Undersea Medical Officer Course


NUMI WEEK ONE

Today is Monday, the beginning of the second week of the Undersea Medical Officer Candidate Course, Class 109. This course is designed to train US Navy Medical Corp Officers (Medical Doctors) to treat USN Divers and Submariners and is divided into three phases. The first phase is held in Groton, CT at Submarine Base New London in the Naval Undersea Medical Institute (NUMI) and consists of daily brutal physical training (PT) sessions and various didactics. Day one was the typical military check in with the students running around to different locations having their check in sheets initialed and listening to multiple briefs from different groups on base. After a day of introductions, the class headed to the Grinder (gym) to have an afternoon break-in PT session which left everyone pretty wiped from sprints, suicides, lunges, squats, pushups, situps, crunches, flutter kicks, sun-gods, etc. We were informed that this was an “easy day,” which the class quickly adopted as a “hooyah! easy day!” for brutal PT sessions to follow.

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Day two started promptly at 0500 with the Diver Physical Screening Test (PST), a screening test that must be passed to attend Dive School in Phase 2. It consists of a 500yd swim, max pushups, max situps, max pullups, and a 1.5 mile run all for times or reps with strict form and a regimented timeline. Having just PT’d hard twelve hours previously was likely an ingenious design to lower our PST scores so that there would be a significant improvement by the end of the six weeks, kudos to the instructors. All but five of the fourteen candidates met the requirements with most of those who failed only slightly missing the standards. Hooyah! Thinking we were awesome, none of us imagined a lengthy celebratory PT session directly following the PST in honor of our success. After morning PT, we marched back to NUMI in the sub-freezing weather developing ear frostnip and frozen sweat pants. It just so happened that our very first week of marching around base in early January in our UDT shorts and T-shirts with USN PT sweats over top was also the week that a frigid arctic storm descended upon the US plunging the temperatures to 10 degrees and below with a wind chill of 10-15 degrees. Anyways, a lot of mental roadblocks were obliterated that first week, and marching in sweats in sub-freezing weather really is not that bad.

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Day three was “pool day” starting with a 1000 yard bay-fin, followed by more physical torture and creative water instruction. On day four, we found ourselves on the grinder with an upper body workout devised by some PT fiend. By Day five, another pool day, nothing brutal was really surprising us anymore until halfway through the pool workout when we did 200 4-count air squats without stopping, talk about another mental barrier again obliterated. So for the next six weeks, Monday/Wednesday/Friday will be pool days and Tuesday/Thursday will be on the grinder.

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Morning PT was followed by multiple lectures in radiation basics and radiation health that will assist us in understanding the unique medical issues surrounding submariners in case we are assigned to a submarine billet. So week one is done, and week two has begun. More to come. Hooyah 109!

NUMI WEEK TWO

Ah yes, a three day weekend. My body needed this. Week two upped the ante on everything. Flutter kicks were with fins, sun gods (twirling your arms above your head, at your side, and in front of you) were while holding our fins, the reps were higher, and much more was required of us. On Wednesday, I felt like my body hit a wall, a feeling that was mirrored by most of the class and sensed by the instructors. Our motivation was not up to par, so the instructors went to work on us and quickly remedied our motivation. Whoever invented frog-hop burpees was a sadist, and two football fields later I was smoked, just in time for multiple 100 meter lunges spaced apart by backpedaling and jogging. Thursday started with a jog in formation down to the PT field. When one of the students messed up the running cadence we were ordered into road ranks (pushup position) while reciting Boyle’s law and singing the three stanzas of Anchors Aweigh as a class. Good thing we practiced together earlier that morning or we would have been there a lot longer. Then it was time for “Angie,” a Crossfit workout, that is typically 100 pullups, 100 pushups, 100 situps, and 100 air squats for time. But since we are UMOC 109, we each had the privilege of doing 109 reps of everything. Anecdotally, developing blood blisters underneath my calluses from the pullups was a first. Friday was pool day again starting with 1000 yard bay fin followed by lots of pool fun. An interesting addition to the routine was treading water as a class for extended periods varied by the instructors by having us hold our hands, elbows, and arms above the water. As much as it hurts during the morning workouts though, most of us later laugh and relish in the fact that we are getting paid to have an entire team of personal trainers dedicated to the honing of our physical conditioning. The more days go by, the more the instructors reveal that the workouts are designed for specific activities in dive school at which we must excel to succeed.

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Friday was our Radiation Health test over the material that we had been learning for the last two weeks. Yes, we are all doctors, so the educational stuff should be a breeze, but not having thought of physics, algebra, logs and natural logs in many years, it took a little dusting off the cobwebs before we got into a groove. But thankfully, we all passed on Friday and avoided the Academic Review Board. We also learned a lot of cool information about submarines, nuclear propulsion and weapons, and general Navy saltiness that will help us in our future assignments.

Earlier today, I headed to the local theater to watch Lone Survivor. Years ago I began reading war biographies and descriptions of current conflicts as an attempt to understand what our deployed servicemembers are experiencing. It was my way of contributing while being stuck here in the states for endless medical training. When it was first published, I wept while reading Lone Survivor and learning about the single largest loss of life in the Naval Special Warfare (NSW) community up to that point. More recently, I read Marcus Luttrell’s second book Service: A Navy Seal at War that described his return to the teams and subsequent deployment. It just blew my mind that he returned to operating as a SEAL after sustaining a broken back and femur and multiple other injuries in addition to the psychological trauma of having suddenly lost so many of his close friends. He is and will always be one of my few heroes, so out of duty to Marcus and to the fallen of Operation Red Wings, I wanted to see this depiction of those events. Other than shocking asystole, altering a few events, and adding details for cinematic effect Hollywood seems to have nailed it. Again, I cried a few times knowing that the horror on the screen was reality.

