Why not treat DCS yourself?

[WetSEAL]

The other thing you're not taking into account is that your PO2 levels are going to have increased from your dive you just did....so it's not simply just grabbing an O2 cylinder and diving in to "table safe depths and times"

Yes, but that's what I've been saying all along I've stated repeatedly that the table of safe depth and time for breathing O2 would have to be based on an estimate of your current nitrogen loading from your previous dive(s).

This statement is not correct

Yeah, I get it, if your dive profile says you exceeded NDL time then you call your stops "deco stops" and if you don't think you've exceeded NDL time, then you may still do an optional deco stop for safety which most people call a "safety stop" for short...but it's the same thing. The nitrogen bubbles in your blood don't know if you've arbitrarily decided to call it a "safety stop" or a "deco stop," but the effect that the stop has on any nitrogen in your blood is the same no matter what you call it.

Whether or not you've exceeded NDL limits based on some heuristic algorithm, there is still some nitrogen in your blood, and the act of stopping and breathing for a while before ascending the rest of the way gives the nitrogen bubbles in your blood time to escape more slowly, reducing the risk of DCS.

WetSeal, I hope that you listen to some of the voices in this thread and don’t just look for confirmation wherever you can find it to “win” an Internet argument. The idea that IWR is always preferable over CT is an oversimplification and potentially dangerous.

I didn't create this thread to push a pre-determined position. I never said IWR was better than hyperbaric therapy....I pointed out that based on the explanations I've received, it seems in illogical and unsafe recommendation to NOT do IWR in some situations. I asked people why IWR should not be done. I've been reading your posts but I don't feel that you've been answering that question at all. You've simply been repeating the same recommendation that I knew from the start, "that it's not recommended" without giving any explanation why, or addressing the evidence that I'm pointing to which suggests IWR appears a safe option in some circumstances. I'm not saying it is, but if you're going to disagree, please provide evidence to back it up instead of just telling me to listen to those who know better...because in my experience, that's how myths are promulgated.

 

[KeithG]

...

Whether or not you've exceeded NDL limits based on some heuristic algorithm, there is still some nitrogen in your blood, and the act of stopping and breathing for a while before ascending the rest of the way gives the nitrogen bubbles in your blood time to escape more slowly, reducing the risk of DCS....

.

Safety stop vs decompression stop. They mechanically "look" the same, but they are not. You are confusing the act of stopping with the actual effect of the stop.

An analogy (maybe not a very good one?) could be thinking that eating your first hamburger of the day will have the same consequences as eating your 15th hamburger of the day. They are the same action, but you are in a very different situation.

 

[doctormike]

I didn't create this thread to push a pre-determined position. I never said IWR was better than hyperbaric therapy....I pointed out that based on the explanations I've received, it seems in illogical and unsafe recommendation to NOT do IWR in some situations. I asked people why IWR should not be done. I've been reading your posts but I don't feel that you've been answering that question at all. You've simply been repeating the same recommendation that I knew from the start, "that it's not recommended" without giving any explanation why, or addressing the evidence that I'm pointing to which suggests IWR appears a safe option in some circumstances. I'm not saying it is, but if you're going to disagree, please provide evidence to back it up instead of just telling me to listen to those who know better...because in my experience, that's how myths are promulgated.

Sure. I thought that had been explained adequately in this thread, but possible risks of IWR include:

Oxygen toxicity
Loss of consciousness underwater due to DCS or seizure
Thermal stress
Lack of ability to aggressively hydrate
Delay of medical care in general if the diagnosis is incorrect (e.g. pulmonary barotrauma, stroke, immersion pulmonary edema, etc...)
Worsening of the diver's condition if the diagnosis is incorrect (e.g. pulmonary barotrauma, stroke, immersion pulmonary edema, etc...)
Risk to the support divers

Again, we are probably in agreement that IWR should be done in SOME situations. Very few people would say that it should never be done, so that's a straw man. The devil is in the details.

 

[boulderjohn]

I'm not seeing how the situation of missing a deco stop and going back down to repeat it is significantly different from the scenario I was brought up in the original post, which is a person who is starting to experience mild DCS symptoms (ie, skin rash or mild joint pain) but is still fully in control. In both cases, the diver is in control, has too much nitrogen in their system, and we know that going back down is a way to get rid of that nitrogen...so why not do it?

A person who is showing no signs of DCS is considerably different from a person showing mild signs of DCS. Mild signs of DCS can progress, and they can progress quickly. If no signs progress to mild signs, then you have changed categories and should act accordingly.

A friend of mine surfaced after missing some stops (the circumstances would take several paragraphs), and soon after surfacing, he started to show mild signs of DCS. While he was still in the water, people assisting him from a boat put him on O2 from his decompression bottle and brought him to shore. Once on shore, he was able to assist in getting his gear off and preparing for his evacuation. He started to show stronger symptoms as they prepared to leave. A few minutes after they left, the paralysis from the waist down set in. It would not have been good for him to be going through those stages under water. Perhaps if they had had the equipment needed for truly effective IWR, it might have been different, but they did not have that.

...and a safety stop is the exact same thing as a decompression stop,

Others have pointed out that this is not true, but I will pile on. A safety stop is an extra measure of caution, with the key word being "extra." The algorithm being used says that the diver is not at risk if no stop is performed, but the diver does one anyway. With a deco stop, the algorithm says that a diver will be at significant risk for DCS if the stop is not performed. That stop is not "extra."

 

[100days-a-year]

So I have learned....
" If I don't have the knowledge to do this it must be impossible or freakishly dangerous and no one else can either "

This sounds vaguely like PADI concerning nitrox or mixed gas a few years ago.

 

[MaxBottomtime]

What I have learned is that if I don't have the knowledge to do this either seek the knowledge or don't do it. It's not necessarily dangerous but could become dangerous if I place blind trust in others.

 

[doctormike]

So I have learned....
" If I don't have the knowledge to do this it must be impossible or freakishly dangerous and no one else can either "

Where did you learn that?

 

[boulderjohn]

So I have learned....
" If I don't have the knowledge to do this it must be impossible or freakishly dangerous and no one else can either "

This sounds vaguely like PADI concerning nitrox or mixed gas a few years ago.

Boy, I don't know where you got that. It sure looks to me like the main message of this thread is that IWR can be a good decision under the right circumstances, but it should only be done under those circumstances and should be done in accordance with established procedures and with the right equipment.

 

[KeithG]

Boy, I don't know where you got that. It sure looks to me like the main message of this thread is that IWR can be a good decision under the right circumstances, but it should only be done under those circumstances and should be done in accordance with established procedures and with the right equipment.

Any idea (or guess) on what percentage of dive ops will have the proper equipment? The LOBs we use do have O2 onboard but that is about it...

 

[boulderjohn]

Any idea (or guess) on what percentage of dive ops will have the proper equipment? The LOBs we use do have O2 onboard but that is about it...

It would be pretty rare for a dive operation to have it, because it is pretty rare for a dive operator to need it. Most are within close enough proximity to proper treatment that IWR would not be a good option.

I think someone who is diving in a remote location where access is extremely limited should strongly consider investing in both the equipment and the training. Where I do most of my diving during the year, some people in the past have both brought IWR equipment and used it. I have decided against it. I am 2 miles from a hospital, and although it does not have a chamber, it has the ability to get someone to one in a reasonable hurry (and that has happened as well.)

I mentioned the Opal Cohen case earlier. In that case, she was close enough to a chamber, but the captain made the questionable decision to wait for the other divers to surface, so her treatment was greatly delayed.