Emergency pressure treatment when bent?

[DevonDiver]

It's not a trend that I had any awareness of. I will re-post that as a question in the technical forum to see if any forum members have done it, or heard of it being done...

 

[graywhale]

The other thread covered this, thanks to all. But I will throw one thing out:

If anyone is aware of a specific case where during IWR a victim became worse, died or was hurt, please post it. Otherwise it is pure speculation that IWR does these things. From my case reading, there is not a single known case where this has happened - that I have come across anyway.

 

[TSandM]

Well, there is a basic problem with the question you have asked, and that's selection bias. People who appear to be developing significant symptoms probably rarely opt to get back in the water, nor do their companions want to be part of an attempt at IWR. People with minor or doubtful symptoms may do this, but may have had at worst extremely minor DCS or equivocal symptoms, and therefore did fine with the decision to do IWR.

It's like aggressive early treatment for strokes . . . since a good many stroke-like symptoms resolve on their own anyway, it takes large numbers and good study design to tease out what really works as opposed to what simply doesn't hurt.

 

[laurin]

IWR seems to be a bit hard subject, as people tend to mix it with 'missed deco'-procedures.

IMHO IWR isn't really an option as an ad-hoc or emergency solution - you need to have the gear, the gases and the crew to manage it, and even then it would take a pretty informed decision to start it, as a mild symptoms might disappear on their own, or with breathing O2 at the surface. Taking a mildly bent diver back down might actually do harm, if the treatment needs to be cut short due to environmental etc issues - we know the diver had bubbles to begin it, now we might have just made them pass to arterial side.

Starting IWR when a chamber is an option would be downright stupid.

I really see it as an option when 1) a chamber really isn't available due to, say, remote location (cost isn't an excuse) 2) the symptoms are severe enough to require treatment but not bad enough to make going back to water dangerous 3) the necessary kit and knowledge is there, as in 'planned and prepared for'.

A much better option is to scale down your dives if you know you can't get to a chamber should you need to.

//LN

 

[DCBC]

The other thread covered this, thanks to all. But I will throw one thing out:

If anyone is aware of a specific case where during IWR a victim became worse, died or was hurt, please post it. Otherwise it is pure speculation that IWR does these things. From my case reading, there is not a single known case where this has happened - that I have come across anyway.

Sussex, England. Twelve experienced divers conducted an 18-minute dive on a wreck in about 215 feet. They surfaced following 38 minutes of air decompression, at which time two of the divers reported "incomplete decompression". These two divers obtained additional supplies of air and returned to the water in an apparent effort to treat DCS symptoms. They never returned to the boat, and their bodies were recovered two weeks later. The reason for their deaths remains a mystery. It is possible that they were suffering from neurological DCS symptoms, and drowned as a result of these symptoms. The tragedy of this case lies in the fact that they most likely would have survived had they not re-entered the water. The boat was equipped with 100% oxygen (surface-breathing) equipment, and the incident occurred in an area where emergency air-transport could have delivered the divers to a recompression chamber less than an hour after surfacing. The water temperature in this case was about 61-63° F (16-17° C), and the surface conditions were relatively rough (3-5 ft seas). Whether or not these divers perished as a direct result of DCS symptoms, they would, in all likelihood, have survived the incident had they not returned to the water. (In-water Recompression as an Emergency Field Treatment of Decompression Illness Richard L. Pyle and David A. Youngblood)

 

[DandyDon]

Not for me. This subject has been the focus of a number of threads lately, and I guess that's good - as it's been well established as a very risky wager.

 

[Mr Carcharodon]

The other thread covered this, thanks to all. But I will throw one thing out:

If anyone is aware of a specific case where during IWR a victim became worse, died or was hurt, please post it. Otherwise it is pure speculation that IWR does these things. From my case reading, there is not a single known case where this has happened - that I have come across anyway.

For a specific example read case #3 in: "The case for in-water
recompression". aquaCorps, No. 11:35-46, by Pyle and Youngblood. Two divers returned to the water and both died. But my take away from this was that the outcomes in cold water tend to be much worse than in warm water.

Also I do not think it can be reasonably said that oxygen toxicity is speculative. Some of the suggested IWR protocols use 2 ATA oxygen. The risk of toxing could be a few percent which might be an acceptable risk in an emergency when no alternatives are available.

 

[DevonDiver]

IWR seems to be a bit hard subject, as people tend to mix it with 'missed deco'-procedures.

Which people do that?

Here is the definition I posted for the two, very differing, procedures...

Omitted Deco = Conducted before presentation of DCI symptoms, to specifically remedy a deviation from the planned deco schedule.

IWR = Conducted after presentation of DCI symptoms, to specifically treat DCI.

 

[Mr Carcharodon]

Not for me. This subject has been the focus of a number of threads lately, and I guess that's good - as it's been well established as a very risky wager.

But risk may be on the order of a few percent. Which may be rather better than not recieving timely treatment.

 

[TSandM]

Let's face it . . . if you develop major DCS symptoms in an area where transport to a chamber can't be done in a timely fashion, you are in serious trouble. But taking someone with serious symptoms back into the water requires major preparation -- you may survive a spinal cord embolism as a paraplegic, but you're extremely unlikely to survive an oxygen toxicity event unless you're in a FFM and have experienced tenders.

For mild (Type I) symptoms, I don't think there is ANY question that you are better off on the surface, breathing oxygen, than you are back in the water.

The real answer is, if you are doing aggressive dives in a remote location, have an on-site chamber