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may require different considerations from divers. "The action of medicine under hyperbaric conditions is largely untested," Pollock said. Interaction hazards can be magnifed by multiple medicines. Consult with a physician about such effects and whether diving safety will be compromised. Even seemingly innocuous drugs such as "baby aspirin" or blood thinners may pose a hazard in diving because diving subjects its participants to bumps and bangs. Petar Denoble, M.D., D. Sc., is the Senior Research Director of DAN Medical Research. He specializes in studies in open circuit, closed circuit, deep bounce, and saturation diving. He said oxygen can be toxic at high pressure and individual susceptibility to such toxicity can vary, but most persons affected by oxygen toxicity will exhibit central nervous system disturbances including seizures, ocular hyperbaric-induced myopia that can last weeks, and pulmonary problems. All are dose-dependent. Symptoms might include lip twitching, nausea, vertigo, respiratory disturbances, body twitching, feeling of drowsiness, numbness, confusion, visual disturbances, acoustic hallucinations, and parathaesia. Although some of these symptoms might seem harmless, they could be fatal such as a seizure that makes the diver drop the mouthpiece or make an inappropriate ascent. Dr. Denoble recommended a mouthpiece holder or full facemask for extra safety. Those most at risk for oxygen toxicity are close-circuit oxygen divers, nitrox divers, mixed-gas open circuit, or those who have been treated with hyperbaric oxygen, but case-by-case variations can occur. Some prescription and over-the-counter drugs can have adverse effects on a diver. Cialis®, Viagra®, Sudafed®, Aleve®, statins, antihistamines, decongestants, and antidepressants can remain potent in the body for hours to even days, and may have side or after effects that cause restlessness, nausea, vomiting, headache, drowsiness, nervousness, dizziness, diffculty sleeping, stomach pain, dry membranes, diffculty breathing, slowing of coordination, slow judgment, irregular heartbeat, hypertension, imbalance, vasodilatation, some increases in blood pressure, myocardial infarction and arrhythmia. Dr. Denoble advised asking one's physician about side effects and their possible exacerbation in diving or in going to greater depths than ordinary. And such drugs may actually lower an individual's threshold for oxygen toxicity. Ear and sinus problems plague some divers. Martin McCafferty, EMT-P, DMT, EMD-A, is a Medical Information Specialist for DAN. He said about 40 percent of the inquiries DAN receives about diver health tend to involve questions about ears and sinuses, including motion sickness while traveling by boat to and from a diving area. DAN has an Emergency Hotline phone number of (919) 684-9111. He explained that the ear actually has an outer ear and ear canal, middle ear (also the Eustachian tubes), and inner ear (and auditory nerves), any of which can be affected by diving. The frontal sinuses above the eyebrows, (which tend to be the most problematic), sinuses near the cheekbones, behind the eyes, and toward the back of the head can be affected by diving. An active cold, congestion or allergy can exacerbate diver's ear and sinus problems, he said. Symptoms can include dizziness, uncoordinated gait, a sense of spinning, vomiting, congestion, or pain behind the eyes. Middle ear problems usually involve feeling a fullness or "water" in the ear (not in the ear canal), muffed hearing, dizziness, lightheadedness, tinnitus, discomfort, hearing pops or cracks on yawning as the air moves, acute pain, hearing loss, feeling off balance, or having blood in the sputum. Sinus problems are usually marked by pressure in the sinuses, lightheadedness, dizziness, localized headache, pain at the forehead/cheeks/upper teeth/ occipital area/behind the eyes; severe dizziness, numb cheeks/ teeth/gum line, or bloody nose or blood in the mask. Learning the right technique for equalizing is important, McCafferty said, and the technique that works for one person might not work for another. All sinuses need to equalize at the same time with the ears. The openings to the sinuses are small so mucus or congestion can interfere when trying to equalize. "If you're feeling increased pressure, equalize literally every 2 feet!" he said, adding that repeatedly equalizing on the way to the dive site, pushing the lower jaw forward to loosen the muscles to open the Eustachian tubes, and other techniques can help the process of equalizing. Stephenie Slahor, Ph.D., J.D., writes in the felds of law enforcement and security. She can be reached at drss12@msn.com. Photos courtesy of Dive Rescue International. LaO Post your comments on this story by visiting www.lawandordermag.com Visit Us at IACP 2013 Booth #1510 Click on EInfo at - www.lawandordermag.com reader service #34 www.lawandordermag.com 81