Dr Megan Evans / Diving and Hyperbaric Medicine Doctor / DDRC Healthcare
Diving: Managing Decompression Illness in Remote Locations
After her first taste of working as a dive medic on expedition, Megan went on to develop her interest by working for the DDRC Healthcare hyperbaric medical facility in Plymouth. Here she gives us a fascinating insight into what goes on at the centre and the unique opportunities they offer for junior doctors interested in learning more about diving and hyperbaric medicine.
My journey to DDRC
I first became interested in diving medicine during my F3 year when I volunteered as an expedition medic for a marine conservation organisation. I was going to be looking after staff and volunteers who were diving every day in a remote location, and although I was already a keen diver, I knew that I would need to do some preparation and ensure I was able to manage diving related conditions. A scuba medic course at London Diving Chamber (which has now sadly closed) helped me to get ready for the expedition and also piqued my interest in pursuing diving and hyperbaric medicine further – eventually leading me to DDRC!
DDRC Healthcare (formerly the Diving Diseases Research Centre) is a hyperbaric medical facility in Plymouth and is one of only 10 chambers in the UK that provide emergency hyperbaric oxygen therapy (HBOT) as members of the British Hyperbaric Association. DDRC is a registered not-for-profit organisation and has three key aims: research into hyperbaric illnesses and treatments; education to improve diver safety and accident management; and treatment with HBOT for a range of emergency and non-emergency conditions. It is also one of the only places that junior doctors can train and work in diving and hyperbaric medicine in the UK, due to their unique SHO positions.
What is diving medicine?
Diving and hyperbaric medicine are not routinely taught in medical school nor as part of postgraduate training, and many doctors I speak to have little knowledge of the field. For readers of Adventure Medic, diving medicine will be most relevant to those of you who, like me, find yourself going off on diving expeditions as the medic, and need to know what do to in the case of diving emergencies – especially when working in remote locations. Managing patients with diving-related pathologies can be complicated, and appropriate and timely treatment can have a huge impact on the patient’s outcome and whether or not they are left with a lifelong disability. DDRC offers an expedition diving medicine course for this purpose, and are also happy to give advice to medics going on diving expeditions. I would recommend reading Adventure Medic’s article on decompression illness as a good starting point, written by previous DDRC doctors!
In addition to the treatment of decompression illness in divers, hyperbaric oxygen therapy is also recommended for many other conditions including carbon monoxide poisoning, arterial gas embolus, radiation cystitis, sudden sensorineural hearing loss, central retinal artery occlusion, problem wounds, and many more. At DDRC we treat patients with many of these conditions, and also deliver teaching to colleagues in emergency medicine and other specialities to increase knowledge and awareness of the uses of HBOT and ensure patients are being referred to hyperbaric centres when necessary.
Another key aspect of diving medicine is assessing fitness to dive. Registered dive medical referees are able to assess whether someone is able to dive safely, and with specialist knowledge can take into consideration things like the effects of medication under pressure, cardiovascular strain due to immersion, and respiratory pathology with the risks of gas trapping and pulmonary barotrauma. This is also the case for commercial divers who are required by the Health and Safety Executive to have specific medicals in order to work, and both diving and occupational physicians can be involved in diving medicine from this perspective. Specialists such as cardiologists, psychiatrists or respiratory physicians with experience in diving medicine can also be invaluable when assessing fitness to dive, particularly when someone has a pre-existing medical condition or complex medical history. There are only a few individuals in the UK who are able to provide this specialist diving medicine advice, and so the field is definitely in need of more doctors with diving medicine experience!
What can I do at DDRC?
The junior doctor position is a one year post working three days a week at DDRC. This allows you to use the rest of your time to work locum shifts in your chosen speciality, which is fantastic for maintaining your clinical skills. You receive excellent training in hyperbaric medicine, both from the experienced staff at DDRC and through formal teaching. The DMAC level I and IID courses (Diving Medical Advisory Committee) that are provided as part of the role are the only specific diving medicine courses for physicians in the UK, and allow you to work more independently and be part of the DDRC on call service.
The 24/7 British Hyperbaric Association emergency helpline is in my opinion the most exciting aspect of the job, where you may end up taking calls from divers, paramedics or coastguards from all over the country for advice regarding suspected decompression illness. Assessing and treating unwell divers at DDRC can be immensely rewarding, often with rapid resolution of severe symptoms. We also take referrals for elective patients, many of whom will receive around 40 treatments and will therefore come in every day for eight weeks. Looking after them for an extended period means that you can build strong relationships, and you’re able to spend more time with your patients than is possible in the NHS. Recently we discharged a patient who had been struggling with a chronic wound for years, and seeing the drastic improvement in their wound and quality of life was incredibly satisfying.
Learning about fitness to dive issues and providing advice to divers is another really interesting aspect of the job, and was a real eye opener for me. It certainly made me consider more carefully the effects of diving on someone’s physiology, and how different medical comorbidities can be affected. This is also vital to be aware of if you’re planning on going on a diving expedition as a medic, as participants with pre-existing conditions may need detailed medicals by a diving doctor before setting off!
DDRC provides training courses not only for doctors and other healthcare professionals, but also for commercial divers, hyperbaric technicians, offshore medics and more. You can gain a real insight into the world of commercial diving and offshore work, and many of the participants have very interesting stories to tell! The doctors at DDRC work alongside the training team to teach various aspects of the courses ranging from diving physiology and decompression illness, first aid and life support, to complex care of patients in remote environments including practical skills such as catheterisation and chest drains. This is a great opportunity to get plenty of teaching experience which will always be helpful for doctors, especially when you’re looking at future job applications!
At DDRC you are encouraged and given the time and opportunities to pursue individual projects, including research, audit, developing teaching programmes, or writing for different publications. DDRC doctors have presented work on diving and hyperbaric medicine at national conferences, and one of the current SHOs is working on an exciting study related to diver’s lung function following Covid-19 infection. The role is flexible and definitely suited to applicants with some initiative – you really do get out what you put in.
I would absolutely recommend working at DDRC, it’s a great opportunity to pursue your interests, build your portfolio, and explore a really interesting aspect of medicine!
Get involved
DDRC employs three junior doctors. If this role interests you, please visit www.ddrc.org/jobs/ for more information and application details.