In August 2011, this horrible event repeated itself when another helicopter full of NSW operators responding as a Quick Reaction Force was shot down. I had just finished my first week of a four week rotation in the Basic Underwater Demolition / SEAL (BUDS) Medical Department, which also happened to be “Hell Week” for one of the SEAL candidate classes there. We had been treating that class daily and ensuring they were medically able to continue training until they finished Hell Week on Friday. Over the weekend, we learned the horrible news. That experience intimately revealed the reality these men face, and the gravity of my job as a medical provider to them. I am so thankful that my family can “sleep safely in our beds because rough men stand ready in the night to visit violence on those who would harm us.” Amazingly, via this unique training I may have the opportunity to medically support these men. There’s a little glimpse into the “WHY” of Undersea Medicine. Hooyah 109!

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NUMI WEEK THREE

It’s hard to believe we are halfway done with Phase One already. This week was a short week with the MLK holiday and then a “snow day” on Wednesday. Logistically, our class needs the gym, pool, and classrooms open with staff and instructors, so when the base shuts down or opens late, we get a snow day, something most of us have not experienced in years. On Friday, 109 passed another exam covering Radiation Control despite the shortened week. After the exam, a British exchange officer gave a very interesting lecture concerning submarine escape, a subject of renewed concern in the USN after the disaster with the Russian submarine Kursk in 2000. The week previous we toured the “Escape Trainer” on base, a 40 foot tower filled with water built in 2007 for training submariners to escape from a disabled submarine lying on the ocean floor. Submarines are equipped with “Steinke Hoods” and more recently with inflatable suits for the crew members to exit the sub through an escape hatch and shoot to the surface from depths greater than 600 feet. The newer suits offer thermal protection, buoyancy, air to reach the surface, a life raft, and the ability to reach the surface in less than a minute from incredible depths in a worse case scenario. Ideally, there would be enough time to rescue the crew with submersibles that dock with the submarine and then transport the crew to surface ships and decompression chambers if needed, but with a deteriorating and dangerous submarine environment the crew now has the ability and training to escape on their own.

Training is going as beautifully as ever. Thursday, due to the ridiculously low temperatures, the instructor staff elected to let us PT in the NUMI building instead of marching outside to the gym. To quote one of the chiefs, “It was a great day for Stairway to Heaven.” The “Stairway to Heaven” involves running to the top of three flights of stairs, performing one burpee, then running down a floor and performing one pushup, then running down a floor and performing one squat, then down to the ground floor for ten four-count flutter kicks. Then back up and increasing the reps to two, two, two, and twenty. We were to perform ten sets total, and halfway through we felt awesome, until we got up into the sixty four-count flutter kick range. Our last set was ten burpees, ten pushups, ten squats, and 100 four-count flutter kicks. The workout was not that bad except for the flutter kicks, which after 550 four-count flutters, our hip flexors were officially smoked. Friday was another pool day with a 1250 yard bay fin, sprints utilizing different strokes, various calisthenics, more water treading, and occasional instruction. In addition to improving our different swim strokes and fin, the instructors are preparing us for dive school by teaching us how to enter the water, surface correctly, perform underwater checks, and perform multiple other diver specific tasks.

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One diver tradition is the “buddy system,” something that is practiced in many other professions as well. In the dive world though, things can go very badly very quickly, and the buddy system is a huge asset for mitigating these risks. During our training time, we are required to do everything together as a buddy team including entering the water, surfacing, swimming laps, calisthenics after our laps, filling our water bottles, and even going to the bathroom. Early in our training, the class was penalized steeply when two guys ran to the bathroom and another followed instead of grabbing his own buddy. We have not made that mistake again.

Another tradition that is as old as the military is the strict adherence to uniformity, especially in the training environment. From day one, we were required to do everything uniformly as a class. We are required to always have uniform sources of hydration with uniform labeling, which resulted in everyone carrying around twenty ounce Gatorade bottles with our last names written with a Sharpie in a semi-circle around the top of the G on the cap. We also wrapped athletic tape around our gear (fins, masks, snorkels, dive bags) in the same location and direction and initialed the tape uniformly. We wear the same uniform daily, and when PTing we wear the same ankle high white socks, black spandex, UDT shorts, white t-shirt with our names sharpie stenciled on the front and back. In the cold we wear the same Navy PT sweatshirt and sweatpants, watchcap, and black gloves. When we march we carry our gear in the same hand. When we take our sweats off to PT, we fold everything uniformly and place it all stacked in a line at the edge of the wall. At the pool we fold our booties in half and insert them into our fins, then stack our fins upright with the heel straps toward the wall, the mask wrapped around the top fin with the snorkel pinned to the fin under the mask with the J hook facing to the left, and our water bottle to the left of the stack of gear. One pool day, our gear wasn’t perfectly lined up against the wall, so while we stood at attention dripping wet after the previous evolution, the instructor staff began separating our gear and tossing all the individual pieces into the pool. We were then instructed to retrieve all the pieces as a class and have it all assembled and organized perfectly at the edge of the pool within sixty seconds, an impossible task. We went over our time by ninety seconds and paid dearly. Again, lesson learned. Despite the inconvenience to the individual, uniformity in the military is one of the military’s great strengths. In our class when squared away, everyone is on the same page, doing the same thing, at the same time, and not much has to be said to get something done.

Tomorrow is another PST, and all our scores should improve significantly compared to the first week. Hooyah 109! Week four, here we come.

