In-Water Recompression, Revisited

[Miyaru]

So the consensus is still that IWR is the last option to resort to. What value would a portable/foldable monochamber have over IWR?
Disadvantages of a monochamber are patient isolation and much higher costs than a ffm and umbilical for IWR treatment. Portable monochambers have been around for years, but I've never read of one being used for treatment.

 

[KevinNM]

The foldable/inflatables apparently can't be used with Oxygen and you apparently can't pressurize them enough to get much response without oxygen. I don't know if it would be as good as 100% at atmospheric pressure. If they are more capable that that then you'd want to discuss it with the medical officer who would be handling DCS for your expedition.

 

[Duke Dive Medicine]

There are collapsible chambers that can be pressurized to 2.8 ATA with scuba tanks. Some have penetrators for delivery of 100% oxygen via BIBS mask. From a treatment perspective they're just as efficacious as any hospital or clinic-based chamber. The patient is isolated, which could be problematic if the dive site was distant from advanced medical care and the diver decompensated while in the chamber. Stable patients are treated all the time in hospital and clinic-based monoplace chambers though, and the incidence of problems is low. Advantages are that the diver could be kept warm and dry and provided with a full Navy Treatment Table 6 or similar protocol provided there was sufficient gas. Disadvantages are that they require more training and a higher level of qualification for safe operation.

Best regards,
DDM

 

[Kay Dee]

This is an important question and I suspect gets to the heart of why Gilliam thinks it is fine to go to 2.8ATA on oxygen underwater - because he has seen it done in a chamber many times without any problems. He is failing to appreciate the difference in risk between a subject at rest in a chamber and a diver underwater..............

It is my understanding (although I am still waiting on a reply / confirmation from the old coot himself), that he has done it in-water, not just witnessed / done it in a chamber. I could be of course completely wrong on that, but......................that was my impression from way back when. Let's see what he says, if he deems to reply that is (as he is usually having way too much fun to be bothered with forums). And even if he has done it in-water, it still doesn't mean it is an 'acceptable' practice.

That being said, and for the record again, and let me shout this out this time "I AM NOT RECOMMENDING IT (I.E. 2.8 ata IN-WATER ON O2), AND I DON'T RECALL SAYING I WOULD, (RECOMMEND IT) EXCEPT SAYING I, REPEAT I, WOULD TAKE THE CHANCE MYSELF IF IN A TOTAL WORSE CASE EMERGENCY AS I ALLUDED TO WAY BACK MANY PAGES AGO"

Is that clear enough re my position now for all?

Dive safe, and if you cant be good, be careful!

 

[Kay Dee]

And the following, although regarding cancer in this instance, may be of interest to some re my earlier post re my 'position / attitude' re not 'fearing' death, and / or not coming to terms with it / not even thinking about it, as if it wasn't going to happen to them.

Safe diving and best fishes!

 

[cerich]

Disadvantages are that they require more training and a higher level of qualification for safe operation.

Best regards,
DDM

ok.. can you explain exactly what it is you perceive requires more training and higher level of qual for safe operations versus IWR?

My 2psi, IWR requires a team that has understanding of the process, thus training. The in water logistics of IWR are inherently more difficult than those of employing a flexidec .

Deploying a flxidec is not rocket science and easily trained to chamber operators. Operating one is easier than most hard chambers. The monplace limitations aren't unique to flexidec and extend more to medical issues secondary to the dcs..however also potentially more immediately life threatening, thus a serious limitation with mono's anyhow.

IWR, Flexidec or hard chamber, seems to me that the underlying knowledge of dcs treatment needs to be present regardless.

On site re compression for emergency management, regardless of the vehicle used requires a trained and competent team. Unless you are talking seriously supported logistics wise (multi place, medical professional tenders, gas supply for multiple treatments and the time..often weeks of multiple treatment) beyond even the military/commercial world norm, on site is either last ditch or mitigation to get the afflicted stable then transported to comprehensive treatment...

The days of "symptoms disappeared let's get him back on job" have pretty much and thankfully passed.

 

[cerich]

It is my understanding (although I am still waiting on a reply / confirmation from the old coot himself), that he has done it in-water, not just witnessed / done it in a chamber. I could be of course completely wrong on that, but......................that was my impression from way back when. Let's see what he says, if he deems to reply that is (as he is usually having way too much fun to be bothered with forums). And even if he has done it in-water, it still doesn't mean it is an 'acceptable' practice.

