Why not treat DCS yourself?

[Jack Hammer]

The consensus you speak of is simply not accurate. Many of the replies over these 10 pages have been from VERY experienced divers who have argued a case for IWR. Do none of the people below count as trained competent divers to you?

Many of the people against IWR haven't given any specific reason, but have just insulted me for asking, or sarcastically recommended that I go and try to kill myself.

Another large group of people have not recommended IWR, and given specific reasons for why not, but most of the reasons given don't make logical sense and can be easily debunked, and when I try to calmly ask for an explanation of their reasoning, they don't even attempt to explain themselves or address any of the points I raised, and instead just switch over to ad hominem attacks against me or my experience level. Those are not behaviors that I find particularly convincing.

I think you are confusing a trained and experienced technical diver with a reasonable understanding of deco theory and O2 pros and cons weighing their options and choosing IWR as a better choice under certain conditions with a general recommendation of just jumping in the water with an O2 bottle to "treat" a suspicion of DCS.

 

[Storker]

Many of the replies over these 10 pages have been from VERY experienced divers who have argued a case for IWR.

Ok, I'll bite. For this time.

IWR may be the least crappy alternative given a bunch of conditions. However, there are a lot of risks to IWR, so in most cases it's definitely far from the optimal solution. Advocating IWR as a fit-all solution to DCI and a viable alternative to sniffing O2 and jumping into a helicopter is, at best, irresponsible and at worst (IMNSHO) bordering on criminal.

But keep on flogging that horse. And, BTW, your experience level does in fact affect the weight of your arguments to some degree.

 

[PfcAJ]

Ok, I'll bite. For this time.

IWR may be the least crappy alternative given a bunch of conditions. However, there are a lot of risks to IWR, so in most cases it's definitely far from the optimal solution. Advocating IWR as a fit-all solution to DCI and a viable alternative to sniffing O2 and jumping into a helicopter is, at best, irresponsible and at worst (IMNSHO) bordering on criminal.

But keep on flogging that horse. And, BTW, your experience level does in fact affect the weight of your arguments to some degree.

Well if you could just hippity hop into a helicopter and be in a chamber lickity split no one would be discussing this seriously. But the reality is for a lot of places that's not a real option.

 

[Lorenzoid]

The consensus you speak of is simply not accurate. Many of the replies over these 10 pages have been from VERY experienced divers who have argued a case for IWR. Do none of the people below count as trained competent divers to you?

As I see it, that's exactly it. It is impractical to make IWR the default or first line of treatment for everyone in all situations--impractical for both the victim and whoever may be responding/assisting. There is no way that IWR is going to become the default procedure on every liveaboard. However, very experienced divers who are trained in deco procedures have made what seems to be a good argument for IWR for people like them, doing the kinds of dives that they do and with the equipment and assistance they have.

 

[Gareth J]

I think the medical advice is clear.

The optimal treatment for a DCI casualty.
Evacuate as quickly as possible to a hyperbaric facility.

The first aid treatment for a DCI casualty.
Give the casualty 100% O2 if available, or the richest O2 available.
Maintain Airway, Circulation.

In areas where access to medical support is unavailable, IWR may be the only practical solution.
If IWR is part of the emergency plan. Then a proper plan and equipment should be available, and all divers suitably briefed.
On the rare occasions I have been involved in diving where IWR has been part of the emergency plan. It was been warm water. We have had full body harness, a full face mask, surface supply O2, and a scheduled recompression plan.
The dive plan has been double up the last decompression stop.

IWR is the least preferred treatment. Where practical it should be avoided.

In temperate waters I don't think IWR is practical. I know too many people who have been bent inside the table, where cold has been the suspected contributing issue. Trying to decompress someone suffering from or approaching hypothermia I think is a non starter.

 

[JohnnyC]

IWR is one of those funny things where it's the least preferred treatment, and also the most preferred treatment. It is entirely situationally dependent. That being said, you can't just hop off a dock with a bottle of O2 and a laminated Australian table and sit there for a few hours. Learn how to do it if you're considering doing it.

 

[dberry]

By all means feel free to share with us your case in starting another thread if you wish . . .(was this accident just during your recent past trip to Cozumel?).

FYI, your home state has one of the finest Hyperbaric Medicine & Emergency Departments in the northeast US. No Diver suffering DCI coming from Dutch Springs divesites ought naught ever consider having to resort to IWR, having at least Pennsylvania Medicaid and or Federal Medicare policies as basic automatic, ACA type gov't sponsored public health care insurance coverage.

Penn Emergency Medicine – Penn Medicine
Penn Hyperbaric Medicine – Penn Medicine
The Hyperbaric Chamber – Penn Medicine

I walk past the Penn Hyperbaric Medicine unit on my way from parking garage to my office, but I'm ashamed to admit I assumed it was biased toward non-diving, non-emergency hyperbaric treatment. Thanks for those links to straighten me out.

Furthermore, I found this link for the PENN Diving and Hyperbaric Medicine Fellowship Program which is "designed to provide licensed physicians the opportunity to be educated and trained in the theory and practice of diving and hyperbaric medicine."

That's an incredibly important service to the diving community, IMO. More MDs with experience with diving and DCI treatment = a really good thing.

 

[Gareth J]

I know this is not strictly in line with the OP.
But..

If you have the opportunity to do a chamber dive, I would strongly recommended.
Those that I have experienced include a lot of education on DCI and treatment, and on treatment practices in a chamber.

As a buddy of mine said, 'It's lot more reassuring going into the chamber for treatment when you know whats coming next".

 

[KeithG]

Well if you could just hippity hop into a helicopter and be in a chamber lickity split no one would be discussing this seriously. But the reality is for a lot of places that's not a real option.

Do we need to stop feeding the troll?

I have asked and none of the IWR advocates has yet stated that they dive with all the necessary gear and support staff required for proper IWR. So I claim many IWR advoates seem to be "jump in the water with o2" types. I could be wrong?

For those that are pro IWR, maybe it makes more sense to inform the OP on the necessary support system for proper IWR. I also know little about this topic.

My first concern is thermal protection. As a warm water diver the majority of divers I see are cold after a 45 minute dive. I can not imagine forcing them back underwater for an extended period of time.

How is thermal stress to be handled?

 

[PfcAJ]

Do we need to stop feeding the troll?

I have asked and none of the IWR advocates has yet stated that they dive with all the necessary gear and support staff required for proper IWR. So I claim many IWR advoates seem to be "jump in the water with o2" types. I could be wrong?

For those that are pro IWR, maybe it makes more sense to inform the OP on the necessary support system for proper IWR. I also know little about this topic.

My first concern is thermal protection. As a warm water diver the majority of divers I see are cold after a 45 minute dive. I can not imagine forcing them back underwater for an extended period of time.

How is thermal stress to be handled?

If you don't have the required stuff (sufficient oxygen supply, full face mask, surface guy and in-water guy), then you aren't prepared for proper IWR. If you can't manage the thermal stress then you aren't a candidate for IWR.

If you're serious about IWR as an option on the table take the steps needed to do it right.