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Diving and Hyperbaric Medicine The Journal of the South Pacific Underwater Medicine Society (Incorporated in Victoria) A0020660B ISSN 1833 3516 Volume 36 No. 1 ABN 29 299 823 713 March 2006 Autopsies for diving fatalities Asthma and diving – TSANZ discussion paper DAN Diabetes Workshop More on RDPs Dirty diving Print Post Approved PP 331758/0015 Diving and Hyperbaric Medicine Volume 36 No. 1 March 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 Chris Acott 30 Park Avenue, Rosslyn Park Email <[email protected]> South Australia 5072 Public Officer Dr Guy Williams P.O.Box 190, Red Hill South Email <[email protected]> Victoria 3937 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 Guy Williams P.O.Box 190, Red Hill South Email <[email protected]> Victoria 3937 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: +6433640045, Fax: +6433640187 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. 1 March 2006 1 This was timely as it had been intended to invite several The Editor’s offering respiratory clinicians and scientists to contribute to just such a debate in the SPUMS Journal in the near future. In the analysis of diving fatalities, it has been said frequently Instead, we republish the TSANZ material in this issue for that drowning is not a diagnosis, a cause must be looked members to consider. Please contribute to this debate. We for. Causation is often difficult to establish. Many potential would like to think that some combined recommendations factors – bad diving practice and poor decision making, could come out of the two societies working together on contributing environmental conditions, concomitant this thorny issue. It is noteworthy that some recent papers medical problems, etc – combined with secondhand with new data do not appear in the bibliography of the knowledge, conflicting eyewitness reports, inadequate TSANZ material.6,7 police investigations and incomplete autopsy procedures mean that the truth is elusive in many cases. This is partly In 2003, the Society Executive was asked to review the because the investigations may be conducted, with the best need for medical assessment of users of a new underwater of intentions, by people who know little or nothing of scuba tourist device, the ‘Scubadoo’. Quoting from the minutes diving and with little guidance as to how to go about such of the Committee teleconference of 5 August 2003, “the investigations. As a result, surveys of diving fatalities such concensus…was that Scuba Doo should follow the as those by the Divers Alert Network1 in the USA and Project guidelines set out by Workplace Health and Safety.” Dr Stickybeak2 in Australia have been hampered in their Simpson, following a singlesubject study suggests analysis of causation by the gaps in the information and otherwise here. As he points out, the data could be predicted the failure to ask the right questions. from basic principles (succinctly laid out by Camporesi and Bosco8), and he argues that the risks involved in this This was also frequently true of coroners’ autopsies in divers. activity are minimal. What do you think? Registrations are Diving autopsies are undertaken to determine the immediate going well for this year’s ASM. Keep them coming! cause(s) of death, and to explore and identify potential underlying causes. Whilst drowning is often the terminal References event, this is a diagnosis of exclusion made at the end of a full examination of the evidence and the deceased’s body. 1 Report on decompression illness, diving fatalities and In the 20year review (1980–2000) of New Zealand Project Dive Exploration. Durham, NC: Divers Alert fatalities, only about half the autopsies were conducted in Network; 2003. accordance with recommended guidelines.3 In Australia 2 Walker D. Report on Australian diving deaths 1972 and New Zealand, this is now changing. New police 1993. Melbourne: JL Publications; 1998. guidelines for diving fatality investigations, combined with 3 Davis FM, Warner M, Ward B. Snorkelling and scuba detailed autopsy advice and the involvement at an early deaths in New Zealand, 1980–2000. SPUMS J. 2002; stage in the investigation of physicians experienced in 32: 7080. diving medicine should ensure that as much information as 4 Jenkins C, Anderson SD, Wong R, Veale A. Compressed possible is gleaned from each such tragedy. air diving and respiratory disease. A discussion document of the Thoracic Society of Australia and New The Royal College of Pathologists of Australasia has for Zealand. Med J Aust. 1993; 158: 2759. many years promulgated guidelines for autopsy in divers, 5 British Thoracic Society Fitness to Dive Group. British but getting investigators to use this information has been a Thoracic Society guidelines on respiratory aspects of problem. Recently, Drs Lawrence and Cooke updated this fitness for diving. Thorax. 2003; 58: 313. information, which is freely available on the College 6 Gotshall RW, Fedorczak LJ, Rasmussen JJ. Severity of website (www.rcpa.edu.au). However, it was felt that this exerciseinduced bronchoconstriction during excellent monograph needed wider promulgation amongst compressedair breathing via scuba. SPUMS J. 2004; the diving medical community to enhance understanding 34: 17882. of what should be involved and the difficulties inherent in 7 Glanvill P, St Leger Dowse M, Bryson P. A longitudinal interpreting autopsy findings. cohort study of UK divers with asthma: diving habits and asthma health issues. SPUMS J. 2005; 35: 1822. Linked to this topic (we do not want them to die) is the on 8 Camporesi EM, Bosco G. Ventilation, gas exchange going debate regarding whether asthmatics should scuba and exercise under pressure. In: Brubakk AO, Neuman dive and if so what criteria should be used in assessing their TS, editors. Bennett and Elliott’s physiology and suitably or otherwise. Widely differing views have been medicine of diving. 5th edition. London: Saunders; promulgated in the past by such learned groups as the 2003. p. 812. Thoracic Society of Australia and New Zealand (TSANZ)4 Michael Davis and the British Thoracic Society Fitness to Dive Group.5 Recently, the TSANZ revisited this issue in a discussion Front cover photo of two technical divers using paper in the Thoracic Society News, which drew a vigorous underwater scooters taken by Dr Simon Mitchell at about response from one respiratory physician. 40 msw depth at the Poor Knights Islands, where the 2007 SPUMS ASM diving will be held. 2 Diving and Hyperbaric Medicine Volume 36 No. 1 March 2006 Review article Autopsy and the investigation of scuba diving fatalities Chris Lawrence and Clive Cooke Key words Diving deaths, scuba accidents, snorkelling, investigations, autopsy, review article, reprinted from Abstract (Lawrence C, Cooke C. Autopsy and the investigation of scuba diving fatalities. Diving and Hyperbaric Medicine. 2006; 36: 28.) The investigation of diving fatalities is multifaceted, and the pathologist has a central and critical part to play. It is important that the pathologist has knowledge of and understands the physiological risks and possible pathological changes associated with diving, and should be aware of other facets of the investigation. This review article reproduces the guidelines for autopsy in diving accidents on the Royal Australasian College of Pathologists website (www.rcpa.edu.au). The investigation of the diving fatality is multifaceted, of the absence of expired gas bubbles. Particular risks involving inquiry into a number of areas, including: include failure of the scrubbers to remove carbon dioxide, i the past medical history of the deceased hypoxia and oxygen toxicity seizures when using oxygen ii the past diving history of the deceased (including rebreather circuits at oxygen pressures of greater than 1.5– satisfactory completion of appropriate training) 1.8 ATA.
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