Article: In-Water Recompression

[BestPublishingCompany]

You can view the page at http://www.scubaboard.com/forums/content.php?r=748-In-Water-Recompression

 

[kr2y5]

What strikes me is that even a distinguished diver with 30+ years of experience feels too embarrassed to admit he has symptoms, one can only imagine how much worse it gets for an inexperienced diver on a shallow recreational dive, who will not ask for Oxygen on the boat when they start to feel funny, because they do not want to become the center of attention and feel (or imagine) the judgmental looks of everyone else around them. In all the dive trips I have done, I have never seen people willingly and openly talking about how they feel after the dive, it just does not seem to be a part of the diving culture...

 

[ti325v]

Great article Joe.
We have a dive shop in a remote location, at least 18 hours (on the best of days, and sometimes up to three days when the airport is closed and we are still diving) to qualified medical care.
We take the safety of our customers very seriously.
Joe is spot on with divers not being aware of how they feel and what it could be related too.
I had one customer, a tall thin young man, who I saw on the street about 8 hours after diving.
I asked him how he was doing and he said something about pressure in his chest at full inhalation, but he reported that he was fine.
I was not so sure, so I brought him back to our shop, rang up DAN and sure enough, spontaneous mediastenial emphysema. (He fit the profile).
This young man was lucky, surface 02 overnight while being monitored in my shop till the local hospital would open up the x-ray machine to confirm the diagnosis, X-ray sent to DAN for evaluation and confirmation.

All of my staff are trained to look for and be aware of the signs and symptoms of both clinical and subclinical DCI.

People clearly do not report when they have problems.
There have been several incidents like this in three years of operation, and we are a TINY shop.
I can only imagine what is going on in large destinations, (Though fortunately most have better medical facilities then we do).

We set up for in water re-compression and have been qualified in the practice by noted hyperbaric physician Jean-Eric Blatteau over 2 years ago.
We have used this protocol successfully on a local hookah diver, (We worked with Jean Eric to train the local fishermen how to dive safely and how to use this technique to treat themselves) and a staff member, who may have had an "undeserved hit"

Getting qualified was a two year battle with every diving doctor I spoke with saying 'Yes this is great stuff" but none willing to go on the record and use their name. Horribly frustrating.

Thank you Joe for taking up the torch, and carrying the message. This is serious and important stuff.
I understand IANTD is now doing a program in IWR, and I urge any dive operator in a remote location to get in touch with him to take his course. You have a responsibility to your staff and customers to be as prepared as you can be.

 

[Carl_F]

It makes sense to me to use IWR as qualified first aid. But similar to CPR, and I'm sure other first aid treatments I can't recall off the top of my head, it should be utilized under trained/qualified individuals lest the treatment make the condition worse or just delay proper treatment with no benefit. If IANTD is developing or has developed such a training / qualification program, Bravo Zulu (good work.)

 

[DiversDiscountFlorida]

Great article Joe.
We have a dive shop in a remote location, at least 18 hours (on the best of days, and sometimes up to three days when the airport is closed and we are still diving) to qualified medical care.
We take the safety of our customers very seriously.
Joe is spot on with divers not being aware of how they feel and what it could be related too.
I had one customer, a tall thin young man, who I saw on the street about 8 hours after diving.
I asked him how he was doing and he said something about pressure in his chest at full inhalation, but he reported that he was fine.
I was not so sure, so I brought him back to our shop, rang up DAN and sure enough, spontaneous mediastenial emphysema. (He fit the profile).
This young man was lucky, surface 02 overnight while being monitored in my shop till the local hospital would open up the x-ray machine to confirm the diagnosis, X-ray sent to DAN for evaluation and confirmation.

All of my staff are trained to look for and be aware of the signs and symptoms of both clinical and subclinical DCI.

People clearly do not report when they have problems.
There have been several incidents like this in three years of operation, and we are a TINY shop.
I can only imagine what is going on in large destinations, (Though fortunately most have better medical facilities then we do).

