies as much to diving a famous Med. 2013;43:72-7. wreck lying in 150 metres of seawater as it does to the peak of Everest or K2. That is not to say that such motivation lacks Michael Davis validity or substance, since adventure and discovery are vital drivers for the human psyche. Nevertheless, defining the Key words purpose of a deep technical dive determines many factors Editorials, technical diving, deaths, resuscitation that need to be in place to ensure that such an enterprise is achieved at the least risk.4 Recently a planned dive to a wreck in deep water swept by strong currents off the northern tip Front page photos: Inspecting a fossil at 90 metres’ depth of New Zealand was abandoned because the infrastructure in the Wakulla-Leon Sinks cave system, Florida (courtesy (the support vessel) was deemed inadequate and the weather David Rhea, underwater photographer, Florida, outlook poor; this despite an extremely experienced diving <www.davidrheainc.com>); divers decompressing team, including one of the authors in this issue. after diving the USS Atlanta in 125 msw, Guadalcanal, Solomon Islands
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