SEATTLE – A group of medical providers and medics recently spent two weeks at the National Oceanic and Atmospheric Administration’s National Dive Center here learning how to treat patients who may have suffered a dive injury.
They were all students in the Joint Hyperbaric Medical Officer and Technician Course, sponsored by the Army's Office of the Surgeon General, held April 18-29.
Nearly 40 people from multiple military services and federal agencies – including the Army, Navy, Air Force, Coast Guard, U.S. Public Health Service, Defense Health Agency, and NOAA – attended the course at the NDC, located in Seattle’s historic Warren G. Magnuson Park.
Underwater instruction took place in the aquatic facility at Naval Station Everett, Washington.
Diving, in both military and civilian sport applications, can be dangerous. While dive injuries are generally rare, they do happen, and that’s where Hyperbaric Oxygen Therapy – HBOT – comes in.
HBOT was originally developed and used for diving complications such as decompression sickness (‘the bends’), which results from bubbles of nitrogen or other gases forming in the bloodstream. The bends can be caused by returning too quickly to a normal altitude after being at ocean depths.
The most common symptom of the bends is extreme joint pain at the shoulders, elbows, knees, and ankles, but in extreme cases, the affliction can be fatal.
Patients suffering injuries needing HBOT are placed into a 100% oxygen environment for up to two hours. HBOT eliminates gaseous bubbles from the bloodstream and encourages the body’s cells to repair themselves. HBOT is painless.
Dr. (Maj.) Nicholas Studer, the medical director for the Army’s emergency medical services program at OTSG and a physician-scientist at the USAISR, was the course director. Studer said the course was part of a “longstanding effort” to train people to prevent and handle dive injuries.
“It’s probably been going on for about 50 years,” Studer said. “There are some predecessor courses that were involved in this and there’s other courses that the military has that are of a different utility or focus.”
Studer said there used to be another course taught at the NOAA facility to train medics and providers how to prevent dive injuries, and prevention via the hyperbaric chamber, but it was discontinued in 2019.
“What I learned was that there was no Army DMO [dive medical officer] course, and there was no similar program in the Army,” he said.
Studer said there were other, similar courses offered by different services or agencies, but they weren’t quite applicable to the Army’s needs.
“I brought this up and said, ‘this is a big problem’,” Studer said.
His boss felt, “This fit the portfolio of the EMS program office. No one else was doing it, and there was this need” now that NOAA was no longer teaching its course, Studer added.
So, the program of instruction was developed, the word put out, and class rosters filled. The NOAA location in Magnuson Park, in a part of Seattle known as Sand Point that once housed Naval Station Puget Sound, was chosen, since it’s the home of NOAA’s premiere dive training center.
Early intervention and treatment are key elements in any dive emergency.
“The future of Army Medicine is prehospital,” Studer said.
Prehospital treatment is the assessment, stabilization, and care of a medical emergency or trauma victim. It can mean onsite care at the scene of an accident or injury, up to and including transportation to a health care facility. The HBOT strategies taught during the course fell into that category.
Studer said the course was the first of what's planned to be a regular occurrence.
"There'll be two courses per year," Studer said. "The next one is in August. This is a new pilot program, run directly by the Office of the Surgeon General at the moment, as we look at who's going to be the final owner of the courses.
Students put in nine-hour days, six days a week, for the duration of the two-week course, studying the particulars of dive medicine.
Subjects as diverse as ‘Diving Maladies and Injuries’ and ‘Aerospace Decompression Illness’ occupied their time, along with practical exercises and training in the facility’s hyperbaric chambers, and open-circuit scuba diving.
While most of the students came from military medical backgrounds, not all had diving experience. Some were military-trained divers, some were experienced recreational divers, and others had never worn diving equipment.
Army Sgt. Ethan Bunting was one of the students without diving experience. A medic assigned to the 74th Engineer Dive Detachment at Joint Base Langley-Eustis, Virginia, the five-year veteran said he wasn’t even aware the Army had divers until he received orders to the unit.
“I’d just requested a PCS [permanent change of station] originally trying to get closer to my wife, and chose Fort Eustis,” Bunting said. “I got orders to the 92nd Engineer Battalion, looked up the UIC [unit identification code] of the unit I was going to, and it said ‘dive detachment.’
“I was like, ‘What? What’s this?’” Bunting added.
Despite not knowing anything about diving and admitting, “I really don’t swim” even while adjusting dive tanks and a mask, Bunting said his mind changed after reporting to the dive detachment.
“It’s a great environment,” he said. “I’m super happy there.”
Bunting said attending the course would go a long way to improving his knowledge.
“Engineer dive detachments don’t really have much of a use for your typical combat medic,” Bunting said. “You’re there in case somebody bumps their head on the way up, or gets a cut while they’re working.”
But, Bunting added, the course provided him with valuable information he’s able to use back at his unit.
“This course helps me learn and broaden my horizons and my scope of practice,” he said. “It also helps out my team, because I can relieve one of the diving supervisors to go help with something else in the diving department.”
Bunting said his favorite part of the course was learning how the equipment works and the science behind dive injuries and their treatment, especially the medical aspects of them.
“Understanding the physics of diving,” he explained, “and understanding how and why these injuries occur to divers.”
Luckily, Bunting added, no diver injuries have occurred while he’s been assigned to the 74th Engineer Dive Detachment.
“But,” he said, “now I definitely feel way more comfortable and confident in being able to help out and treat them [if they do].”
Even those with extensive diving experience thought the course offered a wealth of new information they'd be able to put into use at their commands.
Petty Officer 1st Class Westley Gorman, a Navy hospital corpsman assigned to the Defense POW/MIA Accounting Agency at Joint Base Pearl Harbor-Hickam, Hawaii, has been a recreational diver for 10 years.
He said it’s helpful for those above the water to know what’s going on in the event there’s an emergency below the surface.
“Normally our dive profile lets us…formulate a diagnosis in our plan,” Gorman said. “Me, as an IDC [independent duty corpsman], Air Force IDMTs [independent duty medical technician], or Army ‘whiskeys’ (combat medic, Military Occupational Specialty 68W), we’re typically out there as the sole provider, so we’ll be the ones responsible for treating that individual if they have some sort of DCI [decompression illness].”
Gorman said he found the scientific aspects of the course the most interesting.
“I’m a huge fan of recreational diving, so I just expanded my knowledge in that area,” he said, “as well as expanding my professional knowledge and medical treatments related to dive-related casualties.”
After two weeks of lectures, study, and practical exercises, the course’s students were able to put what they learned into practice by being run through a number of scenarios, including a diver suffering from a DCI, a near-drowning, and medically evacuating a patient in a portable hyperbaric chamber placed aboard a Navy MH-60S helicopter, flown down from Naval Air Station Whidbey Island, Washington, for the exercise.
Perhaps the most important takeaway, though, was how students will be able to apply what they learned to real-world situations.
Gorman, assigned to DPAA – the agency charged with finding America’s lost and missing service members from past conflicts – said he “100% recommends this course.”
But, Gorman said, that’s not all.
“What I’m most excited about,” Gorman said, “is that after leaving this course, I can go out and support dive missions to help bring those fallen back home.”
Christopher Larsen is a Public Affairs Specialist with Regional Health Command-Pacific, U.S. Army Medical Command, Joint Base Lewis-McChord, Washington.