We set up for in water re-compression and have been qualified in the practice by noted hyperbaric physician Jean-Eric Blatteau over 2 years ago.
We have used this protocol successfully on a local hookah diver, (We worked with Jean Eric to train the local fishermen how to dive safely and how to use this technique to treat themselves) and a staff member, who may have had an "undeserved hit"

Getting qualified was a two year battle with every diving doctor I spoke with saying 'Yes this is great stuff" but none willing to go on the record and use their name. Horribly frustrating.

Thank you Joe for taking up the torch, and carrying the message. This is serious and important stuff.
I understand IANTD is now doing a program in IWR, and I urge any dive operator in a remote location to get in touch with him to take his course. You have a responsibility to your staff and customers to be as prepared as you can be.

The practice of in water recompression is not only dangerous and life-threatening, it harks back to a primitive time before recompression chambers were readily available wherever safe diving is supported. To prescribe it as a treatment for hyperbaric incidents is not only irresponsible but demonstrates a preponderance of ignorance of proper procedures. Submerging with signs and symptoms of a hyperbaric event increases the possibility of a life-threatening event. Prior to all diving, proper evacuation procedures and diving accident management protocols must be established. Extreme depths require additional equipment and safety procedures. In water recompression is not an accepted procedure and never a protocol for treatment of a hyperbaric trauma.

The author of this article obviously wanted to fluff his feathers and strut his macho ego since he survived his fiasco. He also harks back to a primitive type of diver that have mostly have killed themselves off. Question one is what was he doing at 400 feet? Government ops to that extreme depth would require a chamber onsite. What were the protocols for emergencies established prior to this operation? Hiding with signs and symptoms because of ego is stupid and follows the pattern of irresponsibility prescribed by the author. He delayed his own treatment for 45 minutes while his condition deteriorated. Then, he jumps in like Tarzan and has to be saved from his own stupidity.

To prescribe in water recompression is ludicrous, dangerous and insane. Get to a chamber as quickly as possible. Never go back in the water and risk complications, like convulsions, blackout or pulmonary embolism. Administering pure oxygen is the immediate treatment during transport. It should be available onsite or onboard every diving operation. Most victims exhibit an improved condition and many signs and symptoms are even eliminated upon arrival at a treatment facility.

 

[Akimbo]

The practice of in water recompression is not only dangerous and life-threatening, it harks back to a primitive time before recompression chambers were readily available wherever safe diving is supported.….

Good grief man, IWR is for when there is no chamber available, as-in days away. Nobody is going to do IWR when they are an hour from a chamber.

Alert Diver | In-Water Recompression

If you are properly prepared, it is an option that can suck less than taking days before you get treatment. You don’t just jump over the side with an O2 bottle.

 

[BRT]

I've often wondered if in some of the cases where divers were badly bent and still conscious if they might have had a chance with another tank of air. Even if it was just to wait for the helicopter to get there.

 

[Akimbo]

I've often wondered if in some of the cases where divers were badly bent and still conscious if they might have had a chance with another tank of air. Even if it was just to wait for the helicopter to get there.

Another tank of air? Probably not. Breathing pure oxygen at 20', in a full face mask ideally with voice communications to the surface, monitored by a tender, adequate thermal protection, in protected waters, and everyone involved well trained to identify Oxygen toxicity symptoms? Probably yes if the symptoms aren’t too severe.

Keep in mind that a decompression treatment starts with a Table 5 at 60' on pure O2 in a chamber. The increased PPO2 and compression is pretty significant and adverse reactions are much more manageable. This may help explain some of it: http://www.scubaboard.com/forums/diving-medicine/440726-oxygen-toxicity-limits-symptoms.html

There is a risk-reward balance: http://www.scubaboard.com/forums/ad...thoughts-water-recompression.html#post5419046

You are describing a situation where you must choose what sucks the least. What preparation and skills are available, how far is a chamber, and what are the symptoms?

