Aşkın YILDIRIM

Diving Medicine

Diving Medicine is a specialized area of medical science dealing with the biological effects of the undersea environment on health and safety. In addition to treating diving injuries, a diving physician must also make decisions regarding the "fitness" of an individual to dive. A number of courses in diving medicine are offered each year that allow physicians and other professionals the opportunity to stay current in diving medical issues. Usually the courses are sponsored by organizations that maintain high standards of educational quality. Among the most highly regarded of these organizations are the Undersea and Hyperbaric Medical Society (UHMS) , the Divers Alert Network (DAN), the American Academy of Underwater Sciences (AAUS), the South Pacific Undersea Medical Society (SPUMS) and the British Subaqua Club. Of course, U.S. Military training in Undersea Medicine is highly regarded and the National Oceanic and Atmospheric Administration (NOAA) provides excellent training for both military and civilians alike. No doubt I have unwittingly left someone off this list, but for all practical purposes this is a fairly complete listing of the relevant diving organizations in the western world. I welcome information about organizations committed to diving medicine and dive safety that I have inadvertently omitted.

Hyperbaric Medicine is another specialized area of medical science that overlaps with Diving Medicine. It specifically deals with the administration of Hyperbaric Oxygen (HBO) as a medical treatment for certain diseases. For the diver, HBO is the specific cure for Decompression Illness (DCI), and is life saving in the treatment of Air Embolism. Aviators also suffer decompression illness due to rapid changes in altitude or cabin pressure and occasionally require HBO therapy. Due to the serious nature of some HBO responsive diseases, Hyperbaric Specialists tend to also be Intensive Care Medicine Specialists (Intensivists). This is primarily true when the hyperbaric chamber is part of a medical center. Confused? Here is a list of all the other things HBO is good for.

Air Embolism
Carbon Monoxide Poisoning
Clostridial Myonecrosis (gas gangrene)
Crush Injury and Compartment Syndrome
Cyanide Poisoning
Decompression Illness
Necrotizing Soft Tissue Infections
Osteomyelitis (refractory)
Osteoradionecrosis and other types of Radiation Tissue Injury
Problem Wounds (adjunctive)
Skin Flaps and Grafts (compromised)
Thermal Burns (life threatening)
Thus, it is possible to be a Hyperbaric Physician and only occasionally treat divers. Conversely, a Diving Physician may see few individuals who need Hyperbaric Oxygen Therapy. In many regions of the world however, these two areas of specialization are closely aligned.

Who Needs Diving Medicine?

Students, and those new to the sport of diving are the largest group seen in my office.
The older diver (older than age 45) has a number of unique needs.
Professional Instructors and Dive Masters are required to maintain standards of health and fitness.
Hazardous Material and Nuclear Plant Divers are a challenge for Occupational Medicine.
Military, Police and Technical Divers require rigorous physical exams.
Inshore Professionals: Engineers, Archaeologists, Oceanographers, Marine Biologists, Salvors and ...
Offshore Professionals: Saturation Welders and other Mixed Gas Construction team members all have special needs.
Regulatory and Training Agencies such as the Professional Association of Diving Instructors (PADI), and the National Association of Underwater Instructors (NAUI) are well known. Guidelines for health are provided but requirements for physical exams among student sport divers rely on voluntary disclosure of potentially disqualifying medical conditions. In the United Kingdom, The British Sub-Aqua Club (BS-AC) sets appropriate standards for sport diving. For Professional divers, the Association of Diving Contractors and the Health and Safety Executive (HSE) of the United Kingdom, along with the National Oceanic and Atmospheric Administration (NOAA) set the standards of health and fitness. The American Academy of Underwater Sciences (AAUS) sets standards for scientific diving and undersea research.

Diving and Hyperbaric Research is the most essential element of diving medicine. Without a constant flow of accurate statistical information regarding diving physiology and diving injury, meaningful intervention to save lives is much more difficult. In some states of the US, confidentiality laws make it impossible to properly investigate diving accidents. This leads to assumptions and inaccuracies that distort our perception of diving and the safety of the sport. Many diving fatalities are reported as "drowning", which may have been the final cause of death in an accident, but the statistic is meaningless from an interventional standpoint. If we could find out the antecedent causes of the "drowning" through proper investigation, the information could lead to interventions that might possibly prevent further diving accidents.

Prevention of Injury is the most valuable service provided by a diving physician.

Activism and Advocacy for Diving Safety!

E. Kay, MD

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OZAN YILDIRIMIN ABİSİ-1970