In an archipelago renowned for recreational and technical scuba diving and with many other maritime and commercial activities, including fish farming and ship repair, it would be unthinkable not to have a facility which may treat recreational scuba divers and commercial divers in case things go awry.
At the end of last year, divinginfo.mt visited the local Hyperbaric Unit located within the Mater Dei Public General Hospital to get a little bit of insight about its history and day-to-day activities. At the Hyperbaric Unit, we were greeted by Dr Stephen Muscat and Dr Kurt Magri who made us feel very welcome and dedicated a couple of hours to give us a quick run-through of the history and functions of the unit.
Recent history of the Hyperbaric Unit
Dr Muscat, who for local instructors and many divers is a familiar face due to his almost four decades (37 years to be precise) of serving in the Hyperbaric unit, provided us with a veritable time travel back to the origins of the Hyperbaric Unit, starting off with the first recompression chamber at the unit, whose origin dated back to World War II!
Dr Muscat explained that the first recompression chamber used by the Hyperbaric Unit was a recompression chamber of Japanese origin that had been obtained by the British Services during or at the end of World War II. Dr Muscat recalled from his memories with a hint of nostalgy his early days in the mid-eighties tending to divers at Kalafrana (the site of today’s Malta Freeport), where the recompression chamber was housed in a dedicated building, photos of which are being reproduced below. Dr Muscat at that time served under Dr Carmelo Brincat of Qormi, a Specialist in Hyperbaric medicine.
Photos of the Hyperbaric Unit at Kalafrana. Pictures courtesy of Hyperbaric Unit staff.
Back at that time, the Freeport was still under construction and therefore the recompression chamber been in very frequent use for the Chinese and local divers that were being employed to construct the facility. It is a bit ironic if you know a bit about the relationship between Japan and China up to World War II (and lingering to this day as some say) that a Japanese chamber was used to save or treat Chinese workers.
Whilst as stated, the recompression chamber at that time had already travelled much since originated from Japan, the same recompression chamber had also travelled quite a bit on our shores too.
Dr Muscat recalled that the first time he had seen it, it was located at Fort St. Angelo (Birgu), prior to it being transferred to Kalafrana in 1979 for the Freeport project. In 1988, the recompression chamber was again moved to St. Luke’s Hospital, the former General Hospital at Guardamangia Hill, Pieta’. (It is possible as well that at Manoel Island, the British services also made use of a monoplace recompression chamber that could take in only one patient, who would be on his own during such treatment, therefore unable to be immediately assisted if needed due to other potential medical emergencies. For these reasons, sometimes this type of chamber was also nicknamed as “a coffin”)
The move of the Japanese recompression chamber to St. Luke’s, apart from being relocated to a new purpose-built building to house it, also resulted in the first hyperbaric treatment for non-diving use. Dr Muscat stated that in fact, once moved to St. Luke’s Hospital in 1988 the first recompression chamber casualty was also the first non-diving related casualty, a victim of Carbon Monoxide poisoning. Until 1994, this also was the only recompression chamber in public hospitals for treatment of divers in Malta, serving to treat up to one casualty at a time accompanied by a nurse for any eventuality.
The limitation of having only one chamber at that time meant that the 50+ years old chamber occasionally had to be unavailable due to servicing which had to be conducted on an annual basis. The Hyperbaric Unit used to give notice of such servicing periods in advance to inform commercial and recreational divers that the recompression chamber was going to be unavailable for a period of normally 3 days in which diving was discouraged.
Photos of the Hyperbaric Unit’s equipment at St. Luke’s Hospital. Pictures courtesy of Hyperbaric Unit staff.
Due to the rise in the early nineties of the recreational diving sector, the need was felt for a second recompression chamber to be procured. Unfortunately, the procurement process stalled a bit in bureaucracy until a serious accident occurred. This accident involving a German diver who had been diving down solo to 73m at Dwejra, Gozo whilst the recompression chamber was undergoing a servicing period. The diver had run out of air to fill his “toilet seat” BCD, got super-narcosis and the worst DCS Dr Muscat had ever seen at that time. Emergency use was made of another commercial divers’ chamber at Kalaxlokk with lack of redundancy systems and oxygen treatment, that was located on a diving barge, which however still resulted in the diver being treated successfully, but in a very lengthy manner and with great risks which today would be unthinkable.
Following this accident, the new recompression chamber procurement process was speeded up, and Dr Muscat on the 25th of June 1994 had two deliveries to take care of, one being his daughter who was born on the day and a new Italian recompression chamber that could treat ten persons at a time.
Photos of the old WW2 era Japanese recompression chamber and the Italian recompression chamber obtained in 1994 at the former St. Luke’s Hospital Hyperbaric Unit. Pictures courtesy of Hyperbaric Unit staff.
This new chamber served well until 2007, when the Hyperbaric chamber moved to today’s facility at Mater Dei which had two brand new recompression chambers which are still in operation until today which may take up to 12 persons in one, and four in the other.
(Video from https://tvmnews.mt/en/news/the-hyperbaric-unit-works-miracles-you-leave-in-one-piece-as-good-as-new/ – This video shows footage of the recompression chambers at Mater Dei Hospital)
Since 2008, the diving community in Gozo also benefitted from an additional recompression chamber commissioned at the Gozo General hospital, which reduced further the time to travel for treatment especially in view of the growing technical diving community in Gozo and the urgency for treatment that diving accidents require.
