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Hyperbaric pressure - 211 entries found

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CIS 11-0066 Bernaola Alonso M.
Prevention of risks in professional diving
Prevención de riesgos en prácticas de buceo profesional [in Spanish]
Professional diving or work under hyperbaric atmospheres involves very specific risks, in particular decompression sickness. However, the prevention of occupational hazards remains underdeveloped in this sector and pathologies are often not understood, even among physicians and safety and health professionals. Contents of this article on the prevention of risks in professional diving: brief description of professional diving, of accidents inherent to this activity and related legislation; differences between land and aquatic environments; diving techniques; risks related to diving; risks related to breathing hyperoxic gas mixtures.
Mar. 2010, No.56, p.13-25. Illus. 12 ref.
Prevención_de_riesgos.pdf [in Spanish]


CIS 09-1149 Rüegger M.
Updating of occupational medicine prevention for divers and persons working under hyperbaric conditions
Neugestaltung der arbeitsmedizinischen Vorsorge von Tauchern und Überdruckarbeitern [in German]
Remaniement de la prévention dans le domaine de la médecine du travail chez les plongeurs et les personnes exerçant une activité en milieu hyperbare [in French]
Diving work under hyperbaric conditions involves specific health hazards. Swiss regulations require persons carrying out such work to pass a preventive occupational medicine inspection. However, new findings in hyperbaric medicine having come to light since the coming into force of these regulations, the scope of the medical inspection needed to be updated. The changes required are presented in this article, together with basic information aimed at helping understand the issues related to hyperbaric medicine.
Suva Medical, 2009, No.80, p.50-59. 3 ref. [in German] [in French]

CIS 09-918 Toklu A.S., Cimsit M.
Sponge divers of the Agean and medical consequences of risky compressed-air dive profiles
The objective of this study was to analyse the relationship between occupational health problems among Turkish sponge divers and their level of knowledge, diving equipment and dive profiles. Data were collected by interviewing former sponge divers, reviewing the relevant literature and examining the medical records of sponge divers who underwent recompression treatment. Divers used profiles that are now known to involve high risks of decompression sickness and dysbaric osteonecrosis. The records of 58 divers who had received recompression treatment showed that all cases involved severe decompression sickness and delays from dive to recompression that averaged 72h. Complete resolution of symptoms occurred in only 11 cases. Several factors that contributed to the risks in this occupational group, including unsafe dive profiles, resistance to seeking treatment, long delays before recompression and the fact that recompression treatment had used air rather than oxygen.
Aviation, Space, and Environmental Medicine, Apr. 2009, Vol.80, No.4, p.414-417. Illus. 10 ref.

CIS 09-917 Lafère P., Germonpré P., Balestra C.
Pulmonary barotrauma in divers during emergency free ascent training: Review of 124 cases
The objective of this study was to evaluate the risks of pulmonary barotraumas (PBT) or arterial gas embolism (AGE) associated with normal recreational dives, training dives, and emergency free ascent (EFA). All diving accidents treated at the Centre for Hyperbaric Oxygen Therapy (Brussels, Belgium) from 1995 to 2005 were reviewed. Data on the average number of dives performed and the proportion of training dives were obtained from the major Belgian diving associations. A total of 124 divers were treated, of whom 34 were diagnosed with PBT. Of those, 20 had symptoms of AGE. In 16 of those, EFA training exercise was deemed responsible for the injury. The association between EFA training and PBT proved to be very significant, with an odds ratio of 11.33. It was found that training dives carry a 100 to 400 times higher risk, and an ascent training dive a 500 to 1500 times higher risk for PBT than a non-training dive.
Aviation, Space, and Environmental Medicine, Apr. 2009, Vol.80, No.4, p.371-375. 20 ref.

CIS 08-1427 Vann R.D., Denoble P.J., Howle L.E., Weber P.W., Freiberger J.J., Pieper C.F.
Resolution and severity in decompression illness
Study of the terminology of decompression illness (DCI). It is argued that an analysis of clinical outcome, using an approach known as "survival analysis" would be a better basis for classifying cases of DCI than more traditional means of classification, dependent in part on clinical judgment concerning severity and therapy.
Aviation, Space, and Environmental Medicine, May 2009, Vol.80, No.5, p.466-471. 34 ref.


CIS 09-438 Gempp E., Blatteau J.E., Stephant E., Pontier J.M., Constantin P., Pény C.
MRI findings and clinical outcome in 45 divers with spinal cord decompression sickness
Decompression sickness (DCS) affecting the spinal cord is the most dangerous form of diving-related injury with potential sequelae. This study was conducted to evaluate the relationship between spinal cord lesions on MRI and clinical findings in divers with spinal DCS. A total of 45 cases of DCS that were referred to a hyperbaric facility with clinical evidence of spinal involvement during the period 2002-2007 were studied. The study included only patients who underwent MRI within 10 days of injury. The severity of spinal DCS for each patient was rated numerically for both the acute event and one month later. The presence or absence of back pain was also noted. Spinal cord lesions were significantly more frequent in divers with severe DCS, and did not occur in any diver who experienced a favorable outcome. It is concluded that MRI could be helpful in predicting clinical outcome in divers with spinal cord DCS. Other findings are discussed.
Aviation, Space, and Environmental Medicine, Dec.2008, Vol.79, No.12, p.1112-1116. Illus. 23 ref.

