Journal of Marine Medical Society

: 2018  |  Volume : 20  |  Issue : 1  |  Page : 55--56

Update in military medicine

Rohit Verma 
 PMO, INS Agnibahu, Mumbai, Maharashtra, India

Correspondence Address:
Surg Cdr Rohit Verma
49 Bhagirathi, Near Afghan Church, Colaba, Mumbai - 400 005, Maharashtra

How to cite this article:
Verma R. Update in military medicine.J Mar Med Soc 2018;20:55-56

How to cite this URL:
Verma R. Update in military medicine. J Mar Med Soc [serial online] 2018 [cited 2022 Nov 27 ];20:55-56
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 Epidemiology of Diving Injuries

Diving-related morbidity and mortality data are usually scant and difficult to gather due to the variety and magnitude of diving activity. A joint study by Divers Alert Network and Public Health Agency of Canada undertook a 10 years' longitudinal study [1] to investigate the morbidity and mortality among recreational divers in the US and Canada. The findings demonstrate a low prevalence of diving-related injuries. In Canada and the USA, only one out of every 10,000 Emergency Department (ED) presentations was found to be due to a self-contained underwater breathing apparatus (SCUBA) diving-related injury. However, there were 47 deaths for every 1000 ED presentations for scuba injuries. This relatively high figure illustrates the peculiarities of the SCUBA diving environment and the limitations of providing definitive healthcare to victims of injuries related to SCUBA diving. There were 1.8 deaths per million recreational dives, and mortality in scuba diving is nonetheless relatively low.

 Decompression Practices in Altitude Diving

Decompression practices are forever evolving; however, data regarding decompression from dives conducted at high altitude are scanty. The decompression tables at sea level are extrapolated for use at high altitude using conversion factor to take into account the decreased ambient pressure. A recent study published [2] in the Aerospace Medicine and Human Performance journal conducted by the Chinese workers tried to objectively evaluate the effects of acute high-altitude exposure on fitness to dive and the safety of decompression after Helium– Oxygen (heliox) diving while using the U.S. Navy heliox decompression tables with cross-correction. They found that diving at high altitude with a short acclimatization period appeared safe despite divers exhibiting clinical symptoms and electroencephalogram signs of impairment by hypoxia at high altitude. The study also found the application of the U.S. Navy standard heliox decompression tables with altitude correction is effective for high altitude.

 Survival at Sea

The scenario of being lost at sea is a real danger to mariners. Even with modern tracking technology and best of the equipment, loss of mariners at sea due to exposure remains a challenge. This interesting case report [3] delves in the physiology of prolonged immersion and exposure of a New Zealand diver who was lost at sea for 75 h and survived immersion in temperatures of 16°C–17°C. Key findings regarding factors which helped in the survival of the diver were: A large bodyweight, donning a thick wetsuit and staying in the “Heat Escape Lessening Posture.” However, using safety devices such as a buoy marker and diving with a buddy could have prevented his situation in the first place.

 Submarine Medicine

The current escape philosophy of escape from a disabled submarine involves fast buoyancy ascent escape (FBAE). In an experimental model, this type of escape induces a special type of decompression sickness (DCS) characterized by cardiopulmonary injuries. A recent Chinese Navy study [4] in a rat model evaluates the preventive effect of pyrrolidine dithiocarbamic acid (PDTC) in FBAE-induced DCS rats. The results demonstrated that PDTC administration could provide satisfactory effects on abnormal FBAE-induced DCS through partially regulating the perturbed metabolic pathways. This study could have a significant effect on subsequent submarine escape training procedures.

 Hyperbaric Oxygen Therapy

Cochrane has undertaken its periodic review of the hyperbaric oxygenation for tumor sensitization to radiotherapy. It has found lack of good quality studies. Based on the limited evidence, it has found HBOT improves local tumor control, mortality, and local tumor recurrence for cancers of the head and neck. However, it has emphasized on the need for better quality randomized control trials for arriving at a firm direction.

 Tactical Combat Casualty Care

Tactical Combat Casualty Care (TCCC) is being periodically revised on the basis of latest evidence emanating from the various conflict zones. The recent review in September 2017[5] evaluated among other things; usage of extracorporeal membrane oxygenation in prehospital care,[6] successful usage of ketamine as a prehospital analgesic,[7] and usage of intramuscular tranexamic acid as an adjunct in the management of hemorrhagic shock.[8] There is paucity of data regarding safety due to the peculiar scenario of TCCC which precludes to large-scale randomized control trials.

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Conflicts of interest

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1Buzzacott P, Schiller D, Crain J, Denoble PJ. Epidemiology of morbidity and mortality in US and Canadian recreational scuba diving. Public Health 2018;155:62-8.
2Shi L, Zhang YM, Tetsuo K, Shi ZY, Fang YQ, Denoble PJ, et al. Simulated high altitude helium-oxygen diving. Aerosp Med Hum Perform 2017;88:1088-93.
3Massey H, Leach J, Davis M, Vertongen V. Lost at sea: The medicine, physiology and psychology of prolonged immersion. Diving Hyperb Med 2017;47:239-47.
4Yiqun F, Pu Y, Haitao W, Xiaochen B, Jun M, Shi Z, et al. Metabonomic potential plasma biomarkers in abnormal fast buoyancy ascent escape-induced decompression sickness model and the protective effects of pyrrolidine dithiocarbamic acid. Undersea Hyperb Med 2017;44:109-19.
5Hartford B, Shapiro G, Marino MJ, Smith R, Tang N. Proceedings from the 2017 mid-year meeting of the committee for tactical emergency casualty care (C-TECC) and committee updates. J Spec Oper Med Spri 2018;18:160-1.
6Macku D, Hedvicak P, Quinn J, Bencko V. Prehospital medicine and the future will ECMO ever play a role? J Spec Oper Med Spri 2018;18:133-8.
7Lyon RF, Schwan C, Zeal J, Kharod C, Staak B, Petersen C, et al. Successful use of ketamine as a prehospital analgesic by pararescuemen during operation enduring freedom. J Spec Oper Med Spri 2018;18:70-3.
8Vu EN, Wan WC, Yeung TC, Callaway DW. Intramuscular tranexamic acid in tactical and combat settings. J Spec Oper Med Spri 2018;18:62-8.