Why not treat DCS yourself?

[PfcAJ]

In-water Recompression | Rubicon Foundation

 

[Kevrumbo]

There are quite a few divers who self treat due to lack of insurance and/or money.

That never ever has to be a last resort option here in SoCal, the birthplace of recreational Scuba. . .

We have had the privilege for over 40 years of a civilian government-run, combined public tax-payer and private donation funded, Los Angeles County Gov't EMS Recompression Chamber on stand-by 24/7 & 365, solely for the emergency treatment of diving accidents, from simple type I DCS to the most serious AGE in full arrest and near-drowning, with the full support of a mainland University Teaching Hospital and Level One Trauma Center, and US Coast Guard rotary wing assets to provide medevac casualty transport from as far out offshore as 200km round-trip and 90min max ETA if needed -regardless of whether the victim has health insurance or DAN Accident coverage and the ability to pay or not.

Home > USC Catalina Hyperbaric Chamber > USC Dana and David Dornsife College of Letters, Arts and Sciences

USC Dornsife Scientific Diving: The Catalina Hyperbaric Chamber

 

[KeithG]

Not all cases of DCS are the same. Some cases of skin bends resolve after an hour or 2 of O2 at the surface with no need to go back in the water or to a chamber.

A question for the OP: how soon would you get cold? Many people are very marginal on their thermal protection since they do not plan to spend several extra hours or more in the water. How long before hypothermia complicates things?

 

[Scared Silly]

My first thought after reading the title of this thread was Abraham Lincoln's quote: “He who represents himself has a fool for a client” Except in this case “He who treats himself has a fool for a patient”

 

[rjack321]

Thanks! This is interesting (haven't read it fully yet), and I just want to be clear that I'm not saying that IWR should never be done. But it's also important not to read beyond the data in this or in any published article. Pyle (in this 1999 paper) cites the same caution. The two reports discussed are retrospective case series, and there is always going to be a selection bias if you collect data after the fact relying on individual reporting. As was alluded to upthread, do failed IWR efforts make it into the studies?

Certainly, people with real insight into this problem (e.g;. Doolette and Mitchell) have more recently said that IWR isn't a good first option in all cases of DCS, and despite this report raise the concern of the risks of IWR:



Does that mean that IWR never should be done? Of course not. But going back to the OP, a gross oversimplification of the problem and casting aspersions on experts in the field isn't the same thing as thoughtfully exploring where and when IWR is appropriate.

The problem is that you have no idea IF initially mild symptoms are going to progress to the point of life threatening or if they will spontaneously resolve. And except for Kevin and SoCal, your time to treatment is almost always measured in many many hours (sometimes days). You are unlikely to die by redoing a bunch of deco. So those of us who have been bent and at the scene of a mildly bent person often escort them back in the water. Prompt treatment now being more useful than a chamber ride 8+ hours from now.

Even if it doesnt completely fix them, between 30 and 60 mins of extra deco (thermal units being a big consideration) will almost assuredly attenuate their symptoms. Bringing an extra 40cf of O2 really isnt magic. Or going back in to the depth symptoms resolve on CCR. Happens ALOT more than you probably realize.

 

[Tom_Ivan]

A lot of the replies here are criticizing the idea that a diver would do DIY treatment instead of going to a chamber. But what about as well as going to a chamber?

If you start having symptoms and have a tank of O2 on board you'll obviously use it. But what about going back down a few meters at the same time while waiting for the chopper/ambulance etc? Would there be any additional risk here? If not, would your overall treatment benefit at all from having this moderate but immediate re-compression?

 

[WetSEAL]

Missing a safety stop is rarely an issue--it is not a requirement to do it in the first place. That is why most agencies recommend against going back down in the event it is missed. On the other hand, missing a decompression stop is more serious, and every agency I know does recommend going down and doing it, with the exact procedure depending upon what was missed and how long it took to get back down.

I'm not seeing how the situation of missing a deco stop and going back down to repeat it is significantly different from the scenario I was brought up in the original post, which is a person who is starting to experience mild DCS symptoms (ie, skin rash or mild joint pain) but is still fully in control. In both cases, the diver is in control, has too much nitrogen in their system, and we know that going back down is a way to get rid of that nitrogen...so why not do it?

Why would you expect DCS symptoms to get worse if you know that your actions are immediately reducing nitrogen, which is the known cause of DCS symptoms? And by the same token, why would you not prefer to breathe a higher O2 concentration while doing so, assuming you know how long it's safe to breathe this without getting O2 poisoning, and don't get anywhere near that limit?

