Pulmonary barotrauma
Meaning of pulmonary barotrauma: For the purposes of this Statement of Principles, pulmonary barotrauma: (a) means an acute lung injury arising from an abnormal pressure gradient across pulmonary tissues resulting in pulmonary haemorrhage from pulmonary compression, or air leakage into the pleural space (pneumothorax), the pericardial space (pneumopericardium), the peritoneal space (pneumoperitoneum), under the skin (subcutaneous emphysema) or into the blood (arterial gas embolism); and (b) includes: (i) iatrogenic pulmonary barotrauma; (ii) explosive blast injury; (iii) pulmonary barotrauma due to forceful coughing, vomiting, forceful Valsalva or Muller manoeuvres; (iv) pulmonary barotrauma of ascent; (v) pulmonary barotrauma of descent also known as lung or thoracic squeeze; and (vi) pulmonary barotrauma to abnormal pulmonary conditions such as bulla, blebs and cysts; and (c) excludes: (i) decompression sickness; (ii) arterial gas embolism due to decompression sickness; and (iii) pneumothorax, pneumopericardium, pneumoperitoneum, and arterial gas embolism due to non-pressure causes such as lung disease, and penetrating trauma including surgery.
Reasonable Hypothesis (RH) — Statement of Principles No. 64 of 2023
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting pulmonary barotrauma or death from pulmonary barotrauma with the circumstances of a person's relevant service:
- (1)experiencing an episode of rapid change in the ambient pressure exerted by an envelope of gas or water surrounding the person whilst: (a) descending in an underwater dive; (b) surfacing from an underwater dive; (c) increasing in altitude whilst flying in an aircraft; (d) suffering loss of cabin pressure in an aircraft at altitude; (e) decompressing in a hypobaric chamber; (f) returning to surface air pressure after being in a hyperbaric chamber including hyperbaric oxygen therapy chambers; within 24 hours before the clinical onset of pulmonary barotrauma;
- (2)receiving artificial ventilation at the time of the clinical onset of pulmonary barotrauma;
Note: artificial ventilation is defined in the Schedule 1 - Dictionary.
- (3)sustaining a blast injury involving the chest at the time of the clinical onset of pulmonary barotrauma;
- (4)smoking or inhaling cocaine or cannabis within 24 hours before the clinical onset of pulmonary barotrauma;
- (5)undertaking a Valsalva manoeuvre whilst: (a) forcefully vomiting; (b) forcefully coughing; (c) giving birth; (d) performing positive anti-g straining manoeuvre; (e) suffering intractable hiccups; or (f) weight lifting at a gym; within 24 hours of the clinical onset of pulmonary barotrauma;
Note: The Valsalva manoeuvre is exhaling air against a closed glottis (airway).
- (6)inability to obtain appropriate clinical management for pulmonary barotrauma before the clinical worsening of pulmonary barotrauma;
Aggravation-only factors: the factors in subsection 9(6) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 65 of 2023
5 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, pulmonary barotrauma or death from pulmonary barotrauma is connected with the circumstances of a person's relevant service:
- (1)experiencing an episode of rapid change in the ambient pressure exerted by an envelope of gas or water surrounding the person whilst: (a) descending in an underwater dive; (b) surfacing from an underwater dive; (c) increasing in altitude whilst flying in an aircraft; (d) suffering loss of cabin pressure in an aircraft at altitude; (e) decompressing in a hypobaric chamber; (f) returning to surface air pressure after being in a hyperbaric chamber including hyperbaric oxygen therapy chambers; within 24 hours before the clinical onset of pulmonary barotrauma;
- (2)receiving artificial ventilation at the time of the clinical onset of pulmonary barotrauma;
Note: artificial ventilation is defined in the Schedule 1 - Dictionary.
- (3)sustaining a blast injury involving the chest at the time of the clinical onset of pulmonary barotrauma;
- (4)undertaking a Valsalva manoeuvre whilst: (a) forcefully vomiting; (b) forcefully coughing; (c) giving birth; (d) performing positive anti-g straining manoeuvre; (e) suffering intractable hiccups; or (f) weight lifting at a gym; within 24 hours of the clinical onset of pulmonary barotrauma;
Note: The Valsalva manoeuvre is exhaling air against a closed glottis (airway).
- (5)inability to obtain appropriate clinical management for pulmonary barotrauma before the clinical worsening of pulmonary barotrauma;
Aggravation-only factors: the factors in subsection 9(5) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
