Why not treat DCS yourself?

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Blaming IWR for her death is ridiculous. The 300ft "plan" and massive omitted deco is where the blame lies here.
I think this example is more about highlighting that extremely few dive ops are capable of supporting IWR.
 
Blaming IWR for her death is ridiculous. The 300ft "plan" and massive omitted deco is where the blame lies here.
When did I blame IWR for her death? The only thing more ridiculous than blaming IWR for her death is saying I blamed IWR for her death.
 
Blaming IWR for her death is ridiculous. The 300ft "plan" and massive omitted deco is where the blame lies here.

I think that we are all giving examples supporting the same conclusion. IWR is an option. It becomes a more and more viable option the further you are from a chamber. It is more likely to be opted for if the decompression stress is very high, even if symptoms have yet to develop. With that in mind, you could consider the missed deco protocol a special case of IWR (do all stops below 40 feet according to the plan, do all stops above 40 feet for 1.5 times as long as the plan).

I didn't read the Cozumel reference as blaming IWR for her death. Of course the reason why she GOT her DCS was the insane "plan", but if you are comparing IWR to surface O2 and transport to a chamber, the question has to be which has a greater chance of success. By definition, any time DCS exists there is something to "blame". There are no undeserved hits. In the words of John Chatterton:

"Every single case of DCS in a healthy diver, without exception, has been caused by the diver..... not doing enough decompression!!!"

So to answer this question scientifically, it would be helpful to compare the approaches so that we could come up with a formula that takes into account the profile and the time to a chamber and determine which option is better. We can't do a randomized clinical trial, so the next best thing would be some sort of cohort study, where you have matched pairs of accidents with similar profiles and times to chamber where one used IWR and one used standard therapy.
 
Sure. I thought that had been explained adequately in this thread, but possible risks of IWR include:

1) Oxygen toxicity

Yes, this is a risk, but I don't see how managing the risk of oxygen toxicity during IWR would be more complicated than managing the risk of DCS from multiple dives in a day. In both cases, you simply need to keep track of how much of the gas (either O2 or N2) is likely in your system based on your dive profile and surface time etc. If we think divers are responsible enough to follow a table for nitrogen, then why can't they similarly follow a dive table to prevent oxygen toxicity for an IWR recovery? And if the diver has a table, or a computer, or even a simple rule of thumb for a time/depth that's highly unlikely to risk oxygen toxicity, then I don't see how this is a reason to not attempt IWR.

2) Loss of consciousness underwater due to DCS or seizure

I don't have actual knowledge about this, and would like to get a better understanding of the actual risks of that. I think the debate around the general soundness of the concept of IWR really comes heavily down to this point.

Based on the fact that DCS symptoms are often reported to get worse over time, I would hypothesize that it simply takes time for the nitrogen bubbles to burst free from blood/bones/etc, and that if you go back down at the earliest sign of symptoms, then it will prevent the remaining nitrogen in your system from escaping and give you time to equalize to a more normal level of nitrogen while under pressure.

Thus, if my hypothesis is correct, then symptoms of DCS would only continue to get progressively worse (ie, into loss of consciousness, seizure, etc) if you remained above water, in which case the potential worsening of symptoms would be a strong argument for IWR, not one against it.

Of course, I'm not a medical expert, and my hypothesis here could be totally wrong. Perhaps all the damage is done immediately upon surfacing, and the progression of symptoms is already set in stone from that point onwards, so that it makes no difference if you go back down under pressure. If this is the case, then it's a strong argument against IWR in any circumstances.

Are you aware of any evidence to suggest that this hypothesis is correct or incorrect?

3) Thermal stress

Considering that IWR must be performed at a shallow depth, shallower than the actual dive that was just completed, the diver must already be wearing (or have available) exposure protection that is at least adequate for this depth, so I don't see how this is a reason not to do IWR.

4) Lack of ability to aggressively hydrate

We're talking about less than an hour, I feel like the risk of dehydration from not drinking for an hour cannot possibly be significant in comparison to the risk of not immediately treating DCS, so again not a reason not to do IWR.

5) Delay of medical care in general if the diagnosis is incorrect (e.g. pulmonary barotrauma, stroke, immersion pulmonary edema, etc...)
Worsening of the diver's condition if the diagnosis is incorrect (e.g. pulmonary barotrauma, stroke, immersion pulmonary edema, etc...)

That's certainly a valid risk, and could be a reason not to do IWR, but this could be overcome with better training at identification of symptoms.

6) Risk to the support divers

There is always a voluntary risk taken when diving recreationally, or when voluntarily participating in a rescue. If IWR is considered to be a potentially life saving procedure, then that's not really a reason not to attempt IWR.

Again, we are probably in agreement that IWR should be done in SOME situations. Very few people would say that it should never be done, so that's a straw man. The devil is in the details.

I honestly don't feel confident saying that IWR should be done in any situations. I have a hypothesis that it is, but I'm not confident about that yet, largely because I don't have factual proof of my hypothesis regarding your point #2.

A person who is showing no signs of DCS is considerably different from a person showing mild signs of DCS. Mild signs of DCS can progress, and they can progress quickly. If no signs progress to mild signs, then you have changed categories and should act accordingly.

A friend of mine surfaced after missing some stops (the circumstances would take several paragraphs), and soon after surfacing, he started to show mild signs of DCS. While he was still in the water, people assisting him from a boat put him on O2 from his decompression bottle and brought him to shore. Once on shore, he was able to assist in getting his gear off and preparing for his evacuation. He started to show stronger symptoms as they prepared to leave. A few minutes after they left, the paralysis from the waist down set in. It would not have been good for him to be going through those stages under water. Perhaps if they had had the equipment needed for truly effective IWR, it might have been different, but they did not have that.

Thank you for sharing this story. It really relates back to point #2 above though -- and if my hypothesis is correct, could actually be a case for IWR, rather than a case against it.
 
Are these boats equipt for IWR?
Why would I rely on the boat to do anything my life depends on? (other than not running me over or leaving me behind

So to answer this question scientifically, it would be helpful to compare the approaches so that we could come up with a formula that takes into account the profile and the time to a chamber and determine which option is better. We can't do a randomized clinical trial, so the next best thing would be some sort of cohort study, where you have matched pairs of accidents with similar profiles and times to chamber where one used IWR and one used standard therapy.
Sounds great, and leaving aside the question of IWR, where are you going to find these "matched" DCS cases?
Age, sex, BMI, blood pressure, gases, profile, smoking status... etc.
 
Considering that IWR must be performed at a shallow depth, shallower than the actual dive that was just completed, the diver must already be wearing (or have available) exposure protection that is at least adequate for this depth, so I don't see how this is a reason not to do IWR..

Well if the DCS is due to freezing from a leaking drysuit (raising my own hand) going back in could be a really bad choice. Even if your suit is not leaking, severe vasoconstriction or hypothermically impaired judgement are both sound reasons why IWR could be a worse choice than surface O2 and transport (time).
 
Of course, I'm not a medical expert, and my hypothesis here could be totally wrong.
I started to respond to each of your sections one by one to explain your errors, but I don't have the time or the patience right now.

Let me first summarize by saying that your hypotheses are mostly wrong.

Let me next make a suggestion, and I am going to try to make this as polite as possible. You started a thread on a topic that has been discussed often. You have admitted that you have no expertise in the matter, but a number of people who do know a lot of this have responded and tried to correct some of your errors. These people have cited the results of research studies conducted and published by the top scientists in decompression science.

In response, you lecture these people about why they are all wrong. Perhaps if you took the attitude of someone who wants to lseek information and learn instead of constantly telling people who really know what they are talking about that they are wrong, you might come out of this thread with a better understanding of the issues.
 
Sounds great, and leaving aside the question of IWR, where are you going to find these "matched" DCS cases?
Age, sex, BMI, blood pressure, gases, profile, smoking status... etc.

Right, that's the point. It is very difficult to do good science with regard to DCS because of its very nature. But if you really want to determine if IWR is better than conventional therapy, you need to try. To do a cohort study, you need to start by spending decades collecting accident reports until you get a large enough database that they start to form cohorts. It's the same with any retrospective cohort study. And maybe it's not logistically or financially feasible. But that doesn't change the nature of the problem.

Otherwise, it's just conjecture. I'm not saying that your conjecture would be wrong. IWR should be in our armamentarium. And right now, without real data and real studies, we make that judgement call on the fly based on distance to chamber and symptoms (as we have been saying all along). Maybe that's the best we can do for now...
 
@WetSEAL With all due respect I'm sure you mean well, please educate yourself further on basic deco theory, what IWR actually encompasses and the basics of how its performed. Misunderstanding these basics invites a lot of opportunity to have a really bad day.
:)
 
i actually know a few divers who treated them self for DCS while diving with them, we were 160 feet for 23 min completed deco stops and at 20 feet swaped to 100% 02 but when we surfaced he had pain in the shoulder and it was getting worse for him as time went on. so what do he do suits up and splashes back down with a nother bottle of 02 for 20 min or less and comes back up and pain is gone.

could be just a fluke or it could of actually worked no one really knows but to this day if he gets any pain he will "self treat" him self..
 
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