Oxygen for decompression onboard, 500 miles from the nearest chamber or chopper to get you there, competent safety divers, and a mild joint pain? I'd be in the water sucking from the green bottle. Five miles offshore, CNS hit, inbound Coast Guard chopper, 20 miles from a hyperbaric hospital unit, onboard a typical sport diving half-day boat? I'd be lying down on deck patiently breathing Oxygen.

The problem is the huge variability between the two circumstances described above. DAN's recommendation is likely the least of the evils in most cases in the recreational setting. However, when you are the one at risk, I believe it is prudent to know more than memorizing a general recommendation rather than interpret it as a rule from God…

 

[Dr. Lecter]

The practice of in water recompression is not only dangerous and life-threatening, it harks back to a primitive time before recompression chambers were readily available wherever safe diving is supported. To prescribe it as a treatment for hyperbaric incidents is not only irresponsible but demonstrates a preponderance of ignorance of proper procedures. Submerging with signs and symptoms of a hyperbaric event increases the possibility of a life-threatening event. Prior to all diving, proper evacuation procedures and diving accident management protocols must be established. Extreme depths require additional equipment and safety procedures. In water recompression is not an accepted procedure and never a protocol for treatment of a hyperbaric trauma.

The author of this article obviously wanted to fluff his feathers and strut his macho ego since he survived his fiasco. He also harks back to a primitive type of diver that have mostly have killed themselves off. Question one is what was he doing at 400 feet? Government ops to that extreme depth would require a chamber onsite. What were the protocols for emergencies established prior to this operation? Hiding with signs and symptoms because of ego is stupid and follows the pattern of irresponsibility prescribed by the author. He delayed his own treatment for 45 minutes while his condition deteriorated. Then, he jumps in like Tarzan and has to be saved from his own stupidity.

To prescribe in water recompression is ludicrous, dangerous and insane. Get to a chamber as quickly as possible. Never go back in the water and risk complications, like convulsions, blackout or pulmonary embolism. Administering pure oxygen is the immediate treatment during transport. It should be available onsite or onboard every diving operation. Most victims exhibit an improved condition and many signs and symptoms are even eliminated upon arrival at a treatment facility.

Anyone who uses as many adjectives and as few facts as I see in your post isn't someone whose opinion needs to considered. Go back to your shop and mind it.

 

[dumpsterDiver]

The practice of in water recompression is not only dangerous and life-threatening, it harks back to a primitive time before recompression chambers were readily available wherever safe diving is supported. To prescribe it as a treatment for hyperbaric incidents is not only irresponsible but demonstrates a preponderance of ignorance of proper procedures. Submerging with signs and symptoms of a hyperbaric event increases the possibility of a life-threatening event. Prior to all diving, proper evacuation procedures and diving accident management protocols must be established. Extreme depths require additional equipment and safety procedures. In water recompression is not an accepted procedure and never a protocol for treatment of a hyperbaric trauma.

The author of this article obviously wanted to fluff his feathers and strut his macho ego since he survived his fiasco. He also harks back to a primitive type of diver that have mostly have killed themselves off. Question one is what was he doing at 400 feet? Government ops to that extreme depth would require a chamber onsite. What were the protocols for emergencies established prior to this operation? Hiding with signs and symptoms because of ego is stupid and follows the pattern of irresponsibility prescribed by the author. He delayed his own treatment for 45 minutes while his condition deteriorated. Then, he jumps in like Tarzan and has to be saved from his own stupidity.

To prescribe in water recompression is ludicrous, dangerous and insane. Get to a chamber as quickly as possible. Never go back in the water and risk complications, like convulsions, blackout or pulmonary embolism. Administering pure oxygen is the immediate treatment during transport. It should be available onsite or onboard every diving operation. Most victims exhibit an improved condition and many signs and symptoms are even eliminated upon arrival at a treatment facility.

To make a post like this with "never" (after a guy makes a post that a chamber is 3 days away) is "ludicrous and insane."