ANAESTHETICS AND SUBMARINE MEDICINE

PLENARY SESSION

MICHAEL REID 16 JUNE 2014

Submarine medicine is a subspecialty branch of diving and hyperbaric medicine

ANZCA Certificate in Diving & Hyperbaric Medicine (course work, research and practical experience)

http://www.anzca.edu.au/training/diving-and-hyperbaric-medicine

Why are Anaesthetists ideally suited for the submarine escape/rescue role.

International Focus

Kursk

Kursk submarine disaster, 12 Aug 2000- Sunk in 108m, 118 perished

International Submarine Escape & Rescue Liaison Office

http://www.ismerlo.org

Submarine Escape verses Rescue

There are two methods for evacuating a submarine

Escape

Rescue

Submarine Escape

Submarine Rescue

Retrieving LR5 Submersible Rescue Vehicle on deck

Transfer Under Pressure

Type B Recompression Chamber

Submarine rescue – unpredictable, mass casualty situation in a hostile environment with resource constraints

Considerations Trauma

(orthopaedic/burns/internal injuries)

Respiratory compromise

Decompression Sickness

Barotrauma (CAGE)

Hypothermia

Petrochemical contamination

Radiation exposure

Recompression Chamber Space

Oxygen supplies

Number of Survivors (reverse triage)

Retrieval – aeromedical evacuation

Iatrogenic Decompression Sickness in rescue personnel.

Surface weather conditions

Decompression Sickness

DCS classified in three types

Type I – mild, typically affecting muscloskeletal, cutaneous and lymphatic systems.

Type II – severe, typically affecting neurological system. Of the neurological cases, approximately 5 % may manifest pulmonary manifestations ‘the Chokes.’ This can lead to right sided heart failure, circulatory collapse and death.

Cerebral Arterial Gas Embolism (CAGE) – usually stemming from high venous gas loads (with patent foramen ovale) or pulmonary barotrauma with gas entraining into arterial circulation.

DCI classification system

Evolution

Organ system involved

Time of Onset

Gas Burden

Evidence of Barotrauma

Comments and Questions

The foundation for submarine medicine lies with these organisations!