In-Water Recompression, Revisited

[Kay Dee]

For the record, and from the horses mouth (or arse, depending on your point of veiw) as it were.

I have been bent twice in a 30 plus year diving career. The first not to serious but still requiring a long chamber ride. The second was a very different beast altogether as it took place at a rather remote location, where the nearest hospital was maybe ten hours away, and was very serious, with the onset of the symptoms starting about five minutes after coming out of the water and within ten minutes both my legs becoming paralysed to the extent of not be able to stand up, or walk unaided without being ‘carried’ between two people.

Hence, given the seriousness of the situation, I insisted on performing ‘in-water recompression’ then and there, and was thus carried back into the water to start the procedure.

Having myself treated other divers by this method in remote locations (the XXXXX XXXXX in the mid-nineties for instance) using my own ‘professional standard’ in-water recompression kit (i.e. full face mask, surface communications to treated diver, tethered treated diver harness with treated divers depth controlled from the surface as per the timing of the recompression tables, etc.), I knew the drill well.

So I ran an in-water recompression treatment on myself (using open circuit 100% oxygen and the timings, or a slightly abreviated version thereof, that I remembered from previously studying the ‘Modified Australian In-water Recompression Tables Method), although without all the above mentioned safety accessories (as they were not available to me at the time), but with another two divers rotating in and out of the water to keep watch over me.

Three and a half or so hours later I walked out of the water and other than taking six weeks off diving on a doctor’s subsequent advice (which in retrospect I somewhat regret, as I now think that duration was somewhat excessive) I was not much the worse for wear (or sillier, than I was before, although some of my friends may debate that). After that six week break I went back to diving very regularly (and deep) and thankfully have stayed 'bend free' as it were ever since.

As a matter of fact I was actually told ‘off the record’ by the same hyperbaric doctor who advised me to take the six week break, who himself professionally 'frowned upon' in-water recompression, that if I had not done it and had taken even a couple of hours to reach a chamber, it would have been too late and I would have probably, he said almost certainly, been paralysed for life. And that folks, is not a good thought!

So I am a very big believer in IWR (and have helped carry it out on others several times since my own 'incident' in the 90's) as a first choice rather than a second, IF the bend is serious enough and you, or your companions, know what they are doing, and you know /accept the risks involved. It's your choice, but me I am going for it should the beast ever rear its ugly head again, and I'm just glad it saved me, and later some of my colleagues.

On the other hand, I also know of another diver who, many years ago, made an uncontrolled ascent from a deepish dive (on a CCR), did not take the IWR option, but waited for a chopper to airlift him to a chamber, and subseqently spent several years in a wheel chair, and I think maybe now he is only able to walk, more or less, with the aid of a cane / walking stick.

Now, on another topic altogether, I'm not sure just how to respond to the poster who was belittling my friend Mr Gilliam for the conduct of a dive way back when, and / or his drinking habits, so I'll let it slide for the moment. But I'll eventually think of something, no doubt. ;-)

Safe diving to all!!!

 

[Duke Dive Medicine]

Kay Dee, thank you for sharing your story. The pitfall of prognosticating an outcome like the physician did for you (i.e. you'd have been paralyzed for life if you hadn't performed IWR on yourself) is that that was a very individual, hypothetical prognosis. We have seen numerous divers over the years who've come in hours after developing significant neurological deficits, and who recovered fully. Divers should not take your story as a mandate to perform IWR for severe neurological DCS. The point that you were trained, experienced, prepared, and used an established protocol, cannot be overstated. Also, the original point of the thread remains, which is, to call attention to a dangerous practice, make an alternative recommendation, and invite debate. Thank you again.

Best regards,
DDM

 

[Akimbo]

Also, the original point of the thread remains, which is, to call attention to a dangerous practice, make an alternative recommendation, and invite debate.

Is IWR the dangerous practice or diving great distances from a chamber? Once you elect to dive hours or days away from treatment you have to make the conscious decision to choose the option that sucks the least. The sad part is too many divers don't think about it at all rather than making the conscious decision.
IMHO, IWR sucks less IF DCS is correctly diagnosed AND your are properly prepared. Emphasis on the "if" and "sucks less".

 

[victorzamora]

Is IWR the dangerous practice or diving great distances from a chamber? Once you elect to dive hours or days away from treatment you have to make the conscious decision to choose the option that sucks the least. The sad part is too many divers don't think about it at all rather than making the conscious decision.
IMHO, IWR sucks less IF DCS is correctly diagnosed AND your are properly prepared. Emphasis on the "if" and "sucks less".

