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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)