CIS 09-202 Rosenkvist L., Klokker M., Katholm M.
Upper respiratory infections and barotraumas in commercial pilots: A retrospective survey
The 948 commercial pilots having visited the Danish Aero Medical Centre during a six-month period were given a questionnaire on symptoms of upper respiratory infections (URI) and barotrauma incidence in relation to flying with a common cold. Every pilot declared having experienced one to two URIs per year. 57.2% reported themselves unfit, while 42.8% continued with their flying duties despite their symptoms. Of the latter group, 78.0% reported taking decongestant medication. More than one-third of the pilots (37.6%) reported having experienced one or more episodes of ear barotrauma, mainly during descent, whereas 19.5% reported one or more sinus barotrauma incidents during their flying career. The findings show that not all pilots and airline companies consider URI a valid reason for unfitness to fly despite the risk for acute incapacitation.
Aviation, Space, and Environmental Medicine, Oct. 2008, Vol.79, No.10, p.960-963. 18 ref.

CIS 08-694 Géraut C., Tripodi D., Géraut L.
Risks of scuba diving and working in hyperbaric conditions
Risques de la plongée sous-marine et du travail en milieu hyperbare [in French]
The techniques used for scuba diving have evolved recently, with the use of mixtures enriched in oxygen or containing inert gases other than nitrogen. New diseases have emerged, related to an excess of oxygen or increasingly high pressures, as well as to the use of sophisticated devices such as rebreathers or open circuit scuba regulators for which even minor dosage errors can have severe consequences. Diving-related disorders which were underestimated until recently, such as pulmonary oedema, involve various and complex mechanisms. There have been advances in the understanding of mechanisms responsible for gas embolism in recent years, together with the tracking of the circulating gas bubbles, which have contributed to limiting such accidents. The recompression protocols are increasingly strict, the importance of an early detection of decompression events is recognized and recompression chambers need to be entered without delay. Regulation has become strict and the criteria for aptitude have been improved thanks to the shared experience of physicians specialized in hyperbaric pathology.
Encyclopédie médico-chirurgicale, Toxicologie-Pathologie professionnelle, 1st Quarter 2008, No.158, 13p. 56 ref.


CIS 08-1436 Jones A.D., Miller B.G., Colvin A.P.
Health and Safety Executive
Evaluation of Doppler monitoring for the control of hyperbaric exposure in tunnelling
After exposures to hyperbaric pressures, the return to atmospheric pressure is generally achieved by gradual decompression following set tables, sometimes in conjunction with breathing oxygen. There is a need to be able to monitor and improve the effectiveness of decompression procedures under routine operational conditions in compressed air tunnelling. The objective of this literature survey was to evaluate Doppler monitoring of gas bubbles in venous blood as a potential monitoring technique. It is concluded that the use of Doppler flowmetry is likely to be limited for routine hyperbaric work, but proposals are made on what would be needed to make such monitoring suitable in the future.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2007. xviii, 120p. Illus. 104 ref. [in English]

CIS 08-1178 Stipp W.
Health and Safety Executive
Time to treatment for decompression illness
Hyperbaric oxygen treatment (HBO) is the standard treatment for divers with decompression illness (DCI). There is conflicting evidence in the medical literature on whether DCI is more responsive to early rather than late HBO treatment. The aim of this retrospective clinical outcome study was to investigate the influence of time to treatment with HBO in divers with neurological DCI. Cases were 372 divers with acute neurological DCI who had received HBO treatment at two specialized medical centres in the United Kingdom between 1986 and 2002. It was found that early HBO treatment was clearly associated with a better outcome. Other findings are discussed.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2007. vi, 29p. Illus. 21 ref. [in English]


CIS 06-739 Blatteau J.E., Gempp E., Galland F.M., Pontier J.M., Sainty J.M., Robinet C.
Aerobic exercise 2 hours before a dive to 30msw decreases bubble formation after decompression
This study investigated the effect of aerobic exercise two hours before a dive. Sixteen trained military divers were compressed to 30msw for 30min breathing air in a dry hyperbaric chamber at rest and then decompressed. Each diver performed two dives three days apart, one with and one without exercise that consisted of running 45min at 60-80% of maximum heart rate. Venous gas emboli were graded at 30min and 60min after surfacing. Mean bubble grades at 60min were 1.25 for control dives and 0.44 for dives preceded by aerobic exercise. This difference is highly significant. Running 2h before a dive decreases bubble formation after diving. The mechanism underlying the protective effect of aerobic exercise remains unclear.
Aviation, Space, and Environmental Medicine, July 2005, Vol.76, No.7, Section I, p.666-669. Illus. 27 ref.


CIS 07-199
Hauptverband der gewerblichen Berufsgenossenschaften (HVBG)
Recompression chambers
Taucherdruckkammern [in German]
Contents of these guidelines of the German Mutual Occupational Accident Insurance Association on recompression chambers: scope; definitions; general provisions; construction and equipment of recompression chambers; operations; checks; date of entry into force. Appendices include inspections of recompression chambers, directives and related rules.
Carl Heymanns Verlag KG, Luxemburgerstrasse 449, 50939 Köln, Germany, Jan. 2004. 23p. Illus. Index

CIS 06-180 Kot J., Sićko Z.
Delayed treatment of bubble related illness in diving - Review of standard protocol
This article reviews the literature concerning the existing standard treatment of decompression illness. The effects on prognosis of a delay in receiving recompression treatment are examined and therapeutic options are reviewed: recompression, hyperbaric or normobaric oxygen therapy, choice of fluids for rehydration, drug therapy. It is concluded that there is no evidence to suggest that the existing recommendations for the treatment of decompression illness should be changed.
International Maritime Health, 2004, Vol.55, No.1/4, p.103-120. 93 ref.