2) We know that safety stops reduce the risk of DCS considerably... Correct me if I'm wrong
You are wrong.

"A decompression stop is a pause in a diver’s ascent made to allow the body to expel dissolved gases primarily nitrogen in the blood. Without decompression stops, these gases would expand, turning into bubbles and causing decompression sickness."
A Guide to Decompression Stops - II

Doesn't seem to me that this is a disputed topic, and a safety stop is the exact same thing as a decompression stop, so I don't know how you can honestly argue that such a stop would not reduce the risk of DCS.

 

[DivealotZA]

assuming you know how long it's safe to breathe this without getting O2 poisoning, and don't get anywhere near that limit?

The other thing you're not taking into account is that your PO2 levels are going to have increased from your dive you just did....so it's not simply just grabbing an O2 cylinder and diving in to "table safe depths and times"

 

[doctormike]

...a safety stop is the exact same thing as a decompression stop

This statement is not correct

 

[doctormike]

The problem is that you have no idea IF initially mild symptoms are going to progress to the point of life threatening or if they will spontaneously resolve. And except for Kevin and SoCal, your time to treatment is almost always measured in many many hours (sometimes days). You are unlikely to die by redoing a bunch of deco. So those of us who have been bent and at the scene of a mildly bent person often escort them back in the water. Prompt treatment now being more useful than a chamber ride 8+ hours from now.

Even if it doesnt completely fix them, between 30 and 60 mins of extra deco (thermal units being a big consideration) will almost assuredly attenuate their symptoms. Bringing an extra 40cf of O2 really isnt magic. Or going back in to the depth symptoms resolve on CCR. Happens ALOT more than you probably realize.

I think that this is an interesting discussion, and the option of IWR is definitely something that any diver should understand, especially those doing dives involving significant decompression stress, or those diving far from conventional treatment (CT). But the important word there is “understand”. That means realizing that (1) it is not without risks, (2) it is not something that universally takes the place of CT (surface O2, hydration, transport to a recompression chamber), and (3) how to balance the risks and benefits of the two options.

The OP has made a number of assumptions and statements that suggests a lack of familiarity with decompression science. That’s OK, that’s why we discuss things here. As long as people are debating in good faith, this is a place to learn. WetSeal, I hope that you listen to some of the voices in this thread and don’t just look for confirmation wherever you can find it to “win” an Internet argument. The idea that IWR is always preferable over CT is an oversimplification and potentially dangerous.

There are a number of well respected divers who do promote a more expansive use of IWR - originally Richard Pyle (a marine biologist) and Joe Dituri (USN CDR ret). I have heard Joe speak, and he is incredibly knowledgeable with an extensive background in decompression. You can read his first hand account of how IWR saved his life in his article “Take Me Back Down”. In this thread, rjack321 has made this case well, and I don’t disagree with him - this is a good option to know about, and it is probably done more than we realize. But even Joe in his paper notes some caution:

“I grabbed an open circuit steel 72 filled with 100% oxygen that had a green regulator on it. I put it under my arm while someone tossed the anchor…I do not recall clearing my ears, the journey downward or hitting the bottom. I became aware again when Jennifer grabbed my arm and pulled me from 40-45 feet up to hang on the anchor line at 30 fsw. Jennifer had little more than a back pack on and was known for being able to dress for diving very quickly. She undoubtedly saved my life.

In water recompression is not the only thing a diver needs to do if they have a DCS. In water recompression is by no means a medical treatment. It is merely a method of lessening the severity of issues that a diver will encounter because of DCS and affording immediacy of care.”

If you look at the 2018 peer reviewed position of two of the most well known decompression scientists in the world (Simon Mitchell and David Doolette), they also acknowledge the utility of IWR but advocate caution.

“These data and case series suggest that recompression treatment comprising pressures and durations similar to IWR protocols can be effective. The risk of IWR is not justified for treatment of mild symptoms likely to resolve spontaneously or for divers so functionally compromised that they would not be safe in the water. However, IWR conducted by properly trained and equipped divers may be justified for manifestations that are life or limb threatening where timely recompression is unavailable.”

So - like most things - the devil is in the details. Learn about this, think about the risks and benefits. That way, if you are ever in the position to have to make a decision about how to manage your own DCS, you will at least be doing so from a position of understanding. One of the problems with doing good science in this field is that you can’t really do a randomized trial, so most of the data is in the form of case series of self reported incidents. And bad outcomes are often underrepresented when collecting data in this fashion.

I am looking forward to the publication of the most recent workshop proceedings, also published this year:

Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies.

I plan on following the IWR story as we learn more about its place in our clinical armamentarium.