Dive Medicine Elective

Thomas Eriksen

Thomas Eriksen is a final year medical student at the University of Glasgow. He has had a life long fascination with the marine world and achieved his PADI Open Water Diver certification aged 15. He has worked as a Divemaster in Honduras and has dived in numerous locations throughout the world. Here, he tells Adventure Medic about the ups and downs of a dive medicine elective at the Townsville Hyperbaric Unit.

Why Townsville?

For me, it was a no brainer that one of my elective placements would be in Hyperbaric Medicine. I chose to go to Townsville Hyperbaric Unit in Queensland, Australia as it had the largest hyperbaric chamber in the Southern Hemisphere and is the main referral centre for the whole of the South Pacific. My interest lies in dive medicine, but specifically recreational dive medicine rather than occupational dive medicine. Townsville offered the best chance to gain exposure to recreational divers with dive injuries due to the proximity of the Great Barrier Reef.

Who do they treat?

Before arriving in Townsville, I had learned that dive accidents were becoming less common and that hyperbaric units were treating fewer and fewer divers. So, I was prepared to only see a few cases during my stay. The unit treats around 10 patients a day of which >90% are non divers with radiation necrosis or hypoxic wounds. I learnt a great deal about the use of hyperbaric oxygen to treat these conditions.

What did you get up to?

The first week was spent familiarising myself with the unit and learning about the many other conditions that are treated with hyperbaric oxygen therapy. I also came up with a research project to keep myself busy while awaiting an incident. I conducted a 10 year patient review to see how the patient groups had changed over the last decade. As expected, the numbers of divers being treated fell steadily over the decade from around one diver a week to around one diver a month. I then reviewed the factors that may have played a role in this apparent increase in the safety of scuba diving. The most likely to have had the biggest impact is the now widespread use of dive computers. They calculate a diver’s nitrogen load taking into account previous dives and surface intervals to give a real time no decompression limit. Other important factors involved are diver and crew education, tougher dive industry regulation and fewer dives being completed due to the global recession

During my stay I observed the treatment of two divers. They both had different diving histories, symptoms and diagnoses. One was treated for decompression sickness and the other for arterial gas embolism to the spinal cord. It was fascinating seeing the coordination of team members, including those on the dive boat, rescue helicopter, emergency department and hyperbaric unit. I followed the divers’ journey from admission to discharge, after successful treatment with hyperbaric oxygen. It was an invaluable learning experience to see the course of conditions I had studied so much, and was very pleasing to observe the successful treatment of their conditions.

As well as the hospital itself, I was able to spend time in the Townsville municipal airport, seeing the rescue helicopter and medical evacuation planes with an A&E consultant and paramedics. Although unable to join a flight, despite my best efforts, I did learn a huge amount about the considerations and logistics involved in getting critically ill patients from remote areas to the relative safety of the hospital. This is an aspect of medicine that is very important for rural Australians since the country is so vast. On my first day I learned that Townsville Hospital serves an area the size of France, which really put things in perspective.

On top of all this, I organised some anaesthetics experience for a few days too. It was during my time in theatres that I realised that Australia is plagued by most of the same health problems that are prevalent in the population of the West of Scotland. There are significant problems associated with deprivation, particularly in the Aboriginal population and remarkably obesity is actually more of a problem than in the U.K.

Sum it up for us

I very much enjoyed my elective at the Townsville Hyperbaric Unit. If I had not been able to relate all I learned to real cases, I think I would have felt differently. My learning experience was greatly enhanced by the misfortune of two divers who fortunately and thanks to the services provided in Townsville made full recoveries. The elective even changed the way I dive. I have deepened (apologies for the pun) my knowledge about the dangers of diving and how they strike both the reckless and the unfortunate. I have since altered my underwater behaviour to be even safer than before. I have also taken reassurance from my project that scuba diving, though viewed as an extreme sport by many, is safer than ever. If only insurance companies would see it the same way and reduce dive insurance premiums!

Positives

• Great to learn about a specialty that some final year students have never even heard of.
• I was welcomed by the whole team and was part of the action when the divers came in.
• I got to spend time at the airport with Emergency Management Queensland and Careflight, and also in theatres.
• I learned about the Australian medical training and what it is like working as a doctor there. Very useful since it is a real career option for British doctors.
• Travel opportunities in Australia and around Australia are fantastic. I went diving on the Barrier Reef and on the incredible Yongala Wreck. After my elective I went travelling in Indonesia, where I spent the majority of my time underwater.

Negatives

• Australia is very expensive to live in.
• There are a very small number of divers treated per year, even in Townsville. So if you have very little interest in the other conditions treated with hyperbaric O₂ it may be boring at times.
• Less hands-on practical experience than other specialties can offer. Which may be a positive for some, but I went seeking practical experience up in theatres.
• Townsville is less exciting than other Australian destinations.

Do it yourself

Destination / Townsville Hyperbaric Unit, Townsville, Queensland, Australia

Time of Year / July and August

Weather / 22-25°C mostly cloudless, cooler at night.

Money Spent / Too much! Australia is expensive to live in! Approx £250 per week

Vaccinations / I required none

First Aid Essentials / Nothing special, plasters for fin blisters!

Risks / For much of the year there are jellyfish in the sea which can be dangerous. There are stinger nets and the sea water pool is filtered but you swim at your own risk. July and August are outside of stinger season so I swam carefree.

Tips

• Understand that decompression sickness and arterial gas embolism are rare conditions before committing yourself
• Liaise with the unit director about a possible project to keep yourself occupied while you are waiting for unlucky divers
• The hospital offers no accommodation and the University charges extortionate rates. Organising an apartment with others would be the most economical. I got a monthly rate with a hostel.