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Introduction: Living aboard submarines has a potential negative effect on health. Although studies have evaluated specific health hazards and short-term outcomes, long-term health effects have not been investigated in this population. Methods: Veteran submariners were contacted through the veterans' society and administered a World Health Organisation validated questionnaire (SF-36) assessing their physical, emotional, and social functioning. Scores were compared with those of the general (reference) population and scores in veteran submariners were differentiated by rank, time at sea and time in service. Statistical analyses were performed using the Wilcoxon signed rank and Kruskal-Wallis tests. Results: Of the 1,025 submariners approached in December 2019, 742 (72.4%) completed and returned the questionnaire before July 2020. All 742 were men, of median age 68 (interquartile range [IQR] 59-76) years (range 34-99 years). Of these subjects, 10.3% were current smokers, 64.4% were former smokers and 23.7% had never smoked. Submariners scored significantly better (P < 0.001) than the general population on all eight domains of the SF-36. Except for 'pain' and 'change in health status over the last year', scores for all domains decreased with age. Scores were not significantly affected by smoking status, rank, service, and time at sea. Conclusions: Dutch veteran submariners have better self-reported vitality and health status than the general Dutch population. Rank, service, and time at sea did not significantly affect scores of Dutch submariners. [ABSTRACT FROM AUTHOR]

Introduction: Performance of routine chest X-rays (CXRs) in asymptomatic individuals to assess hyperbaric exposure risk is controversial. The radiation risk may overshadow the low yield in many settings. However, the yield may be higher in certain settings, such as tuberculosis-endemic countries. We evaluated the utility of routine CXR in diving and submarine medical examinations in South Africa. Methods: Records of 2,777 CXRs during 3,568 fitness examinations of 894 divers and submariners spanning 31 years were reviewed to determine the incidence of CXR abnormality. Associated factors were evaluated using odds ratios and a binomial logistic regression model, with a Kaplan-Meier plot to describe the duration of service until first abnormal CXR. Results: An abnormal CXR was reported in 1.1% per person year of service, yielding a cumulative incidence of 6.5% (58/894) of the study participants. Only four individuals had a clinical indication for the CXR in their medical history. A range of potential pathologies were seen, of which 15.5% were declared disqualifying and the rest (84.5%) were treated, or further investigation showed that the person could be declared fit. Conclusions: In South Africa, a routine CXR has a role to play in detecting abnormalities that are incompatible with pressure exposures. The highest number of abnormalities were found during the initial examinations and in individuals with long service records. Only four individuals had a clinical indication for their CXR during the 31-year span of our study. Similar studies should be performed to make recommendations in other countries and settings. [ABSTRACT FROM AUTHOR]

This study characterizes, for the first time, the lives of U.S. Navy submariners engaged in normal, sea-based operations while following a circadian-aligned 24-h watchstanding schedule. Fifty-eight submarine crewmembers provided objective (actigraphy) and subjective (questionnaires) sleep data, and information about mood and lifestyle behaviors during 30 days underway. Projected performance scores and estimated circadian phase times were also calculated from actigraphy-based sleep/wake data. Submariners' objective (6.62 ± 0.94 h; mean ± SD) and subjective (5.90 ± 1.38 h) daily sleep quantities while underway were largely comparable to the sleep reportedly received by Sailors across other Navy platforms and watchstanding schedules. Additionally, submariners' actigraphy-predicted circadian phases shifted progressively toward better alignment with watchstanding schedules across time. Nevertheless, subjective sleep quality was low, submariners engaged in unfavorable lifestyle behaviors (lack of regular meals and exercise), and participants reported decreased mood at the completion of their underway time. Recommendations for countermeasure development are provided., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Investigation of the cause of death during diving is one of the contents of forensic pathology. In this article, relevant foreign literature is reviewed to summarize the techniques and methods used in the identification of diving deaths, such as accident reconstruction, diving monitoring data, postmortem CT examination and gas analysis （location and quantity） in the body of the corpse, in order to provide a reference for forensic identification of such cases.