CIS 03-1874 Colvin A.P.
Health and Safety Executive
Human factors in decompression sickness in compressed air workers in the United Kingdom 1986-2000: A case-control study and analysis using the HSE Decompression Database
This report presents the findings of a case-control study of hyperbaric chamber workers in the United Kingdom in which subjects with repetitive decompression sickness (DCS) were matched to two control groups. An analysis of the decompression database of the Health and Safety Executive was undertaken to examine the relative contribution of those workers with repetitive DCS to the overall number of DCS episodes during the study period. Results show that 4% of the workforce in the decompression database suffered 50% of the episodes requiring therapeutic recompression. This study did not find any differences in the personal characteristics of compressed air workers with multiple, single or zero episodes of DCS according to the type of work contract, occupation or exposure.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2003. vi, 65p. 104 ref. Price: GBP 15.00. [in English]

CIS 03-1873 Flook V.
Health and Safety Executive
A comparison of oxygen decompression tables for use in compressed air work
The objective of this study was to compare tables used for oxygen decompression in compressed air tunneling work. Comparisons were based on mathematical simulations of decompression using a model validated for decompression studies in an earlier study. Tables from Brazil, France, Germany, the Netherlands, Switzerland and the USA were included, together with United Kingdom tables using oxygen as the breathing gas for the stops from 0.6bar to surface pressure. The main findings of this study were that the United Kingdom tables are predicted to have a volume of gas carried in bubbles within the range of that for the other tables studied, and that the other tables could all be considered acceptable in United Kingdom.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2003. iv, 57p. Illus. 9 ref. Price: GBP 15.00. [in English]

CIS 03-862 Rice G.M., Vacchiano C.A., Moore J.L., Anderson D.W.
Incidence of decompression sickness in hypoxia training with and without 30-min O2 prebreathe
Naval aircrew are required to participate in hypoxia familiarization training. This training is considered high-risk due to the potential for barotrauma and decompression sickness (DCS). Prior analysis of the DCS in U.S. Navy hypobaric chambers revealed a significantly higher incidence among inside observers (IOs) than among students. In response to these reports, all IOs are required to de-nitrogenate by breathing 100% oxygen for 30min prior to altitude exposure. However, there have been no reports validating the efficacy of this measure. This study examined the incidence of altitude DCS during exposures to simulated altitudes of 25,000ft (25k) and 35,000ft (35k) in IOs and students, some who pre-breathed oxygen and some who did not. Results indicate that a 30-min pre-breathe prior to altitude exposure reduces the risk of DCS.
Aviation, Space, and Environmental Medicine, Jan. 2003, Vol.74, No.1, p.56-61. Illus. 16 ref.

CIS 03-641 Webb J.T., Kannan N., Pilmanis A.A.
Gender not a factor for altitude decompression sickness risk
Some earlier studies suggest that women may be more susceptible to altitude decompression sickness (DCS) than men. In this study, 197 men and 94 women underwent 961 exposures to simulated altitude for up to 8h, using zero to 4h of preoxygenation. Throughout the exposures, subjects breathed 100% oxygen, rested or performed mild or strenuous exercise, and were monitored for precordial venous gas emboli (VGE) and DCS symptoms. No significant differences in DCS incidence were observed between men (49.5%) and women (43.3%). However, VGE occurred at significantly higher rates among men than women, 69.3% and 55.0% respectively. Women using hormonal contraception showed significantly greater susceptibility to DCS than other women during the latter two weeks of the menstrual cycle. Significantly higher DCS incidence was observed in the heaviest men, in women with the highest body fat, and in subjects with the highest body mass indices and lowest levels of fitness.
Aviation, Space, and Environmental Medicine, Jan. 2003, Vol.74, No.1, p.2-10. Illus. 34 ref.

CIS 03-868 Faralli F., Panico S., Renzoni F., Cardoni V., Pultrone S., Simonazzi A., Bianchi F., De Cardoni C., Arcangelis N., Pascalizi S., Simonazzi S.
Analysis of underwater diving accidents in a hyperbaric treatment centre
Analyse des accidents de plongée sous-marine dans un centre de traitement hyperbare [in French]
Contents of this article on decompression accidents among divers: persons at risk; diving techniques; Italian regulations concerning underwater work under hyperbaric conditions; description of decompression accidents and their treatment; findings of a survey involving 60 victims of diving accidents having occurred between 1989 and 1999 who were given oxygenotherapy in a hyperbaric treatment centre. Boxes include: French regulations on the protection of persons working in hyperbaric conditions and compensation of decompression accidents; main decompression pathologies (gas emboli, type I and II decompression sickness); diving tables.
Documents pour le médecin du travail, 2nd Quarter 2003, No.94, p.171-181. Illus. 31 ref. [in French]


CIS 03-637 Balldin U.I., Pilmanis A.A., Webb J.T.
Pulmonary decompression sickness at altitude: Early symptoms and circulating gas emboli
Pulmonary altitude decompression sickness (DCS) is characterized by substernal pain, cough and dyspnoea, probably associated with a severe accumulation of gas bubbles in the pulmonary capillaries. It may rapidly develop into a life-threatening medical emergency. This study was aimed at characterizing early DCS symptomatology and the appearance of gas emboli. Symptoms of simulated-altitude DCS and gas emboli (detected with ultrasound imaging) were analysed in 468 subjects who participated in hypobaric chamber tests between 1983 and 2001. Symptoms of DCS were found in 41% of exposures to simulated altitude. Only 29 of these exposures included DCS-related pulmonary symptoms, including 27 cases of gas emboli and 21 cases of severe gas emboli. The mean onset times of venous gas emboli and symptoms in the 29 exposures were 42min and 109min, respectively. In 15 subjects, the symptoms disappeared after recompression followed by two hours of oxygen breathing. In the remaining 14 cases, the symptoms disappeared with immediate hyperbaric oxygen treatment.
Aviation, Space, and Environmental Medicine, Oct. 2002, Vol.73, No.10, p.996-999. 13 ref.

