PADI Divemaster vs TDI Extended Range

[Thalassamania]

IWR is NOT a "drawn out version of omitted deco."

Omitted deco is a non-symptomatic diver returning to the water and using an enhanced deco schedule to get back to the surface.

IWR is a symptomatic diver returning to the water and using an treatment table to get back to the surface.

 

[rjack321]

IWR is NOT a "drawn out version of omitted deco."

Omitted deco is a non-symptomatic diver returning to the water and using an enhanced deco schedule to get back to the surface.

IWR is a symptomatic diver returning to the water and using an treatment table to get back to the surface.

Maybe in your mind. To me, they are merely symantic distinctions between how long you have been out of the water and how symptomatic you are. Both use more deco than might have originally been called for. Omitted is typically 1.5x the original while IWR may or may not use an official "treatment table". In many cases the latter is not occuring with medical direction and the gases and equipment needed to follow one of the few official IWR table are not available. Yet it is attempted anyway, go figure.

 

[dab]

I am not sure if this is a question or a comment, but it grates on me slightly have two such opposite viewpoints in circulation.

I think one has to keep in mind the target audience. PADI is teaching the recreational diver who may likely have a limited amount of gas remaining, in a single tank, and little or no understanding of decompression theory. TDI is teaching a Technical Diver and the diver likely is diving a set of doubles, with some remaining gas reserve and a basic understanding of decompression theory.

 

[Thalassamania]

Maybe in your mind. To me, they are merely symantic distinctions between how long you have been out of the water and how symptomatic you are. Both use more deco than might have originally been called for. Omitted is typically 1.5x the original while IWR may or may not use an official "treatment table". In many cases the latter is not occuring with medical direction and the gases and equipment needed to follow one of the few official IWR table are not available. Yet it is attempted anyway, go figure.

Not in my mind, that's the specification of the those who developed the tables. Symptomatic vs asymptomatic are not semantic distinctions, they are specific observations of a patient's condition. If anyone has trouble telling the difference I recommend that they take a field neurological exam course. Recompression, in-water or in a chamber, without a specific treatment table and plan is, at least to my way of thinking, pretty sketchy.

 

[rjack321]

Not in my mind, that's the specification of the those who developed the tables. Symptomatic vs asymptomatic are not semantic distinctions, they are specific observations of a patient's condition. If anyone has trouble telling the difference I recommend that they take a field neurological exam course. Recompression, in-water or in a chamber, without a specific treatment table and plan is, at least to my way of thinking, pretty sketchy.

I know the field neuro exam. But that only addresses certain types of symptoms. In the case of omitted deco people can progress to symptomatic in short order or even after redescent (although its less unlikely). Symptoms can also be confused with other conditions (e.g. hypothermia) and even under the best controlled conditions its often difficult for a hyperbaric physician to decide whether a symptom is due to DCS or something else.

IWR itself has been developed by trial and error and there are very few IWR treatment tables. Some being too complicated or risky for the equipment or conditions at hand. The fact is that many documented patients of IWR did it successfully with minimal understanding of deco and without even using oxygen nevermind following a published protocol. (which may have helped them avoid O2 toxicity)

It is also interesting (and somewhat disturbing) to note that
none of the divers included in this survey were aware of
published methods of IWR (i.e. all were ÅØinging it?
inventing the procedure for themselves as they went along)
and all had used only air as a breathing gas.

pg 157 from: Rubicon Research Repository: Item 123456789/6083

So for all practical purposes someone omitting deco and presenting with mild symptoms is likely to be better off redoing a bunch of deco either per an established "omitted" protocol or per an IWR treatment table isn't particularly important. Very few patients get worse by trying.

Obviously you need to be smart about it and not use 100% O2 at a PPO2 of 2 for an hour without a FFM, etc.

 

[muddiver]

You know, if you had bothered to read the original question posted you would not be making an a** of yourself going off on a tangent about treatment protocals and IWR.

--Diver off bottom.

 

[Thalassamania]

I know the field neuro exam. But that only addresses certain types of symptoms. In the case of omitted deco people can progress to symptomatic in short order or even after redescent (although its less unlikely). Symptoms can also be confused with other conditions (e.g. hypothermia) and even under the best controlled conditions its often difficult for a hyperbaric physician to decide whether a symptom is due to DCS or something else.

Then you know what symptoms are, that's the first decision point and you proceed from there. If someone is on the omitted deco path and becomes symptomatic then they must be shifted to a treatment path.

IWR itself has been developed by trial and error and there are very few IWR treatment tables. Some being too complicated or risky for the equipment or conditions at hand. The fact is that many documented patients of IWR did it successfully with minimal understanding of deco and without even using oxygen nevermind following a published protocol. (which may have helped them avoid O2 toxicity)

pg 157 from: Rubicon Research Repository: Item 123456789/6083

So for all practical purposes someone omitting deco and presenting with mild symptoms is likely to be better off redoing a bunch of deco either per an established "omitted" protocol or per an IWR treatment table isn't particularly important. Very few patients get worse by trying.

Obviously you need to be smart about it and not use 100% O2 at a PPO2 of 2 for an hour without a FFM, etc.

IWR was not "Developed" developed by trial and error, it was "MacGyvered" repeatedly by people who got themselves into bad spots and had no other hope of a way out.

Treatment tables are treatment tables regardless ot the compression source. As far as the choice between redoing a bunch of deco and adopting an IWR protocol ... those are radically different approaches and call for dramatically different levels of equipment support.

I am not opposed to IWR, not by any stretch. I reviewed Rich's article for aquaCorps before it was published and I have provisioned National Science Foundation Research Vessels for IWR.

My real point is the Omitted Deco is a routine problem that is handled with a routine solution but that can progress to DCS, while IWR is an emergency solution to a potentially life threatening medical issue, DCS, that is best handled by proper planning and practice.

Sorry for the tangent, I just thought clarification was critical. Here's my bashful :mooner:ss.

 

[rjack321]

You know, if you had bothered to read the original question posted you would not be making an a** of yourself going off on a tangent about treatment protocals and IWR.

--Diver off bottom.

Well I imagine that omitted deco is discussed by many instructors for different agencies. Whereas IWR is not, or rarely is. DSAT being an arm of PADI probably has a fairly scripted "book" answer (to both) that I would be curious to know. However nobody here has coughed it up, maybe its one of the few discretionary areas of their program.

 

[muddiver]

I would be interested to know as well if any programs, including PADI/DSAT, provide any IWR guidelines. I usually dive using the U.S.N. tables because they offer the flexability to switch to the Std. Air Tables when I get close to or blow the No "D" tables. Therfore I would have the option of a IWR, if I had the gas, the surface support, warm water, etc.

 

[Thalassamania]

I would be interested to know as well if any programs, including PADI/DSAT, provide any IWR guidelines. I usually dive using the U.S.N. tables because they offer the flexability to switch to the Std. Air Tables when I get close to or blow the No "D" tables. Therfore I would have the option of a IWR, if I had the gas, the surface support, warm water, etc.

Me too, or I use my ancient EDGE or SKINNYDIPPER computers that are Navy based so I can calculate a usefull repetitive dive group.