A survey of scuba diving-related injuries and outcomes among French recreational divers

Epidemiology of adverse events related to sports among community people: a scoping review

OBJECTIVES

Numerous reports have described injuries and illnesses in competitive athletes, but studies on leisure-time physical activity and associated adverse events in the general population have not been adequately reviewed. This study aimed to summarise the previous findings on this topic.

DESIGN

Scoping review.

DATA SOURCES

PubMed and Ichushi-Web for articles in English and Japanese, respectively (13 April 2023).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles on adverse events related to sports performed by 'individuals and groups active in the community' were included, whereas those on elite athletes, exercise therapy and rehabilitation, and school sports were excluded. Terms related to physical activity, exercise, sports and adverse events were used for the search strategies.

RESULTS

The literature search yielded 67 eligible articles. Most articles were from the USA, Japan and Australia. Running, scuba diving, rugby and soccer were the most commonly reported sports. Adults were the most common age category in the samples. The most commonly reported adverse events were injuries; only 10 articles reported diseases. 13 longitudinal studies reported the frequency of adverse events based on the number of events/participants×exposure.

CONCLUSION

Adverse events such as sports trauma, disability and certain diseases occur sometimes during sporting activities by residents; however, the articles identified in this review showed biases related to the countries and regions where they were published and the sports disciplines and types of adverse events reported, and articles reporting the frequency of adverse events were also limited. This highlights the need for more high-quality observational studies on diverse populations in the future.

Chain of events analysis in diving accidents treated by the Royal Netherlands Navy 1966-2023

Introduction

Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries is limited. A previously published 'chain of events analysis' (CEA) framework consists of five steps that may sequentially lead to a diving fatality. This study applied four of these steps to predominately non-lethal diving injuries and aims to determine the causes of diving injuries sustained by divers treated by the Diving Medical Centre of the Royal Netherlands Navy.

Methods

This retrospective cohort study was performed on diving injuries treated by the Diving Medical Centre between 1966 and 2023. Baseline characteristics and information pertinent to all four steps of the reduced CEA model were extracted and recorded in a database.

Results

A total of 288 cases met the inclusion criteria. In 111 cases, all four steps of the CEA model could be applied. Predisposing factors were identified in 261 (90%) cases, triggers in 142 (49%), disabling agents in 195 (68%), and 228 (79%) contained a (possible-) disabling condition. The sustained diving injury led to a fatality in seven cases (2%). The most frequent predisposing factor was health conditions (58%). Exertion (19%), primary diver errors (18%), and faulty equipment (17%) were the most frequently identified triggers. The ascent was the most frequent disabling agent (52%).

Conclusions

The CEA framework was found to be a valuable tool in this analysis. Health factors present before diving were identified as the most frequent predisposing factors. Arterial gas emboli were the most lethal injury mechanism.

Does Decreased Diffusing Capacity of the Lungs for Carbon Monoxide Constitute a Risk of Decompression Sickness in Occupational Divers?

Long-term alterations of pulmonary function (mainly decreased airway conductance and capacity of the lungs to diffuse carbon monoxide (DLCO)) have been described after hyperbaric exposures. However, whether these alterations convey a higher risk for divers' safety has never been investigated before. The purpose of the present pilot study was to assess whether decreased DLCO is associated with modifications of the physiological response to diving. In this case-control observational study, 15 "fit-to-dive" occupational divers were split into two groups according to their DLCO measurements compared to references values, either normal (control) or reduced (DLCO group). After a standardized 20 m/40 min dive in a sea water pool, the peak-flow, vascular gas emboli (VGE) grade, micro-circulatory reactivity, inflammatory biomarkers, thrombotic factors, and plasmatic aldosterone concentration were assessed at different times post-dive. Although VGE were recorded in all divers, no cases of decompression sickness (DCS) occurred. Compared to the control, the latency to VGE peak was increased in the DLCO group (60 vs. 30 min) along with a higher maximal VGE grade (p < 0.0001). P-selectin was higher in the DLCO group, both pre- and post-dive. The plasmatic aldosterone concentration was significantly decreased in the control group (-30.4 ± 24.6%) but not in the DLCO group. Apart from a state of hypocoagulability in all divers, other measured parameters remained unchanged. Our results suggest that divers with decreased DLCO might have a higher risk of DCS. Further studies are required to confirm these preliminary results.

Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment

INTRODUCTION

Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, there are anecdotal reports of technical divers treating mild DCI symptoms themselves and not seeking a medical evaluation and possible recompression therapy. This study aimed to make an epidemiologic inventory of technical diving-related DCI symptoms, to establish the incidence of self-treatment and to determine the apparent effectiveness of different treatment methods.

METHODS

A one-year prospective survey with online questionnaires was conducted. Fifty-five experienced and highly trained Finnish technical divers answered the survey and reported their diving activity, DCI symptoms, symptom treatment, and treatment outcome.

RESULTS

Of the reported 2,983 dives, 27 resulted in symptoms of DCI, which yielded an incidence of 91 per 10,000 dives in this study. All of the reported DCI symptoms were mild, and only one diver received HBOT. The most common self-treatments were oral hydration and rest. First aid oxygen (FAO₂) was used in 21% of cases. Eventually, none of the divers had residual symptoms.

CONCLUSIONS

The incidence of self-treated DCI cases was 27 times higher than that of HBO-treated DCI cases. There is a need to improve divers' awareness of the importance of FAO₂ and other recommended first aid procedures and to encourage divers to seek medical attention in case of suspected DCI.

[What is the Best Therapeutic Strategy for Decompression Illness? First Aid Oxygen Inhalation and Hyperbaric Oxygen Therapy]

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.

Effects of freediving on middle ear and eustachian tube function

INTRODUCTION

During descent in freediving there is exposure to rapidly increasing pressure. Inability to quickly equalise middle ear pressure may cause trauma to the ear. This study aimed to evaluate the occurrence of pressure-related damage to the middle ear and the Eustachian tube during freediving and to identify possible risk factors.

METHODS

Sixteen free divers performed diving sessions in an indoor pool 20 metres' freshwater (mfw) deep. During each session, each diver performed four own free dives and up to four safety dives. Naso- and oto-endoscopy and Eustachian tube function tests were performed on the right and left ears before diving, between each session and after the last session. The otoscopic findings were classified according to the Teed classification (0 = normal tympanic membrane to 4 = perforation). Additionally, ENT-related complaints were assessed using a questionnaire.

RESULTS

Participants performed 317 dives (on average 20 dives per diver, six per session). The average depth was 13.3 mfw. Pressure-related changes (Teed 1 and 2) were detected in 48 % of ears. Teed level increased significantly with an increasing number of completed sessions (P < 0.0001). Higher pressure-related damage (Teed 2) occurred in less experienced divers, was associated with significantly lower peak pressures in the middle ear and led to more ear-related symptoms. A preference for the Frenzel technique for middle ear pressure equalisation during freediving was shown.

CONCLUSIONS

Pressure exposure during freediving had a cumulative effect on the middle ear. Factors such as diving depth, diving experience and number of diving sessions correlated with the occurrence of higher Teed levels.

Recreational diving-related injury insurance claims among Divers Alert Network Japan members: Retrospective analysis of 321 cases from 2010 to 2014

INTRODUCTION

Monitoring trends in diving-related injuries enables implementation of effective safety measures. Divers Alert Network Japan (DAN Japan) membership includes insurance covering recreational diving-related injuries and fatalities. Use of claim data provides both a known denominator and demographic data about injured members.

METHODS

The study analysed 325 insurance claims reported to DAN Japan from 2010 to 2014. Four fatalities were excluded, leaving 321 claims for analysis. Claimants were divided into three age groups: young adults (< 40 years); middle-aged (40-59 years) and older adults (≥ 60 years). The total injury claims rate (ICR), decompression illness (DCI) rate (DCR) and trauma rate (TCR) were calculated. Differences between the sexes within each age group were analysed.

RESULTS

The total number of DAN Japan member-years in the period was 80,617, with a mean age of 45 years. Claims were made by 153 males and 168 females with a mean and median age of 46 years. Trauma was the most frequent reason for a claim (113 cases, 35%), followed by DCI (109 cases, 34%). The ICR (per 104 member-years) was 39.8 (95% confidence interval 35.5 to 44.2) and the TCR was 14.0 (11.4 to 16.6). For every age group, the ICR and TCR were significantly higher for females than males. The DCR was 13.5 (11.0 to 16.1) and did not significantly differ between the sexes.

CONCLUSIONS

The incidence of trauma-related diving injuries exceeds that of claims related to DCI. Females appear to have a higher risk of injury than the general diving population.