CIS 03-636 Freiberger J.J., Denoble P.J., Pieper C.F., Uguccioni D.M., Pollock N.W., Vann R.D.
The relative risk of decompression sickness during and after air travel following diving
A retrospective review of three years of diving data was conducted to evaluate the relative risk of decompression sickness (DCS) from flying after diving. The intervals and the maximum depths in meters of seawater (msw) on the last day of diving were analysed from 627 recreational dive profiles. Injured divers (cases) and uninjured divers (controls) were compared using logistic regression to determine the association of DCS with time and depth while controlling for diver and dive profiles characteristics. The mean for cases and controls were 20.7h vs. 27.1h respectively for intervals and 22.5ms vs. 19msw respectively for maximum depth. Other factors considered included sex, weight, height, age and years of diving. Relative to flying over 28h after diving, the odds of DCS were 1.02 for 24-28h, 1.84 for 20-24h and 8.5 for less than 20h. Relative to a depth of less than 14.7msw, the odds of DCS were: 1.2 for 14.7-18.5 msw, 2.9 for 18.5-26 msw and 5.5 for more than 26 msw.
Aviation, Space, and Environmental Medicine, Oct. 2002, Vol.73, No.10, p.980-984. Illus. 16 ref.

CIS 03-635 Butler W.P.
Epidemic decompression sickness: Case report, literature review, and clinical commentary
This paper reports a collective case of epidemic decompression sickness (DCS) and reviews the literature. The case reported describes six aircrew men with DCS following an unpressurized flight. Factors contributing to this case are discussed in depth. The literature was also examined for similar cases of epidemic DCS, and four other instances were identified. Detailed qualitative analysis of these reports was performed. Based on these data, DCS is defined and classified. Adopting the proposed outline should produce an aetiology that can be used by flight medical physicians and against which control measures can be directed.
Aviation, Space, and Environmental Medicine, Aug. 2002, Vol.73, No.8, p.798-804. 43 ref.

CIS 03-861 Balldin U.I., Pilmanis A.A., Webb J.T.
The effect of simulated weightlessness on hypobaric decompression sickness
A discrepancy exists between the 20-40% reported incidence of ground-based decompression sickness (DCS) during simulated extravehicular activity at hypobaric space suit pressure, and the zero crewmember reports during actual extravehicular activity. This could be due to the effect of gravity during ground-based DCS studies. 39 male subjects were exposed to a hypobaric pressure of 29.6kPa for up to four hours. 26 controls pre-oxygenated for 60min (first 10min exercising) before being exposed to hypobaric exposure while walking around in the altitude chamber. To simulate weightlessness, the 39 test subjects remained supine for three hours prior to and during the 60-min pre-oxygenation, and at hypobaric pressure. DCS symptoms and gas emboli at hypobaric pressure were registered. No significant difference in incidence of DCS was found between control and simulated weightlessness conditions, while emboli occurred more frequently during the control condition.
Aviation, Space, and Environmental Medicine, Aug. 2002, Vol.73, No.8, p.773-778. Illus. 29 ref.

CIS 03-399 Pilmanis A.A., Webb J.T., Kannan N., Balldin U.
The effect of repeated altitude exposures on the incidence of decompression sickness
Repeated hypobaric exposures in a single day occurring during parachute training, hypobaric chamber training, unpressurized flight and extravehicular space activity can cause decompression sickness (DCS). To test the hypothesis that short exposures with and without ground intervals would result in a lower incidence of DCS than a single exposure of equal duration, 32 subjects were exposed to three different hypobaric exposures: a single 2h continuous exposure (condition A, control); four 30min exposures but no ground interval between the exposures (condition B); four 30min exposures and a 60min period of ground interval between exposures (condition C). All exposures were to a simulated altitude of 7500m with 100% oxygen breathing. Subjects were examined for symptoms of DCS and precordial venous gas emboli (VGE). Results indicate that repeated simulated altitude exposures to 7500m significantly reduce DCS and VGE incidence compared with a single continuous exposure of equivalent duration.
Aviation, Space, and Environmental Medicine, June 2002, Vol.73, No.6, p.525-531. Illus. 28 ref.

CIS 02-1910 Baud J.P., Pelé A., Letoublon M., Michel M.C.
Injuries caused by work under hyperbaric conditions
Lésions provoquées par des travaux en milieux hyperbares [in French]
Contents of this information sheet on occupational diseases caused by work under hyperbaric conditions: definitions; occupations and tasks exposed to this hazard (divers, excavations in compressed air environments, welding under hyperbaric atmospheres, controlling for leaks in the containment envelopes of nuclear reactors, work in immersed chambers); mechanisms of health effects (ear barotrauma, neurotoxicity and pulmonary toxicity of oxygen, decompression symptoms); medical supervision at work; treatment of decompression accidents by emergency recompression; prevention measures; regulations; glossary.
Prévention BTP, Feb. 2002, No.38, p.33-40. Illus. 7 ref.