That being said, and for the record again, and let me shout this out this time "I AM NOT RECOMMENDING IT (I.E. 2.8 ata IN-WATER ON O2), AND I DON'T RECALL SAYING I WOULD, (RECOMMEND IT) EXCEPT SAYING I, REPEAT I, WOULD TAKE THE CHANCE MYSELF IF IN A TOTAL WORSE CASE EMERGENCY AS I ALLUDED TO WAY BACK MANY PAGES AGO"

Is that clear enough re my position now for all?

Dive safe, and if you cant be good, be careful!

I wouldn't and haven't pushed a 2.8 doing IWR. Can you get away with it? Yeah, maybe but I wouldn't take those odds in water. Type 1 with localized pain only in a well controlled in water environment, warm water, proper support equipment and team in place...maybe. A bad case with type 2 presenting..not a chance would I attempt 2.8. In fact my "gut" tells me to back off the oxygen for a bit to see what pressure alone does to relive the symptoms, then look at pushing higher ppo2. Then again my thoughts on IWR is it's first aid, not treatment, treatment comes later

 

[Duke Dive Medicine]

That being said, and for the record again, and let me shout this out this time "I AM NOT RECOMMENDING IT (I.E. 2.8 ata IN-WATER ON O2), AND I DON'T RECALL SAYING I WOULD, (RECOMMEND IT) EXCEPT SAYING I, REPEAT I, WOULD TAKE THE CHANCE MYSELF IF IN A TOTAL WORSE CASE EMERGENCY AS I ALLUDED TO WAY BACK MANY PAGES AGO"

Is that clear enough re my position now for all?

Dive safe, and if you cant be good, be careful!

Kay Dee,

You've made your position quite clear, and I recognize that you are not advocating a practice. Please feel free to have whatever procedures performed on yourself that you'd like. It's your body. The reason I keep responding to statements like the one in all caps above is that I don't want anyone reading what you've written and thinking that it's a remotely reasonable option. It is absolutely not. It is based on (potentially fatally) flawed clinical reasoning and is utterly imprudent from a diving and medical perspective, for all the reasons that have been described above. Please don't take this as me questioning your right to exercise your own free will. I just hope it never comes down to you having to make a decision like that.

Best regards,
DDM

 

[Duke Dive Medicine]

ok.. can you explain exactly what it is you perceive requires more training and higher level of qual for safe operations versus IWR?

My 2psi, IWR requires a team that has understanding of the process, thus training. The in water logistics of IWR are inherently more difficult than those of employing a flexidec .

Deploying a flxidec is not rocket science and easily trained to chamber operators. Operating one is easier than most hard chambers. The monplace limitations aren't unique to flexidec and extend more to medical issues secondary to the dcs..however also potentially more immediately life threatening, thus a serious limitation with mono's anyhow.

IWR, Flexidec or hard chamber, seems to me that the underlying knowledge of dcs treatment needs to be present regardless.

On site re compression for emergency management, regardless of the vehicle used requires a trained and competent team. Unless you are talking seriously supported logistics wise (multi place, medical professional tenders, gas supply for multiple treatments and the time..often weeks of multiple treatment) beyond even the military/commercial world norm, on site is either last ditch or mitigation to get the afflicted stable then transported to comprehensive treatment...

The days of "symptoms disappeared let's get him back on job" have pretty much and thankfully passed.

True, you can train almost anyone to turn knobs on a chamber. You can't train almost anyone to make good clinical decisions on the fly, especially when things go wrong. Granted many of the same principles apply to IWR, but I personally think that treating a patient in a chamber requires another skill set on top of that. My own opinion, not written into law or literature anywhere that I know of

Best regards,
DDM

 

[cerich]

True, you can train almost anyone to turn knobs on a chamber. You can't train almost anyone to make good clinical decisions on the fly, especially when things go wrong. Granted many of the same principles apply to IWR, but I personally think that treating a patient in a chamber requires another skill set on top of that. My own opinion, not written into law or literature anywhere that I know of

Best regards,
DDM

I suspect you think of treatment as treatment to a the best outcome. Kinda a long term thing. I think of IWR on site reco regardless of the "how" as first aid until I can get the afflicted to someone like you