I was on a liveaboard in Fiji last year when a fellow diver got bent. It was scarey as hell and has made me reconsider a few things regarding my diving. Some parts of this story are vague as I don't know what / why things happened and others I've kept vague for privacy reasons.
Day 2 of a liveaboard cruise, third dive, diver A surfaces with a story of neck pain and then weakness in her left arm. She is slim, aged 50s-60s, no sig medical history am aware of, am not sure how many dives but def not a 'beginner'. Boat was turned back to nearest port immediately, A was given O2, kept orally hydrated, DAN contacted... chamber in Suva put on standby (apparently). She had complete flacid paralysis of left arm, 0/5 strength... this improved over several hours of O2 and when she left the boat strength had improved to 4/5. Otherwise normally cognition etc, a little argumentative - that may have been anxiety / stress / related to DCI / (normal for her?) Remainder of basic neuro exam normal. Arrived in Suva around midnight - 7-8 hours after onset of Sx. Unable to be put in chamber overnight, then couldn't be put in chamber the next morning (not sure why ?staffing ?island time ?chamber functional - no idea). Symptoms worsen to paralysis of left side of body. The next morning DAN arranges retrieval flight from NZ.. she gets into chamber in Auckland about 30 hours after onset of symptoms. Multiple chamber treatments... likely to be left with some residual symptoms but should be able to 'lead normal life'. (I haven't heard how things progressed subsequently).
My background: about 250 dives, never encountered DCI previously. Am an obstetrician ie medically trained but realistically all I know about dive medicine I know as a diver and not from my medical training. I worked in PNG for a year so have some insight into challenges in providing healthcare in developing countries.. and 'island time' and things generally not happening as they should. I completed my Rescue diver course last year, with one of my motivations being that if there was an 'incident' there would likely be an expectation that as a doctor I would be medically 'useful'.
These are my thoughts (I've thought a lot about this!):
1) no blatantly obvious precipitant for the hit. It was no deco diving, she was diving same profile as her buddy (and likely very similar to others in the group). Last dive quite a bit of current so may have over exerted, may have been dehydrated....?? Nothing exciting on her dive computer.
2) While FIji is a developing country, I would consider their healthcare system significantly better to other countries I've dived in (ie PNG!). The dive region is nowhere near as isolated as other places I've dived ie if it took that long to get to a chamber from Fiji / Bligh waters area, how long would it take from other areas???
3) While on the boat, A was 'cared for' by me and another of the punters who was a nurse... which freed up staff to liase with DAN etc. ie there was indeed an expectation that I'd be medically useful and my opinion carried some weight while we were on the boat...
What I've learned:
1) I'm being a bit more cautious about my diving, particularly in isolated areas.. confess I was often guilty of pushing my no-deco limits right to the limit.. and was excited when my new dive computer had far more liberal settings than my conservatively set Zoop... I've gone back to using the Zoop as primary computer.
2) DAN insurance (or similar) vital... both for advice on phone... and cost of Rx...hate to think how much low level flight cost...
3) teamwork / coordination / helicopter view / people doing allocated tasks. There seemed to be a reasonably coherent plan while on the boat ie it seemed to be a scenario they had considered and had a strategy to manage.
4) I'll keep my ACLS up to date and have done more reading round dive medicine. We gave O2, kept her hydrated and stopped her from getting cold... not sure what else we could have done on the boat? (No IV fluids etc available).
5) It was bloody scarey.
Incidentally, have subsequently discussed events with medical & friends (from various specialties). Conclusion - none of them had any idea how to manage DCI (as I expected).
Cheers.
Day 2 of a liveaboard cruise, third dive, diver A surfaces with a story of neck pain and then weakness in her left arm. She is slim, aged 50s-60s, no sig medical history am aware of, am not sure how many dives but def not a 'beginner'. Boat was turned back to nearest port immediately, A was given O2, kept orally hydrated, DAN contacted... chamber in Suva put on standby (apparently). She had complete flacid paralysis of left arm, 0/5 strength... this improved over several hours of O2 and when she left the boat strength had improved to 4/5. Otherwise normally cognition etc, a little argumentative - that may have been anxiety / stress / related to DCI / (normal for her?) Remainder of basic neuro exam normal. Arrived in Suva around midnight - 7-8 hours after onset of Sx. Unable to be put in chamber overnight, then couldn't be put in chamber the next morning (not sure why ?staffing ?island time ?chamber functional - no idea). Symptoms worsen to paralysis of left side of body. The next morning DAN arranges retrieval flight from NZ.. she gets into chamber in Auckland about 30 hours after onset of symptoms. Multiple chamber treatments... likely to be left with some residual symptoms but should be able to 'lead normal life'. (I haven't heard how things progressed subsequently).
My background: about 250 dives, never encountered DCI previously. Am an obstetrician ie medically trained but realistically all I know about dive medicine I know as a diver and not from my medical training. I worked in PNG for a year so have some insight into challenges in providing healthcare in developing countries.. and 'island time' and things generally not happening as they should. I completed my Rescue diver course last year, with one of my motivations being that if there was an 'incident' there would likely be an expectation that as a doctor I would be medically 'useful'.
These are my thoughts (I've thought a lot about this!):
1) no blatantly obvious precipitant for the hit. It was no deco diving, she was diving same profile as her buddy (and likely very similar to others in the group). Last dive quite a bit of current so may have over exerted, may have been dehydrated....?? Nothing exciting on her dive computer.
2) While FIji is a developing country, I would consider their healthcare system significantly better to other countries I've dived in (ie PNG!). The dive region is nowhere near as isolated as other places I've dived ie if it took that long to get to a chamber from Fiji / Bligh waters area, how long would it take from other areas???
3) While on the boat, A was 'cared for' by me and another of the punters who was a nurse... which freed up staff to liase with DAN etc. ie there was indeed an expectation that I'd be medically useful and my opinion carried some weight while we were on the boat...
What I've learned:
1) I'm being a bit more cautious about my diving, particularly in isolated areas.. confess I was often guilty of pushing my no-deco limits right to the limit.. and was excited when my new dive computer had far more liberal settings than my conservatively set Zoop... I've gone back to using the Zoop as primary computer.
2) DAN insurance (or similar) vital... both for advice on phone... and cost of Rx...hate to think how much low level flight cost...
3) teamwork / coordination / helicopter view / people doing allocated tasks. There seemed to be a reasonably coherent plan while on the boat ie it seemed to be a scenario they had considered and had a strategy to manage.
4) I'll keep my ACLS up to date and have done more reading round dive medicine. We gave O2, kept her hydrated and stopped her from getting cold... not sure what else we could have done on the boat? (No IV fluids etc available).
5) It was bloody scarey.
Incidentally, have subsequently discussed events with medical & friends (from various specialties). Conclusion - none of them had any idea how to manage DCI (as I expected).
Cheers.
