Medical Diver: What is a Medical Diver?

Prologue

I

retired from the U.S. Navy after 28 years of active duty and reserves. I was a medical diver for 24 of those years. Many, many times whenever I told people I was a medical diver in the U.S. Navy, they would ask, What is a medical diver? They would try to imagine what medicine is practiced under water. (We practice medicine under pressure in a recompression chamber, not underwater.) One of the reasons I wrote this book was to answer that question. My adventures working as an Independent Medical Diver (DMT/IDC) and as a tactical medic for over three decades is another motivation for writing this book. A Diving Medical Technician (DMT) is basically a mix between a commercial diver, paramedic, and a physician's assistant in the pre-hospital setting. The long of it is an Independent Duty Medical Deep Sea Diving Technician.

All divers and sailors have plenty of stories, and these are mine. Medical divers are a rare breed; at any given time (40 years ago) there were maybe 165 in the U.S. Navy. There are even fewer advanced DMTs—about 65 to 70, who are titled the Medical Deep Sea Diving Independent Duty Hospital Corpsman in the Navy. Today (2020 according to the Navy's DMT Community Manager special assistant, HMC Scott Schleisman) there are about 97 DMTs and 90 IDC DMTs. My path to becoming a medical diver began with my first four-year hitch in the Navy as a tactical medic (FMF) and surgical technician. During that time, I also became an EMT, CPR, and first instructor, as well as both diving (PADI) and parachute certified (USPA). DMTs are part of whatever team they are assigned to by the needs of the Navy and sometimes, by choice and are the largest rating in the Navy.

For me, DMT School was just over seven months in Panama City, Florida. After graduation, many of us got a large reenlistment bonus: out of the five of us who did, I was the only one who went to jail.

Naval Dive and Salvage Training Center June 1981 still under construction. FAT (free ascent tower) in the background.

Corpsman, in general, perform duties as assistants in the prevention and treatment of disease and injury and assist health care professionals in providing medical care to Navy and Marine Corps personnel of the operational forces, shore activities, and other authorized beneficiaries. Corpsman function as clinical or specialty technicians, administrative personnel, and health care providers at treatment facilities. They serve as battlefield tactical corpsmen with the Marine Corps and Naval Construction Forces rendering emergency treatment to include initial treatment in a tactical combat environment. Qualified hospital corpsmen may be trained for assignment to the Fleet Marine Forces, Special Forces and Operations, Fleet Hospitals, and at isolated duty stations around the world where no medical officer is available. Satellite phones can link you to a physician supervisor for advice when necessary. DMTs are also assigned to the U.S. Navy's SEAL Teams and the Navy's bomb squads (Explosive Ordnance Disposal Teams), and Underwater Construction Teams.

The Hospital Corpsman Manual and the Manual of the Medical Department are the bibles for Hospital Corpsman, and the U.S. Navy Diving Manual is the bible for divers. The current dive manual, DV Man, has become a standard reference and guideline for most aspects of diving for all branches of the military as well as much of the world of diving. All Navy divers are taught diving fundamentals from the DV Man. These topics include physics, physiology, diving gases, dive tables, treatment tables, dive charting and neuro exams. References from the U.S. Navy DV Man are frequently used throughout this book. Charting is writing down the dive profile in a chart that is in accordance with the appropriate dive table in the DV Man. It is noting the exact times, (descent, ascent and stop times) depth, gas used and charted to create the safest dive profile and decompression as required.

Corpsmen in the Navy have many titles and nicknames. Some are Corpsman, nurse, pecker checker, crank mechanic, and the most popular—Doc or fricking Doc— at least in my case. The U.S. Marines most often have an incredibly high regard for their corpsman, but in the diving Navy, DMTs usually need to earn their shipmates and fellow diver's respect.

Before I enlisted, I went to college off and on for a few years and also lived and worked in Colorado and the Utah oil fields, banging nails and working in construction supply sales. I enlisted with plans to travel; after growing up in California, I wanted to see the east coast. I got as far as Florida and the Great Lakes and that went out the window when they transferred me back to the west coast. In 2005 after 28 years in the U.S. Navy, I retired as an Independent Duty Medical Deep-Sea Diver with the title of HMC/DV/IDC/PJ. These abbreviations stand for Chief Hospital Corpsman, diver, Independent duty corpsman, and parachute Jumper. (See ref. A and B to see what it takes for selection to dive school).

The concept of emergency medical support from a medical diver and a recompression chamber should be considered for any diving job from five feet of water to 1000 feet of water. An emergency recompression chamber, as well as a secondary chamber, is an investment in the wellbeing of the dive team members. The value of having and training an emergency chamber team is immeasurable, especially in an austere environment with limited resources. The very nature of and the inherent potential for life-threatening barotrauma is a constant threat.

