Three papers just out in the journal Diving and Hyperbaric Medicine detail one aspect of the scientific diving research carried out by the National Facility for Scientific Diving at SAMS.
Ross JAS, Sayer MDJ. Emergency recompression: clinical audit of service delivery at a national level. Diving and Hyperbaric Medicine. 2009;39:33-7
Clinical audit is an essential element to the maintenance or improvement of delivery of any medical service. During the development phase of a National Recompression Registration Service for Scotland, clinical audit was initiated to provide a standardised tool to monitor the quality of outcome with respect to the severity of presentation. A functional audit process was an essential consideration for planned future measurement of treatment efficacy at local (single hyperbaric unit) and national (multiple hyperbaric units) scales. The audit process was designed to be undemanding, robust and informative, irrespective of the experience of treatment centre and of the clinician in charge of treatment. The clinical records from 104 cases of divers with decompression illness were used to derive and evaluate measures of severity and clinical outcome that could be used for audit and quality assurance. The various measures of disease severity were examined against clinical outcome and days spent in care after admission to a hyperbaric unit. An initial version of the clinical audit format that was developed from this process is presented.
Sayer MDJ, Ross JAS, Wilson CM. Analyses of treatment for divers with actual or suspected decompression illness. Diving and Hyperbaric Medicine. 2009;39:125-31.
Introduction: We examined national and single-centre datasets in Scotland to determine any trends in the treatment of diving-related disease and to assess how the choice of first treatment may be linked to the divers' condition on referral and on discharge. Method: Two datasets were analysed: (1) 300 divers treated for actual or suspected decompression illness by the Dunstaffnage Hyperbaric Unit (Oban) between 1972 and 2007; and (2) 536 divers treated by the Scottish recompression chamber network between 1991 and 2003 (some data were common to both sets). The type and frequency of initial and any subsequent hyperbaric treatment used were examined. Any trends in demographics, reasons for diving, dive series profiles and condition on admission were examined. Results: Ninety to 92 per cent of treated divers received standard or modified Royal Navy treatment table 62 (RN 62) or US Navy table 6 (USN 6) for their primary treatment. Nearly a third of the divers (32%) were rated as having a severe condition on admission; only 4% had a severe condition on discharge. Analysis of outcome versus treatment type was complicated by divers with more severe symptoms on referral tending to have a worse outcome (concomitant with their referral condition) while receiving more prolonged and complex treatments. Conclusions: Shorter and shallower treatment tables (e.g., US Navy table 5, Royal Navy table 61), when used as first treatment, may result in poorer outcomes compared with RN 62/USN 6 treatment. Although subject to ongoing analysis, the shorter and/or shallower treatments have been discouraged as a first treatment in Scotland.
Wilson CM, Ross JAS, Sayer MDJ. Saturation treatment in shore-based chambers for divers with deteriorating cerebrospinal decompression sickness. Diving and Hyperbaric Medicine. 2009.39:168-72.
Nearly 4% of all primary recompression treatments in Scotland employ saturation tables (helium/oxygen-oxygen/air or oxygen/air alone). These cases usually involve divers presenting at the surface who then develop deteriorating spinal cord injury with varying degrees of cerebral involvement. Treatment is delivered either through immediate saturation therapy or through conversion of failing or failed primary treatment. The basic principles and delivery protocols of saturation treatment are outlined. A case study from both types of treatment is presented to illustrate the forms of decompression sickness that may require saturation treatment and how the treatments are initiated and evolve.