The roots of undersea and hyperbaric medicine lie in exploratory, industrial, and military activities requiring personnel to traverse pressure gradients, with decompression posing an infamous threat to health (i.e., decompression sickness or bends). The pioneers of the field recognized that the risks of decompression sickness varied with the method of decompression, and that recompression proved beneficial when illness occurred. For this reason, recompression remains the front-line therapeutic approach to decompression illness. The next great step in the metamorphosis of recompression (hyperbaric) therapy involved the systematic manipulation of the blend of gases breathed by patients during treatment. In particular, increasing the concentration of oxygen relative to nitrogen in the mixture confers enormous practical and therapeutic advantages, shortening treatments and improving outcomes. At the same time, the breathing of oxygen at elevated ambient pressures exhibits curative potential beyond the realm of decompression-dependent injury. In particular, hyperbaric oxygen promotes the growth of vascular structures into metabolically compromised regions, aiding in the healing of persistent wounds and perhaps restoring function to ischemic tissue (e.g., neural and cardiac). As an additional example, hyperbaric oxygen is beneficial in the treatment of anaerobic infections. The use of hyperbaric oxygen has thus entered the medical mainstream as an important adjunctive treatment for a variety of clinical conditions, and experimentation into novel clinical applications of hyperbaric oxygen is escalating.

BENEFITS OF TRAINING

It is inescapable that training in hyperbaric oxygen therapeutics confers important academic and professional advantages to future physicians, immeasurably broadening and deepening their basic scientific foundations. Students enrolled in the Programs of Undersea and Hyperbaric Medicine experience the additional benefits of hands-on exposure to patients as early as the first semester of medical training and hence are greatly clinically advantaged as compared to most of their US-trained counterparts. Certainly, highly favorable clinical reviews/evaluations from preceptors coupled with an increasingly marketable clinical skill enhance competitiveness for residencies in a variety of fields (e.g., emergency medicine, pediatrics). Easily rivaling its horizon- and opportunity-expanding influences, training in undersea and hyperbaric medicine exerts enormous impact on the critical faculties of the students. Participants of the program thus come to understand that, as the number and variety of clinical applications of hyperbaric oxygen increases, so too does the erroneous yet popular view of hyperbaric oxygen as a virtual panacea. This view leads to the unfortunate and increasingly widespread misuse of hyperbaric oxygen by charlatans eager to furnish an expensive placebo to hapless and perhaps desperate victims of conditions for which the benefits of hyperbaric oxygen are at best undemonstrated. By promoting an evidence-based approach to the clinical use of hyperbaric oxygen, the Programs of Undersea and Hyperbaric Medicine endeavor to entrench the judicious use of hyperbaric oxygen, where benefit is demonstrable, and to augment the systematic unbiased investigation of novel clinical applications. At the same time, the promotion of critical thought in students will aid in the abolition of the widespread, irresponsible, and unethical peddling of hyperbaric oxygen, which only serves to marginalize an otherwise important and scientifically sound therapeutic approach.

