Ponencia presentada en el


Lille, Francia, Septiembre de 1994


Jordi Desola, M.D.,Ph.D.

CRIS - Hyperbaric Therapy Unit - The Red Cross Hospital - Barcelona

Diving Medicine has an old tradition in Spain. C.R.I.S., the oldest Diving Centre, was founded in Barcelona in 1954. The Diving Centre of the Spanish Army (CBA) was instituted in 1957. An Spanish doctor from C.R.I.S. was in 1960 the first chairman of the recently founded C.M.A.S.. The CRIS built in 1964 the first civilian hyperbaric chamber of Spain.

Hyperbaric Medicine was initiated near to the diving centres. The first hyperbaric chamber, built just for treatment of non diving related diseases, was developed in Cartagena in 1972. Up to the present moment 10 diving and/or hyperbaric centres are operative in Spain, all linked in a central Coordinating Committee (CCCMH) which is one of the co-founders of our current European Committee for Hyperbaric Medicine.

The CBA, in Cartagena, was performing courses for "Treatment of diving accidents" since 1971, to which medical doctors, nurses, and diving instructors were allowed. The Instituto Politécnico Marítimo-Pesquero del Mediterráneo (Mediterranean Nautic and Fishing Polytechnic Institute) of Alicante, started in 1979 a course of Diving Medicine, which was performed annually until 1990. Later on, the Medical Organization of Alicante has organized three courses of Diving Medicine within a wide programm of continuos education for general practitioners. The CRIS initiated in 1980 courses of Underwater Medicine, and a course of Hyperbaric Medicine in 1982; both were continued annually until 1989, when CRIS-UTH continued this task. No one of these above courses had University level and no degree was obtained other than an "Assistance certificate".

The University of Barcelona performs from 1989 courses of Underwater Medicine, First Aid in the underwater environment, and Hyperbaric Medicine, organized by CRIS-Hyperbaric Therapy Unit (CRIS-UTH) giving a POSTGRADUATE DIPLOMA (16 credits, 160 hours). To obtain this degree candidates need to follow three intensive courses, succeed an exam consisting on a multiple choice test, perform a practice stage in a recognized hyperbaric centre, and elaborate a final Memory-Project about a topic related to diving or hyperbaric Medicine. This is the only high degree on Hyperbaric Medicine existing in Spain in the moment of presenting this paper. Their main caracteristics appear more detailed be low.

A 130 hours course on Diving Medicine was held in 1990 by the University of Alicante. One lecture on Hyperbaric Medicine was included. Candidates needed to succeed an exam. This course has no longer be repeated.

A new course on Diving Medicine is announced for the end of 1994 by the University of Santiago de Compostela.

Nurses are accepted in all these courses, but no specific educational program exists for them in Spain. Hyperbaric centres used to educate nurses according their own practice and experience.

Diving activities are controlled in Spain by the Secretaría General de Pesca (General Secretary of Fishing), which is competent over all professional diving activities and also over the majority of recreational and sport ones. (From 1997 it was transferred to the Dirección General de la Marina Mercante)

This institution recognizes the title for professional divers called "Specialty on Facilities and Systems of Diving". This title may be obtained by divers that follow an intensive course which trains them to operate hyperbaric chambers in diving centres. A recently created new title of "Chamber Operator" will qualify students, with no pre-requisite, to operate hyperbaric chambers used for treating dysbaric disorders in diving centres. These two courses are done in recognized Schools of Professional Diving.

There is no regulation in Spain that requires or defines the education and functions of chamber operators in hospital hyperbaric facilities not in relation to diving.

Physiological Sciences and Nutrition Department
Human Physiology Unit
Faculty of Medicine


ORGANIZATION : CRIS - Hyperbaric Therapy Unit

DIRECTORS : Prof. Dr. Ramon Segura and Dr. Jordi Desola

The complete Postgraduate Diploma consists in five separate modules.

  1. Initiation Course on Underwater and Hyperbaric Medicine
  2. Course on First Aid in the Aquatic Environment
  3. Up-date Course on Hyperbaric Medicine
  4. Practical stage in a qualified Hyperbaric Medical Centre
  5. Memory or Research Project

CANDIDATES. Exclusively Medical Postgraduates, junior or senior medical doctors.

REQUISITES. Pre-registration. Optionally official presentation by a recognized person or institution in the field of hyperbaric or underwater medicine.

DURATION-TIMETABLE. The Diploma consists in approximately 160 accumulated hours that will provide 16 educational credits. The three courses (modules 1-3) are usually held in intensive basis in order to make easy the attendance of students from other parts of Spain or from other countries. The practical stage (module 4) can be done in any hyperbaric medical centre recognized by the CCCMH (the spanish COORDINATING COMMITTEE OF HYPERBARIC MEDICAL CENTRES). More detailed information of any module is included below.

OBJECTIVES. The diploma is oriented to three principal goals :

PROCEDURE TO OBTAIN THE DIPLOMA. Students need to complete the three basic courses in specified dates. Attendance to the 90 % of lectures is mandatory and they must afterward succeed an exam.

Separately they must realize a practical stage in the hyperbaric centre of their choice, which will extend a certificate. Before the closing date of the current academic course, they must write and present the memory.

QUALIFICATION. EXAMINATION. Students can be examined in three calls. The first one immediately after completion of the third module. The second three months later, at the end of the summer. The third, and the last one, in the last week of the next february. A multiple choice questionnaire and problems of decompression calculation, must be individually succeeded for any of the three first modules. The Memory-Project is qualified by the director of the course. Having done the practical period is a requisite sine-qua-non to apply to the final qualification, which is obtained by the accumulation or the four notes according to this percentage : Underwater Medicine 40%, Fist Aid in aquatic environment 10%, Hyperbaric Medicine 30%, Memory-Project 20 %.


