SHO in Diving and Hyperbaric Medicine

Louise Wade / Adventure Medic Staff Writer

Louise spent six months as a Senior House Officer in Diving and Hyperbaric Medicine at the Diving Diseases Research Centre. The post, based in Plymouth, is one of the few ways to become trained in hyperbaric medicine as a junior doctor. They take two doctors every six months. Louise talks us through her time, and tells us how to apply.

From Fiji to Plymouth

The day after I completed my Foundation Training, I got on a 26 hour flight to Fiji. I had decided to have a break from the career ladder to see what I could learn from a different environment. A Fijian beach seemed like a good place to start.

I was beginning a job as an expedition doctor for a marine conservation project and was responsible for looking after a team of divers surveying the reef. I was interested in diving medicine and had read up on it before my arrival but none of our divers had any problems and I was lucky to spend most of my time relaxing on the beach.

My desire for a killer tan was satisfied but I was still keen to gain real experience of diving medicine. A couple of months after my return I was looking for my next adventure and I came across an SHO job at the Diving Diseases Research Centre (DDRC) in Plymouth. The post looked immediately appealing and on completion of an application form and a trip to Plymouth for an interview I got offered a 6 month job starting in February 2012.

The Diving Diseases Research Centre

The DDRC is one of the busiest hyperbaric centres in the country. They operate a 24-hours a day service receiving around 50 diving casualties each year. In addition to this they provide hyperbaric oxygen therapy for a number of other emergency conditions such as necrotising fasciitis and carbon monoxide poisoning. A large part of their work concerns elective patients as well, particularly those with radiation tissue damage or problem wounds.

They have three multiplace chambers at the centre in which they can treat several patients simultaneously and one monoplace chamber which is for an individual patient. The largest chamber, known as the “Krug”, looks like the inside of an aeroplane – it is a large metal tube, with round windows and a TV screen on which DVDs can be played whilst patients are receiving their treatment. For the more serious cases of decompression illness patients could be in the chamber for up to seven and a half hours. During a treatment the chamber is pressurised and, at depth, it can be up to the equivalent of being 30m underwater. Patients breathe oxygen at intervals through special hoods and they always have a trained attendant in the chamber to look after them.

Diving emergencies

Being involved with the diving emergencies was without a doubt one of the most interesting jobs I have had as a doctor. As the SHO you take the emergency calls during normal working hours, and you can find yourself being patched through to the captain of a ship or talking to the coastguard who are coordinating a rescue several miles offshore. The sicker patients would then be brought in by helicopter, landing at the helipad at the nearby Derriford Hospital. As long as there was no suspicion of a pneumothorax they would then come straight to DDRC as the sooner we could get them in the chamber the better chance of a good outcome.

You become part of a really close, well organised team as you quickly carry out an appropriate history and exam while the chamber team are already setting things up to get the patient in. Divers could arrive with quite staggering neurological symptoms – for example patients with a spinal cord decompression illness might lose the power and sensation in their legs – but if treated promptly there is a reasonable chance they could make a full recovery. It is the first time that I have seen patients improve so much, so quickly – looking after a patient who goes into the chamber paralysed and then later walks out is immensely rewarding.

Elective hyperbaric oxygen therapy

Being involved with our routine, elective hyperbaric oxygen therapy patients was quite special too. They could receive up to 60 treatments in the chamber, delivered as one treatment each day Monday to Friday. Patients could therefore be with us for 12 weeks and I saw them almost every day for this period. Many of them had extensive medical histories and would have been through treatment for cancers or suffering from long term conditions like diabetes. At the DDRC we had the luxury of being able to provide a higher staff-to-patient ratio and to have more contact time with our patients than is typical of the NHS. The relationships you can build up with the patients and indeed the support and pleasure they gain from building up relationships with one another are quite unique.

Teaching, training and audit

The DDRC did not only provide hyperbaric oxygen therapy, there was also a large teaching and training department. They ran a range of courses from the Offshore Medics Course (for medics working on oil platforms and boats), to courses for recreational divers and in diving medicine for physicians. There were plenty of chances for the SHO to be involved in teaching on these courses and even opportunities to attend some of them. It was also possible to get involved in audit and with the very active research department. With the DDRC being a small organisation you gain experience in clinical governance and teaching that is often not possible in larger NHS hospitals and this has no doubt been beneficial in my later application for a training post.

As part of the job I also worked one day a week in the Emergency Department at Derriford Hospital. This could in theory include night shifts and weekends, but in order for me to be able to do my four days a week at DDRC it was most commonly a day shift. This is part of the job allows you to maintain your general medical skills and to see a wider variety of patients.

Postgraduate Course in Remote Healthcare

Included in the post is the opportunity to complete a Postgraduate Certificate in Remote Healthcare run by Plymouth University. This was the first part in a Masters Programme and I found myself on the course with a really interesting mix of colleagues including doctors from the British Antarctic Survey and the military. It was a mixture of face-to-face and distance learning. The first module, The Remote Practitioner, covers topics such as altitude medicine, jungle medicine, hypothermia, drowning and, of course, diving medicine. It is an inspiring programme that in turn led to further opportunities – on completing my post at the DDRC I went on to work in Sierra Leone for four months.

Getting involved

Each year the DDRC takes on two SHOs for 6 months each. I would highly recommend the job. It presents a unique range of opportunities: from diving and hyperbaric medicine, to rare neurological presentations and teaching, research and audit. All whilst working sociable hours, being part of a small friendly team and getting to live in one of the most beautiful parts of the UK. The best thing however, is that after completing a job like it feels only right to make use of my new knowledge. I just can’t decide if it would be better to join a diving expedition in the Philippines or the Maldives.

To apply or to arrange a visit, contact the Medical Director Dr Christine Cridge at info@ddrc.org. They require two years post-qualification experience and full GMC registration.