Of the UHMS

Conference/Chapter Meeting

NOVEMBER 4-5, 2006

(pre-courses: November 3)

Hartford Marriott Downtown

200 Columbus Blvd., Hartford, CT

860-249-8000

REGISTRATION: ONLINE WORD PDF

PRE-COURSES: ACRYLICS WINDOW CHT/CHRN PRE-EXAM REVIEW COURSE

CALL FOR ABSTRACTS: DEADLINE: SEPTEMBER 15, 2006

SPONSOR/EXHIBIT INFORMATION: WORD PDF

HOTEL INFORMATION

This year’s Northeast Chapter Meeting will be held November 4-5 at the Hartford Downtown Marriott, Hartford, CT . There will also be two pre-courses on November 3 (one on Acrylics & the other a CHT/CHRN Exam review course).

Friday, November 3: 8:00am-5:00pm: Acrylics Pre-course

Friday, November 3: 8:00am-4:00pm: CHT/CHRN Review Course

Friday, November 3: 5:00pm: CHT/CHRN Exam

Saturday, November 4: 8:00am -5:00pm

• Opening Reception: 6:00pm (Sponsored by OxyHeal Health Group)

Sunday, November 5: 8:00am -12noon

Saturday Breakfast Buffet, Saturday Lunch Buffet and Sunday Continental Breakfast are included with Registration.

HOTEL INFORMATION:

Room rate at the Hartford Marriott Downtown will be $139.00. All guest rooms are subject to 12% State and local taxes. Check in time is 4:00 p.m. , and check out is 11:00 a.m. Individuals are requested to make their reservations no later than OCTOBER 4 to receive this special conference room rate. To make your reservations, please call their toll free reservation number at 860-760-2212 . When making your reservations, you must identify yourself as part of the “Undersea Hyperbaric Medical Society.” A one night’s deposit is due with each reservation.

NBDHT CHT /CHRN Exam will be held Friday, November 3 at 5pm . If you sit for this test and attend the NE Chapter meeting, you will receive the credit hours towards your license. You will be required to sign-in daily.

CME Credits will be available.

The Undersea and Hyperbaric Medical Society (UHMS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The UHMS takes responsibility for the content, quality, and scientific integrity of this CME activity. The UHMS designates this continuing medical education activity as Category I of the Physician’s Recognition Award of the American Medical Association. The individual physician may claim one credit hour for each hour of participation. (Up to TBD credit hours may be obtained).

All faculty members participating in continuing medical education activities sponsored by (Name of responsible organization) are expected to disclose to the participants any real or apparent conflict of interest related to the content of their presentation. Full disclosure of faculty relationships will be made at the activity.

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London Hyperbaric Medicine are pleased to announce their October Hyperbaric Medicine Course.

Monday 2^nd to 6^th October 2006

HYPERBARIC MEDICINE - A Course for Health Care and Diving Professionals

Our Biannual course have been developed to cope with an increasing international demand for high quality education in a professional environment. London Hyperbaric Medicine working in partnership with the Whipps Cross University Hospital now offers a course for interested individuals from all over the world which is recognised by the National Board of Diving and Hyperbaric Medical Technicians (NBDHMT), and has also been approved by the Royal College of Anaesthetists for Continuing Education & Professional Development. (15 CEPD points).

This course is aimed at the following professionals

• Hyperbaric technical staff
• Doctors with an interest in diving medicine
• Military Hyperbaric Staff from other countries
• Hyperbaric nursing staff (including ICU nurses)
• Hyperbaric tunnelling and professional diving specialists

The objectives of the course are to provide educational experience in the fundamentals of Hyperbaric Medicine for Health Care and Diving professionals with an interest in this specialty. The course encompasses the British Hyperbaric Association Core Curriculum for hyperbaric facility staff and includes practical experience in chamber operation and attendant duties.

For bookings contact our administrator, Ms Tricia Wooding on (0044) 020 8539 1222 or email her at mail@londonhyperbaric,com or visit our website at www.londonhyperbaric.com

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Questions are often asked about diving while overweight, body mass index and percent of body fat. There is no question that the risks are increased for divers who are overweight (BMI greater than 30kg/m2). There are several reasons why adiposity is important in considering whether or not a person is ‘fit to dive’.

Obesity and Decompression Illness
There is a considerable body of work relating an increased incidence of DCS to increased percentage of body fat. Higher DCS rates have been noted in the older diver, due in part, to the gradual increase in skin fold thickness (% body fat) and possibly to the increased incidence of cardiovascular disease, commonly noted in the obese.

When one dives, nitrogen dissolves in all tissues of the body in proportion to the gas solubility and the blood flow to the tissue. Nitrogen is very soluble in adipose (fat) tissue and, in overweight people, the fraction of this tissue in the body is high. Nitrogen loads can rise in adipose tissue and bubble formation can be extensive. These gas bubbles would empty into the venous system where they are carried to the heart and lungs. If the gas bubble loads to these organs is high, the lung capillaries become blocked, blood pressures rises in the pulmonary artery, and bubbles can pass through the lung vasculature (or a PFO, patent foramen ovale in the heart) and embolize the brain. This might lead to a vein-to-artery “stroke” and neurological DCS.

Dembert et al, in 1984, reported a higher incidence of decompression sickness in US Navy divers who had higher measures of skin fold thickness. In the same year, McCallum reported a higher incidence of decompression illness in obese commercial divers. Chryssanthrou noted the incidence of osteonecrosis to be higher in those who had a higher degree of obesity.