Novelist Tom Clancy paraphrased writings from Chicken Soup for the Soul: Stop to consider, if you will, healthcare professionals: doctors, nurses, technicians, and corpsmen. They are bright, sharp, dedicated, and so fiercely competitive as to make an NFL coach look mellow. Their professional enemy is Death himself, and they fight their nasty little wars on many fronts, each of which focuses on the body of a human being. We award medals and honors to professional soldiers who risk their lives in battle, typically in a brief span of hours. Healthcare professionals— doctors, nurses, and corpsmen—put their very souls at risk. They do it every day. Do you wonder then who are the most courageous people in the world?

Tom Clancy (RIP, April 12, 1947 – October 1, 2013) based the above comment on his observations of care delivered to one of his friends. As a speaker at a conference, this was his way of saying thank you. I loved his comments and wanted to repost them as a credit to him, his friend, and all medical personnel, especially corpsman. I dedicated this book to my wife Jan and son Matt who have both supported my Navy career and tolerated my absences. Thank you for being independent and strong.

I would like to acknowledge and express my sincere appreciation to Ted Johnston from Pineville Avenue in Cupertino, California and to his wife Barbara and daughters Katherine, Susy and Julie. In the late 1960's Mr. Johnston walked up the street one day while I was walking down the sidewalk and told me he was in the Navy and was a diver. He handed me his snorkel, fins, dive mask and a spear gun in a tough fabric case and said he did not plan on using them anymore and encouraged me to get in the water. Thank you, Mr. Johnston, you influenced me in a great way.

I must also thank my medical and diving shipmates throughout my career as well as all veteran's past, present and future from the USA and many other countries. Hoo Yah to you all.

U.S. Navy Dive Medical Technician Uniform pin.

Transportable Recompression Chamber (mated TRCS)

CHAPTER 1

Diving Medical Technicians

A

fter seven months of DMT training, I found myself and four other fellow graduates in Pensacola, Florida for the weekend. Five DMTs re-enlisted after completing the course requirements and attained the DMT status, and we were all eligible for a $16,000.00 sign-on bonus. After taxes, we had $12,000.00 or more each, totaling some $60,000.00 plus to party with, in Pensacola. The plan was to celebrate for the weekend before we all went to our new assigned dive commands. I was the only one who ended up in jail that weekend. I spent another eight days waiting to see a judge and pay my $25.00 fine before I could leave town. Some thirty years later that night came to haunt me when I applied for a nursing license.

After Hospital Corpsman School, working as a corpsman with the Marines, and later as a surgical assistant, I thought I had a good background in anatomy, chemistry, physics, and physiology. After attending the dive school phases of scuba, surface supplied hard-hat diving, mixed gas diving, and finally, DMT training, the differential diagnosis of dive medicine, I kept learning more and more. It begged the question why they don’t teach everybody (i.e., all divers) the advanced diving medicine. In the scuba phase we learned the basic dive medicine and physiology. When I learned the dive medicine in the surface supplied air diving phase, I thought that this level of medical knowledge should be taught in the scuba phase as well. Understanding diving medicine to me was critical, and I took it to heart because it was a very important aspect that all divers should know. I felt the same way with the dive medicine in the mixed gas phase of dive medicine and then again with the differential diagnosis of diving medicine. The bottom line was that after learning and understanding the physics, physiology, the pathophysiology of diving medicine, and the differential diagnosis of diving medicine, all divers would ultimately benefit and become better divers if armed with advanced dive medicine understanding. The epiphany was this: it is the DMTs destiny to help teach diving medicine to their assigned teams while working as divers. All corpsmen become instructors to their teammates, and DMTs are expected to ensure that all divers they work with understand the importance of diving physics and dive medicine. A thorough understanding of advanced dive medicine helps prevent diving diseases.

Bubble push-ups by Mike Preston on the pool deck. Andy Zimbeck is the first tender with Steve Wakefield the second tender. Army diver Fish (R.I.P.) by the door and pool ladder.

Hyperbaric Oxygen Therapy, also known as HBOT, is used extensively in the military and even more so in the civilian world. The Israelis and Americans are doing some excellent work in HBOT these days, while HBOT has also been used successfully to treat traumatic brain injury in war veterans. (Though HBOT was not utilized in Iraq and Afghanistan, we now know it could have helped many, many traumatic brain injuries (TBI) and post-traumatic stress syndrome (PTSD) patients.) It is now being used across the U.S. for TBI and PTSD though not as extensibly as it should be. Many doctors have and still refuse to recognize the benefits of HBOT. Oxygen is a drug Navy divers call green gas, and green gas is a good gas; use it when you have it. That is a mouthful, so later I will break these down separately and also explain angiogenesis. (See references C and D.)

Going through seven months of DMT training and seeing half of your classmates drop out or fail for medical, physical, or academic reasons increases your bond with those who complete the course with you. You had to get it right (exams and practical's) or go home, simple as that. It has been 40 years now, and today I still stay in touch with several of my classmates. Most will confirm my stories or tell them in a different way; some will completely deny them as sea stories or possibly call me a liar.