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NUMI WEEK FOUR

Most servicemen will understand the expression “Embrace the Suck,” especially those who have deployed or seen combat. Well, that expression could have been the motto for this week. Monday started with a PST, most passed, but curiously, some actually did worse. This may be due to the largely catabolic state that our bodies have been subjected to for the last month. Afterward, we again paid dearly for a variety of infractions. Tuesday and Wednesday were somewhat normal days, but Thursday we were once again in the suck. We started the morning with a brief pull-up pyramid of 5-4-3-2-1-2-3-4-5, and then for the workout of the day, we performed the “Murph” – a workout named after LT Michael Murphy, the Medal of Honor recipient and leader of the four man unit involved in the Operation Red Wings tragedy. The workout is performed for time and starts with a one mile run, 100 pullups (the instructor staff shortened to forty due to the previous pyramid), 200 pushups, 300 squats, and finishes with a mile run. This used to be one of LT Murphy’s favorite workouts which he performed while wearing his body armor, so we substituted a ten pound weight plate to carry with us throughout the workout. We then separated into dive buddies and began Murph. I was pretty motivated to honor one of my heroes, so my dive buddy and I pushed each other hard throughout the workout whenever the other was lagging behind. Then as a class, those who finished early all joined the last dive team to finish as a team. Hooyah 109! But then again, it was judgment time. The instructor staff “sensed” a lack of motivation in the class and felt we were not “putting out,” which mind-boggled me somewhat. So we again paid our dues. Friday was another pool day, and it was the general consensus that we were all physically smoked, which I believe the instructors realized near the end of the workout when they lightened up and allowed us to play an underwater version of rugby to finish out. At the end of pool day, one of the instructor’s stated that we are now done “building,” and will be switching gears into maintaining and preparing for dive school for the next two weeks.

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Academically, we learned more about USN radiation administration issues including protocols, forms, etc. We then spent two days in the Navy Pride and Professionalism course that everyone completes at a new command. On Friday, after the workout, we each presented a medical case scenario to the class for critique that we had prepared for use in the Independent Duty Corpsman (IDC) curriculum. IDCs play a unique and crucial role in the USN, working on subs, surface ships, and with NSW as nearly independent medical practitioners. They are senior enlisted Corpsman who undergo an intense year long school that prepares them to practice under the medical supervision of a UMO. So as UMO candidates, helping develop and expand the IDC curriculum is actually beneficial to our future as well since we will be overseeing and working closely with the IDCs. It was also refreshing to see everyone in their element again expounding upon medical things, since we are really medical doctors.

Each blog I try to relate something unique about our little world that others might find interesting, so this week it is the “mustache.” As 1970s and ugly as mustaches are, they are the “in” thing in the dive world and dive school. So, through intense peer pressure, all of the “UMOCers” are now sporting mustaches except for the one female candidate, we are still working on her. When I first broached the subject to my wife, I was threatened with all sorts of barbaric deeds and briberies, but she finally submitted, and commented the other day that it was actually growing on her slightly. We still have to keep it groomed and within USN standards, but it is the one patch of facial hair that we are allowed, so we are maximizing it.

Another tradition is watching submarine and dive movies together as a class. We finished Das Boot over the course of several sittings during the week when we had spare time, next is The Hunt for Red October. One of our classmates is a former sub officer and a talker, so we also got to listen to his running commentary which was almost as interesting as the script. He has also provided incredible insight into the submarine world over the last month as he contributes bytes of information to the lectures and shares sea stories during our breaks. Here we come week five. Hooyah 109!

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NUMI WEEK FIVE

True to their word, the UMOC instructors were a little kinder during PT this week, though they did reveal a new standard that none of us knew about – a three mile run in 24 minutes. An eight minute mile is not a fast pace by any stretch of imagination, but holding that pace for three miles does require some training and preparation. Because of the cold weather and nearly constant blanket of snow, 109 has not run much at all other than a few warmup laps on the indoor track and the 1.5 miles for our PSTs. On Tuesday, the class gazelles crushed the 24 minute benchmark but some did not, so an interval session was on the menu for Thursday to help the slower runners improve. One of the negatives of the winter UMO class is that we do not get to do much running compared to the summer class, but we get snow days, haha.

Once accepted to the the UMOC program around Christmas halfway through internship, we request either the summer class that starts the following July, or the winter class that starts in January a year later. When internship ends in June, the July class has a few weeks to move their household before reporting, but the January class begins a six month “stash” where each former intern is “stashed” at a nearby USN medical facility doing doctor things (usually primary care). Some in the winter class also get to attend a month long Military Tropical Medicine Course in July hosted at Walter Reed in Bethesda, MD, which was awesome. Then a portion of the class practiced a few weeks of true tropical medicine in areas of Africa and South America for a followup field session to the previous month of didactics. There are other differences between the classes mostly due to the weather including a different emphasis on running versus calisthenics as mentioned above, and a different ratio of outdoor versus indoor training. But otherwise, the classes are very similar, so the decision between the summer and winter class is usually made for logistical or family reasons.

On Friday, all but one of us passed the PST – a requirement to attend dive school in Panama City starting the next week. We followed this with 160 eight-count bodybuilders (a modified burpee), which was somewhat exhausting after maxing out on the PST. One of the tools of the instructor staff has been punitive eight-count bodybuilders. Whenever someone messes up or violates an established rule, the instructors assign an appropriate number of eight-counts, generally ranging from ten to forty at a time. We keep track of our accumulating eight-counts, and then we usually pay them off Friday afternoon before leaving for the weekend. Thankfully, we get to pay them off at our own pace as a class with an instructor proctor, so our breaks between sets are a generally longer than allowed during official PT. As painful as it was, it was nice to get our eight-count debt back to zero.

Well, tomorrow begins the last week of phase one. Crazy! Hooyah 109!

