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DIVING DOCTORS
440
production of atomic power from uranium is a crude affair with many pollution difficulties and with limited materials. Meanwhile the subsistence farmer in a developing country uses his energy resources very economically. For every calorie input he can achieve 26 calories of food: typically he may produce only 10 kg. of meat per hectare per year, but he does it without a large expenditure of energy. Labour-intensive farming is superior to mechanised agriculture from this point of view. The migration of peasants from the land into urban factories producing tractors and fertilisers costs the community much in fuel. The trend is unlikely to stop, because we cannot produce enough food for the present world population without the modem highly-productive but energy-squandering techniques. And the population will double by the end of the century. raw
DIVING DOCTORS
As offshore oil and gas exploration continues and as and their pipelines are constructed, the number of divers working in British seas will continue to grow and so too, probably, will the number of underwater accidents. More and more medical practitioners are being faced with the unfamiliar problems of underwater medicine. Most doctors see the diver only to conduct an examination for fitness to dive. While no special skill or experience is required for the physical examination, a good understanding of the underwater environment and of hazards to which the diver is exposed is essential for interpretation of the physical standards demanded. This background knowledge is just as important in assessment of the amateur diver, for whom medical standards are recommended by the British Sub Aqua Club, as in the more stringent examination of professional divers. The Offshore Installations (Diving Operations) Regulations, which have been effective since January, 1975, and which cover a large proportion of professional divers, state that the required annual medical examinations can be conducted only by practitioners who have been approved by the Department of Energy. They recommend that any doctor who wishes to be approved should attend a course in underwater medicine. The only such course available in Britain is that run by the Royal Navy-spare places on these one-week courses are offered to civilian medical practitioners. Medical support at the site of diving operations is not often needed, but it demands extensive knowledge of the physiological and medical problems of diving. The best way for the doctor to acquire this is to become qualified as a diver. After further experience and reading, he should then be able to cope in an emergency with most decompression casualties and other diving accidents. After deep-sea oxy-helium diving complex problems can arise. To deal with them the doctor must know about the effects of increased densities of helium upon thermal balance, notably on respiratory heat loss; the
production wells
high 1. See
pressure
neurological syndrome; atmosphere-
Lancet, 1974, ii, 263.
control systems; oxygen toxicity; the pathophysiology, diagnosis, and treatment of pulmonary barotrauma and cerebral arterial air embolism; and the various maniThe festations of acute decompression sickness. patient at raised environmental pressure presents special difficulties. Treatment must usually be given at depth and the subsequent decompression may be as slow as 30 m. a day. The doctor must be prepared to enter the compression chamber and he must be fit to do so. Possibly he will have to stay there for the remainder of the decompression which, in a condition such as pulmonary air-trapping, may last for days. Alternatively, the patient may need treatment not for a diving condition but for some incidental trauma or illness. Here the adverse conditions within the compression chamber and the remoteness of most such chambers from hospital and laboratory support can make standard treatment very difficult. For many years medical support for naval diving operations has been one of the tasks of the Royal Naval Medical Service. One consequence of the naval need to develop safe diving techniques has been the creation of a few full-time specialists in underwater
medicine, qualified as professional divers and with research degrees. As oil exploration continues around the coasts more civilian practitioners will be providing offshore emergency medical services. They must be properly trained, and a one-week course is clearly not enough. THE CONSULTANTS’ CONTRACT To judge from the response at B.M.A. House on Monday, the latest attempt by the Secretary of State for Social Services to unlock the door to the resumption of full-scale negotiations on the N.H.S. consultants’ contract is in for a dusty answer. In her statement to the House of Commons that day, Mrs Castle reiterated the two non-negotiable issues: the maintenance of the existing differential between whole-time and parttime consultants; and the unacceptability, in the Government’s view, of an item-of-service system of payment. The Government accepted the principle that the consultants’ present open-ended commitment should be replaced by a closed contract with additional work paid for separately. Negotiations should be resumed, Mrs Castle urged, to discuss how this could be best achieved. But (and it is a big " but " for the B.M.A. and the Hospital Consultants and Specialists Association to swallow in their state of chronic indigestion) sanctions (or " voluntary overtime ") must be lifted first. The H.C.S.A., the bookmakers say, are well backed as front runners for more militant action; and the Central Committee for Hospital Medical Services, due to meet last Thursday, hardly seems to be in the mood to recommend a return to normal working. The Secretary of State is prepared to invite the Review Body to price any new arrangements without commitment and at a later stage; or to ask them to do so within the context of the present review (to be declared in April), though that would mean some speedy decisions. The door is ever so slightly ajar: it will be another sad item in a bleak story if the B.M.A. and the H.C.S.A. slam it shut again.
