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At about 1330h (20 min after surfacing), the patient noticed that he was unable to get up from squatting position, weakness in both the legs, loss of sensations and difficulty in passing urine. However, 12 hrs after the initial dive, the patient stumbled when he got up to pass urine. He realized that the weakness and loss of sensations in both the' legs had reappeared. He was having urinary retention with overflow incontinence. This time he was managed as per USN Table 2A (treatment duration lOh, 59min), recompressed to 165ft (50m) on air and brought to surface in appro x 5 hr after which he did not report any relief of symptoms. The patient was finally brought to us 3 days after the incident. The patient had been diving for 5 years without any professional training. His previous dive was to the same depth 24 hrs prior to the current dive and was uneventful. He did not have any history of similar complaints in the past nor did he have any significant past medical history. Sensory examination showed-involvement of the lateral spinothalamic tracts below the level of the umbilicus with sparing of the posterior columns. The gait was sensory ataxic. Chest radiograph and ECG ruled out pulmonary barotrauma and CT scan Head ruled out Cerebro-vascular Accident. A diagnosis of Type II Decompression Sickness was made and management started with HBOT at 2.5 ATA for 60 min initially twice daily. By day 3, the patient reported a subjective improvement in symptoms and he was able to pass stool with difficulty. By 8th day, he was able to walk without support and pass urine with some difficulty once catheter was removed. After 15 days of treatment, HBOT was reduced to once daily. The patient was able to pass stool and urine without difficulty and was able to walk quite comfortably. Sensory examination revealed an improvement in sensations up to the level of the knee. The muscle power had returned to grade VIV, with normal DTJ, normal Babinsky's sign and absent clonus. http://controlcert.se/wp-content/plugins/formcraft/file-upload/server/content/files/16280395389340---brsla-0404-dc-manual.pdf

The improvement in sensations was seen npto day 18 of treatment after which a small area of reduced sensations remained around the ankle.This technique is more physiological and involves two corrections, corrected equivalent depth and corrected stop depth. Our patient dived to a depth of 18m at an altitude of 61Om and ascended without stops. His dive would have seemed correct had it been at sea level. Not taking the stops appeared to be the primary reason for DCS in this case even though other factors like untrained diver, inadequate recompression and lack of oxygen might have played a contributory role. After the appearance of symptoms of DCS, the patient's condition was worsened by incorrect recompression therapy. INBR 2806 defines this as any altitude more than 100m. The US Navy considers diving at altitudes more than IOOOft (304.8m) as altitude divine. From a particular depth, the diver, compared to a dive at sea level, is coming back to a lower atmospheric pressure thus, increasing the pressure gradient from the depth to surface. This offloading can take upto 12 hrs and as a result ideall,no dive should be undertaken within 1 hrs of reaching the altitude location. The requirement would in 'onatel) wiill the increase in altitude 1.This study aimed to observe differences in allowed dive profiles for five models of computer. Profiles consisted of: Profile 1. a two, rectangular dive series with reducing depths Profile 2. a three, rectangular dive series with increasing depths Profile 3. a multi-level dive with reducing depths Profile 4. a multi-level dive with increasing depths and Profile 5. a series of deep, repetitive, 'bounce' dives. All dives were chosen so they could be compared easily with the DCIEM tables. All computers were set in their standard mode with no 'safety' or altitude time reductions implemented. Results: The decompression requirements varied greatly between dive computers and with respect to the tables. http://bacvietexpress.com/upload/userfiles/files/7500edf-manual.pdf

Conclusions: Some dive computers gave more conservative decompression profiles than others on most, but not all, exposures. Occasional idiosyncratic differences emerged. Some computers were consistently less conservative than DCIEM recommendations. The more conservative computers behaved similarly to DCIEM profiles on many exposures. Diving medicine in fact grew out of concerns for military divers and till today the primary training and research involve military diving. This paper is intended to deal with some current challenges facing the specialty and offers certain solutions. The solutions would mostly involve cooperation and collaboration of international agencies, organizations, and various countries to make a joint effort to resolve these challenges and take the field of military diving medicine forward. It is taught by diving companies and training institutes but has not been subjected to the tenets of evidence based medicine. The diving bell lacks space as well as a flat hard surface to lay the patient on and therefore conventional methods of administering CPR are not possible. Airway is established using a cervical collar to hyperextend the neck and inserting an appropriate oropharyngeal airway. Cardiac compressions are administered by the bellman using his head or the knee while holding the patient with his arms from behind. The bell can be recovered to surface only when spontaneous breathing and circulation have started. Diving bell offers a unique environment for management of unconscious casualties. Even though the method is at variance with the conventional method of administering CPR, it is the only method possible inside the bell. View full-text Discover more Download citation What type of file do you want. RIS BibTeX Plain Text What do you want to download. Citation only Citation and abstract Download ResearchGate iOS App Get it from the App Store now. {-Variable.fc_1_url-