REQUIREMENTS FOR GRADUATION

Requirements for graduation from the Master's Program are a) the completion of a baccalaureate degree from an accredited college or university, b) the completion of the Required Courses (see table below), and c) the declaration of referees that the thesis meets acceptable standards. The failure of all referees to deem the thesis acceptable may necessitate an oral defense. Requirements for graduation from the Diploma Program are identical for those of the Master's Program with the exception of the thesis-related activities. Graduation from the Introductory Technical Program requires that students a) attend three lectures, b) function competently under hyperbaric conditions (one half hour), c) operate the chamber under direct supervision (one half hour), and d) pass a written or computer-based examination relevant to the content of the course. Topics for the course will include the physics of gases, cardiopulmonary physiology and pathology, hyperbaric therapeutics, hyperbaric tending, and hyperbaric chamber driving. Graduation from the Advanced Technical Program requires that students attend lectures (13 hours) covering the following topics: History of Undersea and Hyperbaric Medicine; High- and Low-pressure Physics; Diving Physiology; Decompression Illness; Clinical Examination; Approved Therapeutic Uses of Hyperbaric Oxygen; Experimental Uses of Hyperbaric Oxygen; Transcutaneous Oximetry; Hyperbaric Chamber Safety. Additionally, students must log time as a hyperbaric chamber driver (4.5 hours), tender (3 hours), and recorder (1.5 hours) and pass a written or computer-based examination relevant to the content of the course. Successful completion of the Master's, Diploma, or Technical Programs does not require the continuous presence of the students on the island of Sint Eustatius. Students from other colleges or universities may find it advantageous and convenient to participate in the program, during semester breaks, for example. The administration of the Programs of Undersea and Hyperbaric Medicine thus welcomes applications and visits from students desiring to participate while completing ongoing studies or engaging in professional activities elsewhere.

GRADUATE COURSE DESCRIPTIONS

High and Low Pressure Physics (6 hours)

The course will emphasize laws governing the physiologically relevant behavior of gases (e.g., Boyle's Law, Charles' Law, Dalton's Law, Pascal's Law, Henry's Law). Archmides principle of buoyancy will be discussed along with thermal conductivity, viscosity of water, and underwater properties of sound and light.

Diving Physiology (9 hours)

The course will consider toxic effects of pressurized gases on human organ systems. Students will conduct considerable independent study related to the topics.

Oxygen Therapeutics (27 hours)

The course will encapsulate physiological and clinical aspects of hyperbaric gases in human subjects and patients, taking into account current literature concerning novel applications. Lecture/seminars and independent study will focus on indications for the use of pressurized gases in cases of gas embolism, carbon monoxide and cyanide poisoning, clostridial myonecrosis, traumatic ischemia, decompression sickness, wound healing, exceptional blood loss, necrotizing infections of soft tissue, osteomyelitis, radiation-induced damage to tissue, skin grafts and flaps, and burns. Applications of transcutaneous oximetry in the context of hyperbaric medicine will be stressed. Students are expected to conduct considerable independent study related to the course.

Hyperbaric Tender Training (6 hours)

The course prepares students to attend patients undergoing hyperbaric therapy. Included are practical sessions related to taking histories, conducting physical/neurological examinations, and administering first aid and medication top-side and under hyperbaric conditions. Special consideration is given to issues relevant to toxic effects of oxygen, fire hazards, and general chamber safety. The greatest benefit reaped by the student is the opportunity to experience hands-on contact with patients.

Hyperbaric Recorder Training (3 hours)

Students acquire skills related to the accurate systematic documentation of clinically related events.

Hyperbaric Driver Training (9 hours)

Emphasis is placed on the functional architecture of the hyperbaric facility and chamber. This course integrates theoretical and practical aspects of all facets of the Master's Program of Undersea and Hyperbaric Medicine.

*Anatomy (256 hours)

The course confers an understanding of the structure of the human body.  Clinical concerns are stressed.

*Physiology (160 hours)

The course initially involves assessments of basic principles governing human physiology followed by an intensive overview of specific organ systems.

*Neuroscience (160 hours)

The course emphasizes anatomical, physical, chemical, and functional relations of components of the central nervous system with each other and with peripheral systems.

Thesis Preparation and Defense (not required for participants of the Diploma Program)

Students will, under the direct supervision of qualified faculty, conduct an independent course of research related to undersea and/or hyperbaric medicine. The course will culminate in the preparation of a thesis that meets the academic standards of up to three internal and two external referees. The length of the thesis will depend on the topic of research undertaken. In lieu of the approval of the thesis by all referees, students must undertake a formal oral defense.

