in-water ebs trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/in-water-ebs-trainin… ·...
TRANSCRIPT
![Page 1: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/1.jpg)
![Page 2: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/2.jpg)
In-water EBS Training – The Medical Assessment
Graham FurnaceOil & Gas UK
![Page 3: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/3.jpg)
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)
![Page 4: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/4.jpg)
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?…..
![Page 5: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/5.jpg)
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)’
![Page 6: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/6.jpg)
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
![Page 7: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/7.jpg)
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
![Page 8: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/8.jpg)
![Page 9: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/9.jpg)
![Page 10: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/10.jpg)
![Page 11: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/11.jpg)
Absolute Contraindications
PMH of Spontaneous Pneumothorax (unless
pleurectomy – need advice)
Cystic Fibrosis
![Page 12: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/12.jpg)
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’
![Page 13: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/13.jpg)
BTS/SIGN 2014
![Page 14: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/14.jpg)
BTS/SIGN September 2016
![Page 15: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/15.jpg)
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
![Page 16: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/16.jpg)
NICE says:
![Page 17: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/17.jpg)
![Page 18: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/18.jpg)
NICE says:
![Page 19: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/19.jpg)
MRC Breathlessness scale
![Page 20: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/20.jpg)
COPD or Asthma?
![Page 21: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/21.jpg)
COPD severity
![Page 22: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/22.jpg)
ENT
Advised to avoid immersion/diving?
![Page 23: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/23.jpg)
![Page 24: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/24.jpg)
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
![Page 25: In-water EBS Trainingoilandgasuk.co.uk/wp-content/uploads/2017/01/In-water-EBS-Trainin… · BTS/SIGN September 2016. COPD No single diagnostic test for COPD –history, examination,](https://reader035.vdocuments.mx/reader035/viewer/2022071216/604809a23f7fb8245a011119/html5/thumbnails/25.jpg)
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)