production of atomic power from uranium is a crude affair with many pollution difficulties and with limited materials. Meanwhile the subsistence farmer in a developing country uses his energy resources very economically. For every calorie input he can achieve 26 calories of food: typically he may produce only 10 kg. of meat per hectare per year, but he does it without a large expenditure of energy. Labour-intensive farming is superior to mechanised agriculture from this point of view. The migration of peasants from the land into urban factories producing tractors and fertilisers costs the community much in fuel. The trend is unlikely to stop, because we cannot produce enough food for the present world population without the modem highly-productive but energy-squandering techniques. And the population will double by the end of the century. raw
DIVING DOCTORS
As offshore oil and gas exploration continues and as and their pipelines are constructed, the number of divers working in British seas will continue to grow and so too, probably, will the number of underwater accidents. More and more medical practitioners are being faced with the unfamiliar problems of underwater medicine. Most doctors see the diver only to conduct an examination for fitness to dive. While no special skill or experience is required for the physical examination, a good understanding of the underwater environment and of hazards to which the diver is exposed is essential for interpretation of the physical standards demanded. This background knowledge is just as important in assessment of the amateur diver, for whom medical standards are recommended by the British Sub Aqua Club, as in the more stringent examination of professional divers. The Offshore Installations (Diving Operations) Regulations, which have been effective since January, 1975, and which cover a large proportion of professional divers, state that the required annual medical examinations can be conducted only by practitioners who have been approved by the Department of Energy. They recommend that any doctor who wishes to be approved should attend a course in underwater medicine. The only such course available in Britain is that run by the Royal Navy-spare places on these one-week courses are offered to civilian medical practitioners. Medical support at the site of diving operations is not often needed, but it demands extensive knowledge of the physiological and medical problems of diving. The best way for the doctor to acquire this is to become qualified as a diver. After further experience and reading, he should then be able to cope in an emergency with most decompression casualties and other diving accidents. After deep-sea oxy-helium diving complex problems can arise. To deal with them the doctor must know about the effects of increased densities of helium upon thermal balance, notably on respiratory heat loss; the
production wells
high 1. See
pressure
neurological syndrome; atmosphere-
Lancet, 1974, ii, 263.
control systems; oxygen toxicity; the pathophysiology, diagnosis, and treatment of pulmonary barotrauma and cerebral arterial air embolism; and the various maniThe festations of acute decompression sickness. patient at raised environmental pressure presents special difficulties. Treatment must usually be given at depth and the subsequent decompression may be as slow as 30 m. a day. The doctor must be prepared to enter the compression chamber and he must be fit to do so. Possibly he will have to stay there for the remainder of the decompression which, in a condition such as pulmonary air-trapping, may last for days. Alternatively, the patient may need treatment not for a diving condition but for some incidental trauma or illness. Here the adverse conditions within the compression chamber and the remoteness of most such chambers from hospital and laboratory support can make standard treatment very difficult. For many years medical support for naval diving operations has been one of the tasks of the Royal Naval Medical Service. One consequence of the naval need to develop safe diving techniques has been the creation of a few full-time specialists in underwater
medicine, qualified as professional divers and with research degrees. As oil exploration continues around the coasts more civilian practitioners will be providing offshore emergency medical services. They must be properly trained, and a one-week course is clearly not enough. THE CONSULTANTS’ CONTRACT To judge from the response at B.M.A. House on Monday, the latest attempt by the Secretary of State for Social Services to unlock the door to the resumption of full-scale negotiations on the N.H.S. consultants’ contract is in for a dusty answer. In her statement to the House of Commons that day, Mrs Castle reiterated the two non-negotiable issues: the maintenance of the existing differential between whole-time and parttime consultants; and the unacceptability, in the Government’s view, of an item-of-service system of payment. The Government accepted the principle that the consultants’ present open-ended commitment should be replaced by a closed contract with additional work paid for separately. Negotiations should be resumed, Mrs Castle urged, to discuss how this could be best achieved. But (and it is a big " but " for the B.M.A. and the Hospital Consultants and Specialists Association to swallow in their state of chronic indigestion) sanctions (or " voluntary overtime ") must be lifted first. The H.C.S.A., the bookmakers say, are well backed as front runners for more militant action; and the Central Committee for Hospital Medical Services, due to meet last Thursday, hardly seems to be in the mood to recommend a return to normal working. The Secretary of State is prepared to invite the Review Body to price any new arrangements without commitment and at a later stage; or to ask them to do so within the context of the present review (to be declared in April), though that would mean some speedy decisions. The door is ever so slightly ajar: it will be another sad item in a bleak story if the B.M.A. and the H.C.S.A. slam it shut again.