I remember telling about a high school skiing trip story to Truckee, California at Steve Spangles place in Anton, Arizona. Steve organized many baseball pre-season games and an annual cactus league high school reunion for buddies. It is hilarious how people remember and tell a different version of the story about fighting pissed off boyfriends and tearing up hotel rooms in Truckee, California. Long story short: her boyfriend came looking for her coat and he started fighting anybody and everybody a second time. We destroyed the place and to this day we all have re-told the six different versions of that story. The second version of the night starts off with No, no, no that's now how it went down.

All divers need to practice preventive medicine, that is, safe diving practices, to minimize and/or prevent diving injuries. All Dive Medical Technicians (DMTs) teach and reteach diving physics and physiology to their fellow divers. To most divers, diving itself is a vehicle that takes you into the denizens and realm of King Neptune on a variety of missions to perform the task at hand (it is the same with parachuting). The same rules go for freshwater diving and altitude diving with adjusted decompression stops, as necessary. The rules apply to all military divers, ships husbandry divers, Seals, Explosive Ordnance Disposal (EOD) divers, recon divers, commercial divers, recreational divers, Underwater Construction Team Divers, and pilots in the military.

Another part of the role of an Independent Duty Corpsman Diver is to be someone who constantly prepares for shipping, driving, or flying diving systems/gear, recompression chambers, and the entire life support systems (global logistic specialists). As a mobile unit, responsibilities would also entail mixing and homogenizing gases, analyzing gas percentages, medical kits, shipping banks of air, oxygen, and mixed gas banks, transportable recompression chambers systems (TRCS), medical and clinical gear including narcotics, antibiotics, and complete pharmacy, emergency room, and ACLS equipment to anywhere on the globe as well as setting up a clinic in a tent, trailer, warehouse, or honeymoon suite. (Ref E). Once on site, primary duties would be to set up and establish a clinic ready for the routine sick call or emergency room medicine if needed as well as setting up the TRCS. Though most of this type of medicine is pre-hospital trauma support, some is advanced Pre-Hospital Trauma Life Support (PHTLS). Once the operation is over, all gear is packaged back up and either moved to a new location or returned to the previous one in order to get ready for the next trip. Six- to ten-month deployments were common whether on a salvage tug, in the desert, the mountains, or on the Arctic ice. (Ref. H)

IDC/DMTs are trained to do extensive neurological exams often better than a general MD. Training also includes palatine blocks for dental work (into the roof of your mouth), setting bones, minor surgery, suturing, inserting chest tubes, bladder taps, using myringotomy knives, doing needle decompression for tension pneumothorax, crycoidotomies (cutting a breathing hole in below the Adams apple), and inserting endotracheal tubes— plus conscious sedation, running sick call clinics 24/7, healing the sick, and raising the dead. We also treat more than an average number of hangovers, especially overseas.

DMTs also maintain life support systems alongside other divers on the team (literally using NASA quality controls in oxygen clean rooms), diving systems, construction gear, compressors, generators, water heater/pumps, hydraulic tool systems, vehicles, boats, and all equipment to get the job done. We would do NASA quality maintenance to our recompression chambers and diving gear as well. Take care of your gear and your gear will take care or you.

CHAPTER 2

Corps School, Field Medical School, and Surgical Tech Training

I

n my day, corpsman typically enlisted in the Navy went to boot camp (eight weeks of basic training), Hospital Corpsman School (ten weeks), and Field Medical Service School (FMSS, five weeks), which is combat tactical medicine/the Mash Unit grunt training. Many Corpsmen go directly to FMSS training from boot camp and then onto other assignments.

Field Medical Service School, a five-week tactical medicine training at Camp Pendleton, California. As we marched to the Barber Shop (our first stop). I sang the cadence bip bop, biddly bop, were going to the barber shop, your left, your left, your military left.

The first two schools are basic/generic schools that many corpsmen get, and then a newly trained corpsman is assigned per the good old needs of the Navy. When you near completion of most Navy schools, they ask you to fill out a duty preference card, or a dream sheet, as we called it. The dream sheet is where we would request duty preference assignment and locations. It could even be another school, duty with the U.S. Marines, a hospital, or the geographic location of a clinic. Getting your new orders is typically where the naval adventure begins, with the entire globe as the stage. It isn’t just a job…it's an adventure.

My initial training was eight weeks of Navy boot camp in Florida April 1977, ten weeks of Hospital Corpsman (medic) School at the Great Lakes Naval Training Center Aug 1977, Illinois, then five weeks of Field Service Support School as a Fleet Medical Services School as a combat medic with the U.S. Marine Corps at Camp Pendleton, California. After these three schools, I got permanent change status orders (PCS). Three schools in 25 weeks, and then I was assigned to C Co. We called our unit Charlie Company —Band-Aids, Bean, and Bullets.

Two fine upstanding Corpsman (Dean Hughes and Tim) bored out of our minds with us at Charlie Company First Force Support Group Medical Battalion 13 Area Camp Pendleton, California.

After Corps School I was assigned with the USMC to the First Force Service Support Group, First Medical Battalion, Charlie Company, Camp Pendleton, California FFSG, 1st Med Bat, C Co.) The U.S. Army now calls an FSH a forward surgical hospital and a CSH a