You are redefining IWR for the sake of a better argument???? IWR does NOT have to be "diagnosed, life threatening"
In context with the article referenced on this thread. Did you read it before joining the discussion?
Example:
The extent and severity of the DCS symptoms are also important factors. Whether or not mild DCS symptoms (i.e. pain-only) should be treated is not certain. One perspective is that such symptoms are not likely to leave the diver permanently disabled, and thus the risks associated with attempted IWR would not be worth taking. Furthermore, individuals with such symptoms are prime candidates for "making a bad situation worse" (as was demonstrated in Case #10).
Conversely, the risks of submerging severely incapacitated divers might override the potential benefits of IWR when serious neurological manifestations are evident. Edmonds (1993) recommends against the practice of IWR in situations "where the patient has either epileptic convulsions or clouding of consciousness."The death of the two divers in Case #3 might have resulted from drowning due to loss of consciousness from severe neurological symptoms...
...The immediacy of recompression may be particularly advantageous if DCS symptoms develop soon after surfacing from a deep dive, and when these symptoms are neurological and "progressive" (sensu Francis, et al., 1993). Under such circumstances, the condition of the DCS victim can rapidly degenerate, and permanent damage may ensue in the absence of immediate recompression. However, it is also particularly critical in these circumstances to monitor the condition of the treated diver with a tender close by.
We all know that once DCS symptoms start- they can and often do take a progressive route. That being said - ANY TIME you have a diver with symptoms grab another bottle of O2 and head back under the boat, you are participating in IWR.....If those symptoms are skin rash, sore shoulder, or completely paralyzed........doesnt matter - your still participating in IWR the second he/she hits the water and heads back down.
Yes...it
can be progressive. Which, to me, indicates observation and neurological examination before a decision is made. Pyle agrees...
Further to that, the article and other documents on the subject do overwhelmingly suggest that IWR is risky. That risk has to be balanced against the DCS threat to the diver. Risk of death underwater via complications has to be balanced against the risk presented by DCS. Severity of DCS has to be gauged before a sound course of action is determined.
The key point of note:
DCS can be progressive. IWR is potentially indicated if DCS is actually progressive (and neurological).
Non Symptomatic omitted deco - different story - BUT, once omitted deco results in a symptom and you decide to head back under the boat - its IWR any way you cut it.
Ok... agreed. I've seen it refered to as 'informal' IWR, at best.
In the context of the article however,
formal IWR is presented as a do-or-die potential resolution, with definite risks, when no other resolution is feasible within the timescale for likely death or severe disability.
Again...reiterating the point that IWR presents known and severe risks...and that Pyle et al consider the decision process leading to potential IWR to be based upon a formal risk versus reward decision. Risk of death from IWR should be balanced against risk of death with no other treatment feasible.
BUT - dont kid yourself. Once symptoms start and you decide to head back in - you are taking the same risks.
Agreed. It's a serious decision to make. That's why I am attempting to differentiate between what the article states...and what some thread participants (not you) seem to be imagining.
From wikipedia:
Although in-water recompression is regarded as risky, and to be avoided, there is increasing evidence that technical divers who surface and demonstrate mild DCS symptoms may often get back into the water and breathe pure oxygen at a depth 20 feet/6 meters for a period of time to seek to alleviate the symptoms. This trend is noted in paragraph 3.6.5 of DAN's 2008 accident report
Having this conversation and trying to pretend that the debate is only applicable to SEVERE cases, is counter intuitive, since by its very nature - most of the field practiced (albeit it dangerous or not) IWR - is an attempt to stop symptom progression from non life threatening to something more serious.
In one case, we have divers jumping back in because of a 'twinge' etc, with no further though. In the other case, we have a period of observation, a neuro-exam, before
progressive can be diagnosed. Once
progressive is indicated... and victim deterioration is readily predictable... then we have a case for IWR.
As
Pyle states:
"This method differs from other published IWR methods in several respects. First of all, it includes a 10-minute period breathing 100% oxygen at the surface prior to re-entry into the water. This period allows for assessment of conditions as to whether IWR is appropriate, and provides a brief test to indicate whether surface oxygen alone will be sufficient to resolve symptoms".
Sorry if I didn't make it clear. That's what I was trying to communicate..
