In-water EBS Training – The Medical Assessment

Graham FurnaceOil & Gas UK

Desciption Purpose Depth Inspired Air

Pressure

1 Insert EBS, place face in

water, breath from EBS

Gain confidence EBS will

deliver air without inhalation of

water

15-20 cms 1.015 to 1.02

atmospheres

(absolute)

2 Place face in water, insert

EBS, breath from EBS

Gain confidence that EBS can

be inserted with mouth and

nose under water; clear

mouthpiece by exhalation

15-20 cms 1.015 to 1.02

atm (abs)

3 Place face in water, insert

EBS (opposite hand to 2),

breath from EBS, use purge

button

Gain confidence in use of

non-dominant hand, and use

of purge button

15-20 cms 1.015 to 1.02

atm (abs)

4 Insert EBS, submerge head

below surface, breath from

EBS

Gain confidence EBS can be

used with head completely

submerged

30-40cms,

maximum 70

cms

1.03 to 1.04,

maximum 1.07

atm (abs)

5 Submerge head below

surface, insert EBS, breath

from EBS

Gain confidence EBS can be

deployed with head

submerged

30-40cms, max

70 cms

1.03 to 1.04,

max 1.07 atm

(abs)

6 Deploy EBS underwater, place

hands on bar below water

surface, and pull self hand-

over-hand along bar, while

breathing from EBS with head

submerged

Gain confidence that EBS can

be used while moving around

underwater

Variable

between 15

and 40 cms,

max 70 cms

1.015 to 1.04,

max 1.07 atm

(abs)

Barotrauma Hazard

1 in 76,968 – 200,527 (pneumothorax, military)

1 in 491,000 (AGE in recreational diving)

No barotrauma in BSAC pool training – 17 years

and ‘many thousands’

Hazard for (healthy) BOSIET trainees – lower

But what about the less healthy?…..

Initial HSE Exemption Requirements

‘full clinical assessment of respiratory and ENT systems’

Spirometry for all

Asthmatics assessed in accordance with MA1 (FEV1

exercise test for all)

Tympanometry if ‘eustachian tube dysfunction (any

cause)’

Current HSE Exemption Requirements

In possession of Oil&Gas UK medical certificate

If ‘includes a restriction related to respiratory or ENT

condition’ need a statement of fitness to train

Declaration (at training centre) on day of EBS training

Medical Conditions in Examinees

942 males examinee records:

Condition No. %

Asthma (current) 77 8.2

Asthma (childhood) 30 3.2

Bronchitis 7 0.7

‘Shortness of Breath’ 4 0.4

Pneumothorax 3 0.3

COPD 3 0.3

Sacrcoidosis 2 0.2

Bronchitis/Bronchiectasis 2 0.2

Chest Infection 1 0.1

Cystic Fibrosis 1 0.1

Pneumonia/Pleurisy 1 0.1

Total 131 13.9

Absolute Contraindications

PMH of Spontaneous Pneumothorax (unless

pleurectomy – need advice)

Cystic Fibrosis

Asthma

Disregard resolved childhood asthma

OK (no advice needed) if:

FEV1 is 80% or > of predicted, and FEV1/FVC is 70% or >

On step 1 or 2 of BTS guidelines

No recent (3/12) severe exacerbation (e.g admission)

Ask about symptoms on swimming, when breathing EBS in

‘dry training’

BTS/SIGN 2014

BTS/SIGN September 2016

COPD

No single diagnostic test for COPD – history,

examination, spirometry

airflow obstruction present if FEV1/FVC < 70%

If FEV1 is 80% or > of predicted, diagnose only if

symptoms (cough, breathlessness) present

NICE says:

NICE says:

MRC Breathlessness scale

COPD or Asthma?

COPD severity

ENT

Advised to avoid immersion/diving?

Specific Advice Note

Asthma:

Check PEFR on day of training

Take inhaler before pool exercise

If ‘bad chest’ at any point - tell instructor

COPD:

Have they been given bronchodilator? If so, take it

before pool exercise

Practicalities

Launch/Start Date? - OGUK will announce!

(questionnaire, standard referral ‘script’ and

questions, advice notes)

Assess First? – those with BOSIET/FOET by end

2017

Repeat? - 4 years (before next FOET)

Incorporate into medical? - yes, as annex (c.f. ERT)