ALCOAST 091/25 - FEB 2025 UPDATE TO COAST GUARD UNDERSEA MEDICINE POLICY

R 261343Z FEB 25   MID120001757104U
FM COMDT COGARD WASHINGTON DC
TO ALCOAST
BT
UNCLAS
ALCOAST 091/25
SSIC 6000
SUBJ: UPDATE TO COAST GUARD UNDERSEA MEDICINE POLICY
A. Coast Guard Medical Manual, COMDTINST 6000.1F
B. Diving Program Manual, COMDTINST 3150.1D
C. U.S. Navy Manual of Medicine, Chapter 15
D. U.S. Navy Diving Manual
E. Navy Diving Policy and Joint Military Diving Technology and
Training Program, OPNAVINST 3150.27D
F. Diving Duty for Pregnant Divers, BUMEDINST 6200.15A
G. Clinical Use of U.S. Navy Recompression Chambers,
BUMEDINST 6320.38D
H. USCG OPMED-USN BUMED MOU (Oct2017)
I. Coast Guard Diver Personnel Qualification Standards (16Dec2024)
1. Paragraphs 4-10 of this ALCOAST update Coast Guard undersea
medicine policy outlined in Chapter 3 H. of REF (A). This ALCOAST
also promulgates policy related to the use of recompression chambers
(RCC) by Coast Guard divers and medical personnel for the treatment
of diving related disorders.
2. The Coast Guard Dive Program is enhancing its operational diving
capabilities with the fielding and integration of recompression
chambers at the three Regional Dive Lockers (RDLs) and the Aviation
Technical Training Center (ATTC) during FY25. This initiative aligns
with continued Service efforts to Advance Mission Excellence by
improving diver safety and readiness, enabling a greater focus on
mastery of craft and proficiency that matures the Diver rating, and
streamlining logistical requirements to meet expanding operational
demands.
3. The proper training and development of robust, responsive RCC
procedures coupled with sound judgment by highly trained personnel
are key factors to help ensure all diving and RCC operations are
performed safely. Commands must prioritize training and ensure that
all chamber team personnel achieve the required qualifications
before any RCC operations are authorized.
4. Coast Guard undersea medicine has created an organizational
construct that consists of an Undersea Medical Standardization
Officer (UMSO) who serves under COMDT (CG-1K2), with Health, Safety,
and Work Life Service Center (HSWL SC) providing technical
authority, and provides expertise and oversight to all designated
medical personnel providing comprehensive medical and dive-related
care to divers.
5. The following guidelines, in addition to those policies and
protocols outlined in REFs (A) thru (I), will remain in effect until
the cancellation of this message or when new Coast Guard undersea
medicine policy is promulgated. New policy will provide further
details regarding the Undersea Medicine organizational structure as
well as roles and responsibilities of the UMSO, Undersea Medical
Officers (UMO), Diving Medical Officers (DMO), Hyperbaric Medical
Officers (HMO), and Hyperbaric Medical Technicians (HMT).
     a. Divers who qualify in RCC watch stations-such as Chamber
Operator, Inside Tender, and Chamber Supervisor-receive highly
specialized training in hyperbaric medicine and medical care for
diving casualties. The tasks required for qualification are outlined
in the applicable sections of REF (I), the Coast Guard Diver
Personnel Qualification Standards (PQS) approved by COMDT (CG-721).
     b. Qualified Chamber Operators, Inside Tenders, and Chamber
Supervisors are authorized to perform the full scope of their duties
and responsibilities as outlined in REF (D).
     c. Diving units with qualified Chamber Teams are authorized to
conduct all general diving operations and recompression treatments
using RCCs in strict compliance with the diagnosis and treatment
protocols outlined in REF (D).
     d. For divers with signs and symptoms concerning for serious
Decompression Sickness (DCS) or Arterial Gas Embolism (AGE), where
advanced medical interventions (including but not limited to airway
management, thoracic needle decompression, chest tube placement, or
IV therapy) may be required, a certified HMT, UMO, DMO, or HMO should
accompany the patient inside the chamber in addition to the Inside
Tender, who must always be present in the chamber during treatments.
