ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

and we often split that into two six-monthjobs so we can accommodate two peoplein a year. At Prince of Wales, they rotateanaesthetic registrars through theirunit and in Townsville, which is aboutto apply for accreditation, they have sixmonth positions. At the moment they’remostly emergency medicine trainees goingthrough Townsville, but they can certainlyaccommodate anaesthetic trainees ifthere are any interested. Fremantle has aflexible arrangement for registrars to rotatethrough the unit. Royal Adelaide Hospitalis planning to apply for accreditation inthe near future, so there are a reasonablenumber of jobs around the country.Are there any problems in fulfillingtraining requirements?MW: The main issue is getting the 18months full-time equivalent. It’s fairly easyto get six months full-time experience inany of the units, but most people woulddo the other 12 months part-time so it willobviously take more than twelve monthsto complete. For example, David Cooperhere has been doing his extra twelvemonths over a five-year period by workingone day a week.IM: I suppose another area is getting asmuch exposure to patients with differentconditions for treatment. For example,intubated and ventilated patients are a rarecommodity in this unit but it’s somethingthat trainees need to get experience inmanaging. Unfortunately I haven’t had todeal with an intubated ventilated patientyet and apparently we only get about two tothree a year in this facility. The number ofinjured divers seems to be reducing as well.At the recent South Pacific UnderwaterMedical Society meeting, a number ofdelegates presented their data and thegeneral trend over the last few years isthat there are fewer divers presenting withdecompression sickness.MW: Which is good because it meansour diver education programme is gettingthrough to them.DC: But we’re doing ourselves outof a job in the process.MW: Although that’s not all we do.Diving medicine is a very small amountof our work. The bulk of our work ishyperbaric medicine and that’sactually increasing.What types of patients are treatedin the hyperbaric chamber?MW: Aside from diving injuries, ourpatients are predominantly those withproblem wounds. The largest patientgroup we treat at the moment would bepatients who have had radiotherapy andhave developed a radiation tissue injuryas a result, ranging from skin ulcerationthrough to radiation proctitis or cystitis.The next largest group would be diabeticswith foot or lower limb ulceration, and inthese two conditions we have considerablelevel one experimental evidence indicatingthat hyperbaric medicine is efficacious.Aside from that we do treat otherconditions including acute necrotisinginfections, cerebral arterial gas embolism,carbon monoxide poisoning, compromisedflaps and grafts amongst other rarerconditions. We don’t treat any conditionsfor which there is no evidence that thereare benefits, so things like multiplesclerosis and cerebral palsy which aretreated a great deal in the USA and partsof the UK we would not treat here becausethere’s no evidence of efficacy. We are quitestrongly evidence based in the way wecarry out our practice which is necessary tomaintain credibility and status within themedical community.Diving and hyperbaric medicine as aspecialty does seem quite different fromanaesthesia. Can you describe the areasof similarity and comment on the areasof difference?DC: The areas of similarity are notnecessarily few and far between. Theyarise predominantly in the necessity for thepractitioner to have a sound understandingof the behaviour of gases and vapoursunder various environmental conditions.There is no other specialty group whichhas the same fundamental understandingof physics and physiology which arenecessary to the practice of diving andhyperbaric medicine other thanthe anaesthetist.Above from left: Dr Ian Maddox,Dr Margaret Walker and Dr David Cooper;The Royal Hobart multiplace chamber.The ANZCA Bulletin June 2009 37