CIS 02-1428 Whyte P., Doolette D.J., Gorman D.F., Craig D.S.
Positive reform of tuna farm diving in South Australia in response to government intervention
Most of the tuna harvested in South Australia since 1990 involves the use of divers. From 1993 to 1995, 17 divers from this industry were treated for decompression illness (DCI). In response, the State Government introduced corrective strategies. A decrease in the number of divers presenting for treatment was subsequently recorded. Consequently, the hypothesis was tested that the government intervention resulted in a decrease in the incidence of DCI in the industry and an improved clinical outcome of divers with DCI. The incidence of treated DCI in tuna farm divers was estimated from the number of divers with DCI treated and the number of dives undertaken extrapolated from a survey of the industry in 1997-8. General health was measured in the tuna farm diving population by a valid and reliable self-assessment questionnaire. The outcome of the divers treated for DCI was analysed with a modified clinical severity scoring system. Results show that the apparent incidence of treated DCI has effectively decreased in tuna farm divers since the government intervention.
Occupational and Environmental Medicine, Feb. 2001, Vol.58, No.2, p.124-128. Illus. 12 ref.

CIS 00-1635 Gold D.
The indigenous fisherman divers of Thailand: Determining the hazards associated with indigenous diving practices and developing interventions to reduce the risk of diving-related injury and disease
PhD thesis. A group of 400 indigenous fishermen divers from Thailand's west coast (the Urak Lawoi) was studied between 1995 and 1999. They use primitive diving equipment (relying on surface-supplied compressed air) and practice traditional diving. They have very high morbidity and mortality rates, mostly due to decompression illness. This condition is ascribed to unsafe diving patterns, short surface intervals and the lack of safety awareness or decompression stops after long and deep dives. In the study, 1/3 of the active divers reported decompression illness at some point in their lives, with over one half suffering from recurring non-disabling forms of the disease. Spinal injury and joint damage was detected in 24% and 30% of the divers examined, respectively. Serious cases of decompression illness are treated by in-water recompression, which in many cases resolves the problem, but in some divers does not. Other hazards are exposure to CO in the breathing air from the gasoline- or diesel-driven compressor and sudden interruption of air supply, which forces divers to immediate surfacing, which may result in very severe decompression illness and even death. As a result of the study, the diving practices of the divers were considerably improved and safety awareness increased among the divers and in their community.
Tampere University of Technology, P.O. Box 527, 33101 Tampere, Finland, 2001. 168p. + annexes. Illus. 40 ref.


CIS 01-1597
Secretaría del Trabajo y Previsión Social
Official Mexican Standard - Occupational exposure to abnormal environmental pressure: Safety and health conditions [Mexico]
Norma Oficial Mexicana - Exposición laboral a presiones ambientales anormales - Condiciones de seguridad e higiene [México] [in Spanish]
Contents of this standard: scope (all work activities which include diving, or which involve work under low atmospheric pressure); definitions and symbols; obligations of employers and exposed workers; safety and health conditions of activities performed under low atmospheric pressure; safety and health conditions of activities under diving-type high atmospheric pressure; verification systems. In annexes: decompression tables and other limits connected with work under abnormal atmospheric pressure.
Internet copy, 2000. 18p. + annexes (not included in pagination). [in Spanish]

CIS 01-1805 Simpson M.E., MacKenzie J.
Health and Safety Executive
Noise exposure limits under hyperbaric conditions
An examination of data available on the sources of noise to which divers are exposed suggests that sound pressure levels both underwater and in diving chambers often exceed those allowable to workers onshore. However, sensitivity to different sound conditions is known to be altered in hyperbaric conditions, and current noise exposure limits specified in the Noise at Work Regulations 1989 (see CIS 90-21) are acknowledged to be inappropriate. Furthermore, there are difficulties in measuring noise levels, since calibrated microphones designed to work under normal atmospheric pressure will respond differently in hyperbaric environments. In the absence of complete understanding of how to assess noise attenuation in differing media across the range of frequencies, it is recommended that noise reduction measures be implemented as a precautionary measure. Several noise reduction measures which are currently under development are discussed.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2000. vi, 53p. Illus. 48 ref.

CIS 01-444 Gold D., Aiyarak S., Wongcharoenyong S., Geater A., Juengprasert W., Gerth W.A.
The indigenous fisherman divers of Thailand: Diving practices
Diving practices of a group of 342 indigenous fisherman in Thailand were investigated by using a questionnaire and by field observation. Divers have diving patterns that put them at substantial risk of decompression illness. They breathe air from a primitive compressor through approximately 100m of air hose and have long bottom times coupled with short intervals. 46.2% of the divers indicated they would not make a stop during ascent from a long deep dive (40m for 30min). 72.1% exceeded the no-decompression limits set by the US Navy Standard Air Decompression Table.
International Journal of Occupational Safety and Ergonomics, 2000, Vol.6, No.1, p.89-112. Illus. 40 ref.


CIS 99-2041 Gout D.
Pressurization: Diving into hyperbaric hazards
Mise en pression: plongée dans le risque hyperbare [in French]
Work in conditions of dry hyperbaric pressure. Topics: aircraft industry; barotrauma; caissons; dangerous work; decompression sickness; decompression; diving; hyperbaric oxygen therapy; hyperbaric pressure; information of personnel; nuclear power stations; pressure chamber tests; tunnelling; work aptitude; work in confined spaces; work in pressurized atmosphere.
Travail et sécurité, July-Aug. 1999, No.586-587, p.18-31. Illus.


