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Published on: November 12, 2014
Hypertension screening of commercial divers from an occupational medicine perspective
Alejandro Garbino1, Robert W Sanders1, Charles H Mathers1
1University of Texas Medical Branch at Galveston, Galveston, Texas U.S.
Insights
This study developed a new protocol for managing high blood pressure in NASA divers. It ensures divers receive necessary medical care for hypertension while minimizing operational disruptions.
Area of Science:
- Occupational Health
- Cardiovascular Medicine
- Aerospace Medicine
Background:
- Hypertension is a prevalent chronic disease affecting one-third of US adults, increasing risks for cardiovascular disease and stroke.
- NASA's Neutral Buoyancy Laboratory (NBL) employs professional divers for astronaut training, requiring frequent on-site physical exams including blood pressure checks.
Purpose of the Study:
- To address the lack of a protocol for managing asymptomatic elevated blood pressure among NBL divers.
- To analyze diver blood pressure data and develop an effective management and referral pathway.
Main Methods:
- Analysis of all diver blood pressure data from 2015.
- Vetting of the existing worksite physical examination process.
- Development of a referral pathway for physician follow-up and management.
Main Results:
- Identified elevated blood pressure readings during routine occupational health checks.
- Established a system for analyzing and managing diver blood pressure.
- Created a referral pathway to ensure timely medical intervention.
Conclusions:
- The developed protocol ensures divers with elevated blood pressure receive appropriate management.
- The new pathway integrates blood pressure management into the occupational health program without significant operational impact.
- This initiative improves health surveillance for a unique occupational group.
Abstract:
Hypertension is one of the most common chronic diseases in the world: in the United States, it affects one-third of the adult population. Most cases are primary hypertension - with no identified cause - and significantly increase risk for cardiovascular disease and stroke. At NASA's Neutral Buoyancy Laboratory (NBL), there is a cadre of professional divers who provide underwater support during extravehicular activity training (EVAs, commonly referred to as "spacewalks") for astronauts. The NBL occupational health program requires regular "work-site" physical exams, including blood pressure checks, on at least a weekly basis. Although some blood pressures measured during such regular checks were elevated, the diagnosis and management of blood pressure was outside the scope of that occupational medicine program. As a result, there was no protocol to analyze and manage asymptomatic elevated blood pressure if and when it warranted physician follow-up. We therefore analyzed the blood pressure data from all divers in 2015, vetted the worksite physical and developed a referral pathway to ensure divers have access to effective management of their blood pressure while minimizing impact of such a program on daily operations.
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01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure