Bob3
Contributor
Does anyone here dive in areas that are so remote that they would benefit from having the latest info on IWR procedures?
In Water Recompression
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SeaJay
Contributor
I've never done it, but I've studied it at length... And I've seen the statistics on it.
If I was bent, you'd have to hold a gun to my head to keep me from doing an IWR. Only if I was completely out of gas would I consider staying out of the drink.
Hawiian for me, please.
If I was bent, you'd have to hold a gun to my head to keep me from doing an IWR. Only if I was completely out of gas would I consider staying out of the drink.
Hawiian for me, please.
I've never understood why this is a strick no no with most training agencies.
If you aren't cold and you've got the gas is this not preferable to hanging out dying on a boat and couldn't this buy you more time before a chopper came to take you to a chamber? IE: Get back down with a monitor diver and some gas while they call for help.
Curious.
If you aren't cold and you've got the gas is this not preferable to hanging out dying on a boat and couldn't this buy you more time before a chopper came to take you to a chamber? IE: Get back down with a monitor diver and some gas while they call for help.
Curious.
SeaJay
Contributor
The way I understand it, it boils down to the fact that DCS is an injury. If serious enough, it can lead to shock. And nobody wants to tell an injured diver who's body is going into shock that it's best to go scuba diving at that moment. They don't think that you and I are smart enough to pull it off anyway. 
...But as far as I know, IWR has lead to nearly as much trauma as standard, dry hyperbaric treatment.
I found a couple of interesting articles on the subject not long ago. Thought I'd share:
http://www.bishopmuseum.org/research/treks/palautz97/iwr.html
http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=47
...But as far as I know, IWR has lead to nearly as much trauma as standard, dry hyperbaric treatment.
I found a couple of interesting articles on the subject not long ago. Thought I'd share:
http://www.bishopmuseum.org/research/treks/palautz97/iwr.html
http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=47
d33ps1x:
Its not a strict no-no, most tech agencies have IWR in their literature and better instructors do go over it. IWR is serious and must ONLY be attempted with the proper setup, it is not a prophalactic either, IWR should only be considered if there is a long delay to a hyperbaric facility...Recent studies also show that pain only bends not treated withing 8 hours leaves detectable permanent damage to cartilage and bones.
The 3 most important points are
1) must have a full face mask (you Will be breathing 100% oxygen at atleast 30fsw (some techniques require deeper)) and enough oxygen to complete the schedule. At 30fsw the po2 is 1.9
2) have a safety diver with the injured at all times
3) the diver must be at total rest and depth controlled by someone else.. this means the diver is sitting on something and is lowered/raised by the surface..
There are lots of other issues but the above illustrates why it shoulnd be attempted lightly.
rmediver
New
I think a big part of most agencies making a strict no policy was liability and history.
Folks would go back down on air and finish thier tank off after getting a hit and think it would in some way help. Of course if any change at all normally symptoms would worsen. This is what some people still think of when you mention IWP
It has already been correctly stated that when a proper procedure is followed and planned for it is a safer option than a long surface wait...
Jeff Lane
Folks would go back down on air and finish thier tank off after getting a hit and think it would in some way help. Of course if any change at all normally symptoms would worsen. This is what some people still think of when you mention IWP
It has already been correctly stated that when a proper procedure is followed and planned for it is a safer option than a long surface wait...
Jeff Lane
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Bob3:
I'm a pretty big supporter of IWR. I think the nay-sayers basic concern is that of training and proper equipment. Proper IWR is not simply a matter of jumping in the water. If performed improperly you can easily do more harm than good.
If you dive in remote areas, I would take the time to seek out some expert training on IWR techniques. Unfortunatly you will probably have to leave the country to find someone capable and willing to train you on this.
The common method for IWR is called the "Australian Method." Here is a good description of the proceedure:
http://www.fullcave.com/REMOTEDIVING.htm
As you can see proper IWR can require over 3 hours of O2 so having enough on hand is likely to be a factor.
James
In remote locations, IWR may be the only method available to prevent death or severe injury, and therefore it is valuable knowledge. BUT...I can think of one good reason most agencies don't teach IWR. LIABILITY! An insurance company may have issues with IWR.
Even in the controlled environment of a hyperbaric chamber, things don't always work out the way one hopes, and in a chamber a specialized doctor supervises treatment. IWR drops the victim--alone or with a buddy--back into an uncontrolled environment on whatever gas mix you happen to have available. You cannot accurately monitor symptoms. You can only control pressure by going deeper. The situation has great potential for a negative outcome. Most agencies will not take on that kind of liability. It's much easier to say "get the diver to a chamber." Sure, the diver may die while en route to the chamber. But IWR is not a treatment sanctioned by the gurus and doctors, so agencies probably will not be held liable for not teaching an unorthodox treatment. It's kind of like a doctor not be held liable for malpractice because he didn't prescribe an herbal remedy to a patient.
I suppose in thoery, part of a team's equipment would include the necessary equipment to perform IWR if doing decompression diving, so a team would be prepared for that possibility.
The statistics from the Hawaiian divers look impressive. But there are some unanswered questions: how severe was their DCS hit? How many of those divers would have recovered without treatment? The divers could have been suffering from very mild DCS, but we'll never know.
Also, decompression theory involves a bit of voodoo and faith to begin with. We don't have entirely accurate models. We have some good ones, but they're not perfect. IWR involves guesswork, too. So the problem is compounded--treating an injury that resulted from diving an inaccurate model with a remedy developed on the fly. Yes, I know that's how dive tables were developed, but the Navy had recompression facilities on hand for such operations. And yes, I know that deco stops on the way up are a prophylactic form of IWR. But a preventative measure and treatment of a manifested condition are two separate issues.
Furthermore, how long do you all think it would take some newbie to blow his profile thinking that a quick round of IWR could fix his problem? Like it or not, whatever happens in the tech world trickles down into the recreational world through the miracle of the internet and the other media.
Moreover, the environment will dictate whether IWR is plausible or even possible. And IWR is treatment of a serious medical condition. I have to wonder whether it is within a layman's realm of understanding to correctly diagnose the severity of DCS hit and prescribe a treatment. That's called "the practice of medicine" last time I checks. I think that the decision tree leading to IWR may have too many branches to make it "safe" to teach from a liability standpoint.
Under the right circumstances I'd do it and advocate it. But I tend to be fairly conservative, and I'd be a hard sell most of the time.
Even in the controlled environment of a hyperbaric chamber, things don't always work out the way one hopes, and in a chamber a specialized doctor supervises treatment. IWR drops the victim--alone or with a buddy--back into an uncontrolled environment on whatever gas mix you happen to have available. You cannot accurately monitor symptoms. You can only control pressure by going deeper. The situation has great potential for a negative outcome. Most agencies will not take on that kind of liability. It's much easier to say "get the diver to a chamber." Sure, the diver may die while en route to the chamber. But IWR is not a treatment sanctioned by the gurus and doctors, so agencies probably will not be held liable for not teaching an unorthodox treatment. It's kind of like a doctor not be held liable for malpractice because he didn't prescribe an herbal remedy to a patient.
I suppose in thoery, part of a team's equipment would include the necessary equipment to perform IWR if doing decompression diving, so a team would be prepared for that possibility.
The statistics from the Hawaiian divers look impressive. But there are some unanswered questions: how severe was their DCS hit? How many of those divers would have recovered without treatment? The divers could have been suffering from very mild DCS, but we'll never know.
Also, decompression theory involves a bit of voodoo and faith to begin with. We don't have entirely accurate models. We have some good ones, but they're not perfect. IWR involves guesswork, too. So the problem is compounded--treating an injury that resulted from diving an inaccurate model with a remedy developed on the fly. Yes, I know that's how dive tables were developed, but the Navy had recompression facilities on hand for such operations. And yes, I know that deco stops on the way up are a prophylactic form of IWR. But a preventative measure and treatment of a manifested condition are two separate issues.
Furthermore, how long do you all think it would take some newbie to blow his profile thinking that a quick round of IWR could fix his problem? Like it or not, whatever happens in the tech world trickles down into the recreational world through the miracle of the internet and the other media.
Moreover, the environment will dictate whether IWR is plausible or even possible. And IWR is treatment of a serious medical condition. I have to wonder whether it is within a layman's realm of understanding to correctly diagnose the severity of DCS hit and prescribe a treatment. That's called "the practice of medicine" last time I checks. I think that the decision tree leading to IWR may have too many branches to make it "safe" to teach from a liability standpoint.
Under the right circumstances I'd do it and advocate it. But I tend to be fairly conservative, and I'd be a hard sell most of the time.
:doctor:
IWR has been reported to have made the difference in recovery of a DCI diver. Especially with proper follow up medical care. The risk here is that you may not have sufficient gas supply and other medical considerations and complications that may develope. It is best to arrange for immediate transport to a chamber. Usually we are not so remote that a med-evac chopper can't be able to pick the DCI diver up. I hope you never come accross this problem
IWR has been reported to have made the difference in recovery of a DCI diver. Especially with proper follow up medical care. The risk here is that you may not have sufficient gas supply and other medical considerations and complications that may develope. It is best to arrange for immediate transport to a chamber. Usually we are not so remote that a med-evac chopper can't be able to pick the DCI diver up. I hope you never come accross this problem
Charlie99
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