Retrospective review of enquiries to the Québec diving medicine call centre: 2004 through 2018

2021 ◽  
Vol 51 (2) ◽  
pp. 152-160
Author(s):  
David PM Monnot ◽  
◽  
Jocelyn Boisvert ◽  
Dominique Buteau ◽  
Neal W Pollock ◽  
...  
Keyword(s):  
Decompression Sickness ◽  
Information Service ◽  
Health And Safety ◽  
Breath Hold ◽  
Call Centre ◽  
Medical Opinion ◽  
Phone Calls ◽  
Sufficient Detail ◽  
Diving Medicine ◽  
Life Threatening

Introduction: The Centre de Médecine de Plongée du Québec (CMPQ) established a bilingual 24-hour dive emergency call line and diving medicine information service in 2004. The toll-free number (888-835-7121) works throughout Canada. Calls and emails ([email protected]) are answered by a CMPQ coordinator or on-call hyperbaric physicians and other consultants as needed. We reviewed 15 years of activity. Methods: Details of phone calls and email enquiries to the centre were reviewed individually and compiled into a database. Data were analysed to characterise contact volume and issues addressed. Contacts were categorised into five groups: information only (INF); medical opinion required (MOP); medical issue after the critical period of urgency had passed (PUR); current urgent but not immediate life-threatening issue (NLT); and immediate life- or health-threatening issue (ILT). Data presented as mean (standard deviation) or percentage. Results: A total of 3,232 contacts were made from May 2004 through December 2018: 19 (SD 8) per month [215 (70) per year]. Primary issues of concern were: emergency planning (20%); technical (not medical/physiology) questions (16%); otorhinolaryngological (12%); and decompression sickness-related (7%). Categorisation was 52% INF, 28% MOP, 13% PUR, 7% NLT, and 0.1% ILT, with 0.2% lacking sufficient detail to categorise. The nature of the diving activity of interest was determined in 67% of cases: 48% (n = 1,039) professional; 46% (n = 1,008) recreational; and 1% (n = 11) breath-hold. Conclusions: The call centre serves as a resource to the community, providing information on health and safety for diving in addition to being available to assist with emergent needs.

Diving Accident Evacuations by Helicopter and Immersion Pulmonary Edema

2020 ◽  
Vol 91 (10) ◽  
pp. 806-811
Author(s):  
Laëtitia Corgie ◽  
Nicolas Huiban ◽  
Jean-Michel Pontier ◽  
François-Xavier Brocq ◽  
Jean-François Boulard ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Decompression Sickness ◽  
Mediterranean Coast ◽  
Military Hospital ◽  
Emergency Unit ◽  
Diving Accident ◽  
Landing Zone ◽  
Diving Accidents ◽  
Non Invasive Ventilation ◽  
Life Threatening

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS: A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest.DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE.Corgie L, Huiban N, Pontier J-M, Brocq F-X, Boulard J-F, Monteil M. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform. 2020; 91(10):806811.

Hyperbaric treatment of air or gas embolism: current recommendations

2019 ◽  
pp. 673-683
Author(s):  
Richard E. Moon ◽  
Keyword(s):  
Animal Studies ◽  
Decompression Sickness ◽  
Bubble Formation ◽  
Endothelial Damage ◽  
Neurological Deficits ◽  
Breath Hold ◽  
Gas Embolism ◽  
Hyperbaric Treatment ◽  
Pulmonary Capillaries ◽  
Venous Gas Embolism

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac “vapor lock” and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence-based review of adjunctive therapies is presented.

Statutory Safety Representatives and Safety Committees: Legal and Industrial Relations Implications

1982 ◽  
Vol 24 (3) ◽  
pp. 337-364 ◽  
Author(s):  
W.B. Creighton
Keyword(s):  
Industrial Relations ◽  
Health And Safety ◽  
Safety Issues ◽  
Statutory Provision ◽  
The United Kingdom ◽  
Sufficient Detail ◽  
Structured System ◽  
Safety Committees ◽  
Practical Implications

This article examines the increasingly important issue of the role of statutory safety representatives and safety committees in helping to promote and protect the health, safety and welfare of the Australian workforce. It consists first of an examination of the development of statutory provision in this area in the United Kingdom, culminating in the passing of the Health and Safety at Work Act 1974 and the introduction of the far-reaching Safety Representatives and Safety Committees Regulations of 1977. It then describes and analyses the reception of these provisions, and the philosophy which underpins them, in Australia. Thirdly, it attempts to identify and discuss some of the more important legal and practical implications of this kind of statutory provision. There is reason to suppose that some of these issues have not been analysed in sufficient detail in either Britain or Australia, but overall it is clear that a properly structured system of statutory safety representatives/com mittees can play an important and constructive part in helping to promote a proper awareness of health and safety issues in this country.