Install Keep up with your stats and more Access scientific knowledge from anywhere or Discover by subject area Recruit researchers Join for free Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password. Keep me logged in Log in or Continue with LinkedIn Continue with Google Welcome back. Keep me logged in Log in or Continue with LinkedIn Continue with Google No account. All rights reserved. Terms Privacy Copyright Imprint. Outside Government service, this document is issued on a personal basis, each recipient is personally responsible for its safe custody and for ensuring that its contents are disclosed only to authorised persons. Anyone finding this document should hand it to a British forces unit or to a police station for its safe return to the MINISTRY OF DEFENCE, Defence Security, Zone J (Mail Point), Level 1, Main Building, Whitehall, LONDON SW1A 2HB, with details of how and where found. THE UNAUTHORISED RETENTION OR DESTRUCTION OF THIS DOCUMENT MAY BE AN OFFENCE UNDER THE OFFICIAL SECRETS ACTS CONDITIONS OF RELEASE This information is released by the United Kingdom Government to the recipient Government for Defence purposes only. This information must be afforded the same degree of protection as that afforded to information of an equivalent classification originated by the recipient Government or as required by the recipient Government's National Security regulations. This information may be disclosed only within the Defence Departments of the recipient Government except as otherwise authorised by the UK Ministry of Defence. This information is subject to UK MOD Crown Copyright, it may also be covered by privately owned copyright. https://www.mercedesbenzofaustinservice.com/wp-content/plugins/formcraft/file-upload/server/content/files/16280396b6cbd9---Brp-operator-s-manual.pdf

Therefore, no part of this publication may be reproduced, used commercially, adapted or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publishing authority identified on page ii. By Command of the Defence Council Fleet Commander i 2 BRd 2806(5) SPONSOR INFORMATION This publication is sponsored by the Navy Desk Officer on behalf of Fleet Commander. This authority is exercised on behalf of the Ministry of Defence. 1. BRd 2806(5) constitutes the guiding instructions for the conduct of non-military diving at work in the MOD and collectively known as Service Sub-Aqua Diving. 2. The publication is a partner document to the relevant HSE Approved Codes of Practice (ACOP) for diving projects under the Diving at Work Regulations 1997, applicable to the nonmilitary diving activity being carried out by MOD personnel while on duty. It is required because the HSE ACOPs do not have legal application outside the UK territorial limits, however it is the Secretary of State for Defence s Policy, that where MOD operates overseas, it will comply with UK statutory regulations and relevant applicable laws of the Nation in which the activity is being conducted. This publication provides guiding instructions to cover such situations and also additional measures MOD has determined are required to satisfy its duty of care responsibilities under the Health and Safety at Work Act. 3. The publication is divided into sections which are relevant to particular fields of activity within the Service Sub-Aqua domain. These sections comprise of general instructions; Adventurous Training specific instructions; Cadet Force instructions and those applicable for vocational diving as part of Resettlement Training entitlement. BACSIHA.COM/public/ckfinder/userfiles/files/7500-real-time-pcr-system-manual.pdf

Diving is subject to technological, medical and regulatory advances and reviews, and as a consequence it is important to ensure that this document remains live in order to keep pace with these influencing factors. Any changes will be promulgated by the most effect means possible to ensure it remains relevant and effective. 4. Neither the Ministry of Defence nor the Crown is liable for any use made of this book by any person outside the service of the Ministry of Defence or the Crown, or for anything said or omitted to be said therein, or for any consequences, including any accident, or for anything done or omitted to be done as a result of the use of this manual by any such person. 