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NUMI WEEK SIX

During week six, we finally started reaping the benefits of our hard work. Monday was the last pool day and also the first time that everyone beat the 22 minute requirement for the bay fin. The instructors also kindly ended the workout early enough for us to hang out on the pool deck as a class and take pictures while enjoying the respite. On Tuesday, surprisingly we smoked the three mile run as a class with the last man finishing a good twenty seconds before the 24 minute allotted time. This was probably the most Hooyah moment of phase one due to the vast improvement over the week previous, and it also meant that we did not have to repeat the run on Thursday. On Wednesday, we all passed the PST again for the last time except for one student, the final requirement to be cleared for dive school. Wednesday night, we all had a class party at a local house celebrating the end of phase one and the transition to Florida for dive school. Thursday was our last snow day as the Northeast got slammed again from the Polar Vortex that has been hovering over the US and wreaking havoc for the last few weeks.

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Academically, during the last two weeks of phase one, we began learning the most important practical information for a UMO – physicals. As UMOs, it is vitally important that we screen personnel and only allow those who are physically, mentally, and medically fit for submarine or dive duty to get onto a submarine or dive. In the dive world, things can go very badly very quickly at depth, so there is an intensive screening process involved with multiple steps along the way to filter out those who may have problems in one of the most austere environments on earth. Likewise, submarines are also austere environments with limited resources and often delayed access to further medical intervention due to operational issues or remote locations. Often, IDCs have to “sit on” a patient (supportive management) in a submarine for days when the patient would usually get more advanced medical care immediately in any other environment. This consumes resources and occupies much of the IDC’s time when he has a plethora of other responsibilities. Also, a MEDEVAC could jeopardize an operation or the safety of the entire crew. So, generally only very healthy individuals are allowed into the undersea community to avoid these dangerous scenarios. Therefore, the UMO is responsible for safeguarding the medical readiness of the undersea community which ultimately advances the warfighting capabilities of the Navy.

On Wednesday, we had one of the coolest experiences of phase one, we toured the USS Missouri (SSN-780) – one of the Navy’s newest Virginia-class attack submarines. Without going into detail, it had some of the coolest and most technologically advanced systems I have ever seen. We were required to read Blind Man’s Bluff, a book detailing many incredible feats of USN submarines after World War Two during the Cold War. This book introduced me to the “Silent Service” and gave a me a profound respect for their heroism and amazing accomplishments. After reading this book, and then touring one of most quiet and lethal weapons of the deep, again, I was truly impressed by the dedication of some of our most under appreciated yet hardest working American servicemen.

On Friday, we officially finished phase one, and began meandering down to Panama City, Florida in caravans of cars and on airplanes, ready to begin dive school. Hooyah 109! Hooyah.

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NDSTC WEEKS ONE – TWO

After spending the weekend traveling to Panama City, and then enjoying the Presidents’ Day Holiday, UMOC 109 was ready to begin Dive School. We reported as a class in our Service Dress Blues (SDBs) to the Navy Diving and Salvage Training Center (NDSTC) quarterdeck on Tuesday sharply at 0600. We were joined by an Army Physician’s Assistant and two Japanese Medical Officers to complete Dive School Class 14-10-DMO (14 = 2014, 10 = class designator, the DMO = Dive Medical Officer). The rest of the day was the typical military check in rigamarole with an additional gear issue, gear labeling and organizing, shirt stenciling, and setting up our dive cage.

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The NDSTC is the “Diving Mecca” of the US military, and actually the “largest diving facility in the world.” There are 23 different courses offered here including our DMO course, so we interact with multiple other classes all in various phases in their training – 2nd Class Divers, EOD divers, Marine Engineering Dive Officers, Air Force PJs, Army and Coast Guard Divers, etc. The facilities are incredible and the amount of training opportunities endless, making it a perfect place to be a student. Each class is assigned a training team and formal introductions were made the first day. Our training team has one lead instructor who directs the course and multiple other instructors who all have extensive diving experience. It was evident immediately that we scored bigtime with an awesome instructor cadre, which was confirmed later by instructors from other training teams. Hooyah!

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Tuesday began with a PST which most of the class crushed after the long weekend and plenty of rest. After the PST, we headed to the pool for mask, snorkel, and fin orientation. We learned how to clear our masks underwater, then how to clear a snorkel upon surfacing from being fully submerged, and then we finished by finning a few laps around the perimeter of the pool “dolphining” (diving a few feet and then returning to the surface for a snorkel breath). Thursday began with a “Welcome to Dive School PT beatdown.” Our lead instructor just happens to be a PT stud – we discovered this quickly – and took us on a circuitous five mile running tour around the base at a ridiculous pace that was frequently punctuated with the class getting dropped into the leaning rest and punished with burpees and various other calisthenics for not performing satisfactorily. The training team also used this time to standardize every movement of the class and bring us together as a team in every imaginable way to the most minute detail. We also had the pleasure of getting “Wet and Sandy” – dunking in the bay and then rolling in the sand until we resembled sugar cookies – and then performing more calisthenics until the sand was chafing our thighs via our UDT shorts. We then ran to a nearby boat ramp and entered the chilly water again forming a floating circle around the instructors. While treading water – which we found remarkably easier in saltwater than freshwater – we recited various diving physics gas laws from memory that we had learned the previous day in class. Soon we emerged from the water and resumed what was eventually dubbed the “Death March” back to the grinder – an empty spot of parking lot adjacent to the NDSTC piers. While being instructed on how to enter and exit the water as a class from the piers, the bugle for morning colors sounded and we all came to attention for the national anthem. Treading water in a bayou while observing morning colors was a new, awesome experience which was completed with a resounding “Hooyah America!” from the class after the bugle’s “Carry On.”