I think that DDM's reference to "dangerous practice" was IWR following dangerous protocols. This thread started in reference to an article advocating dangerous IWR protocols and procedures. It seems like it was started to bring awareness to the current recommendations for IWR as opposed to the more dangerous practices advocated in the original article.

In the OP, DDM states that it is their official (and personal) opinion that IWR has its place.

 

[Kay Dee]

Also, the original point of the thread remains, which is, to call attention to a dangerous practice, make an alternative recommendation, and invite debate. Thank you again.

Sir, while l agree that a Table 5 performed in-water may be considered dangerous by some / many I do not accept per se that IWR of itself is dangerous when performed correctly.

That being said, and while I would not expect ANYONE else to agree with me, I would not wait hours for treatment of a neuro hit, if immediate IWR was an option. But thats just me, and my experience of seeing // knowing that in my experiences the odds and outcome appear to favour IWR in many cases.

On the other hand if serious symptoms developed say the next day, or once ashore near a reco chamber, I certainly would not be looking for the nearest body of water to perform IWR on myself!

Anyway, I do not want to offend or get into an argument with you or anyone else on the mater, I just know what works, works.

 

[Akimbo]

@victorzamora

It depends on how you define a dangerous protocol. Where on the risk continuum does DCS begin? Diving deeper than 20'? Repeds in less than 130'? Diving the Doria? Rebraethers at 400'?

There is no question that TRYING to avoid getting bent is always Plan A. But what is Plan B when you get bent anyway? What is the decision matrix? We have one for OOA, but very few divers have one for DCS. My matrix goes something like:

• Skin bends an hour from a chamber? Sit on deck breathing O2 while heading for shore.
• Joint pain 12 hours from a chamber? I'd be at 20' sucking off the green bottle.
• CNS hit one day from a chamber? Kiss my butt goodbye.
• Same scenario with a crew well prepared for IWR? Suck O2 as deep as the crew will take me... what's the risk compared to the alternative?

Like I said, what sucks less when Plan A fails.

 

[victorzamora]

@victorzamora

It depends on how you define a dangerous protocol. Where on the risk continuum does DCS begin? Diving deeper than 20'? Repeds in less than 130'? Diving the Doria? Rebraethers at 400'?

There is no question that TRYING to avoid getting bent is always Plan A. But what is Plan B when you get bent anyway? What is the decision matrix? We have one for OOA, but very few divers have one for DCS. My matrix goes something like:

• Skin bends an hour from a chamber? Sit on deck breathing O2 while heading for shore.
• Joint pain 12 hours from a chamber? I'd be at 20' sucking off the green bottle.
• CNS hit one day from a chamber? Kiss my butt goodbye.
• Same scenario with a crew well prepared for IWR? Suck O2 as deep as the crew will take me... what's the risk compared to the alternative?

Like I said, what sucks less when Plan A fails.

And it sounds like DDM is simply trying to propose using a good/safe IWR protocol to combat DCS when necessary....not using a published protocol deemed dangerous. I think it's fairly clear that DDM is FOR IWR but opposes the way it was proposed in that article....and I think that's what matters. PlanB shouldn't be "Follow sketchy guidelines that increase my chances of death"....it should be "Follow good IWR protocols to help me suffer from this DCS hit as little as possible."

 

[victorzamora]

Sir, while l agree that a Table 5 performed in-water may be considered dangerous by some / many I do not accept per se that IWR of itself is dangerous when performed correctly.

That's my understanding of what DDM stated.
BAD IWR protocols = BAD.
GOOD IWR protocols = GOOD when necessary.

I believe (and it is Duke Dive Medicine's position) that in-water recompression has its place [...] However, the procedure and recompression profile advocated in the article place a diver at grave risk of serious injury or death and should not be attempted.
[followed by links to safer IWR protocols]

 

[Kay Dee]

OK, I'll be blunt; i.e. with no other option, no chamber available within hours say, and the extremely fast and crippling onset of symptoms I myself experienced, I'd rather take what is deemd a 'bad IWR protocol' as opposed to the high possibility of being a cripple the rest of my life. But thats just me.

 

[Akimbo]

And it sounds like DDM is simply trying to propose using a good/safe IWR protocol to combat DCS when necessary....

It was never my intent to imply otherwise. My objective was to provide a perspective that would encourage divers think much more seriously about their plan if they do get bent. Too many recreational divers fuss endlessly about the length of their hoses, checking gauges, and backup gas supplies but ignore that 800 Lb gorilla in the room... DCS.

I would never dive without a chamber onboard and a crew to support it if I had the financial resources. I would actually go farther by saying "good/less dangerous to combat DCS" protocol. Getting bent without a chamber starts as dangerous.