CIS 00-1441 Guidelines - Safety management in multi-workstation hyperbaric chambers in a clinical environment
Linee guida - La gestione in sicurezza delle camere iperbariche multiposto in ambiente clinico [in Italian]
These guidelines, based in part on the requirements of Italian Legislative Decree 626/94 (see CIS 96-1531), provide basic instruction on the safe operation of hyperbaric chambers used for medical treatment in hospitals and clinics. Contents: risk evaluation; safety measures; locales where hyperbaric chambers are installed; construction of hyperbaric chambers used for therapeutic purposes; requirements of materials and systems (electricity, compressed gases, firefighting) used inside such chambers (the greatest hazard is fire - even with the requirements given, the oxygen content of the air inside the chambers should not exceed 23.5%); registers; storeroom management; maintenance; handling and clinical monitoring of patients; required personnel during hyperbaric therapy; emergency and normal use procedures. In annex: comparative survey of safety procedures in connection with hyperbaric chambers in the following European countries: Denmark, France, Germany, Norway, Poland, Spain, Sweden, Switzerland, United Kingdom.
Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro (ISPESL), Via Urbana 167, 00184 Roma, Italy, 1998. 107p.

CIS 99-1669 Flook V.
Health and Safety Executive
Decompression risk factors in compressed air tunnelling: Options for health risk reduction
Topics: central nervous system; compressed air; decompression sickness; decompression tables; decompression; hyperbaric pressure; oxygen therapy; tunnelling; work in pressurized atmosphere.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 6FS, United Kingdom, 1998. iv, 67p. Illus. 8 ref. Price: GBP 20.00.


CIS 98-379 Order of 14 October 1997 approving safety standards for work under water [Spain]
Orden de 14 de octubre de 1997 por la que se aprueban las normas de seguridad para el ejercicio de actividades subacuáticas [España] [in Spanish]
Topics: dangerous substances; decompression tables; decompression; deep diving; diving suits; diving; explosion hazards; health hazards; hyperbaric pressure; law; maintenance; Spain; underwater breathing apparatus; work in pressurized atmosphere.
Boletín Oficial del Estado, 22 Nov. 1997, No.280, p.34419-34427.

CIS 97-2088 Sulaiman Z.M., Pilmanis A.A., O'Connor R.B.
Relationship between age and susceptibility to altitude decompression sickness
Data on 1,299 subject flight exposures in altitude chambers conducted during 1983-1994 were examined. Ages of subjects ranged 18-48 years. There was a trend towards increased susceptibility to decompression sickness with increasing age, with a particularly strong trend for individuals over 42 years of age.
Aviation, Space, and Environmental Medicine, Aug. 1997, Vol.68, No.8, p.695-698. Illus. 15 ref.

CIS 97-1384 Loftin K.C., Conkin J., Powell M.R.
Modeling the effects of exercise during 100% oxygen prebreathe on the risk of hypobaric decompression sickness
Previous studies on the effect of exercise during oxygen prebreathe on the incidence of hypobaric decompression sickness (DCS) were analyzed, and a statistical model was developed as a predictive tool for DCS. A dose-response probability tissue ratio (TR) model was created for two groups: prebreathe with exercise and resting prebreathe. Results suggested that exercise during prebreathe increases tissue perfusion and nitrogen elimination approximately 2-fold and markedly lowers the risk of DCS. The model provides a useful planning tool for developing appropriate prebreathe exercise protocols and for predicting DCS for astronauts.
Aviation, Space, and Environmental Medicine, Mar. 1997, Vol.68, No.3, p.199-204. 23 ref.


CIS 99-682 Normand J.C., Thomas P., Baud J.P.
Importance of exercise tests to assess fitness for work under hyperbaric conditions
Intérêt de l'épreuve d'effort pour l'aptitude au travail en milieu hyperbare [in French]
During a submaximal exercise test on an ergometric bicycle, the average power reached was 199W and the maximum oxygen consumption was 43.2mL/min/kg. The hazards and physical constraints of work under hyperbaric pressure highlight the need for an ECG both at rest and during exercise to assess the strength of the cardiovascular system and its adaptation to strain. Topics: aptitude tests; comment on law; compression; decompression; electrocardiography; exercise tests; heart rate monitoring; hyperbaric pressure; oxygen intake; tunnelling; work aptitude.
Revue de médecine du travail, Sep.-Oct. 1996, Vol.XXIII, No.4, p.184-191. Illus. 7 ref.

CIS 97-2032 Tetzlaff K., et al.
Pulmonary barotrauma of a diver using an oxygen rebreathing diving apparatus
A case is reported of a healthy male diver who developed clinical symptoms of mediastinal emphysema after performing a dive using a closed circuit oxygen rebreathing apparatus according to normal procedure. Spiral volumetric computed tomography of the chest four days after the incident detected a small subpleural emphysematous bulla next to the left ventricle. In any case of suspected pulmonary barotrauma, computed tomography of the thorax should be performed to evaluate future fitness to dive.
Aviation, Space, and Environmental Medicine, Dec. 1996, Vol.67, No.12, p.1198-1200. Illus. 18 ref.