Call Centre Evolution in the Digital Government

2011 ◽  
pp. 3980-3986
Author(s):  
V. Ambriola ◽  
S. Bertagnini ◽  
L. Pratesi
Keyword(s):  
Public Administration ◽  
Information Service ◽  
The Other ◽  
Call Centre ◽  
Digital Government ◽  
Call Centres ◽  
Administrative Service ◽  
Relevant Role ◽  
Front Office ◽  
Back Office

Public administration is undergoing a radical transformation. Citizens, rather than administrative documents, will be the primary and active subjects of the process of service supply. A new attitude toward administrative service is emerging. Citizens interact with public administration through new channels such as unified administrative counters, multifunction administrative counters, citizen liaisons offices, and Internet. Furthermore, having in mind the goals of shortening the distance between citizens to public administration and improving efficiency and efficacy of public bodies, the use of call and contact centres is quickly spreading out. It is worth to recall the recent case of Allô Service Public, the unified call centre of the French public administration, which on its first day of activation has been contacted by more than 100,000 people, more than any optimistic expectation. For a public administration, a call centre represents a simple way for interacting with citizens. Call centres provide many advantages such as improved efficiency, increased hours of operation, and reduced costs. The main advantage for citizens is that call centres can provide the information they need, as fast as possible and reducing waiting time. Call centres and contact centres are based on an innovative use of the phone channel, on one side, and on multi-channel strategies of access to service and information, on the other side. The combination of these two aspects allows public administration to develop and activate new modes of managing interaction with citizens. A phone-based information service is often the first channel chosen by citizens that want to get in touch with a public body. Call centres, on the other hands, have a relevant role for implementing the link between front-office and back-office services.

Pesticide incidents reported to the Health and Safety Executive 1989/90- 1991/92

1995 ◽  
Vol 14 (8) ◽  
pp. 630-633 ◽  
Author(s):  
JP Thompson ◽  
PB Casey ◽  
JA Vale
Keyword(s):  
Great Britain ◽  
Methyl Bromide ◽  
Private Property ◽  
Information Service ◽  
Health And Safety ◽  
Insufficient Data ◽  
Pesticide Poisoning ◽  
The Public ◽  
Occupational Setting ◽  
The Uk

1 Data concerning pesticide incidents investigated by the Field Operations Division (FOD) of the Health and Safety Executive (HSE) in Great Britain have been collated for the three year period April 1989 to March 1992. Over this period the HSE investigated 613 incidents concerning pes ticides : 338 related to general or environmental com plaints not involving human poisoning and 275 were sus pected poisoning incidents. 2 The two hundred and seventy-five suspected poisoning incidents were assessed by the Pesticide Incidents Appraisal Panel (PIAP) as 'confirmed', 'likely', 'unlikely', 'not confirmed', or that there were 'insufficient data' to make an assessment. Assessed data are unavailable for eight incidents reported in 1989. 3 Four hundred and eighteen members of the public were involved in 202 assessed incidents and 79 workers were exposed in 65 assessed incidents. Overall, 129 (48%) inci dents were assessed as 'confirmed' or 'likely', 121 (45%) as 'unlikely' or 'not confirmed' and in 17 (6%) there were 'insufficient data' to form a judgement. Incidents occur ring in an occupational setting were assessed as 'con firmed' or 'likely' more frequently (62%) than those involving members of the public (44%). 5 Thirty-six per cent of those involved in a 'confirmed' poisoning incident were working with a pesticide or were in close proximity to the operator; 41% were on private property adjacent to a field being sprayed and a further 23% involved those walking, cycling or jogging past a sprayed field. 6 These data underestimate the number of occupational pesticide poisoning incidents in Great Britain as incidents involving sheep dips are not considered by PIAP but are dealt with by a parallel scheme run by the Veterinary Medicines Directorate. In addition, few of the non-occupa tional incidents, for example those referred to one of the UK National Poisons Information Service Centres, are included in these data. 7 Sixty deaths from pesticide poisoning were recorded in England and Wales between 1989-1991, though the major ity of cases followed the deliberate ingestion of a pesticide rather than occupational exposure. Only one of these was reported to the HSE and that concerned the deliberate ingestion of mevinphos. A second death reported to the HSE involved a farmer who died some 11 months after he became unwell following fumigation of his glasshouse soil with methyl bromide by a contractor. It is unlikely that this death was related to exposure to methyl bromide. 8 Over the 3 year period of the study there was an increase in the number of prosecutions laid before the courts (Under the Control of Pesticides Regulations 1986 made under the Food and Environment Protection Act 1985), though the number of Enforcement Notices served decreased. In addition, the average total fine decreased for the incidents prosecuted successfully.

scholarly journals Deadly diving? Physiological and behavioural management of decompression stress in diving mammals

2011 ◽  
Vol 279 (1731) ◽  
pp. 1041-1050 ◽  
Author(s):  
S. K. Hooker ◽  
A. Fahlman ◽  
M. J. Moore ◽  
N. Aguilar de Soto ◽  
Y. Bernaldo de Quirós ◽  
...  
Keyword(s):  
Marine Mammal ◽  
Marine Mammals ◽  
Multiple Stressors ◽  
Decompression Sickness ◽  
Tissue Injury ◽  
Bubble Formation ◽  
Gas Bubbles ◽  
Breath Hold ◽  
Technological Advances ◽  
Measured Time

Decompression sickness (DCS; ‘the bends’) is a disease associated with gas uptake at pressure. The basic pathology and cause are relatively well known to human divers. Breath-hold diving marine mammals were thought to be relatively immune to DCS owing to multiple anatomical, physiological and behavioural adaptations that reduce nitrogen gas (N 2 ) loading during dives. However, recent observations have shown that gas bubbles may form and tissue injury may occur in marine mammals under certain circumstances. Gas kinetic models based on measured time-depth profiles further suggest the potential occurrence of high blood and tissue N 2 tensions. We review evidence for gas-bubble incidence in marine mammal tissues and discuss the theory behind gas loading and bubble formation. We suggest that diving mammals vary their physiological responses according to multiple stressors, and that the perspective on marine mammal diving physiology should change from simply minimizing N 2 loading to management of the N 2 load . This suggests several avenues for further study, ranging from the effects of gas bubbles at molecular, cellular and organ function levels, to comparative studies relating the presence/absence of gas bubbles to diving behaviour. Technological advances in imaging and remote instrumentation are likely to advance this field in coming years.

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