Introduction: Routine dipstick urinalysis is part of many dive medical assessment protocols. However, this has a significant chance of producing false-positive or false-negative results in asymptomatic and healthy individuals. Studies evaluating the value of urinalysis in dive medical assessments are limited., Methods: All results from urinalysis as part of dive medical assessments of divers, submarines, and hyperbaric personnel of the Royal Netherlands Navy from 2013 to 2023 were included in this study. Additionally, any information regarding additional testing, referral, or test results concerning the aforementioned was collected., Results: There were 5,899 assessments, resulting in 46 (0.8%) positive dipstick urinalysis results, predominantly microscopic haematuria. Females were significantly overrepresented, and revisions resulted in significantly more positive test results than initial assessments. Lastly, almost half of the cases were deemed fit to dive, while the other half were regarded as temporarily unfit. These cases required additional testing, and a urologist was consulted three times., Conclusions: To our knowledge, this is the most extensive study evaluating urinalysis in dive medical assessments. In our military population, the incidence of positive test results is very low, and there have not been clinically relevant results over a period of 10 years. Therefore, routinely assessing urine in asymptomatic healthy military candidates is not cost-effective or efficacious. The authors advise taking a thorough history for fitness to dive assessments and only analysing urine when a clinical indication is present., Competing Interests: The authors report no conflicts of interest in this work., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Copyright of Journal of Forensic Medicine / Fayixue Zazhi is the property of Journal of Forensic Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Submariners face many challenges. For example, they "live where they work" and can be called to duty anytime. They have limited access to open space, natural settings, fresh air, fresh food, sunlight, privacy, exercise, and outside communication. They support a wider range of missions than occur aboard most other Navy vessels. At sea or on shore, submariners work long hours under conditions with little margin for error. They may traverse remote or disputed areas of the ocean far from rescue assets, and must remain vigilant for potential encounters with hostile forces, onboard fires, anomalies in the breathing atmosphere, leaks, undersea collisions, or radiation exposures. If any of these factors cause casualties, the Independent Duty Corpsman (with intermittent advice from shore-based medical personnel), must be ready to provide aid as long as necessary. The challenges of submarine service led to the growth of the unique field of submarine medicine, which has maintained an excellent record of health and safety. This review introduces the field of submarine medicine as practiced in the U.S. Navy, describing its major concerns, giving an overview of the operation of a submarine medical department, and identifying several medical gaps that researchers are working to fill. Submarine medicine already has a stellar record in terms of radiation and atmospheric safety and has made strides in fatigue management. Ongoing work will deliver improved psychological screening and support tools. This report summarizes developments in these and other areas of submarine medicine. [ABSTRACT FROM AUTHOR]

Decompression illness (DCI) is well known in compressed-air diving but has been considered anecdotal in breath-hold divers. Nonetheless, reported cases and field studies of the Japanese Ama, commercial or professional breath-hold divers, support DCI as a clinical entity. Clinical characteristics of DCI in Ama divers mainly suggest neurological involvement, especially stroke-like cerebral events with sparing of the spinal cord. Female Ama divers achieving deep depths have rarely experienced a panic-like neurosis from anxiety disorders. Neuroradiological studies of Ama divers have shown symptomatic and/or asymptomatic ischaemic lesions situated in the basal ganglia, brainstem, and deep and superficial cerebral white matter, suggesting arterial insufficiency. The underlying mechanism(s) of brain damage in breath-hold diving remain to be elucidated; one of the plausible mechanisms is arterialization of venous nitrogen bubbles passing through right to left shunts in the heart or lungs. Although the treatment for DCI in Ama divers has not been specifically established, oxygen breathing should be given as soon as possible for injured divers. The strategy for prevention of diving-related disorders includes reducing extreme diving schedules, prolonging surface intervals and avoiding long periods of repetitive diving. This review discusses the clinical manifestations of diving-related disorders in Ama divers and the controversial mechanisms. [ABSTRACT FROM AUTHOR]

Submarine operations require strict adherence to standard operating and safety procedures and errors in judgement or accidents could lead to catastrophe and impair the submarine's ability to surface. In case of disablement of a submarine (DISSUB), the crew would have to survive inside the submarine for a variable period awaiting rescue. Microclimate and habitability of the submarine would have to be maintained and crew would have to consume emergency rations and water. In order to validate these procedures, a simulation was carried out in which 80 crew members were closed up inside a submarine in harbour for 24 h simulating a DISSUB situation without power and ventilation. Average temperature of the submarine compartments rose from 29.33 °C at the beginning of the simulation to 33.5 °C at the end of 24 h. Relative humidity increased from 79% to 87.67%. Crew members consumed an average to 973 kcal worth of rations during the 24 h of the exercise with 500 ml water. Submarine crew could survive successfully inside a disabled submarine awaiting rescue if thermal stress could be addressed. In the present simulation, the crew suffered from effects of thermal stress. Thermal stress would not only affect damage control capabilities, but could also lead the crew into earlier escape. Greater research and further studies are required to mitigate thermal stress and its effects in order to prolong survival. [ABSTRACT FROM AUTHOR]