Following the relocation of the Hyperbaric Unit to Mater Dei, the old recompression chambers at St. Luke’s Hospital were de-commissioned. The Japanese recompression chamber was donated to the Malta Maritime Museum at Birgu to be kept amongst its exhibits, though unfortunately, its ornate brass items went missing prior to its arrival there.
Hyperbaric Treatment
Originally, treatments in the recompression chambers were conducted using the US Navy Hyperbaric Treatment Air Tables. Over the years, one other change apart from the various recompression chambers used, has been the introduction of Oxygen treatment for divers. This was introduced in 1988 after Dr Muscat returned from a period of study in the United Kingdom and after a short period in which this change in treatment was better understood by his colleagues at the unit.
In fact, within the recompression chambers at Mater Dei and Gozo General hospital, whilst the air inside the recompression chamber is normal compressed air at higher pressure, the patients breathe via face masks or hoods,100% oxygen or an oxygen rich gas mix to assist in their treatment, depending on their needs.
Dr Magri also clarified that the Hyperbaric Unit provides treatments in line with the European Committee for Hyperbaric Medicine standards. This committee updates these standards every few years depending on evidence-based research. These treatments are used by the Hyperbaric Unit consultants for several types of injuries and conditions, not just for divers. For example, hyperbaric treatment is nowadays used to promote healing of injuries or treat in case of certain infections, diabetic ulcers, sudden onset of sensorineural hearing loss, radiation injuries, burns, carbon monoxide poisoning, anaerobic infections, necrotising soft tissue infections and other conditions.
The bulk of the emergency work for the Hyperbaric Unit that requires recompression treatment involves decompression sickness (DCS) and arterial gas embolism (AGE). The Unit also reviews cases of immersion pulmonary oedema, however this is not a condition that requires recompression in the recompression chamber.
Dr Muscat and Dr Magri also confirmed that emergency treatment is given urgently to all divers who require treatment, irrespective of whether they are local resident divers or visiting tourists.
Being the only facility with recompression chambers on the island, one should always immediately call 112. Speedy conveyance to the facility of divers suffering DCS or AGE ensures treatment starts as early as possible for the best possible results and to prevent potentially deadly consequences.
In cases of emergency, when the diver is stable, breathing normally and co-operative, he/she can be started on O2 and transferred to hospital with a private car. Divers themselves also need to recognise at the earliest symptoms like rashes, tingling, visual disturbances, balance issues, limb weakness etc, and immediately make the call to get specialist advice rather than wait for symptoms to become worse!
Diving Medicals
The Hyperbaric Unit consultants, apart from attending medical emergencies requiring their speciality and monitoring scheduled treatments for other patients treated at the unit, also carry out diving medicals for Scuba Diving Instructors and divers referred due to specific medical conditions. Under Maltese Law, diving guides and instructors are legally obliged to have a yearly medical conducted by a diving medicine specialist to be able to provide their services.
Dr Muscat and Dr Magri stressed on the importance of all divers (irrespective whether these are guides or instructors or not) to keep physically fit. They identified morbid obesity and uncontrolled hypertension as being the commonest issues of concern, apart from the absolute contraindications as identified in the medical questionnaire such as in the annex to the Recreational Diving Services Regulations.
Asked what such a medical includes, Dr Muscat and Dr Magri explained that medicals consist in assessing the divers’ general physical health and any conditions that such individuals already know or have experienced that might affect their ability to conduct their work or that might have an adverse effect on their health whilst diving. Dr Muscat and Dr Magri also remarked that basic investigations are conducted in such medicals, such as urine tests, ECG, and Lung Function tests. The diver’s past medical history may also warrant further investigations and tests.
The diving medicals normally conducted for diving instructors however are not commercial diving medicals, which would require even more higher standard of fitness and intensive investigations. Even though these are offered at the unit very few of them are requested. Partly, these may not be sought for so much because currently there is no specific legal obligation requiring these more intensive medicals for industries as required for the recreational diving service providers. Another reason may be because these are conducted against payment.
Contacting the Hyperbaric Unit
In Emergency: Call 112
Non-emergencies: Call 25455269 or email the unit on hyperbaricunit.mdh@gov.mt to setup an appointment with the Consultants at the unit. The service is available for diving instructors, divemasters and recreational divers with any medical issue.
Where to come in an emergency at Mater Dei Hospital
In case of need of emergency treatment, always head to the Mater Dei Hospital Emergency Department. If you need a link for navigation, use: https://goo.gl/maps/hgkVPjn3RNTFNMRm8
Location of Hyperbaric Unit at Mater Dei
Got a story to tell, or a question to ask?
In the coming months we hope to get another opportunity to speak back with the Consultants at the Hyperbaric Unit and bring back some more information that may be of interest of divers. Let us know in comments below, or through our Facebook Page if you have something you’d really want to ask, or a story to share (please consider that not all questions may be accepted for this public website as it is meant for informational purposes). You may also contact us in private using the “Contact Us” page.