CIS 97-627 Webb J.T., Fischer M.D., Heaps C.L., Pilmanis A.A.
Exercise-enhanced preoxygenation increases protection from decompression sickness
The use of exercise-enhanced preoxygenation (breathing 100% oxygen prior to decompression) to reduce the risk of decompression sickness (DCS) during high altitude flight was investigated. 26 male subjects accomplished a 1h preoxygenation with exercise, a 15min preoxygenation with exercise, or a 1h resting preoxygenation. Exercise involved 10min of dual-cycle ergometry. Incidence of DCS following the 1h preoxygenation with exercise was significantly less that than following 1h resting preoxygenation, indicating that preoxygenation with exercise can provide improved DCS protection compared with resting preoxygenation.
Aviation, Space, and Environmental Medicine, July 1996, Vol.67, No.7, p.618-624. 29 ref.

CIS 96-2288
Health and Safety Executive
A guide to the Work in Compressed Air Regulations 1996
This document provides the text of the Work in Compressed Air Regulations 1996 with accompanying guidance. Provisions relate to appointment of compressed air contractor; notification of work; safe system of work; plant and equipment; appointment of contract medical adviser; medical surveillance; compression and decompression procedures; medical treatment; emergencies; fire precautions; information, instruction and training; fitness for work; intoxicating liquor and drugs; welfare facilities; identification of compressed air workers. Appendices include: use of portable electronic atmospheric gas monitoring equipment in compressed air workings; outline syllabus for a course in hyperbaric medicine.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 6FS, United Kingdom, 1996. vi, 81p. Price: GBP 10.50.

CIS 96-1015 Conkin J., Kumar V., Powell M.R., Foster P.P., Waligora J.M.
A probabilistic model of hypobaric decompression sickness based on 66 chamber tests
An approach to estimating the probability of decompression sickness (DCS) in astronauts performing extravehicular activities (EVAs) is described. Data from 66 hypobaric chamber tests (211 cases of DCS in 1075 exposures) were analyzed. Variables considered were denitrogenation prior to decompression, magnitude of the decompression, exercise after decompression, and length of the EVA. Probability models were fitted using techniques from survival analysis. Constant probability of DCS was better described by tissue ratios that decrease as ambient pressure after decompression decreases, a conclusion supported by other studies.
Aviation, Space, and Environmental Medicine, Feb. 1996, Vol.67, No.2, p.176-183. 20 ref.

CIS 96-1017 Sowden L.M., Kindwall E.P., Francis T.J.R.
The distribution of limb pain in decompression sickness
A review of over 19,000 cases of limb pain in decompression sickness (DCS) revealed a predominance of upper limb involvement in bounce divers and in aviators; lower limbs were more commonly involved in compressed air workers and saturation divers. A hypothesis based on the counter current exchange of inert gas is put forward as a possible mechanism to explain this reported distribution of limb pain in DCS. The hypothesis is discussed in relation to bounce diving, saturation diving, compressed air workers, and decompression to altitude.
Aviation, Space, and Environmental Medicine, Jan. 1996, Vol.67, No.1, p.74-80. Illus. 74 ref.

CIS 96-1016 Goldenberg I., Shupak A., Shoshani O.
Oxy-helium treatment for refractory neurological decompression sickness: A case report
A case study is presented of a diver with paraparesis and urinary incontinence that appeared 10 minutes after surfacing from a dive. Symptoms persisted even after hyperbaric oxygen therapy. Subsequent oxy-helium treatment resulted in a marked improvement in gait and in sensory and motor function. Examination indicated an upper motor neuron lesion. Further hyperbaric oxygenation resulted in complete restoration of urinary control and virtually complete sensory and motor recovery. The case reinforces the limited clinical data regarding the value of oxy-helium in the treatment of neurological decompression sickness.
Aviation, Space, and Environmental Medicine, Jan. 1996, Vol.67, No.1, p.57-60. Illus. 24 ref.


CIS 95-1101 Van Liew H.D., Burkard M.E.
Simulation of gas bubbles in hypobaric decompressions - Roles of O2, CO2 and H2O
A study was carried out to gain insight into the special features of bubbles that may form in aviators and astronauts. The growth and decay of bubbles was simulated in two hypobaric decompressions and a hyperbaric one by using a system of equations. The constancy of partial pressures of metabolic gases, unimportant in hyperbaric decompressions, affects bubble size in hypobaric decompressions in inverse relation to the exposure pressure.
Aviation, Space, and Environmental Medicine, Jan. 1995, Vol.66, No.1, p.50-55. 14 ref.


CIS 94-2085 Kumar K.V., Powell M.R.
Survivorship models for estimating the risk of decompression sickness
The applicability of survival analysis for modelling the risk of decompression sickness (DCS) is illustrated by using data from earlier studies of hypobaric chamber exposures. A method for estimating the overall incidence-free survival rates for circulating microbubbles, symptoms and test aborts is described and the results are discussed. Survival analysis is shown to have certain advantages over other methods for modelling the risk of DCS.
Aviation, Space, and Environmental Medicine, July 1994, Vol.65, No.7, p.661-665. 15 ref.


CIS 99-1425 Order of 5 March 1993 amending and completing the Order of 28 Jan. 1991 specifying the means of safety training for personnel undertaking hyperbaric operations [France]
Arrêté du 5 mars 1993 modifiant et complétant l'Arrêté du 28 janv. 1991 définissant les modalités de formation à la sécurité des personnels intervenant dans des opérations hyperbares [France] [in French]
For the Order of 28 Jan. 1991 see CIS 91-1775. Topics: approval; dangerous work; diving; France; hyperbaric pressure; law; qualifications; safety and health training; work in pressurized atmosphere.
Journal officiel de la République française, 17 Mar. 1993, No.64, p.4149.