It is usually held, as intensive form, in the Faculty of Medicine or in other associated house. Seven parts can be differentiated.

  1. Fundamentals. Physiology. Cosmobiology, physiology of exercise, thermal regulation, respiratory physiology.
  2. Environmental and underwater physics and physiology. Comparative biology, underwater biophysics and biochemistry, underwater biomechanics, fundamentals of diving technology, decompression theory.
  3. Non dysbaric underwater disorders. Coincidental pathology, aquatic traumathology, marine animals lesions, thermal problems.
  4. Dysbaric disorders. Barotraumatic disorders of ENT, digestive, thoracic and respiratory systems, decompression sickness, dysbaric osteonecrosis, toxic effect of underwater gases, narcosis and HPNS, other decompression illness.
  5. Treatment. Primary assistance to an injured diver, transport modalities, normobaric or under pressure, drugs, recompression, hospital assistance of a seriously injured diver, treatment and surveillance of long-term effect, rehabilitation of permanent deficits.
  6. Decompression calculation. Practical exercises.
  7. Practical exercises in the hyperbaric chamber. Introduction to chamber technology and recompression procedures. These exercises are done during the days of the course and are independent of the practical stage that students will realize in other hyperbaric centre.

It is a tehoric-practic course held in the diving school of the C.R.I.S. (Underwater Research and Recovering Centre) in Barcelona. It consists of nine separate parts.

  1. Pathophysiology of water related disorders. Drowning, near drowning, hypothermia.
  2. Basic First Aid theory.
  3. Primary Cardio Pulmonary Reanimation.
  4. Basic and primary assistance to an accidented diver.
  5. Instrumental CPR.
  6. Hospital treatment and surveillance of water related disorders.
  7. Practical exercises of CPR. Ground CPR, principals of rescue, CPR on different scenarios (in water, small boat, ground manned transport, ambulance).
  8. Instrumental reanimation exercises. Ambu, portable mechanical ventilation, portable aspirators.
  9. Oxygen administration to divers. Open or closed circuit systems of high or low oxygen flow, fundamentals of denitrogenation.

The 11 parts of this course cover the fundamentals of Hyperbaric Oxygen Therapy and all physiopathological and therapeutical aspects of diseases than can be treated with HBO.

  1. Fundamentals of oxygen therapy.
  2. Fundamentals of hyperbaric oxygenation.
  3. Hyperbaric technology.
  4. Contraindications, side and toxic effects,
  5. Hospital technics in hyperbaric environment. Mechanical ventilation, fluid venous perfusion, transcutaneous oximetry, blood samples and others.
  6. Classification of diseases. Therapeutical groups.
  7. Group I. Diseases in which HBO should be applied. Dysbaric illness, gas embolism, carbon monoxide poisoning, clostridial mionecrosis.
  8. Group II. Diseases in which HBO has a complementary effect. Chronical refractory osteomielytis, radionecrosis of bone and soft tissue, crush and compartmental sindrome, non clostridial necrotizing soft-tissue infections, wound healing disorders, compromised grafts, limb reimplantation.
  9. Group III. Experimental indications of HBO. Central retinal artery occlusion, frostbite, multiple sclerosis, sudden deafness.
  10. Exercises of decompression calculation.
  11. Practical exercises in the chamber. Introduction to hyperbaric oxygenation and associated apparatus and technics. These exercises are done during the days of the courses and are independent of the practical stage that students will realize in other hyperbaric centre.

This practical stage will be realized after completion of the three former modules. Students can do the stage in the Hyperbaric Therapy Unit of the CRIS or in one of the other 8 hyperbaric centres recognized by the CCCMH, that means following the same procedure of practical exercise at any centre. This will include the following aspects that will be organized in each centre according to their characteristics.

  1. Exercises of recompression and decompression. Students must accurately operate the chamber.
  2. Calculation of decompression schedules in real situations. Review of decompression procedures for attendants.
  3. Hyperbaric oxygen therapy in the chamber with real patients.
  4. Use of medical instruments within the hyperbaric chamber. Mechanical ventilation, transcutaneous oximetry, fluid venous perfusion.
  5. Study and review of the medical protocols of the centre

At the end of this practical stage, the chairman of the hyperbaric centre will extend a certification that students must present in the moment of closing their expedient.


Student can select the topic of their work, but it needs to be accepted previously by the director of the course. The work must be original and inedit. Suggested topics are the following.

  1. Experimental works on physiological aspects of underwater adaptation, biophysical of biochemical variations, or other underwater related matters, realized with sport or professional divers.
  2. Review of series of patients that had suffered from dysbaric illness from different diving centres.
  3. Design of prospective clinical studies on hyperbaric oxygenation.
  4. Retrospective review of groups of patients, or groups of diseases, having been treated with hyperbaric oxygenation.
  5. Comparative reviews of groups of patients, or groups of diseases that should had been treated with HBO, but that they had been treated with conventional therapeutics that did not include HBO.
  6. Deep and relevant theoretic reviews, with wide bibliographic support, on general topics in relation to HBO.


From 1989 to 1984, 106 students have been registered, what means an average of 26,5 students per year.

The 14 % proceeded from the geographical zone of Barcelona and surroundings. The 75 % from other parts of spain. The rest came from foreign countries, 8 % from south-america and 3 % from other european ones.

The 72 % of the registered students did satisfactorily accomplish the five modules that integrates the whole Diploma.

From those that completed the five modules the 86 % succeeded the exams and they finally obtained the DIPLOMA OF UNDERWATER AND HYPERBARIC MEDICINE OF THE UNIVERSITY OF BARCELONA.

Jordi Desola, M.D.,Ph.D.
Barcelona, June of 1994
Lille, France, 19-21 september 1994

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