Treatment of a suspected victim of decompression Sickness outside Recompression Chamb

[BoltSnap]

Is there a recommended protocol to treat a suspected victim of decompression sickness by immediate re-submersion in water in absence of a nearby re-compression chamber? Victim dove to 47 meters on two consecutive dives and came down with signs and symptoms of decompression illness after the second dive. Is re-submersion in water to 20 meters (or close to it) on air acceptable treatment or effective at all?

 

[hroark2112]

Alert Diver | In-Water Recompression

In-water Recompression | Rubicon Foundation

Here's a few articles to peruse

 

[danvolker]

On air will do little....potentially you might make matters worse.

Pure O2 at 20 feet is the safest course toward reversal of symptoms.....if you had a full face mask, 100% at 40 feet would be even better ( but the risk of a O2 tox blackout requires the FFM as well as someone else in the water for deeper than 20 feet......Hopefully this is NOT something you are trying to deal with right now....

If this guy was diving to this depth, why was pure 02 not on site, and part of the standard deco plan?

 

[underH2Oman]

Start on Oxygen and seek medical attention.

 

[BoltSnap]

Forgot to mention, this is in Libya which is still in the dark ages as far as diving medicine. No one carries O2 or anything. In fact, most of these guys go spearfishing at these depths to catch the big grouper. MOST of them are not certified either.

 

[danvolker]

Forgot to mention, this is in Libya which is still in the dark ages as far as diving medicine. No one carries O2 or anything. In fact, most of these guys go spearfishing at these depths to catch the big grouper. MOST of them are not certified either.

Maybe you could explain the concept of Evolution to them, and survival of the fittest...in this case, how the "fittest" is indicative of some IQ and knowledge of diving.

 

[BoltSnap]

I am just fighting the ignorance spread by some jerks here. Some think that it is OK to take an injured diver back to the water for in water re-compression.

---------- Post added March 1st, 2014 at 01:44 AM ----------

I am just told that somebody got bent after diving to 37meters and then was taken down for in-water-recompression and now he is OK and diving again. The ONLY problem is difficulty in walking and standing, that's all!!

 

[Dr Deco]

Hello BurhanMuntasser:

Protocol

Most informed barophysiologists would say that the protocol is “Do not do it. ”
There are several reasons for this:

[1.] Air recompression simply introduces more nitrogen into the tissues. This is not going in the right direction, obviously. Oxygen is used today for this reason, but has its own problems.
[2.] Oxygen at pressure has the potential to produce seizures. For this reason, a full face mask is needed to prevent drowning. Not everyone has this piece in their kit.
[3.] Another diver must accompany the injured diver. (This individual is now at risk if they have a gas load from previous dives. Now you have two injuries.) This diver needs to assist in case the subject vomits underwater in the mask. The subject might be incapacitated and unable to help himself.
[4.] Hypothermia is a problem in water. Even warm water will cool a diver after a while. This now presents another problem.
[5.] Oxygen on the surface avoids these problems and lasts much longer than oxygen at pressure. Most divers do not carry a large supply of supplemental oxygen.

Bad Idea

These are several reasons that I can recall from memory alone. Now you know why it is not recommended.

Dr Deco :doctor:

 

[BoltSnap]

I see, agree with and understand all the points detailed above as you all so kindly have detailed. However their counter point is that "a little is better than nothing."

I'd like to ask the question a little differently just to make sure I am asking it in the correct context of the situation at hand in Libya:

In the event of a severe injury of a diver who is thought to exhibit signs of DCS in a context where there is none of required first aid supplies; such as O2 or properly trained personnel capable to provide the needed treatment, and where recompression chamber and/or proper medical facility are hours away from the incident, would there be any justification at all to take the diver back underwater for recompression (on air) as part of the urgently needed treatment/first aid, especially if the diver’s condition is seen to be critical? I should also add that the people at the injured diver's side do NOT have the best of training and the proper equipment is NOT available there (no FFM or 100% O2).

 

[danvolker]

I see, agree with and understand all the points detailed above as you all so kindly have detailed. However their counter point is that "a little is better than nothing."

I'd like to ask the question a little differently just to make sure I am asking it in the correct context of the situation at hand in Libya:

In the event of a severe injury of a diver who is thought to exhibit signs of DCS in a context where there is none of required first aid supplies; such as O2 or properly trained personnel capable to provide the needed treatment, and where recompression chamber and/or proper medical facility are hours away from the incident, would there be any justification at all to take the diver back underwater for recompression (on air) as part of the urgently needed treatment/first aid, especially if the diver’s condition is seen to be critical? I should also add that the people at the injured diver's side do NOT have the best of training and the proper equipment is NOT available there (no FFM or 100% O2).

My understanding of this, for those clearly exhibiting signs of DCS...and what I think Dr Deco was saying, is that you are MOST LIKELY TO MAKE THINGS WORSE if you take the diver back down with only air as a breathing source....
The gradient you have to work with using air, is just not going to remove the bubbles that have formed. Pure O2 has the gradient you need, even on the surface it is FAR superior to air at 60 feet. Pure O2 at 20 feet, or deeper with Full Face Mask and another support diver, would be much better still. Unfortunately, you are telling us that O2 is not going to be an option. Without this, you can wish all you want for a solution, but you won't have one.

I do believe if you could get them back down immediately after one of their polaris missile ascents from a deep dive, with a new tank and reg...that they could do a real deco with the new tank if they could accomplish this re-descent prior to the 2 minute or so window you can have before hyper-saturation and it's major bubbling occurs.... But once the serious bubbling begins, and the DCS symptoms are clear, to attempt this recompression is most likely to make the injuries worse.