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Later that afternoon was a Pool PT session with more treading, calisthenics, leaning rest, etc. Friday began with a 1000 yard bay fin in “Alligator Bayou,” another job sheet that must be passed before open water diving. We all passed the “bay fin” in the pool at NUMI previously, but learning to navigate without lane lines and close reference points in the bayou proved somewhat difficult. We immediately repeated the bay fin with everyone’s times improving significantly once we got a mental bearing, discovered usable landmarks, and buddied up with those who needed help navigating. The rest of the first two weeks continued similarly, with morning PT consisting of PSTs, bay finning, and “Death Marches” followed later in the afternoons with more Pool PT and instruction. Our afternoon treading sessions graduated to treading with fins, then we passed dumbbells around the treading circle, then the number and weight of the dumbbells progressively increased until we were doing weighted treading as a class for more than an hour. This was purposefully designed to prepare us for the In Water Proficiency testing (IWPs) of pool week that requires us to do our buddy checks and tread water while wearing all of our dive gear.

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Each day, after morning PT and showers, we headed to the classroom for didactics on various diving related topics. We began with Basic Diving Physics and Charting which included the theory and practical application of Archimedes Principle and the various gas laws that most of us have not thought about since the MCAT six to seven years ago. Additionally, we had lots of practice charting various dives. We all passed that test, then progressed to Basic Diving Medicine which focused on the Nervous, Respiratory, and Circulatory systems and all the various diving related issues – O2 toxicity and hypoxia, Nitrogen Narcosis, Air Gas Embolisms (AGE), Decompression Sickness (DCS, the Bends), Pulmonary Over Inflation Syndromes (POIS), CO2 toxicity, CO toxicity, near drowning, hypothermia, etc. We all passed again and then started learning about SCUBA operations in preparation for Pool Week.

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Pool Week is a three day evolution that introduces us to breathing off compressed air underwater and progressively advances us through basic SCUBA skills to “confidence training,” or pool hits. We started pool week on Friday and spent nearly the entire day either in the water or underwater – an excellent change of pace from the classroom. After obtaining all of our gear and performing preventive maintenance and function checks we were ready to begin. We started with ladder training, which sounds somewhat mundane but may be one of the most important evolutions. After exhalation and max inhalation, we descended the ladder to the bottom of the pool, and then made a gradual ascent at thirty feet per minute to the surface while pursing our lips and maintaining a constant gradual stream of bubbles. Once on compressed air, if a diver bolts to the surface or ascends too quickly without exhaling, he could experience a POIS with the worst outcome being an AGE, and possible death. So practicing these simple, basic skills can be life saving.

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After that we donned our SCUBA gear, entered the pool as buddy teams, and headed to the shallow end where we practiced breathing underwater, clearing our masks and regulators, buddy breathing, and then finned a few laps around the deep end of the pool for an “orientation dive.” Next, we started “Ditch and Don” procedures in the deep end. At the pool bottom, we removed our gear in a specific order, took a last breath of compressed air, and then made a gradual ascent to the surface with the instructor “Safety Swimmer.” After reporting to the dive supervisor, we dove back down to our gear, began breathing off our regulator, then donned the rest of our gear in reverse order while performing our five-point checks. We then moved on to In Water Proficiencies (IWPs). For IWPs we again entered the pool as buddy pairs with SCUBA gear on, performed our buddy checks, and then treaded water for a minute before inflating our life preservers and finning to the shallow end.

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Once everyone reached the shallow end, we began “Pool Hits” – the evolution that usually generates the most anxiety. Each student fins down to the deep end and swims in a big square while looking at the pool bottom and waiting for “the hit.” An instructor dives from the surface and “imposes” a twenty second hit that includes ripping off the mask and regulator, removing fins, undoing straps, and generally throwing the student around the bottom of the pool. After the hit is imposed, the instructor signals the student by tapping him on the head, and the student goes to work problem solving. The first step is to retrieve the regulator and begin breathing again, then the student cycles through his five-point checks – air, reserve, strap, strap, strap. Each hit is graded and observed by the safety diver who is directly adjacent to the student with air if absolutely necessary. Later the hits are made more difficult by the instructors turning off the air and tying the regulator hose in knots behind the students back. The most important points are for the student to never panic, never lose his tanks, and to always secure his air first – since we as humans suck at breathing underwater. After each student received two light hits with most passing both hits, we called it a day and began cleaning and storing all of our gear. And so ended week two and the first day of Pool Week. Hooyah UMOC 109, Class 14-10-DMO!!!

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NDSTC WEEKS THREE – FOUR

Week three of dive school was chock full of win. We started it off early Monday with back to back bay fins with four other classes which made for an epic fiasco in the water and only a few students passed due to multiple in water collisions while competing for a perfect line between buoys. The buoys are set 250 yards apart, so two full laps will complete the 1000 yards, but any variance off a straight line between the buoys quickly adds yardage and decreases the likelihood of making the 22 minute standard. And colliding with students from other classes further decreases the likelihood of passing. Thankfully we had a chance to redeem ourselves Tuesday morning. With fewer classes and a staggered start time, all but one in the DMO class beat the 22 minutes on the first bay fin. Our lead instructor put us back on the line immediately and said that if we all passed the second bay fin that it would be our official graded bay fin. Honestly, I was a little skeptical since we were all gassed, but everyone put out and the last DMO candidate passed the final buoy at 21:50, just in time. There was a chorus of “Hooyahs!” as the last group finished, another hurdle passed. We were pretty motivated since each student is required to pass the bay fin before open water diving, and it also meant that we graduated to more enjoyable PT sessions. The next day’s PT was an orientation to functional fitness style workouts and Olympic lifting; we were so jazzed to throw on some weight and leave the endless repetitive calisthenics behind. Thursday was was an interesting workout, it included four rounds of a 500 yard swim with fins (freestyle or sidestroke), 25 kettlebell swings, and 25 burpees for time. Friday, we performed another “Crossfit” style workout with multiple sets of deadlifts, goblet squats, single-legged Romanian deadlifts, running, and carrying kettlebells up and down multiple flights of stairs. The next week was much of the same with more swimming workouts and varied functional fitness workouts with different exercises added each day. We were all glad to have graduated from the beat-down make-you-want-to-quit workouts to the more enjoyable, high-intensity, building muscle mass and improving cardio endurance workouts.

