In Water Recompression

[pipedope]

could benefit from the information.

Unless you have a chamber on site, that is the diver can be in the chamber in 20 minutes, then you should either have a chamber with you or be ready to do IWR.

This pretty well brings *most* wreck divers into the mix.

Say you are 20 miles off shore, even with a chamber equipped hospital right on the beach it is going to take an hour to get someone to the chamber and that is if there are no problems getting a chopper going.

My personal bias is toward having a chamber and a DMO on site but IWR is far better than nothing.

 

[Bob3]

I have a copy of the latest procedure (Pyle method) for IWR, was going to post it but the board uploads are set at 200kb instead of the 2 mb file size as stated. (its a 280kb file)
My rootings around have found that IWR was "commonly" used in Hawaii & Australia to the extent that 2 of the IWR procedures carry their names.
Richard Pyle (from one of SeaJay's links) has slapped those techniques together & come up with what looks to be a pretty comprehensive application.
The current line of thought is with more & more divers becoming proficient in more complicated gas switchings & use that the same knowlege can be applied towards IWR for those instances where a chamber may be hours (or days) away.
If I can upload the paper here I'll do it, otherwise I'll use one of my commercial accounts.
Here it is, reprinted & used by permission of the author (Richard Pyle) & publisher, UHMS (Undersea Hyperbaric Medical Society): : http://www.angelfire.com/ca/divers3/IWR.pdf

 

[SeaJay]

NP

 

[BigJetDriver]

I think a big part of most agencies making it a strict "no-no" policy was liability and history.

Folks would go back down on air and finish their tank off after getting a hit and think it would in some way help. Of course if there was any change at all it would be that normally symptoms would worsen. This is what some people still think of when you mention IWR.

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

Jeff has hit the critical points here. When you are making decisions affecting somone's life and future well-being, you had best be able to articulate exactly why and how what you did was in the best interest of your patient. Using any procedure that is controversial, and/or not well established in the field can lead to some serious liability concerns, even if the patient consents.

This is not to say that the procedure does not have its uses, or that it is not valid. On the contrary, if you have the PROPER equipment, the PROPER training, and the PROPER conditions, it can be extremely valuable.

Given the above conditions, the next step is the Risk / Benefit Analysis. A LOT of variables must be taken into account. Some of the more obvious considerations are the distance to the nearest chamber in terms of transport time, and the condition of the patient. Some of the less obvious are any real-world difficulties in communication in order to obtain advice, and transport. Also, the running estimate of progression of the afflicted diver's symptoms will affect the balance of your decision making process.

With the complexity of the decision-making process, the practical problems of applying the procedure, and the liablity concerns, it should be absolutely NO surprise that the Recreational Scuba agencies will not touch the subject, and you can't really blame them.

To paraphrase Mr. Natural: "Get the right tools and training for the job, kids, and DON'T TRY THIS AT HOME!"

BJD

 

[pipedope]

Is that IWR is not needed unless you are doing significant staged deco diving.

The bends suffered by divers within the NDLs are not likely to be life threatening and you can take more time getting to treatment. In fact many are not recognized for several hours.

In the normal recreational diving area people are not likely to be trained, equiped or prepaired to do IWR. Doing it 'off the cuff' might help, hurt or make no change at all. Like the rest of the things we do in diving the chances of good outcome increase with the amount of preparation and practice.

Hey, if I am going to dive somewhere that a chamber is days away I will want both a chamber onboard AND be rigged to do IWR.

 

[rmediver2002]

Here is a report of a successful IWR case off of NJ last month. It looked initially like it was just execution of a missed deco procedure after a diver surfaced with 22 minutes of missed deco, but since the diver had symptoms, it was really IWR.

Charlie

I am curious what protocol was being followed?

The report cited shorter stops as the diver was ascending, this is niether IWR nor ommitted "D" protocol.




On another note it would seem even within this discussion there is some difference in opinion as to what IWR is and what ommitted decompression is...

IWR - In water recompression protocols are methods of conducting recompression treatments on divers that require treatment when there is no chamber available...

Ommitted "D" - If you can get the diver back down to the depth of the missed stop within five minutes you can continue decompression mutiplying the stops above 40 FSW by 1.5 times, if the interval exceeds five minutes then (Navy protocol) is to perform a treatment table five for an asymptomatic diver and treatment table six for symptomatic divers...



