A review of 149 Divers Alert Network emergency call records involving diving minors.

INTRODUCTION: Minors have been scuba diving for decades, and while the initial concerns about potential long-term complications related to bone development appear to be unfounded, the incidence of scuba diving injuries among them has been poorly studied. METHODS: We reviewed 10,159 cases recorded in the DAN Medical Services call centre database from 2014 through 2016 and identified 149 cases of injured divers younger than 18 years. Records were analysed for case categorisation on the most common dive injuries. Information about demographics, level of training, risk factors, and relevant behavioural aspects were collected when available. RESULTS: While the most common reason for the call was to rule out decompression sickness, the majority of cases pertained to ear and sinus issues. However, 15% of the dive-related injuries involving minors had a final diagnosis of pulmonary barotrauma (PBt). While no reliable data is available on the incidence of PBt in adult divers, the authors' impression based on personal experience suggests that the number of cases of PBt in minors trends higher than in the general diving population. The narratives on some relevant records describe unmanageable levels of anxiety leading to panic. CONCLUSIONS: Based on the results and narratives on these cases, it is reasonable to infer that psychological immaturity, suboptimal management of adverse situations, and inadequate supervision might have led to severe injuries among these minor divers.

Tactical Combat Casualty Care Maritime Scenario: Shipboard Missile Strike.

The types of injuries seen in combat action on a naval surface ship may be similar in many respects to the injuries seen in ground combat, and the principles of care for those injuries remain in large part the same. However, some contradistinctions in the care of combat casualties on a ship at sea must be highlighted, since this care may entail a number of unique challenges and different wounding patterns. This paper presents a scenario in which a guided missile destroyer is struck by a missile fired from an unmanned aerial vehicle operated by an undetermined hostile entity. Despite the presence of casualties who require care, the primary focus of a naval vessel that has just been damaged by hostile action is to prevent the ship from sinking and to conserve the fighting force on board the ship to the greatest extent possible. The casualties in this scenario include sailors injured by both blast and burns, as well as a casualty with a non-fatal drowning episode. Several of the casualties have also suffered the effects of a nearby underwater explosion while immersed. Challenges in the care of these casualties include delays in evacuation, the logistics of obtaining whole blood for transfusion while at sea, and transporting the casualties to the next higher level of care aboard a Casualty Receiving and Treatment Ship. As the National Defense Strategy pivots to a focus on the potential for maritime combat, the medical community must continue to maintain readiness by preparing fo.

Health and wellbeing of recently active United States scuba divers.

INTRODUCTION: This study aimed to describe recently active adult scuba divers in the United States (US) and compare their characteristics with other active adults. The research question was: do active scuba divers have different health and wellbeing characteristics, compared with adults active in other pursuits? METHODS: The Behavioural Risk Factor Surveillance System (BRFSS) is a proportionally representative annual survey of adults in the US. It is the largest continuous population health survey in the world. Since 2011, data on scuba diving is collected biannually. A comparison group were matched on age, sex, being physically active and state of residence. RESULTS: The dataset comprised 103,686,087 person-years of monthly behavioural data, including 14,360 person years of monthly scuba data. The median weekly frequency of recent scuba diving was 1.0 times per week and the median weekly duration was equivalent to two dives each of one hour. Compared with the comparison group, divers more often earned > USD$50,000 per year, were less frequently married, with fewer children in the house, which they more often owned. They reported being able to afford a doctor if needed within the previous year, but more often reported excellent/good health and excellent/good mental health, despite the divers being 16% more frequently overweight. CONCLUSIONS: The results demonstrate a relatively healthy cohort of active scuba divers, confirming previous survey results that active divers are commonly college-educated, unmarried, without children, home owning, often overweight, they often currently drink alcohol, and smoked tobacco in the past, but commonly gave up smoking ten years or more ago.

Rock Climbing Injuries Treated in US Emergency Departments, 2008-2016.

INTRODUCTION: Previous research identified a trend for increasing numbers of injuries sustained while rock climbing. This study investigates whether that trend continued and describes characteristics of climbing injuries. METHODS: The National Electronic Injury Surveillance System registry was searched for rock climbing injuries in US emergency departments in 2008 through 2016 among patients aged ≥7 y. Variables included each patient's age, diagnosis, injured body part, mechanism of injury, and disposition. Injuries were graded using International Mountaineering and Climbing Federation injury grades. National estimates were generated using sample weighting. RESULTS: An estimated 34,785 rock climbing injuries were seen in emergency departments nationally, a mean of 3816 per year (SD 854). The median age of injured climbers was 24 y (range 7-77), with those aged 20 to 39 y accounting for 60% and males for 66%, respectively. Fractures (27%) and sprains and strains (26%) were the most common types of injuries. The most frequently injured body parts were lower extremities (47%), followed by upper extremities (25%). The most commonly fractured body part (27%) was the ankle. The knee and lower leg accounted for 42% of all lacerations and were 5.8 times as likely as lacerations to other body parts. Falls were the most common mechanism, accounting for 60% of all injuries. CONCLUSIONS: This study reports continued increase in annual numbers of climbing injuries. Whether this is based on a higher injury rate or on a higher number of climbers overall cannot be stated with certainty because no denominator is presented to estimate the injury rate among climbers.

Case report: acute facial swelling in a recreational technical diver.

A recreational scuba diver wore a second scuba regulator against his face during a scuba dive, attached by an elastic rubber cord necklace. After surfacing, the diver's left face became swollen. Through a process of elimination all other items of scuba equipment were excluded as potential causes. A dive with the same equipment minus the necklace confirmed the involvement of the necklace in the pathogenesis of the hypersensitive reaction. In vitro ImmunoCap IgE assay was positive to latex (1.30 kUa/L), subsequent patch testing for contact dermatitis provoked a reaction for benzophenone-4, (a UV stabalizer) and Fourier Transform Infra Red spectroscopy identified the elastic as ethylene propylene rubber, containing additional unidentified compounds. Allergy to natural rubber latex occurs in as many as 6% of Americans and Australians. Around three million American residents are thought to scuba dive each year. Recreational divers are, therefore, advised to check such necklaces, which are typically worn around the throat, for frayed ends and exposed rubber filaments.