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Before and after our morning PT sessions during pool week, we were busy with Preventive Maintenance Service (PMS) of all the dive equipment. PMSing – appropriately named – the equipment is a vital component to the beginning and end of each day, and ensures the reliability and proper functioning of life preserving equipment. The last place you want to figure out that your regulator or buoyancy compensator has a problem is when you are underwater depending on their functioning to stay alive. Each piece of equipment is inspected for visible defects and then function checked following a regimented, checklisted process. As detailed, lengthy, and annoying as this can be at times, I am very thankful for this attention to detail and emphasis on safety in the USN dive community.

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Each day after the preliminary morning PT and PMS, we got right back into pool week from where we left off the day before. On Monday, we resumed individual light hits and by the end of the day we had finished all the “single” moderate hits. Each student is required to pass three of each of the light, moderate, and heavy hits to continue in pool week for a total of nine satisfactory individual hits. Each hit is “imposed” by a “safety swimmer” who is snorkeling above the student on the surface like a shark searching for prey. The safety swimmer is allowed twenty seconds to administer the hit before swimming back to the surface and leaving the student to “problem solve.” A “safety diver” is on standby for the entire hit with a regulator ready in case the student needs air or gets hit on an exhale. Each student is required to fin around the deep end staring at the pool bottom waiting for the inevitable moment, an experience that can be anxiety provoking.

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Often, the first sign of the hit is having the regulator ripped from your mouth, so some students – with variable success – devised breathing techniques to avoid losing their air supply at the end of an exhale when there is no more air in the lungs. The hit then continues with various pieces of equipment being ripped off and the student being steamrolled in all directions and bouncing off the pool bottom. The end of the hit is signaled by either the safety swimmer’s twenty second alarm sounding, a pat on the head, or a few moments of solace – the signal to “go to work.” The student must then immediately sit down on the pool bottom and attempt to retrieve his regulator via various techniques. Once the regulator is retrieved, inserted, purged, and the student is breathing, he must cycle through his five-point checks – air, reserve, strap, strap, strap – before passing the hit successfully. Once completed, the safety diver inspects and then informs the student whether or not he passed. If counseling is needed the pair ascend to the surface and talk over what went wrong. If the student passes, he continues on his way along the pool bottom again waiting to be preyed upon from above.

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With moderate hits the instructor can also turn off the air supply, and with the heavy hits the regulator can be “fouled.” It turns out that fouling a regulator is somewhat of an art form that includes various knotting techniques that wrap the regulator hose around the manifold and one technique called “the thong” that traps the second stage of the regulator between the bottom of the two tanks. Generally, fouling a regulator makes it unretrievable and the student must remove the tanks from his back following a specific process before the regulator can be unfouled and the student can breathe. This requires a lengthy breathhold and quick problem solving, but some of the students found the heavy hits to be enjoyable due to the challenge. The instructors also enjoyed spicing up the process by swimming in front of the students and flashing their stopwatch before starting the hit, or counting down with their fingers. Or occasionally the safety divers would distract the students by playing rock-paper-scissors while the safety swimmer snuck up from behind – something we found humorous after the fact when we finished inhaling water.

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Once the individual hits were completed, we transitioned to buddy hits which basically involved the same process except now with a dive buddy and both divers getting hit at the same time. This required extra coordination and occasional buddy breathing, but in the end we all finished and passed. Pool hits are officially termed “Confidence Training,” and all the students escaped the week with an improved ability to troubleshoot the equipment while under water, under duress, and without air. The pool hits, while mentally traumatic, are designed to simulate a current tossing the divers into various objects while under water – a likely eventual scenario for any diver. By working through this scenario multiple times in a controlled environment initially, it greatly increases the likelihood of survival in what could be a deadly situation underwater if not handled correctly. By Wednesday afternoon, there was a collective sigh as the entire class completed pool hits successfully.

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On Thursday, we moved over to the “New Pool” – a forty foot deep pool with a crane for lowering various training props and moveable grates to increase or decrease the depth of the pool bottom. We finally graduated to real buoyancy compensators and oriented to the new equipment with a pool dive. Then we underwent rescue diver training and each student simulated an unconscious diver for their dive buddy who then went through the process of correctly retrieving the diver from the pool bottom. And thus ended pool week, one of the more memorable weeks of training we had during this course.

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On Friday of week three, after PT, we headed back to the classroom to learn about various techniques of underwater searching including “Circle Line Searches” and “Jack Stay Searches.” On Monday and Tuesday of the next week, we practiced these two techniques as buddy pairs in twenty feet of muddy, murky zero-visibility water on the bottom of Alligator Bayou searching for a body (a dummy) and an M16 (a dummy rifle). These two techniques are basically an organized way of searching a specified area and involve the dive team swimming in a grid-like pattern or in a incrementally enlarging circle. We learned very quickly that it sucks to be searching for something when you can not see your hand in front of your face. But we also learned that the task can be accomplished through teamwork and by following a well designed pre-dive plan. After fumbling through the searches and occasionally finding what we sought, we understood what one of the instructors stated matter-of-factly: “As a Navy Diver, it’s always dark, it’s always cold, and it’s always far away.”