The Submarine arm of the Indian Navy is in its Golden Jubilee year, celebrating 50 glorious years of service to the Nation. From a small force of Foxtrot class, it leapfrogged into high technology boats in just 25 years of its coming into being. Forays into operating a nuclear Submarine have brought the Navy into the fold of of modern Submarine powers. In this journey, it has also graduated from acquiring Submarines from foreign nations to the present day indigenous construction of both conventional and nuclear boats. Submarine Medicine has been an inseparable part of strengthening the Naval capability throughout this endeavor. This article briefly describes the tale of Submarine medicine in India since its origin, highlighting significant milestones.

If the situation would so occur, during a disabled submarine (DISSUB) situation the decision on whether to escape or to wait for rescue to arrive would a difficult one to make for a submarine commander. There would be certain situations where the decision would be unilateral, but often not so. Escape on one’s own means using the submarine escape set would be fraught with the possibilities of a multitude of medical problems whilst rescue would be associated with the uncertainty of the long wait for help to arrive. Nevertheless, if the conditions so allow, rescue is a preferable option. However, the catch is, ‘if the conditions so allow’. That means that the conditions inside the submarine have to be favourable for the crew to survive inside the submarine for a period of 3 to 6 days. The submarine therefore is accordingly provisioned with emergency food and water and regeneration equipment. However, one factor which can be the deciding factor for the decision between escape and rescue is that of temperature inside the submarine. In a study carried out on survival inside a submarine, submarine crew were made to stay inside a simulated disabled submarine for 24 hours surviving only on emergency food and water supply. The temperature and humidity inside the submarine rose to an extent that the crew suffered from dehydration and severe thermal stress. Thermal stress, especially, uncompensable thermal stress as would be expected inside the DISSUB, has been seen to lead to cardiovascular strain and increased ventilation later progressing to hypotension, lassitude and reduced cognition. The thermal stress therefore would need to be addressed so as to not to become a factor which would lead the crew to escape sooner rather than wait inside the submarine for rescue. This paper discusses the effects and the resultant consequences of thermal stress that would likely occur inside the disabled submarine especially with respect to the decision between escape and rescue.

Introduction: Lack of physical activity is one of the major factor which affects crew health while onboard submarines at sea. Lack of physical activity along with increase in body weight and body fat content can lead to increase predisposition to lifestyle disorders in submarine crew. Materials and Methods: Omron Bioimpedance monitor to measure weight, body fat percentage and muscle mass of crew of a submarine while on a 26 days sortie. Pre-sailing and post-sailing measurements were compared and analysed using the student t test. Results: Mean weight of the submarine crew increased significantly by 0.5% from 70.71 kg on day 1 to 71.06 kg on day 25. BMI increased by 0.5% from 24.42 kg/m2 to 24.55 kg/m2. Mean fat percentage increased by 2.6% and muscle mass decreased by 0.7%. Discussion: Increased body fat along with lack of physical activity can lead to development of lifestyle disorders in submarine crew. These crew members need to be actively encouraged to participate in physical activity when in harbour. In addition dieting program specifically to encourage reduced fat consumption needs to be instituted in submarines during sorties at sea.

Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled "Management of mild or marginal decompression illness in remote locations". A contemporary review was initiated by the Diver's Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; first aid strategies for DCI; remote triage of possible DCI victims by diving medicine experts; evacuation of DCI victims; effect of delay to recompression in DCI; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Meeting, discussion by registrants at that workshop and finally several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis on resolving controversies around the definition of "mild DCI" arising over 12 years of practical application of the 2004 workshop's findings, and on the controversial issue of in-water recompression. The guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication. [ABSTRACT FROM AUTHOR]

