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DCS hits: "deserved" vs. "explained"

Discussion in 'Basic Scuba' started by SeaHorse81, Dec 11, 2013.

  1. SeaHorse81

    SeaHorse81 Solo Diver

    # of Dives: 200 - 499
    Location: PA
    In another thread there was a bit of dialog about the language we use when we discuss DCS hits, and the consequences of that language. Rather than derail that thread, I’d like to talk about it here. I know this isn’t the first time we’ve had this particular conversation, but I think it bears periodic review.

    It is my perception that the diving community in general takes a judgmental stance toward DCS hits, as evidenced by the words “deserved” and “undeserved.” If a hit happened, it must be because somebody made a mistake, misjudged something, failed to accurately predict conditions, failed to make themselves physically prepared for safe diving, or some other failing.

    To the best of my knowledge, there are some hits that nobody ever figures out. Clearly, there was a reason it occurred, but it can’t be nailed down. Educated guesses ensue.

    Let’s assume for the sake of argument that every single DCS hit can indeed be traced to diver behavior and choice. Every last one. Let’s certainly include those people who are train wrecks in gear that anybody could predict might be likely to get hit. Let’s include the arrogant jerks who think the laws of physics and physiology don’t apply to them. Of course we’re also talking about all the nice people who try to keep themselves sharp and prepared, but who are not perfect.

    Here’s the problem with the judgmental language: It can only add to the denial that every diver initially experiences when noticing the early symptoms of DCS. Adding to the denial adds to delay in starting treatment, which can only reduce the efficacy of treatment. Given that permanent neurological damage or worse is on the table, I believe that we need to make it as easy as possible for people to come forward. Ideally, we’d create a climate of, “Let’s see if we can figure out how this happened,” rather than, “Let’s see if we can figure out how you screwed up.” Then if it is indeed a screw-up, that can be acknowledged and assessed. How about innocent until proven guilty, if you’re of that mindset?

    Let’s say, as someone whose opinion I respect did, that it is disingenuous to use descriptive language for this rather than judgmental language. What’s still on the table is possible disability, the inability to remain employed and support one’s family, the inability to fully raise one’s children, the unavailability of one for the assistance of aging parents, etc. Most of us are connected to other people who will also be deeply affected by any DCS hit we happen to take. For the sake of all those connections, I think being disingenuous if it gets somebody into treatment sooner is an outstanding result. Sign me up.

    If none of that means anything, how about this? If somebody is slower getting to treatment, they’re more likely to end up officially disabled and being supported in part by all of us. It’s in our personal interest for others to get treated sooner rather than later.

    Personally, I’m not okay with saying anybody deserves neurological damage. Well, maybe pedophiles, arsonists, murderers and the like, but certainly not divers who may not have done everything properly while pursuing recreation. Regardless, it’s about minimizing the damage and collateral damage as much as possible.

    That’s my thinking, for what it’s worth. Thanks for listening.
    iamrushman likes this.
  2. Dr. Lecter

    Dr. Lecter Solo Diver

    # of Dives: 500 - 999
    Location: NYC/Honolulu
    The very fact that "undeserved" is used belies your assertion and all the touchy-feely stuff that follows from it. The whole point of the term is to recognize that some hits, while "deserved" in the sense that physics is what it is, are undeserved in so far that despite complying with present understandings of decompression theory and DCS risk factors, the diver still got bent. On the other hand some hits are deserved: the diver in question did something--whether intentionally or not, whether negligently or not--that puts them outside what any understanding of decompression theory would consider an acceptable chance of avoiding DCS.

    What you're missing is that the deserved/undeserved language isn't tracking diver moral culpability, just compliance/non-compliance with understandings of deco theory -- and non-compliance without regard to fault, at that. Nor is your "explained" language better: violating the rules dictated by deco theory doesn't explain why you got bent, it suggests a likely cause you could have avoided if your dive had been better planned, better executed, or just plain less unlucky. The fact that others have done the exact same thing without consequences indicates that nothing is explained.
    nimoh, chillyinCanada and shoredivr like this.
  3. miked

    miked Contributor

    # of Dives: 500 - 999
    Location: Park Ridge NJ
    In 2004, I had a DCS2 hit. Even then, the terminology of "deserved/undeserved" was in some places being changed to "expected/unexpected" or "explained/unexplained" or the clumsy "explainable/unexplainable". The ER Drs. said that the change was for the reasons that the OP suggested-to lessen the "stigma" of a hit, and to increase the likelihood that a diver with "weird feelings or symptoms"might be more likely to seek medical help.
    I never felt that any of those terms were stigmatizing, but even if they were, it would not have kept me from getting to the Drs.I delayed for a few hours due to denial and stubbornness.

    (BTW, my hit was "un-whatever". The ER Doc said "you broke no rules did nothing wrong, but sometimes S#$% happens".)
  4. Akimbo

    Akimbo Just a diver Staff Member ScubaBoard Supporter

    My objection to the “deserved” and “undeserved” terms is they imply a much higher degree of precision than the state of the art deserves. Frankly, “explained” is an overstatement. “Not really surprised” and “didn’t see that coming” are closer to reality. This is a pretty good historic summary:

    Dive Tables and Decompression Models | DIVER magazine

    Decompression algorithms are based on theory not laws. The algorithms are then modified to accommodate broad averages of the diving population and acceptable hit rates. Want zero risk of getting bent? Never leave sea level. Everything else is a crap shoot.
    Last edited: Dec 11, 2013
  5. GrimSleeper