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On Wednesday, we got kitted up early in the AM on one of the Dive School’s 133 foot Yard Diving Tenders (YDTs) and headed out for some open water diving, but due to the wind and weather the dive was cancelled and we returned to NDSTC. The weather foiled our open water plans again on Thursday, so we dove off the side of the moored YDT and received more rescue training. The instructors used this time to teach different techniques for retrieving an unconscious diver from the water via a Rescue Strop, a Miller Harness, or carrying the diver up a ladder. We then practiced on each other, some simulating DCS pains and others an unconscious diver with the rest of the students responding appropriately medically and hurrying the victim to the onboard decompression chamber.

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Friday of week four was an epic day of epicness. We loaded our gear into two small Rigid Hull Inflatable Boats (RHIBs) and headed out to sea for some open water dives. These boats were incredibly fast so we reached the first dive site – The Red Sea – within 30-40 minutes. Half the class dove first while the other half tended and prepped. We descended the buoy line 60-70 feet where we first saw the “Red Sea,” an old tug boat that was sunk a few miles off the coast in 2009 to serve as an artificial reef. Visibility was 30-40 feet for our dive, which is great for that site according to a few of the instructors. After rounding the sunken vessel and observing the marine life including one goliath grouper hiding in the cabin we returned to the surface and switched out. We then headed to the second dive site (Stage 2 – piece of an old Navy platform in about 60-70 feet of sea water) and repeated the process. On the ride back to NDSTC with the sun shining, salt spray, and wind whipping, I couldn’t help but think about the awesome opportunity we found to be dive docs. And all the hard work is finally paying off. Hooyah 109! Hooyah 14-10-DMO!

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NDSTC WEEKS FIVE – SEVEN

Well, I spoke too soon. Monday of week five started early with a “Death March,” with the terminology having now evolved to “Death Run” for a more accurate representation. We were running with another class due to instructor manning issues and one of the other students committed a serious infraction during the sprint. So we were led to a remote concrete pad behind an old Navy building and subjected to calisthenics torture including eight-count bodybuilders and flutter kicks. Our lead instructor whose pace we are required to match in these Death Sprints did every rep with us though, and also led us in 100 four-count flutter kicks unbroken to prove the point that he will never require something of us that he himself cannot do. Again, another huge WIN for our training team. The rest of the week we performed more “Crossfitesque” workouts which most of us are loving.

Friday, after the typical morning workout, we were led by the instructor staff on a run to the “Back Forty” of the Navy base to “Thor’s Playground.” Thor’s Playground is a small patch of sand nestled in a small jungle of palm trees and underbrush with various objects for torture/exercise available for those so inclined. At Thor’s Playground, we organized into different groups and were instructed to somersault to one end of the playground, bear-crawl back, then sprint to the other end. We did the same thing again racing, except this time we were instructed to retrieve our class shirts from the back of the instructor’s truck that none of us had noticed until that moment, then perform the same evolution again with our new shirts before finishing. It was humorous watching our fellow classmates roll around in the sand clumsily like drunks after the somersaulting, and then awesome to see each other in the blue and gold having graduated from the white stenciled T-shirts. With the new blue and gold T-shirts also came a heightened level of responsibility and respect. Hooyah!

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Week six and seven continued with more Crossfit and running workouts with the addition of new swimming workouts in the pool. On Friday of week seven, nearly the entire command performed the Training Officer Challenge, a nearly monthly event when warmer weather allowed. We divided into groups of four and pushed through the approximately five mile run while carrying one sandbag per team and performing various calisthenics at stations along the way. The fastest team finished with a time of 49 minutes, and most teams were done by 70 minutes. This was a blast because of the Hooyah! team aspect, but it was also brutal with nearly no rest during the entire high intensity hour long workout.

After morning PT, week five was spent in the classroom learning about decompression dives and all the various nuances involved. Previously when learning SCUBA, we planned every dive to be a no-decompression dive. No-decompression dives are shorter dives after which the diver can ascend straight to the surface at the established ascent rate of thirty feet per minute without stopping for decompression. Decompression dives are longer in duration and due to surpassing the “no-decompression” time limits, the diver must make decompression stops at various depths during the ascent to allow the dissolved inert gases to “off-gas.” Because water is much more dense than air, the pressure exerted on a diver increases rapidly as he descends in the water column, with as much pressure being exerted by every 33 feet of sea water as is exerted by the entire atmosphere. Due to this elevated ambient pressure underwater, gases (nitrogen, oxygen, etc.) dissolve into a diver’s tissues at much higher levels than seen on surface, and the deeper the diver goes the worse it gets – the more he “on-gases.” Also, the longer he is at depth, the more he on-gases until his tissues reach equilibrium. If that same diver were to ascend straight to the surface like a no-decompression dive, his tissues would become supersaturated due to the decreasing pressure and the dissolved inert gases would come out of solution and form bubbles in various tissues causing some variant of decompression illness – more commonly known as “The Bends.” But if that same diver ascends slowly making decompression stops along the way, his tissues would off-gas in a much more controlled fashion – thus avoiding the Bends, and all of the subsequent associated medical problems. Learning to perform decompression dives safely by following the Navy Dive Tables and the Dive Manual is vitally important for all Navy Divers since many missions require extended periods spent at depth.

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Thursday and Friday of week five were spent orienting to the Mark 20, Mark 21, and KM-37 surface supplied diving systems. Surface supplied diving is much different from SCUBA in that your air is supplied by a hose from the surface, rather than from a tank on your back. This has enormous advantages for Navy Diving including a practically unlimited air supply and communications with the surface, but it does sacrifice the portability, maneuverability, and low maintenance of SCUBA. Surface Supplied diving, also referred to as “hard-hat diving,” is considered by most Navy Divers to be true Navy Diving.

