Lessons Chamber Fatality in Malta

[scooba_kev]

I read a story this morning about a diver fatality in a Maltese chamber after it initially appearing like the patient was recovering. Not too many details in the story and I'm not particularly interested in speculating about this specific case, but as someone who has worked at a chamber in the past I'm curious what hyperbaric medicine professionals have seen that cause this type of outcome? In my experience patients who go in the chamber conscious usually come out conscious and those that go in unconscious tend to not regain it. Barring some major procedural failure in the treatment itself as may be the case in Malta, it seems like a sudden fatality would most likely be a result of some pre-existing condition of the diver. Any other possibilities worth considering?

Links:
'Hero’ diver sacrificed life to try to save colleague
Hyperbaric consultant suspended following death of Polish diver

 

[boulderjohn]

This is the aftermath of this incident:

Error - Two wreck divers dead - Marsascala, Malta

We're taught to not become the second victim, but if you're helping a distressed buddy, it might be difficult to avoid at times. https://timesofmalta.com/article/diver-dies-following-rescue-off-marsascala.1094998 Two divers died after finding themselves in difficulties while exploring a wreck...

scubaboard.com

 

[scooba_kev]

This is the aftermath of this incident:

Error - Two wreck divers dead - Marsascala, Malta

We're taught to not become the second victim, but if you're helping a distressed buddy, it might be difficult to avoid at times. https://timesofmalta.com/article/diver-dies-following-rescue-off-marsascala.1094998 Two divers died after finding themselves in difficulties while exploring a wreck...

scubaboard.com

Yeah I read that thread. It mostly focuses on the accident itself. I'm interested in hearing what folks have seen causing that type of sudden negative outcome during treatment.

 

[runsongas]

some of the scenarios are covered in the USN Diving Manual sections 20 and 21 for DCS treatment and chamber operations. Anything from CNS tox/convulsions due to the high pO2 for the chamber ride, pulmonary DCS due to fluid leakage which can also be a complication from IV administration, cerebral edema due to fluid leakage into the intercranial space, etc.

It is going to be a serious inquiry and if it turns out an unqualified operator was left alone that is an egregious act of malpractice. That's about on par with your surgeon walking away to let a med student close you up.

 

[justinthedeeps]

A somber salute to these ocean lovers who gave their lives for a deep passion together.

An also uncommon(?) show of responsibility, buddy commitment and heroism by the diver who attempted to help their struggling buddy to recover and save a life.

Comments in a prior thread were quick to ask whether it's best to let a doomed diver surface alone. While may be true in some cases, there are plenty where a hero can save the day (and also themselves).

It seems like they can put commercial divers into a chamber within minutes of surfacing, and it works out. Not sure what their chamber schedules are though?

In the case of the tragedy, and most other severe DCI cases, it is possible that severe enough effects (and large emboli) had already become irreversibly large before recompression was ultimately administered.

Given that eventual chamber therapy was not curative, it should be discussed whether the diver's instinct to immediately re-descend might have been successful.

Discussion about immediate in-water recompression is ongoing, and I believe was mentioned in Rebreather Forum 4.

 

[Duke Dive Medicine]

I read a story this morning about a diver fatality in a Maltese chamber after it initially appearing like the patient was recovering. Not too many details in the story and I'm not particularly interested in speculating about this specific case, but as someone who has worked at a chamber in the past I'm curious what hyperbaric medicine professionals have seen that cause this type of outcome? In my experience patients who go in the chamber conscious usually come out conscious and those that go in unconscious tend to not regain it. Barring some major procedural failure in the treatment itself as may be the case in Malta, it seems like a sudden fatality would most likely be a result of some pre-existing condition of the diver. Any other possibilities worth considering?

Links:
'Hero’ diver sacrificed life to try to save colleague
Hyperbaric consultant suspended following death of Polish diver

There aren't many details here, though the news story mentions omitted decompression. There are cases where divers with DCS were fully conscious and interactive initially but decompensated and died later on due to the effects of the DCS.

Best regards,
DDM

 

[dmaziuk]

Yeah I read that thread. It mostly focuses on the accident itself. I'm interested in hearing what folks have seen causing that type of sudden negative outcome during treatment.

Have you seen post #23, specifically the

Chris most likely tried to help him here but probably knew there wasn't much he could do. He swam back to the chartered boat and got on and told them about the situation. He placed himself on oxygen and wanted to replace his diving tanks with new ones and jump to do the decompression stop but they stopped him from doing that.

part?

 

[Duke Dive Medicine]

Have you seen post #23, specifically the

part?

I think what @scooba_kev was driving at was not the dive history that led to the DCS but what could cause a diver with DCS who initially looked fine to suddenly take a turn for the worse. Immediate bad outcomes are typically related to the bubbles themselves. Delayed decompensation is often related to the inflammatory effects of the bubbles on the lining of the blood vessels. Example: a diver with pulmonary DCS who does ok initially on surface O2 but decompensates and goes into pulmonary edema during treatment. That is hard to predict and can be difficult to manage once it happens.

Best regards,
DDM

 

[boulderjohn]

I think what @scooba_kev was driving at was not the dive history that led to the DCS but what could cause a diver with DCS who initially looked fine to suddenly take a turn for the worse. Immediate bad outcomes are typically related to the bubbles themselves. Delayed decompensation is often related to the inflammatory effects of the bubbles on the lining of the blood vessels. Example: a diver with pulmonary DCS who does ok initially on surface O2 but decompensates and goes into pulmonary edema during treatment. That is hard to predict and can be difficult to manage once it happens.

Best regards,
DDM

Sounds like it's a good idea to have a properly trained hyperbaric physician present throughout treatment in case something like that happens.

 

[Duke Dive Medicine]

Sounds like it's a good idea to have a properly trained hyperbaric physician present throughout treatment in case something like that happens.

Yes, with a lot of "ands". One big one: there are a lot of facilities in the US (and I'm sure outside) that have properly trained hyperbaric physicians and are quite capable of treating emergent indications but are not equipped to manage critically ill patients in the chamber. There's a good example in your neck of the woods: a hospital in the Denver metro area can take emergent hyperbaric indications but isn't equipped to care for ICU-level patients. The closest hyperbaric facilities to you with critical care capability are in Salt Lake City. There's a complex risk-benefit calculus that goes into deciding when and where to treat a hyperbaric patient who may decompensate. Treat in the closer chamber while gauging and accepting the risk of decompensation, or fly the patient 500-ish miles and accept the risk of a delay in care?

Best regards,
DDM