5. Users wishing to comment on the contents of this publication should use a duplicate of the special form provided on page vi, copies of which are to be forwarded through the usual administrative channels to the addressees shown on page ii. A copy should also be forwarded to the Subject Matter Expert (SME) for this publication, DSO (AT). EQUALITY ANALYSIS 6. The sponsor of BRd 2806(5) has undertaken an Equality Analysis to ensure that the outcome does not have a disproportionate impact on those in the Protected Characteristics groups. CONVENTIONS 7. The following convention is used throughout this publication. Note. An operating procedure, practice or condition that is essential to emphasis.As a result, all Joint Services sub-aqua diving is to be conducted in accordance with these regulations. 2. Authorisation BRd 2806(5) will be updated on an annual basis in conjunction with the other volumes. Amends falling within this time frame will be promulgated by JSSADC and will also be published on the MOD Diving Safety Web site. These regulations are not to be amended or altered, except by authority of SofD. Dispensation to depart from these regulations may only be given by SofD. 3. Availability These regulations are available from the MOD Diving Safety Web Site at the following address: MOD Diving Safety Website v 6 BRd 2806(5) PROPOSALS FOR CHANGES Forward through usual Administrative Channels to the addresses listed on Page ii. All changes are to be submitted at the earliest opportunity and not retained awaiting instructions for submission.Diving expeditions are often conducted under challenging conditions. Diving involves controlled exposure to risk within the confines of structured, progressive training whilst complying with proven safety procedures. Responsibilities must be clearly understood by those appointed to oversee the activity. The MOD has a legal and moral obligation to provide resources, assistance and protection to personnel whilst on duty. b. JSP 433, MOD Diving Safety Policy includes the overarching policy for Joint Services sub-aqua diving. BRd 2806(5) provides direction and guidance for all MOD Joint Services sub-aqua diving activities. c. The British Sub Aqua Club (BSAC) is the national governing body for recreational diving in the UK. In addition to these regulations, Joint Services subaqua divers shall follow BSAC safe diving (see note2). d. The definition of Joint Services sub-aqua diving is that conducted by authorised personnel using one or more of the following: MOD supplied equipment (see note 3), facilities, resources or funding from any public or non-public service fund. This includes: (1) Diving undertaken as pre-release vocational (Resettlement) training. (2) Enhanced Learning Credit (ELC) and Standard Learning Credits (SLC) approved courses. (3) Diving activity undertaken by personnel working in the MOD sponsored Combined Cadet Force (CCF). The Secretary of State for Defence has directed that, where the MOD operates overseas, it shall comply with UK standards, or the standards of the host country, whichever is the more stringent. All Joint Services Sub-Aqua diving activities are to comply with the DWR. Unit CO s retain responsibility for approving resettlement or ELC scheme plans for individuals under their command. SofD is mandated by PUS through Director, Defence Safety and Environment Authority (DSEA) for regulation, safety and standards of Joint Services sub-aqua diving activities. He is responsible for the setting and development of, diving safety policy. Diving Supervisors (SADS) will act as the diving contractor s representative Breaches of Diving Safety Policy and Regulations Where a breach of MOD diving safety policy and regulations is identified, SofD may, if the circumstances warrant, issue sanctions to prevent unsafe activity or use of unsafe equipment. These sanctions would be issued in place of HSE Crown Censures. Failure to comply with such notices may result in disciplinary action. Options are as follows (see note): a. Improvement Notice. An Improvement Notice would be served as a result of a lapse in standards which, if not rectified, could lead to unsafe diving practise or equipment. It would demand that any breach or shortfall to be addressed as soon as reasonably practicable. b. Prohibition Notice. A prohibition notice would be issued to immediately stop the use of unsafe equipment or conduct of unsafe diving practises. These are to be posted on the DST(AT) web site and forward to OIC JSSADC for onward distribution. (6) In the event of a serious incident, conduct accident investigation duties in order to identify root cause and prevent reoccurrence. This investigation may be conducted in association with HSE Diving Inspectors. b. Provide SME advice to a Service Inquiry or other formal investigation. c. DST(AT) is to conduct quarterly safety review of incidents with OIC JSSADC and association representatives. Outcome of review will be posted on DST website and published by OIC JSSADC. d. DST(AT) comprises of 2 personnel. Due to their limited numbers, DST(AT) staff are exceptionally permitted to dive IAW with the recreational ACOP with regard to minimum personnel and act as in water supervisors on the following occasions (1) When participating on a continuation diver training course to maintain the necessary qualifications to enable them to carry out their DST duties. Training to be conducted in UK centres. (2) When conducting site surveys and instructor validation of candidate commercial oversees MOD Approved Centres. (3) When conducting annual certifications of existing commercial oversees MOD Approved Centres. 