Cardiovascular Disease Risk Increase

BMI

In some areas of the world where medical fitness is more stringently regulated than the US, a high BMI (body mass index) would deter one from diving. Complicating conditions of adiposity include diabetes mellitus, dyslipidemia or hypertension and their associations with coronary artery disease. The BMI is important to divers due to the fact that people with high BMI are more prone to coronary artery disease and an untoward coronary event while diving. A BMI above 30 kg/m2 is thought to be excessively risky for diving. Of course, measured %BF can sometimes show that the diver is quite large and muscular and this needs to be taken into consideration.

Appetite Suppressants

Medications given for appetite suppression also have a risk for diving in that most have psychotropic effects and can cause elevated blood pressures. The possible ill effects of nitrogen added to the drugs are not known.

DAN ’s Report on DCI and Diving Fatalities for 2000 shows a high incidence of cardiovascular disease fatalities in divers over the past 9 years, surpassed only by AGE in 1998.

Diabetes

The overweight person as also at increased risk for diabetes. Unknown and untreated diabetics are at risk for wide swings in blood sugar levels, often brought on by stressful situations such as diving and cold water. Low blood sugar (hypoglycemia) is a risk factor for divers, known to cause drowning and gas embolism on ascent.

Decreased pulmonary function (hypoxia, CO2 retention)

The obese diver would be at risk for carbon dioxide retention and hypoxia due to decrease in all parameters of pulmonary function. This would be highly variable with the individual and would require PFTs to determine the real risk. Pulmonary function tests that are more than two standard deviations from normal would indicate high risk. Low vital capacity and FEV1 would be indicators of possible increased risk.

Decreased physical fitness, often associated with obesity thus can lead to the following:

Increased DCS

Decreased ability for self rescue

Decreased buddy rescue ability

Increased risk of panic in stressful situations

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A diver recently wrote asking about return to diving after having had a bang in the head in an automobile accident. He was briefly unconscious, had no memory loss and had not had any seizures. He was observed overnight in the ER and allowed home with negative studies to be followed by his family physician.

What Are the Problems Posed by a head injury in a diver?

Head injury generally poses two main problems with diving: post-traumatic epilepsy and changes in cognitive status.

Diving may be resumed or started after head injury if:

1.) No drugs are required

2.) There has not been loss of consciousness greater than 30 minutes

3.) There are no localizing signs

4.) There has not been amnesia longer than one hour.

What About Drugs?

Anticonvulsants should not be used with diving as they are all sedating and potentiate the effect of nitrogen narcosis, leading to disorientation at unexpectedly shallow depths. Diving may be resumed three months after the cessation of anticinvulsants without seizure activity.

What do others have to say about diving and head trauma?

Divers Aleret Network has several articles about diving with head trauma. One of these is in DAN FAQ about head trauma at http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=76

Another article in the DAN website by Dr. Hugh Greer (dec.) is located at http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=15

The British SubAqua Club have this to say about head trauma and diving:

BS-AC recommendations: “The length of post traumatic amnesia (PTA) including any period of unconsciousness may be used as an index to the severity of injury. Where PTA has been less than one hour, there should be a three week layoff from diving. With PTA of an hour to 24 hours, there should be a two month layoff. Where the period of PTA exceeds 24 hours, there inevitably has been severe brain damage and there is considerable likelihood of subsequent epilepsy and impaired mental functioning. A minimum period off diving of three months is suggested and cerebral function should have returned to normal.

If epilepsy should have developed as a result of injury then further diving is banned unless it was an isolated fit occurring at the time of injury. Likewise if anticonvulsant medication is being taken as a prophylactic measure, diving should be banned, but may be resumed three months after this is withdrawn if the individual never had a seizure.

Operative intervention to raise depressed bone or evacuate haematomas should disqualify for three months but otherwise may be disregarded except insofar as it may be associated with subsequent fits, anticonvulsants treatment or other factors above.”

Get the approval of your physician

You should be able to dive if you have

—the approval of your physician,

—have not had seizures

—have not had a reduction in your ability to perform the task-loading required in safe diving, self-rescue and rescue of your buddy

—and have been off medication as described above.

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Divers Alert Network now offers three online seminars, addressing safety and
health issues of interest to divers.

The most recent addition to the online seminars is ³Inert Gas Exchange,
Bubbles, and Decompression Theory,² presented by Richard Vann Ph.D., DAN
vice president of research, at a recent Diving and Hyperbaric Medicine
course offered by DAN. Participants can learn about inert gas exchange in
the body and the affects those bubbles can have on one¹s dive.

This presentation addresses some of the fundamental principles that govern
inert gas exchange between the environment and tissue, particularly, the
profound effects bubble formation can have on inert gas exchange. Vann
places these ideas into a historical context to show how decompression
theory has evolved and how this has affected the severity of decompression
sickness (DCS).

Stephen Belth, DAN DES Instructor from Merrick, N.Y., highly recommended the
latest DAN online offering for both instructors and students who want to
further their knowledge about dive safety.

“Dr. Vann provided a great experience for me in very easy to understand
language,² Belth said. ³I found it extremely enjoyable and enlightening as
he cleared up many concepts around DCS that I had previously understood only
vaguely.²

DAN also offers two other web-based seminars about diving and dive medicine:
³Ears and Diving² and ³Pathophysiology of Decompression Illness.²

Open to the general public at a cost of $25 US, this online presentation
takes 60-90 minutes to complete. Participants receive certificates of
completion from DAN. See this presentation and others at
http://www.diversalertnetwork.org/training/seminars/index.asp.

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