There is a big difference between in water recompression treatments and returning the diver to the depth of the missed stop to complete his decompression.




One big issue in determining whether or not either of these procedures will benefit the diver is to determine if the injury is DCS related or POIS (AGE). One of my biggest issues with this type of procedure is that the person supervising the treatment must be at a very advanced level of understanding as far as symptom recognition and treatment...

As you can see proper IWR can require over 3 hours of O2 so having enough on hand is likely to be a factor.

Yes an no... The procedure could be done with a 100% O2 re-breather (this is going to require a more creative system for switching gas than a simple surface supplied system would) in the event the casualty has an O2 hit. On the subject of O2 hits, it would be much safer to outfit your system with at a minimum a full-face mask rig and communications to monitor the casualty as well as the in water tender.

One "K" cylinder would normally be adequate for this procedure.

Again this is something that must be planned for not conducted off the cuff...


Jeff Lane

 

[SeaJay]

In the normal recreational diving area people are not likely to be trained, equiped or prepaired to do IWR. Doing it 'off the cuff' might help, hurt or make no change at all. Like the rest of the things we do in diving the chances of good outcome increase with the amount of preparation and practice.

That's part of the problem, I think... Not having the "right gear" to do the procedure.

Let's say that a diver is out on a boat... Maybe it's offshore Savannah, GA... 20 miles or so. And he dives, blows his deco and misses 25 minutes of decompression. He has an equipment malfunction or an OOG, and finds himself at the surface when he shouldn't be. He's not yet showing signs of DCS.

What would you do?

I'd grab more tanks and put myself back underwater - symptoms or not.

There's no doubt that in these types of situation (anywhere that deco is planned), O2 should be on the boat. In fact, it should be on the boat no matter what sort of diving you're doing. But I've been on boats where it was supposed to be there, and wasn't... And I've been on boats where the O2 was available only as a positive pressure EMT mask... Nothing designed to work underwater. So, what then?

Some say, "Lifeflight." Sure, that's true... But the nearest chambers are Charleston and Jacksonville - both of them at least an hour flight, and the chopper won't get there for at least one hour. And this isn't a "faraway" place... This is offshore Savannah!

Me? I'd be in one place... Underwater, with the best gas I can find for the job. Period.

Depending on the situation severity, I'd be calling USCG for Lifeflight, too... But I wouldn't lay on the deck waiting for the chopper to get there...

...So what would I advise a friend to do? Well... Jumping back in the water to do any sort of IWR is really taking your life into your own hands. Like so many other things, it can have dire consequences... Or it can save your life. So I wouldn't recommend a buddy to do anything - I'd simply point him/her to some sources so that they've got some idea of the best ways to perform IWR with whatever equipment they have, and for whatever reason. After they've got some ideas, then they can make their own decision.

...Since I am a rescue diver by profession (volunteer), I'm already familiar, and would do IWR in any situation that I was involved in.

And that's what I would recommend - education. Then practice. Close your eyes and do the procedure in your head so when the fit hits the shan, you can perform.

 

[SeaJay]

There is a big difference between in water recompression treatments and returning the diver to the depth of the missed stop to complete his decompression.

That's a really great point... And there's a lot to that:

What I'm talking about is not true IWR... What I'm talking about is missed deco. But that's sorta the point... If you can treat the problem as "missed deco" and not have to actually treat it as "IWR," then you're better off anyway.

And avoiding IWR in place of missed deco procedure is why I believe that time is so much of the essence... And why I would take the situation into my own hands.

In a case where, eight hours after diving I am symptomatic of DCS, I'd head to the hospital - not attempt IWR.

But missed deco I'd treat as missed deco. And I'd much rather treat missed deco than DCS (IWR).

 

[Bob3]

... missed deco I'd treat as missed deco.

Just checking, what's your missed stop protocol?

Our standard "skipped stop" protocol is to head down & do the missed stop and extend the stops above 40' by 1.5x.

We usually drag along a plain old 300 cf O2 bottle & hose it down to a hang bar/pipe with 4 octos screwed onto it.
Adding 60' of hose with a Bandmask on the critter would seem to make sense, we have all the goodies laying around there anyway.

 

[d33ps1x]

Even though I didn't make the original enquiry, thanks. Great read so far.