However, recompression treatment must not be delayed while awaiting
the arrival of a UMO, DMO, HMO or HMT.
     e. Chamber Supervisors must ensure a UMO is contacted at the
earliest opportunity during a recompression treatment and before
release of any treated patient. When conducting recompression
treatments, the UMO may recommend the proper course of treatment,
consult with other medical personnel, and prescribe medication and
other treatment adjuncts as necessary.
     f. Coast Guard dive-trained medical officers will provide training
and support to diving units, to include topics in hyperbaric medicine
and RCC medical treatments and skills, at a frequency deemed
appropriate by the UMSO and with concurrence from the MRST-West and/
or ATTC Commanding Officer. The goal is to maintain proficiency in
all medically associated diver training and skills. The UMSO will
work with these providers to identify medical procedures or actions
that may require more frequent performance by divers and establish
currency requirements to maintain qualifications in RCC watch
stations.
     g. Divers are non-medical personnel operating under the authority
of the unit Commanding Officer. Personnel such as HMOs, HMTs, EMTs,
operate under the supervision of the UMSO.
     h. The UMSO and Coast Guard dive-trained medical officers will
serve as consultants to all dive units in the procurement, inspection,
storage, issuance, transfer, and accountability for all medical stores
and equipment found in the Primary and Secondary Medical Kits for
Hyperbaric Chamber Operations.
     i. Coast Guard dive-trained medical officers may be requested to
be on-site for specific dive missions or training events as deemed
appropriate by the MSRT-West and/or ATTC Commanding Officer or
recommended by the UMSO. Funding for the presence of Coast Guard
dive-trained medical officers for these dive missions or training
events will be provided by MSRT-West and/or COMDT (CG-721).
     j. Coast Guard Icebreakers or Polar Security Cutters conduct
underway operations with the presence of Coast Guard divers aboard.
Due to the high-risk conditions that exist with cold-water diving
and the austere location of these Cutters, a dive-trained Coast Guard
medical officer, at the level of HMO or above, is required to be
present as part of the Coast Guard Cutter's medical team.
6. All Coast Guard medical officers will apply the medical and
physical standards outlined in Article 15-102 of REF (C), instead of
those listed in COMDTINST 6000.1F, Section 3.H, to Coast Guard divers,
which will serve as the primary resource for determination of diving
duty. If medical conditions are not covered or adequately addressed
in REF (C), or if specific Coast Guard operational needs dictate,
Coast Guard medical providers will contact the UMSO for further
guidance.
7. Coast Guard dive-trained medical officers and RDLs will follow
medical guidelines in REF (D) and REF (B) with the following
exceptions:
     a. List of items for primary and secondary dive-side emergency
medical kits are outlined in REF (D). Coast Guard will authorize the
addition of epinephrine and Narcan to dive-side emergency medical
kits. Narcan can be administered by any Coast Guard member with
appropriate training. Epinephrine may only be administered by a
Coast Guard diver who is certified as an EMT, Coast Guard Healthcare
Service Technician (HS), or Coast Guard medical officer.
     b. Each RDL will be required to qualify and sustain 5 Coast Guard
divers as certified EMTs.
8. Coast Guard medical officers will follow medical policy IAW REF
(E) with the following exceptions:
     a. Coast Guard Dive Medicine Organizational Structure. Coast
Guard dive medicine organizational structure will differ from USN
dive organizational structure outlined in Chapter 2. Each member's
roles/responsibilities will be further outlined in a forthcoming
COMDINST.
     b. Dive Waivers. Coast Guard's dive medical waiver process will
differ from USN's waiver process outlined in Chapter 5. Current
Coast Guard dive medical waiver guidance is stated in REF (A),
Section 3.H.1.e though updated policy will be further outlined in a
forthcoming COMDINST. The UMSO is the primary point-of-contact for
any questions about or requests for Coast Guard dive waivers.
9. Coast Guard medical officers will follow medical policy IAW REF
(F), the USN's policy regarding diving duty of pregnant divers, as
written.
10. Coast Guard medical officers will NOT follow medical policy
contained in REF (G), the USN's policy regarding clinical use of
USN RCCs for non-diving related diseases and conditions. The use
of Coast Guard RCCs will be authorized for the treatment of dive
related conditions only. Any non-diving related conditions suffered
by Coast Guard personnel that would benefit from hyperbaric oxygen
therapy should contact their primary care manager or visit the
nearest emergency room if indicated.
11. The integration of Coast Guard-owned RCCs within the Diving
Program represents a significant and historic advancement for the
Service. The endeavor to improve diver safety and operational
effectiveness reflects the Coast Guard's commitment to Mission
Excellence. Commands are encouraged to embrace this capability and
provide the necessary support to their teams during the
implementation process.
12. These changes will be incorporated into the next revision of
REF (A), which will be released within the next year.
13. This message will be cancelled on 25 FEB 2026.
14. POC: CDR Scott Blanchet, Dive Medical Officer, Base LA/LB-DD-
Sector San Diego, (619) 278-7130, Scott.M.Blanchet@uscg.mil
15. RADM Paul I. Jung, Assistant Commandant of Health, Safety,
and Work-Life (CG-1K), sends.
16. Internet release is authorized.