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On Monday of week six, adhering to the tried and true Navy “crawl, walk, run” method, we started surface supplied diving in the pool. After a few days of becoming accustomed to the new gear, operating the communications and console, and learning to perform in-water emergency procedures we moved to the Pier Side Support Building (PSSB) to begin diving in the bayou. We spent the rest of the week searching the murky bottom of Alligator Bayou for a “lost rifle” and performing “hose stretches” – their term for just diving the rig, walking it out, and returning.

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On Monday and Tuesday of week seven, we headed out on the YDT for open water diving. A few miles offshore, the Captain found a flat spot of sand in about sixty feet of sea water for us to dive. Surface supplied diving off the YDT is similar to diving off the poolside or pier, except now with the addition of a stage – a large metal framed “elevator” operated by a crane that transports the divers up and down in the water column. Each dive team had a chance to dive, with the other classmates following the “Dive Bill” and performing all the other operations that are necessary for a successful surface supplied dive – comms, logs, console, tenders, wire man, etc.

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We all dove the KM-37, a hard yellow helmet made of fiberglass, metal, and other materials weighing 28 pounds. The air hose and comms connect directly into the hat which has a built in regulator similar to a second stage SCUBA regulator. Each diver wore a single SCUBA tank on his back as an Emergency Gas Supply (EGS) in case the air supply from topside malfunctioned. We also wore wetsuits for thermal protection, and weighted boots that allowed us to walk on the ocean floor. After riding the stage down, setting on bottom, and exiting the stage, it was a phenomenal experience to move out onto the ocean floor – it looked and felt as if we were moonwalking in near zero-gravity. So our playful, experimental, and youthful traits emerged and gave way to handstands, cartwheels, ocean floor eight-count bodybuilders, and any other shenanigans that we could imagine. Walking on the ocean floor wearing the KM-37 was literally one of the coolest things I have ever done in my life, and unfortunately it had to end as we returned to the YDT. These dives concluded the actual diving portion of the nine week course, but it was a beautiful, sunny, and very fitting closing day as we basked in the warmth on the deck of the YDT during the return to NDSTC.

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Wednesday and Thursday of week seven were spent in the classroom orienting to the Mark 25 and Mark 16 – rebreather rigs used by Naval Special Warfare and the Explosive Ordnance Disposal guys. Unfortunately, we only were able to familiarize ourselves with these rigs on the surface and did not have the chance to dive them – something that should change in future classes. On Friday, we started the hardcore medical portion of the course, the time that we as medical providers learn to operate as true DMOs and fill our niche in the dive community. Hooyah 14-10-DMO!

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NDSTC WEEKS EIGHT – NINE

Weeks eight and nine continued with the same morning PT routine including running, swimming, and Crossfit style workouts. Our lead instructor had mentioned earlier in the course about potentially performing outside the box “fun” PTs, something that sounded interesting, but also mildly intimidating. On Thursday we showed up early and began PMSing our UDT vests (life preservers) and organizing our wetsuits, booties, fins, and goggles. When the instructor team arrived, we piled our gear into two Zodiacs and lined up in formation in our UDT shorts, blue and golds, and running shoes and then we headed off on a mile mile interval sprint into the “back forty” past Thor’s Playground and onto Ammo Pier. The support small boats were arriving at the pier via the water as we arrived by land. After retrieving and donning our gear, we all entered the water and began the one mile open water swim following our lead instructor back to NDSTC. As one of the mediocre to slower swimmer’s in the group, it was quite a bit of work to keep up with my dive buddy and the class. But if you are ever having difficulty smoothing out certain swim strokes in the pool, just go and swim a mile or two, you will figure it out.

On Monday of week nine, we did our typical show up at 0530, march to NDSTC, change out into our PT gear, line up on the grinder, and stretch in formation as we waited for the instructors. By this point, we had developed a method educatedly guessing the morning workout by watching for the number of instructors and what clothes they were wearing. When the entire instructor cadre emerged wearing running shorts and instructed us to load our med gear/backboard into the bed of a truck, we began suspecting bad things. When we noticed our lead instructor carrying a tube of lube that is generally used for checking rectal temperatures in hyperthermia, we feared the worse. Then we were off on a run that took us outside the front gate of the base and over the Hathaway Bridge connecting Panama City Beach to Panama City. Thankfully, it was only a six mile run at a not too strenuous pace that ended back at NDSTC. The last workout of Dive School was another two mile run and one mile swim evolution, which was a pretty cool way to go out.

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Intellectually, weeks eight and nine included the training that would truly make us Dive Medical Officers. In the classroom, we sat through many more dive medicine lectures that really dove deep (pun intended) into the background, theory, diagnosis, and management of dive related illnesses. As doctors, we were back in our comfort zone, but unfortunately, we were finished with the diving of dive school. We became Navy Divers first, and then were molded into Dive Medical Officers. During these two weeks, the most informative and helpful training evolutions were the chamber shams. These were scenario based evolutions where one student enact a script and specific dive related injury, the other student would be the dive doc and attempt to diagnose and treat the illness appropriately. Often these resulted in the injured diver being taken into the chamber and pressed to depth on a specific dive table and for a specific time as prescribed by the dive doc. Since many of the dive diagnoses are tied intimately to the dive profiles and conditions experienced undersea, having trained as divers immersed in that environment assisted phenomenally in our competence as physicians. After more training, we all completed a final exam and the class passed in flying colors.

Having completed all of the dive and medical training, we graduated as a class, packed our gear and began the trek back to Groton, Connecticut for phase three of the UMO course. Hooyah 109! Hooyah 14-10-DMO!

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