    GrimSleeper Dive Shop

    # of Dives: 2,500 - 4,999
    Location: Ozstraya
    My preference is for "predicted" and "unpredicted", as in hit (a) is predicted by the models we currently have, whilst hit (b) is not.Whether or not the language of "deserved"/"undeserved" implies a moral judgement, the truth is that there is a tendency to assume a bend is the result of someone doing something wrong. The common response to finding out that I once got seriously bent (it was "unpredicted") is invariably "Did you go too deep for too long? Or come up too fast?". The notion that we just don't know enough to predict with any great precision what will or won't result in a bend seems to be a bit of a dirty little secret in recreational diving, and it does lead to doubt and denial when someone presents with possible DCS. The current edition of DAN Asia Pacific's 'Deeper With DAN' highlights exactly such a case DAN Divers Alert Network Asia-Pacific : DAN Helped Me.
  6. TSandM

    TSandM Missed and loved by many. Rest in Peace ScubaBoard Supporter

    I have a friend who is doing his PhD research on risk mitigation and accident analysis in divers. I think he would also concur that our current nomenclature discourages reporting incidents, whether "explained" or "unexplained", and also discourages divers from getting treatment. In tech diving, it's even worse -- being "immune" to DCS is seen as a chest-thumping measure of machismo. What I know about DCS research says that some divers virtually never bubble, and others bubble at the slightest provocation. But it is no metric of the quality of the person or the diving that you happen to be one of the lucky ones.
  7. Akimbo

    Akimbo Just a diver Staff Member ScubaBoard Supporter

    There were stories of several diver/guinea pigs at EDU (US Navy Experimental Diving Unit) that were famous for never getting bent. There was a guy who really screwed up the development of the original Helium-Oxygen tables under Swede Momsen of the Squalus submarine rescue fame. They would run a new table on this guy and think it was good only to find divers getting bent later. They finally figured out his unusual "tolerance" and only used him as part of groups after that.

    By the same token, we had a Master Diver when I was in the Navy that would get hit every time he got wet. Great dive supervisor, but you couldn’t put him in water deeper than a bathtub.

    When that level of variability exists in a young, physically-fit, and healthy (except maybe for alcoholism) all-male population, think what it is in the diverse recreational diving population.
  8. Jerry_

    Jerry_ Contributor

    # of Dives: 500 - 999
    Location: Europe
    Any decompression algorithms (and therefore f.i. also NDL limits) are based on statistics, not on a physical model, and are based on an average body.
    A decompression that fits for one person in a dive, might not be as secure for another person doing the same dive.
    A decompression that was ok the other day for a given diver, might not be ok for the same diver/same dive the next day, as his/her physical&mindset conditons are different.

    Therefore saying that a hit is deserved or not is defintely inaccurate because it means that the diver intentionally violated the recommendations thus getting far out of the statistical model; therefore using the term deserved may get an in surance company to argue to what extend they have to consider that accident.

    Saying a DCS can be explained (or not) is much more accurate, because it implies that here has been a detailed analysis of what happened (both he cause and the impact), and which made the diver to be hit by a DCS.
    Last edited: Dec 12, 2013
  9. DivemasterDennis

    DivemasterDennis DivemasterDennis ScubaBoard Supporter

    # of Dives: 500 - 999
    Location: Lakewood, Colorado
    I do not understand the "passion" that is emerging in this thread. All DSC hits should lead to immediate medical attention and proper treatment, whether they are from irresponsible and reckless behavior, inadvertent action, an error in dive planning, or a mystery of the universe. I am not aware of anyone being denied care because they were a "dumbass" in their diving. It is also essential that every diver who has a DCS event learn all they can from it, as should anyone else who is aware of or a part of the event or the treatment. Proper treatment requires revelation of all known facts, and perhaps the reckless diver is reluctant to confess, but if (s)he fails to do so, (s)he hurts only himself. Every diver should practice what they learn in proper training to minimize ( but never eliminate) the risk of DCS. AND.. every diver should always report any DCS symptoms without delay and seek out appropriate available treatment without delay. It's only your life. If you let arrogance or embarrasment stop you from accurate reporting or seeking treatment, then you are asking for what happens next - which is a more serious episode due to delay in or improper treatment. Some people refuse to see a doctor for anything. They take a aspirin for a hear attack, ignore persistent symptoms until they manifest as a serious illness; fail to get a tetanus shot after an injury. I was once that guy. No more. If you have symptoms of a DCS hit, tell everyone, report accurately, get treatment. So what if you "shot yourself in the foot," get the foot taken care of. Same applies to DCS. Then learn from it and avoid it in the future through safe dive planning and execution.
  10. Bob DBF

    Bob DBF Solo Diver

    # of Dives: I just don't log dives
    Location: NorCal
    Anyone that is dissuaded from seeking medical attention for a life threatening problem because of what words are used should re-evaluate their priorities. And those that think that changing words used after the event will change how people diagnose their own medical problems at the time of the event are looking for the wrong scapegoat.

    Personally, I think the reason people don't go for help immediately is because, like heart attacks, they haven't had one yet and have no idea what is going on. Toss in a little human denial to put it off longer and you get a picture of the problem. Divers don't want to be hit, by DCS or heart attack or any other life threatening issue, and have a tendency to lay symptoms off to other minor problems, rather than perhaps facing the Reaper.

    My problem is that, at my age, I have a lot of the DCS symptoms before I get in the water. I have to differentiate any symptoms before and after the dive to see what is going on. I have been hit once so I may have a better than average chance of figuring out if I'm hit. I didn't deny that one so....

    Or may be this country is getting too "touchy-feely" for me, and everything will be fine if you just say the right words.

    "the future is uncertain and the end is always near"
    Jim Morrison
    Last edited: Dec 12, 2013
    nimoh, Akimbo and Dr. Lecter like this.

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