1-6 14 BRd 2806(5) e. In order to mitigate the reduced numbers of divers required at Para 0202, before diving commences they are to ensure that the dive centre provides a minimum of: (1) A suitably qualified person who is familiar with the diving project plan and the arrangements for obtaining assistance in the event of emergency. (2) The first aid equipment identified in the risk assessment and a competent person trained in its use Joint Service Sub Aqua Diving Centre (JSSADC) The JSSADC is the lead centre for Joint Service sub-aqua diving. Formal notification of this temporary qualification is to be made in writing (an attachment is acceptable) to the individual concerned and is to include details of the duration and any limitations applicable to the qualification and copies sent to DST(AT) and the Unit CO. Wherever possible, the DO is to be an ESADS. 1-9 17 BRd 2806(5) (4) The duties of the Branch committee members are described in the BSAC Branch Officers' Handbook and each post should hold Terms of Reference (TOR s) which should be reviewed at least annually or if a post holder changes. These TOR s are to be made available during the RDSC. (5) A record of Committee meetings is to be kept and the proceedings are to be reported to the unit CO. (6) The CO is to ensure that an effective diving safety management system appropriate to the circumstances of the Branch is established and maintained by the Branch Committee. (7) Branches are to submit an annual report by 31 October in accordance with Annex 1B. b. Encroachments. When non service Sub Aqua Diving organisations have organised local encroachments within MOD property and when no MOD supplied equipment, facilities, resources or funding from any public or non-public service fund are being used then their diving activities are not covered by Joint Services sub-aqua diving and they are not entitled to any of the advantages available to a JSAT branch. Any risk associated with the non service Sub Aqua Diving organisations within the encroachment is borne entirely by the CODH that granted the encroachment; diving is conducted exclusively at the risk of the individuals involved Commanding Officer s Responsibility and Supervision of Diving (Guidance for Commanding Officers is at Annex 1C) a. By its very nature Service sub-aqua diving involves controlled exposure to risk. COs have responsibility for safety of all personnel under their command. They are to ensure that there is a system of safety which reduces risks to As Low As Reasonably Practicable (ALARP). To assist them in exercising this responsibility, Service open water diving must be carried out under the supervision of a currently registered SADS unless specifically exempted under Para 0114 sub para g and Para b. Where Command authority is granted to personnel to undertake training or examinations under the BSAC Instructor Training Scheme or BSAC nationally controlled examinations or to undertake a qualifying course at an HSE compliant civilian diving school in the UK or a MOD Approved Centre, whether BSAC or otherwise (see note), a SADS is not required. However, any diving undertaken outside that examination or course must be supervised by a SADS in the normal way. 1-10 18 BRd 2806(5) c. Service personnel wishing to use a non-bsac diving school for a MOD sponsored diver qualifying course under the Joint Services sub-aqua diving scheme, including resettlement training, ELC or SLC approved courses (e.g. PADI Open Water Course) must be in possession of a Medical Fitness to Dive Certificate (BRd 1750A, Part 2, Chapter 12, Leaflet 12-03), have obtained the relevant authority to undertake the course and undertake it at a site authorised and cleared by DST (AT) Note. This information should also be recorded in the branch competent persons register f. SADS are to attend a refresher course at JSSADC every five years or when called forward by OIC JSSADC. Non attendance, except for circumstances beyond the control of the SADS, will result in the suspension of that individual s qualification. g. Unless deputising for an ESADS, BSADS are only permitted to supervise dives at locations listed on the Branch Site Register (see para 0109 sub para h). 1-11 19 BRd 2806(5) Authority to Award BSAC Qualifications The delegation of authority to a Branch DO to award BSAC diving qualifications up to the grade of Advanced Diver comes from the BSAC National Diving Officer (NDO) and not the chain of command. In addition to BSAC members, the expedition leader can accept divers from other recognised training agencies listed at Annex 1D, this includes military professional divers (RN, RM and Army). All diving is to be conducted in accordance with BSAC rules and guidelines. It is essential that expedition leaders carry out a risk assessment on each diver to ensure that they have the necessary qualifications and skills to meet the aim of the expedition. If additional training is identified, this must be completed either before deployment or during a dedicated training session on arrival at the expedition location. Divers are to be medically fit in accordance with Para 0201 and are to be familiar with BSAC decompression tables and procedures.