Diving Accident Evacuations by Helicopter and Immersion Pulmonary Edema

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS: A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest.DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE.Corgie L, Huiban N, Pontier J-M, Brocq F-X, Boulard J-F, Monteil M. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform. 2020; 91(10):806811.

The significance of health selection among divers and its effect on diving safety

Diving is a kind of human activity that requires special health predispositions due to the nature of an aquatic environment. The environment of an increased atmospheric pressure imposes a significantly greater burden on the respiratory and circulatory system as compared with normobaric conditions. Due to their health status, not everyone among those that wish to take up diving should undergo diving training, as diving can have an adverse effect on their condition while staying under water and considerably raise the risk of an occurrence of a diving accident. As regards diving activities performed within the Armed Forces, individuals with particular health burdens are eliminated via the medical checks conducted at the time of recruitment to the diving service. The checks, based on detailed parameters and described in legal acts, minimise the risk of an occurrence of a diving accident. This problem is quite different when it comes to recreational diving, where quite often, by presenting a health certificate, an interested diver candidate begins a training course and further individual diving activities while being aware of a medical condition that may affect their future safety under water. An analysis of the effect of health selection on the level of diving safety was performed.