Background: Decompression sickness (DCS) is a rare condition that is often difficult to diagnose in deep-sea divers. Because of this, prevention and early diagnosis are important. In this case-control study, we examined the risk and preventive factors associated with DCS. Methods: Our original questionnaire survey was conducted among 269 recreational divers in Okinawa. Divers who were diagnosed with DCS by a physician (n = 94) were compared with healthy recreational divers (n = 175). The questionnaire consisted of 30 items and included a dive profile. Odds ratios and multiple logistic regression analysis were used to estimate the relative risk of DCS. Results: Logistic regression analysis revealed the following risk factors for DCS: a past history of DCS, drinking alcohol the evening before diving, indicating decompression stops, cold exposure after the dive, and maximum depth. Preventive factors included hydration before the dive, deep stops, safety stops and using nitrox gas. The results were reliable according to the Hosmer-Lemeshow and omnibus tests. Conclusion: We identified certain risk factors, together with their relative risks, for DCS. These risk factors may facilitate prevention of DCS among Okinawa divers. [ABSTRACT FROM AUTHOR]

Psychoactive drugs pose a risk to both the diver and his or her buddy. Little is known about the safety of diving with antidepressants. Amongst the potential interactions with the diving environment are: somnolence; convulsions; a bleeding tendency (potentially worsening decompression illness, DCI), alterations to glucose metabolism and psychiatric side effects. Fluoxetine may potentially reduce the inflammatory process associated with DCI. This article presents guidelines for recreational diving in combination with antidepressants. These guidelines were endorsed at a meeting of the Dutch Association for Diving Medicine in 2015 and are solely based on 'expert' opinion. [ABSTRACT FROM AUTHOR]

Saturation Diving is a highly technical and advanced form of diving utilized to perform dives at depths greater than 55 metres. It employs physiological principles and decompression techniques which enables the diver to have an almost unlimited stay at the depth. This requires the diver to be saturated at the requisite pressure in a diving chamber for prolonged periods. Saturation diving necessitates stringent fitness standards of divers, careful and exhaustive planning of the dive, creating tailor made breathing mixtures, a high level of medical preparedness and response, continuous scrupulous monitoring of the divers’ physiological and environmental parameters and long term follow up to obviate any unwanted outcome. The purpose of Saturation diving is to provide cost effective and extensive period of stay underwater to perform useful work at great depths. It is employed commercially for exploration and maintenance of offshore platforms such as oil rigs and militarily for submarine rescue and salvage of sunken aircraft and ships. In Submarine rescue, it provides the valuable back up and training effort. The limitations of Saturation diving are: highly technical equipment which is expensive and maintenance intensive, prolonged training of personnel and meticulous execution of the dive is mandatory.

Injuries suffered as a result of a rebreather oxygen explosion and fire occurred to a diver on vacation in the island state of Chuuk, Micronesia. The medical and logistical management of the diver in a remote location are described. The mechanism of both the fire and the subsequent blast and burn injuries are discussed. Prevention of and preparation for such incidents are discussed in the context of the increasing frequency of dive and adventure travel to remote areas. [ABSTRACT FROM AUTHOR]

Background/Aim. Sudden sensorineural hearing loss is manifested by the loss of hearing for more than 30 dB at three consecutive frequencies in the timeframe of 72 h. It is of unclear etiology and pathogenesis, which leads to the use of different therapeutic methods. Treatment protocols are not compliant, making it difficult to objectively quantify their impact. The aim of this study was to show the effect of hyperbaric oxygen therapy as the only method for the treatment of sudden sensorineural hearing loss. Methods. This retrospective study included 20 patients treated for sudden sensorineural hearing loss with hyperbaric oxygenation (HBO) in the period from 2004 to 2014. The study was conducted in the specialized medical clinic for hyperbaric and underwater medicine, HBO Medical Center in Belgrade. The patients were treated according to the following protocol: a session of 60 min at the pressure of 2 bars (2ATA) two times a day, a total of 30 sessions. Assessment of the therapy effects was performed by observing the change in the hearing threshold at the frequencies of 500, 1,000, 2,000 and 4,000 Hz at the end of the treatment. Results. After the completion of treatment according to the protocol, a full hearing recovery (total improvement of hearing damage or achieving final hearing threshold above 25 dB) was found in 11 (55%) of the patients. A partial recovery (hearing improvement of up to 15 dB, and a final hearing threshold below 45 dB) occurred in 4 (20%) of the patients. In 5 (25%) of the patients, improvement was not verified (there was no recovery or it was less than 5 dB). The average absolute hearing recovery was 24.94 dB. The mean relative hearing recovery was 65.45%. Conclusion. Because of the unclear multifactorial etiopathogenesis of this disease, there are many therapeutic protocols. Based on the results of our study HBO therapy could be recommended primarily as the treatment for sudden sensorineural hearing loss. [ABSTRACT FROM AUTHOR]