DIVING MEDICINE

KNOWLEDGE OBJECTIVES
In organizing and scheduling the course, the instructor should keep these learning goals in mind as the objectives to be achieved and be flexible enough to satisfy the needs of each class.  After the period of instruction and rigorous, balanced examination process, the student should satisfy the instructor that he understands the following:

1. Role of the medic
    a. similarities and differences compared to non-diving
    b. record keeping
    c. relationship to diving physicians and others in the medical system

2. Medical/Fitness to Dive
    a. baseline, pre- and post-dive exams
    b. disqualifying conditions, temporary and permanent

3. Decompression sickness
    a. possible predisposing conditions, concept of susceptibility to an environmentally-caused
        disease
    b. theoretical physiologic events leading to DCS, initial and later phases of DCS, hematologic
        and other effects of tissue and intravascular bubbles
    c. common and unusual signs and symptoms of DCS, mild (Type I) and serious (Type II) DCS,
        major forms of DCS (skin, vestibular, joint, CNS, pulmonary, saturation)
    d. the test of pressure and its proper use in approaching the uncertain case of DCS
    e. concept of treatment table as a treatment or medication (ie, a dose); tables USN 5, USN 6,
        USN 6-A, Royal Navy 71 and 72, Comex 30 and 30-A, saturation tables; usual application of
        the treatment tables; follow-up after treatment
    f.  the flow chart from Field Guide for the Diver-Medic (or similar chart) and ability to sketch or
        form a general treatment plan and various options
   g.  the possible role of drugs in treatment (adjunctive), fluids, and those which diving physicians 
        may use

4. Barotrauma
    a. anatomy and physiology of the air-containing spaces, mechanism of squeeze and
        pulmonary over-inflation (air embolism, pneumothorax, Mediastinal emphysema, 
        subcutaneous emphysema)
    b. the principle signs and symptoms of squeeze and overpressure injuries and distinguishing
        features between them
    c. routine and emergency management of squeeze and over-pressure understanding of 
        tension  pneumothorax as encountered in diving

5. Oxygen toxicity
    a. simple concepts of causes of oxygen toxicity, signs and symptoms of CNS and pulmonary
        toxicity,  usual CNS and pulmonary oxygen limits
    b. understanding the difference between oxygen percentage and partial pressure
    c. UPTD general concept and that is additive, concept of air breaks and role in reducing
        oxygen toxicity problems

SKILLS OBJECTIVE                                             

The student should satisfy the instructor that he has mastered the following:

     1. Physical examinations
         a. an adequate emergency baseline assessment, obtain and evaluate vital signs, provide
             basic life support, properly use basic equipment such as pen light, stethoscope, blood
             pressure cuff
         b. use of the otoscope in performing a simple ear exam
         c. ability to keep adequate records of exams and treatments

      2. Neurological exams (student or instructor posing as patient)
         a. the ability to do an adequate field neuro exam covering; state of consciousness and
              intellectual functions, cranial nerves, sensory function, motor function, and
              balance/coordination
         b. ability to do exam inside and outside chamber and as follow-up to treatment

      3. Sham treatments (student or instructor posing as accident victim)
         a. ability to elicit symptoms of simulated DCS or barotrauma case
         b. ability to discover signs of same
         c. ability to use basic medical kit and equipment properly, at surface and in chamber
         d. ability to function smoothly at depth
         e. ability to formulate and conduct a basic treatment plan, both as inside and outside tender
         f.  ability to keep adequate records and make accurate reports to a diving physician or other
             higher authority
         g. ability to observe and maintain proper oxygen limits, recognize and manage simulated
             symptoms of toxicity

CHAMBER OPERATIONS MODULE

The usual role of a DMT is to tend the injured diver.  Therefore, the primary goal of DMT training is providing emergency medical care in and outside the chamber; there is no primary intent to make the medic an expert on chamber operations or hardware

Since chambers in many areas are thinly staffed, perhaps by persons of unknown competence, the major goal of the Chamber Operations Module is to enable the DMT to see to the safety of himself and his patient while in the chamber.  Secondarily, he is taught the rudiments of hands-on chamber operations, time-keeping, dive recording, pre- and post-dive checklists, and the conduct of a simple chamber treatment

Content Outline and Knowledge Objectives are presented the same as in the Diving Medicine Module.  A Sample Course Schedule is not given, as the additional time required will vary.  Much of chamber operations can be incorporated into the Medical Module (e.g, oxygen analyzers with oxygen toxicity, chamber ventilation with sham treatments) and a few hours of lecture will suffice for the rest.  As with Diving Medicine, much will probably depend on the individual instructor and the needs of each class

KNOWLEDGE OBJECTIVES                                                                                  

The student should be able to demonstrate clear understanding of the following:

I.  CHAMBER SAFETY

    A. The main codes and standards relating to chamber operations, safe handling of gases used
         in diving, and sources of information

    B. The factors necessary for occurrence of chamber fires, extreme hazard of chamber fires,
         oxygen percentage versus oxygen partial pressure, various ignition sources, flammability of
         ordinary materials in chambers, zone of combustion, need for proper clothing and oil-free
         environment

    C. The role of electrical systems as possible sources of fire, electrical failure as threat to safe
         operation of chamber

    D. The various ways fire can be extinguished (sand, water, etc)

    E. The methods for maintaining safe levels of oxygen and carbon dioxide, ventilation
         requirements, use of BIBS, use of analyzers, dangers and sources of carbon monoxide

    F. The need to protect ears from high noise levels, safe use of medical equipment in chamber,
         avoiding injury to medic and patient

    G. The function of carbon dioxide scrubbers, avoidance of caustic injury

II. CHAMBERS

    A. The main general types of chambers and main uses for each

    B. The basics of chamber construction, basic terminology of chamber operations

    C. An understanding of gas requirements for typical treatments, backup supplies, emergency
        procedures for supply failure

III. PRE- DIVE CHECKLIST

     Prepare a basic checklist and show how each item relates to the safe operation of the
     chamber. Student should not omit any significant item.

IV. POST- DIVE CHECKLIST

     The essential steps necessary to ensure the chamber is left ready for safe use, properly
     equipped and supplied

V. CHAMBER

     The ability to perform the essential functions of chamber operation and conduct a simulated
      treatment under supervision