CIS 97-277 Bernini P., Faralli F., Fiorito A., Gagliardi R., Brauzzi M., Panico S., Paoluzzi M.
Decompression sickness, pathogenesis and management of spinal damage
Patogenesi e trattamento del danno spinale nella forma neuro sensoriale della malattia da decompressione [in Italian]
The effects and management recommended for decompression sickness are reviewed. Clinical local symptoms are mainly neurological with motor and sensory deficits. They are accompanied by other symptoms ranging from skin and joint pains to sudden death from respiratory arrest. The management of the patients consists of emergency treatment for basic life support, followed by advanced treatment using pharmacological means, recompression therapy, neuromuscular rehabilitation with cycles of hyperbaric oxygen therapy and physiotherapy.
Prevenzione oggi, Jan.-Mar. 1993, Vol.V, No.1, p.87-103. Illus. 29 ref.

CIS 94-1056 Géraut C., Simon C., Dupas D., Bellec J.M.
Hazards associated with underwater diving and work under hyperbaric conditions
Risques de la plongée sous-marine et du travail en milieu hyperbare [in French]
Summary of this survey article: mechanical hazards (barotrauma); risks to the middle and inner ear, the vestibular system, the sinus, the teeth, the face and the digestive system; biochemical hazards (hypoxia, hyperoxia, excess carbon dioxide and suffocation, carbon monoxide poisoning, nitrogen narcosis, high-pressure neurological syndrome); risks of gas embolism (physiopathology and circumstances of appearance; symptoms; what to do; prevention); water hazards; drowning; hazards due to plants and animals; aptitude determination; legislative information; compensation.
Encyclopédie médico-chirurgicale, Intoxications - Pathologie professionnelle, 1993, Vol.64, No.101, 8p. 18 ref.

CIS 94-595 Bennett P.B., Elliott D.H.
The physiology and medicine of diving
This book is an edited collection of reviews each written by an internationally recognized authority. Contents: compressed air work; SCUBA-diving procedures and equipment; commercial diving equipment and procedures; fitness to dive; respiration and exertion; oxygen toxicity; inert gas narcosis; the high pressure nervous syndrome; underwater accidents; management of diving accidents; otological and paranasal sinus problems in diving; prevention and treatment of thermal problems; history of decompression procedures; decompression physiology and practice; Doppler and ultrasonic bubble detection; pathogenesis, manifestations and treatment of the decompression disorders; clinical hyperbaric oxygen therapy; dysbaric osteonecrosis; aseptic necrosis of bone; long-term health effects of diving.
W.B. Saunders Company Ltd., 24-28 Oval Road, London NW1 7DX, United Kingdom. Available from: Harcourt Brace and Company Ltd., Foots Cray High Street, Sidcup, Kent DA14 5HP, United Kingdom, 4th ed., 1993. x, 613p. Illus. Bibl.ref. Index. Price: GBP 70.00.

CIS 93-1706 Ikeda T., Okamoto Y., Hashimoto A.
Bubble formation and decompression sickness on direct ascent from shallow air saturation diving
To find the minimum supersaturation pressure for detectable bubble formation and for contraction of decompression sickness (DCS), three shallow air saturation dives were performed at depths of 6m, 7m and 8m. One bubble was shown in the 6m dive group, a small number of bubbles were seen in some subjects in the 7m dive while all subjects in the 8m dive presented various amounts of bubbles. Four subjects in the 8m dive suffered from DCS and required recompression treatment. The minimum depth for detectable bubble formation was assessed at around 6m and the direct ascent from saturation at 8m seems to have a high risk of DCS.
Aviation, Space, and Environmental Medicine, Feb. 1993, Vol.64, No.2, p.121-125. Illus. 21 ref.


CIS 95-2237 Ohgaki T., Nigauri T., Okubo J., Komatsuzaki A.
Exostosis of the external auditory canal and sensorineural hearing loss in professional divers
Shokugyō daiba ni mirareta ji shikkan-gaiji dō gai kotsushu to kan'on'sei nanchō ni tsuite [in Japanese]
Audiometry and endoscopic examination of the external auditory canal were performed on the 31 professional divers of a fishing cooperative, who were frequently exposed to dysbaric conditions. Over 40% of the subjects had exostosis (projections of bony tissue in the canal). Over 70% had sensorineural hearing loss, even when audiometric data were corrected for aging. Hearing loss increased with the number of years spent in diving. Few of the subjects had experienced inner ear barotrauma on descent. It is proposed that the frequent small changes of pressure occurring in the outer ear are transmitted to the middle ear and perilymph, which eventually damages the inner ear.
Journal of Otolaryngology of Japan, 20 Sep. 1992, Vol.95, No.9, p.1323-1331. Illus. 20 ref.

CIS 94-776 Government Order of 15 May 1992 on the procedures relating to access to, staying in, egress from and work organization in hyperbaric atmospheres [France]
Arrêté du 15 mai 1992 définissant les procédures d'accès, de séjour, de sortie et d'organisation du travail en milieu hyperbare [France] [in French]
This Order (published in the French Journal officiel of 26 June 1992, pp.8413-8416) lays down instructions for the access to, staying in, egress from and organization of work in hyperbaric atmospheres in France, including: intervention procedures in subaquatic settings; hyperbaric intervention procedures without immersion; preventive and emergency measures; final provisions.
Documents pour le médecin du travail, 3rd Quarter 1992, No.51, p.429-431.

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