Manipal Emergency Medicine’s Residency Trained MCI Recognized Emergency Medicine Specialist and EMA Leader Dr. Freston Marc Sirur led an expedition as an Emergency Physician to Sulu Sea in the Philippines. Wellness and Hyperbaric Emergency Medicine was the perfect section for this fantastic experience…..
This is his Story:
“SCUBA diving is synonymous with awe, adventure and fear. Perhaps like the deep blue sea and its unknown and mysterious depths. With over 6 million divers worldwide and 20 million snorkelers. Diving can be dangerous but for the most part is relatively safe for the well-trained individual with the exception of cave diving and deep-sea exploration. However, the untrained and unhabituated individual remains at significant risk for a dive related medical emergency.
On the 7th of June 2018 a small group of divers aged between 17 and 63 met aboard the Stella Maris explorer, a live aboard vessel in the Philippines. Philippines is an archipelago of 7000 islands, a part of the pacific ring of fire.They embarked on a journey to the Tubbataha reef national marine park situated in the middle of the Sulu sea. One of the remotest locations in the Philippines approximately 160 kilometers south of Puerto Princessa, the capital of Palawan. It is also the country’s largest coral reef covering 33,200 hectares and consisting of two atolls that rise up from very deep water to form two shallow lagoons and a number of islets. They are surrounded by some of the most spectacular sea life to be found in south east Asia, ranging from the tiniest corals to the biggest sharks and even whales.The reef was declared a national marine park in 1988 and a world heritage site in 1993. Philippines is an archipelago of 7000 islands, a part of the pacific ring of fire. It is exposed to the southwest monsoons from June to October and north east monsoons from November to February.
Pacific ring of fire
The expedition included 17 dives that were spread out over 7 days at various locations in the Sulu sea, stormy weather limited the diving at Tubbataha, with the captain having to make emergency evacuation from Tubbataha due to the storms and large swells. Weather patterns changed in minutes with launch boats and divers having to wait out or ride out of swells before boarding the main vessel again. The dives however remained calm close to the reefs with strong under currents only away from the atolls. Pelagic fish like manta rays, barracuda, sharks and trevally were around the reefs. The reefs biodiversity was amazing in its vibrant colors, peculiar creatures like the cup, table and staghorn corals. Numerous crustaceans like the popcorn and crinoid shrimp or the coral crab. damsel fish, darter fish, angel and pipe fish. Venomous marine creatures such as scorpion fish, lion fish, coral catfish, sea urchins, wasp fish, helmut gurnard, jelly fish, sting rays and puffer fish. An ecosystem with breath taking beauty beyond imagination.
I participated as a diver and medical officer for the expedition. With formal training in open water, advanced adventurer, stress and rescue training from the scuba schools international through Barracuda diving, a training center in Goa. The work of being a medical officer for such an expedition, origins from an interest and passion for Wilderness medicine- a branch of emergency medicine that includes the study of natural forces, improvisation, environmental risk factors and preparation. It covers fields such as mountain medicine, marine medicine, rescue and survival, environmental hazards and disasters. On this expedition preparation included medical histories with a focus on dive medical history, consent to treat in emergency, customized medical kit, logistics, communication and emergency evacuation, risk assessment, permissions, local medical support and advanced medical support on the mainland, as well as insurance and medical supplies available on-board.In case of an emergency the only way out of the park was a by speed boat stationed at the TubbatahaReefs National Park ranger station, a 3-4 hour journey to the mainland. The medical kit constructed covered anaphylaxis, epistaxis, trauma, resuscitation, advanced airway protection, sea sickness, acute gastroenteritis, pain management and hemodynamic monitoring equipment. A number of research questions were proposed prior to the expedition, the answers remain as dark as the depths of the sea but the ideas erupt as does the life on the reefs. As a first time Medical officer on a dive expedition the learning curve has been immense with a future vision to provide such a service with a better equipped medical kit, dive physiology monitoring equipment, dive resuscitation equipment and planning.
