Dr Ayesha Sithirapathy / Clinical Fellow /DDRC Healthcare, Plymouth
Diving and Hyperbaric Medicine is a unique subspecialty of medicine that many trainees never get exposed to throughout their entire careers. For aspiring adventurous medics, a new opportunity to work as a Foundation Doctor at the DDRC is a great way to gain experience in this field in a supportive setting. Dr Ayesha Sithirapathy describes her experience of working as the first-ever F2 doctor in Diving and Hyperbaric Medicine at the DDRC Hyperbaric Chamber.
What is the DDRC?
DDRC Healthcare (formerly the Diving Diseases Research Centre) is a hyperbaric medical facility in Plymouth. It is one of only 10 chambers in the UK providing emergency hyperbaric oxygen therapy (HBOT) as British Hyperbaric Association (BHA) members. 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 HBOT for both emergency and non-emergency conditions.
Whilst the centre is best known for treating diving decompression illness or ‘the bends,’ divers only account for one-third of their patients. They also offer HBOT for a variety of non-diving-related conditions. These conditions include iatrogenic gas embolisms, radiation proctitis, sudden sensorineural hearing loss, non-healing wounds, and many more.
DDRC delivers 24/7 diving and hyperbaric medical emergency services, operating the national BHA Emergency Helpline. As well as this it produces diver safety materials, presentations, courses, and events.
My Journey to DDRC
The Foundation Year Two role was created in 2023, making me the first person to rotate to DDRC in this capacity. The application process for this job has since changed, and now uses the national allocation process on Oriel. Having been an active member of the University Wilderness Medicine Society I had a small amount of academic exposure to dive medicine and medicine in controlled environments. However, no prior knowledge or experience in this field is required with excellent on-the-job teaching and close supervision to guide you through. It was a steep learning curve initially, but rewarding to see the progress of assessing and treating patients with both emergency and non-acute presentations.
What cases do you see?
The DDRC’s clinical work is roughly divided into emergencies (e.g. ‘the bends’ and gas embolisms) and elective therapies. The DDRC is also involved with outpatient clinics and reviews inpatient referrals from Derriford Hospital.
As the F2 Doctor, you occasionally hold the on-call doctor bleep in hours as the ‘duty doctor’ and can take calls through the BHA Emergency Helpline. You will always be supervised and have people to ask for advice if you are unsure about anything.
For example, when I was the duty doctor, I took a call regarding a diver in Dorset who developed neurological symptoms after surfacing; unilateral arm paresthesia and weakness. Working through a proforma of questions the patient’s history suggested a likelihood of having the bends (inert gas bubbles evolving within body tissues). For this condition, the patient required an in-patient assessment at our chamber. I provided advice on how to stabilise the patient and arranged for a transfer to the chamber.
On arrival of the patient, I led the initial assessment, including a full history, neurological exam, and hyperbaric chamber safety checklist. As an F2, all of this is done under supervision from a senior doctor highly experienced in hyperbaric medicine.
This patient responded brilliantly to treatment in the chamber. The treatments have set times but can be extended until the patient’s symptoms resolve, sometimes lasting several hours. If, despite this, there is not a satisfactory resolution of symptoms, the patient would be reassessed to decipher whether there may be another cause for the symptoms.
Outcomes are significantly improved the faster treatment is commenced thus helicopter versus ambulance transfer is often a decision we need to make. The DDRC is technically a remote medical site, so patients must be stable before arriving here. If they are unwell, we recommend they attend the Emergency Department first as a clinical priority – we are then only five minutes away from Derriford Hospital, a major tertiary centre.
How does this role fit into Foundation Training?
This job is located within the Peninsula Deanery (covering Devon and Cornwall) and accounts for your community F2 job if working at Derriford Hospital in Plymouth. Although the hours are Monday to Friday, 08.30 am to 5 pm, you are welcome to attend any out-of-hours emergency calls for excellent learning. It is a standard-length 4 monthly rotation with only one F2 doctor at a time thus providing a wealth of supervised learning opportunities.
As a community placement, I found it to be a well-needed break from the acute hospital rush. If you are an outdoorsy person then living in the South West is fantastic. Having Dartmoor and the South Coast on the doorstep is a huge perk and a complimentary bonus of training in Devon.
Other opportunities
Aside from the clinical work mentioned above, the role has plenty of non-clinical opportunities. You can get involved with teaching on the various courses offered by the DDRC, delivered to both medical and non-medical personnel. With this teaching experience, and more head space, I designed and implemented a new part of the Peninsula Deanery Foundation Doctor’s regional teaching programme.
Engaging in research and audit opportunities has also been an excellent benefit of the job. Having protected project time allowed me to complete an audit of the BHA helpline calls from last year; presenting these results at the national 2023 BHA/UKDMC in London.
There is an opportunity to attend teaching, including the Diving Medical Advisory Course (which is the qualification required to become an Approved Medical Examiner of Divers) around your work commitments.
As well as being a great start for anyone wanting to pursue a future career in Diving Medicine this role supports doctors looking to do any remote or expedition work near the coast or sea. Aside from this F2 position, there are junior clinical fellowship positions available at DDRC which I am fortunate enough to be starting now.
The Verdict
My experience at DDRC was overwhelmingly positive. The staff are all extremely friendly, supportive and keen to teach. I found it intellectually stimulating covering new and exciting content whilst being very practical. The only downside is that it is slightly less clinical when compared to other Foundation rotations but the other opportunities more than make up for this.
Overall, I would wholeheartedly recommend applying for this F2 role if you can. DDRC is one of the only places in the UK where junior doctors can train and work in diving and hyperbaric medicine, so whether you are specifically interested in pursuing a career in these fields or simply want to learn something new, it is a fantastically unique opportunity!
Photos Courtesy of Dr Ash Sithirapathy
