CONCEPT

We had been tracking the progress of COVID 19 since November 2019, and discussed our options to do something practical in response.  This project really kicked off on the 2nd April 2020 with a conversation between two members of AMDP who are former Diver Medical Technicians. 

We decided to find ways to support our health service using professional divers. Our thinking was:

• There was a capability crisis within UK NHS Intensive Care Units (ICU)
• Diver Medical Technicians (DMTs) are ideally suited to fill the gap (more on DMTs below)
• We have access to the professional diving community
• Any assistance must be on a not-for-profit basis

DEVELOPMENT

We briefed the AMDP team and asked Dr Michael von Bertele CB, OBE, FRS, former Director General of Army Medical Services, to provide Medical Direction.  We also asked Ian Hughes of https://www.trauma-training.org/ to provide medical training and specialist ICU advice and support.  We also asked Sarah Hutcheons of www.dive-source.com to liase with the Scottish hospitals.  As a matter of courtesy we informed the International Marine Contractors Association https://www.imca-int.com/ and the Offshore Diving Industry Agreement team http://www.odia.org.uk/ of our intentions.  In each case we recieved a warm note of acknowledgement and acceptance.   

We collectively started to draw on our knowledge and professional networks within the medical and professional diving sectors to offer assistance to the UK National Health Service.  

Within three days we had a working (and constantly evolving) concept of operations, the team had prepared processes for registration, mobilisation, induction and exit from the NHS system and incredibly we had registered a willing team of over 350 Diver Medical Technicians volunteering to help in the COVID19 fight, this rose to over 500.  

PILOT

At Day four we were asked to conduct a pilot project at a leading NHS training hospital in London.  Within 18 hours of the request we had a team of DMTs at the hospital, they were inducted into the NHS Trust bank, were trained by Ian and ICU Nurse Tutors in some specific ICU procedures and then went into the operational phase with a coordinator outside the ICU and Ian Hughes inside providing ICU mentoring. The competence of the divers exceded expectation, typical tasks undertaken (under supervision) included for example:

• Donning and doffing of Personal Protective Equipment (PPE) in accordance with WHO guidelines.
• Management of life support equipment on unconscious, patients who require assisted breathing.
• Mechanical aspiration to clear airways and above the cuff suction. Flushing of equipment on completion.
• Cuff pressure checks on endotracheal tubes with syringe adjustments.
• Blood sampling including arterial bloods.
• Fluid intake and urinary output checks.
• Patient oral and facial hygiene.
• Gathering of accurate medical history of physical signs (BT, BP, HR, RR) as well as tidal flows and volumes, and managing observation chart entries.
• Turning and controlling unconscious, paralysed and intubated patients.
• Patient physiotherapy under direction.
• General patient evaluations.
• Support to critical care nurses as required.

At the hospitals request we doubled the number of DMTs and they remained in place until the 30th April 2020.  At a national level we were asked to prepare larger teams for potential deployment into a number of locations coordinated through a national team at Health Education England https://www.hee.nhs.uk/.

CLOSURE

At day 28 on the 1st May 2020, we made a very difficult and heartfelt decision to cancel the project.  This decision was based on Diving Medical Advisory Committee (DMAC) http://www.dmac-diving.org/ supplied clinical findings suggesting there was an important change in the risk profile linked to commercial diver lung function.  We assessed that:

• The surge in viral infection had reduced
• NHS ICU demand was in control
• The risk to divers had potentially increased
• It was time to call a halt to this unique project and consider the learning and decide what direction to take next

OUTCOME

DMTs saved lives, provided unexpected levels of skills and knowledge, brought an amazing attitude to a challenging situation and raised the morale of exhausted and stressed ICU medical professionals. We were able to:

• Complete a competency gap analysis and develop task cards
• Set up NHS employment banding and clinical competencies
• Further develop the entire operational work flow
• Provide experiential learning for both the NHS staff and the DMTs
• Provide a continuous flow of DMTs into the ICU operating rota
• Coordinate the welfare needs of the DMTs during and after deployment

The project proved an important concept, in times of crisis it is possible to deploy external resources into technical medical functions if there is a creative, open minded leadership and a willing, inteligent resource pool.  The project has been assessed to be extremely successful.

LEGACY

Michael von Bertele explaines that the evaluation of the project, and the lessons learned, will be shared with a team that is being set up in NHS England to develop the concept of recruiting a ‘Reserve’ of people with appropriate skills and experience to be trained so that they can move seamlessly into position to reinforce critical care units locally should it be required. They are also considering how to recruit and train people from outside of the NHS to provide the same function in the Nightingale hospitals should they be needed. 

He compares it to the Territorial Army.  “This crisis has shown us that the NHS cannot always be expected to scale up immediately to deal with every emergency, while continuing to deliver excellent healthcare to the whole population.  We are exploring whether there is a greater need to formalise the roles of volunteers, including those with specialist and technical skills, so that they can receive enough of the training that would enable them to step in at very short notice to bolster local capacity, whenever it might be needed. 

“We will continue to identify other occupational groups who possess some of the skills and competencies that would make them suitable for employment in this challenging environment.”

We are all delighted and very proud to have started this invaluable ball rolling.  The final word must go the divers who stepped up to be counted and of course to the NHS, thank you.

Professional Divers and Life Support Technicians

Professional divers and Life Support Technicians (LSTs) are used to working in extreme conditions, remote from others and reliant on themselves and their small teams to achieve complex tasks with limited resources. Many have engineering, construction, medical and military backgrounds and share some general traits for example:

• They share a 'can do' attitude.
• They are practical people and technically competent across may subjects including hyperbaric life support.
• They work equally well alone, or in teams in unusual locations and situations.
• Their work is in hazardous environments wearing cumbersome PPE.
• Their work is physically demanding and mentally draining for long periods.

Diver Medical Technicians 

These are professional divers and LSTs who have extra capabilities and are responsible for managing divers during illness or when injured.  This is always in remote locations generally without any other medical assistance and often inside decompression chambers where they are locked into a confined space for weeks breathing mixed gasses.  Diver medical competences include the understanding of:

• Life support functions and equipment and how to operate and monitor it. 
• Airway management, intubation and non-invasive breathing apparatus management.
• Respiratory conditions and mixed gas / oxygen therapies.
• Drug and fluid administration.
• Decontamination and cross infection.
• How to maintain hygienic conditions for continued life support.