The recreational dive fraternity is fast growing in India and in particular, on the Konkan coastline. Its tropical waters and islands hold a fresh and beautiful experience for those who choose to go. The international dive sites holding even more lure with their marvel, beauty and biodiversity, attracting adventure sportsmen, photographers, recreational divers of various backgrounds and emergency physicians. Perhaps a Dive medical center is in the making on the Konkan coast with Hyperbaric oxygen therapy, Anti-venoms and an offshore/ waterways research and rescue vessel.
Dive suit on, oxygen on, fins clear, buddy check done, regulator secure, 1 2 3 and entry!
Join me and let’s explore the seas and develop Hyperbaric Emergency Medicine in India !
Dr.Freston Marc Sirur, MBBS, MD (MCI-Emergency Medicine) MAHE-KMC Manipal Emergency Medicine, Karnataka
Photographs: Dr.Freston Marc Sirur, Mr.Nanda Kumar-Dive Photographer
Acknowledgements: Stella Maris Explorer, Scuba centric, Barracuda Diving India, Auqalung, Tubbataha Reef National Marine Park, Department of Emergency Medicine KMC Manipal
The INDUSEM mission is to envision and implement the future of Patient Care across the world. The partnership brings together Expert Educators, Inquisitive Innovators and Physicians supporting Safe Patient Care across India, United States and the World. INDUSEM is the Top International Partnership across the World and brings together Institutions, Individuals and Initiatives focused on improving patient care globally. Till date INDUSEM has reached over 50,000 Experts and its reach continues to grow daily. For more information, visit www.indusem.org
The Emergency Medicine Association was founded in 2015 during the INDUSEM2015 World Congress of Academic Emergency Medicine in New Delhi. EMA is the Official voice of competent Emergency Experts. Working towards provision of quality emergency care The EMA is an organized Guild of Emergency Leaders in Health and Medicine. Focused on Developing, Practicing and Progressing Emergency Medicine. EMA has a strong relation with partner organizations, individuals and institutions across the world. The EMA boasts of a strong DNA with its relationships, which are geared towards potentiating growth. EMA has the support of the INDO-US Emergency and Trauma Collaborative, the Academic College of Emergency Experts in India and the Academic for Clinical Emergency Nursing in India. For More Information: www.emaindia.net
The Academic College of Emergency Experts was established by Leaders of INDUSEM to create a guild of expert clinicians who are have a mastery at providing safe patient care with high quality therapeutics based on latest evidence based medicine. The only Unique College in Asia ACEE only bestows affiliation after a rigorous coaching and testing process hereby maintaining its high standards of commitment to education and excellence. It surpasses the erstwhile ideology of existing academic colleges where affiliation is based on recommendation. There are multiple pathways to be a Fellow of the College namely Emergency Medicine, Emergency Pediatrics. Toxicology, Emergency Nursing Pathway etc. For More Information. Visit www.acee-india.org
About KMC Manipal
Kasturba Medical College (KMC) is a medical college based in Manipal, Udupi DistrictKarnataka, India.Established by Dr. T.M.A. Pai on 30 June 1953. KMC Manipal is one of the most prestigious and premier medical colleges in India. It has been ranked among the top three medical colleges in India by The Hindu and India Today, preceded only by AIIMS, New Delhiand Christian Medical College & Hospital, Vellore. KMC Manipal was ranked as the Institute of Eminence by the Government of India in 2018. Today, students from 44 countries have graduated from KMC, and the medical degree (MBBS) is recognized worldwide, including by the General Medical Council, ECFMG, Australian Medical Council and Malaysian Medical Council among several others.KMC was under the purview of the Mangalore University. In 1993, the government of India granted Deemed University status to MAHE (Manipal Academy of Higher Education), which saw KMC coming under its wing. For More Information: https://manipal.edu/kmc-manipal.html