Required Courses	Hours
High and Low Pressure Physics	6
Dive Physiology	9
Oxygen Therapeutics	27
Seminar in Hyperbaric Medicine	3
Hyperbaric Tender Training	6
Hyperbaric Recorder Training	3
Hyperbaric Driver Training	9
*Anatomy	256
*Physiology	160
*Neuroscience	160
Thesis Preparation & Defense	Variable

*Transfer credit may be given to students who have already completed indicated courses at another university, college, or medical school.  Students enrolled in the program of Basic Sciences at the University of Sint Eustatius fulfill the indicated requirements as part of their training in the Basic Sciences.

APPLICATIONS AND ENROLLMENT

Medical students enrolled in the University of Sint Eustatius School of Medicine must complete an application and submit it to the Director of the Programs. Enrollment in the Master's and Diploma Programs will not be permitted, however, unless students have successfully completed all first-semester courses in the program of Basic Sciences. Medical students transferring into the program of Basic Sciences with advanced standing may be admitted to the Programs of Undersea and Hyperbaric Medicine immediately upon matriculation at the discretion of the Director. Students may join the Technical Programs following a favorable outcome on their first set of examinations for the Basic Sciences (i.e., three weeks after the beginning of their first semester). Successful applicants not enrolled in the program of Basic Sciences at the University of Sint Eustatius School of Medicine may begin training in undersea and hyperbaric medicine immediately upon arrival on Sint Eustatius.

ACADEMIC STANDARD

Medical Students enrolled in the University of Sint Eustatius School of Medicine must establish and maintain a cumulative GPA of 85% in the program of Basic Sciences to ensure continued enrollment in the Master's and Diploma Programs. Students not enrolled in the program of Basic Sciences (but enrolled in the Master's Program) are expected to achieve and maintain a cumulative GPA of 85% for Anatomy, Physiology, and Neuroscience. In order to enter the either Introductory or Advanced Technical Programs, medical students must have running averages of at least 75% in each of the courses in which they are currently enrolled in either the Basic Sciences or the Premedical Sciences.

TIME-LINE

As a general rule, successful completion of the coursework inherent in the Master's Program of Undersea and Hyperbaric Medicine requires three semesters, but it is common for students to require additional time to complete the thesis. In such cases, thesis requirements may be met after students have left the island of Sint Eustatius. However, for logistical reasons, students are strongly encouraged to complete ALL requirements for the degree of Master of Science in Undersea and Hyperbaric Medicine before permanently departing from the island. In the absence of either special dispensation or leave of absence granted by the Director, all requirements must be met within seven semesters of initial enrollment in the Programs of Undersea and Hyperbaric Medicine. The Diploma Program of Undersea and Hyperbaric Medicine generally requires two semesters for completion. The Director may grant additional time for students to complete assignments. Students are expected to complete requirements for the Introductory Technical Program of Undersea and Hyperbaric Medicine within six weeks, whereas 1 – 2 semesters is generally sufficient for completion of the Advanced Technical Program.

TUITION AND FINANCE

For students coenrolled in the program of Basic Sciences and either the Master's or Diploma Programs of Undersea and Hyperbaric Medicine at the University of Sint Eustatius School of Medicine, tuition charges of $5400 and $3600, respectively, will be levied. Tuition will cover the costs of thesis-related use of the hyperbaric chamber (for students enrolled in the Master's Program) and required texts. Students may pay tuition in equal installments, which are due at the beginning of each semester. Students not coenrolled in the program of Basic Sciences must also pay tuition for Anatomy, Physiology, and Neuroscience (see "Tuition" at http://www.eustatiusmed.edu). Any student withdrawing before completion of a given semester may be eligible for a partial refund of tuition. The Programs of Undersea and Hyperbaric Medicine will cover costs of and sponsor applications for student membership in the Undersea and Hyperbaric Medical Society. Required textbooks will be made available to students upon payment of the first installment of tuition. Tuition for the entire Introductory Technical Program is set at $225, whereas tuition for the Advanced Technical Program is set at $1800. These amounts may be applied to tuition for the Master's and Diploma Programs of Undersea and Hyperbaric Medicine for students ultimately pursuing further training.

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