In Water Recompression (IWR)...death invited?

[amascuba]

I don't really think that in water recompression is a death trap. In some instances it may be the only valid option.

The U.S. Navy Manual list the procedures for IWR, as does the TDI Decompression Procedures book.

http://www.gue.com/Expeditions/Norway05/norway-dcs.html - This is a pretty good report of one IWR incident.

 

[limeyx]

I thought they still chiseled their words out on rocks.

They have rocks now?

 

[muddiver]

Ok, so you are not doing a Table 6 , but you still have to deal with the loss of body heat. I doubt that any of you dive with a hot water suit and even in a dry suit you start to lose alot of heat underwater after a long period. The treatment you are pointing out in the USN is :60@30, :60@20 and :60@10 on O2. That's 180 minutes, or 3 hours of diving without surfacing. Not exactely a SCUBA routine if you ask me.

Also the USN states:

"21-4.2 In-Water Recompression.

Recompression in the water should be considered an
option of last resort, to be used only when no recompression facility is on site and
there is no prospect of reaching a recompression facility within 12 hours. In an
emergency, an uncertified chamber may be used if, in the opinion of the Diving
Supervisor, it is safe to operate. In divers with severe Type II symptoms, or symptoms
of arterial gas embolism (e.g., unconsciousness, paralysis, vertigo,
respiratory distress, shock, etc.), the risk of increased harm to the diver from inwater
recompression probably outweighs any anticipated benefit. Generally, these
individuals should not be recompressed in the water, but should be kept at the
surface on 100 percent oxygen, if available, and evacuated to a recompression
facility regardless of the delay. To avoid hypothermia, it is important to consider
water temperature when performing in-water recompression."

 

[Saturation]

Just finished reading an article (or at least most of the article on In water re compression.) Obviously we are tought that this is a no no, except possibly with the correct training and when diving remote locations, BUT, from the studies discussed it appears to me as if the benefits of IWR have been ignored or at least downplayed?

It is FACT that administering 100% oxygen topside is more beneficial than taking the diving down to a pre-determined depth (30ft in this article) and applying treatment via a full face mask? Not sure what im asking here, but rather just thinking out loud.

Jay

http://www.bishopmuseum.org/research/treks/palautz97/iwr.html

IWR can be done safely under specific conditions. It is recommended only for technical divers, as its methods are extensions of in-water decompression procedures.

Just as DCS is not one disease, but a spectra of different diseases, the confusion, as exemplified by the discussion on this thread, is where the cutoff for treatment begins.

Commercial and military diving often have little use for IWR as dive regulations often require fully capable chambers in dive operations. In rare instances, such as in SEAL operations or SpecOps, there may be a need for IWR in deep infiltration operations.

In general, IWR is often adequate, and done frequently under-the-table by many seasoned cave divers, for joint bends or less. It has been often mislabeled as extending deco, but once symptoms begin and a return to the water is done, it is IWR.

It is riskiest in any form of neurologic bends because the patient must cooperate with treatment and follow directions, and if consciousness is impaired in any way, it is difficult to monitor status even when fully supervised underwater as a tenderer is part of the protocol.

In risky conditions, its used as a last resort.

Edmunds has described the Australian protocol very well.

 

[Gene_Hobbs]

My top pick for more reading on IWR is the UHMS workshop. It covers techniques from Aust, Hawaii, USN and NOAA.
Kay E, Spencer MP (eds). In Water Recompression. 48th Undersea and Hyperbaric Medical Society
Workshop. UHMS Publication Number RC103.C3. Kensington: Undersea and Hyperbaric Medical
Society; 1999; 108 pages.

Available from DAN for $20.00 or we have one copy listed in the Gear/ Equipment Classifieds for best offer.

Several papers have been written on the subject for South Pacific Underwater Medicine Society (SPUMS) Journal. SPUMS Journal abstracts can be found in the Ovid SPORTDiscus database (NOT in PubMed/ MEDLINE) and may only be available to search through a library. SPUMS sells their journal on CD for Aust $25 to members and Aust $90 to non-members. They plan to release volumes 1 to 35 soon so it may be worth the wait.

This is also a topic of discussion for the 2008 DAN Technical Diving Conference

 

[Kaikoa]

I have seen IWR used on several occasions with complete success (no symtoms upon surfacing). I beleive time of treatment is a big factor. It depends on how long it will be before the bubbles can be removed. IWR = immediate relief of symptoms, chamber= delayed relief of symptoms.