In Water Recompression vs Missed Deco

[oly5050user]

I've got a question for the experts on this board (it looks like we have a lot of staff here reading this). I'm a safety professional, and have made comments on other threads which haven't been taken very seriously, but I need to make them again. There are a lot of "recreational" divers here who are doing technical diving that includes decompression. They are now using computers to calculate it, and are coming quite close to the "knife edge" of the no-decompression limits even when they are not doing decompression diving as they are using 90 cubic feet tanks, or sometimes doubles. My questions are:



I'll say it again, if Walter Starck, a biologist who wrote The Blue Reef, A Report from Beneath the Sea* could equip his research vessel on a very limited budget in the mid-1970s with a recompression chamber, why cannot charter dive boats who get paying customers do the same? Let me quote part of Dr. Starck's discussion on recompression, where he told of the need to recompress his wife after a bad "hit":

one reason is cost another is training another is space --primary reason may be once you are bent and need treatment it is now a medical problem and you need a doctor--ever hear of medical malpratice?? pratice without a license and you open up yourself to all kinds of problems.. In this day and age you cannot hand someone an asprin without a chance of being sued..Better to place the problem with the diver himself/herself who most likely(not always) caused the problem to themselves ...Having a chamber available is not considered due standard of of care for a recreational resort to support and for the non medically trained to use .

 

[BigJetDriver]

one reason is cost another is training another is space --primary reason may be once you are bent and need treatment it is now a medical problem and you need a doctor--ever hear of medical malpratice?? pratice without a license and you open up yourself to all kinds of problems.. In this day and age you cannot hand someone an asprin without a chance of being sued..Better to place the problem with the diver himself/herself who most likely(not always) caused the problem to themselves ...Having a chamber available is not considered due standard of of care for a recreational resort to support and for the non medically trained to use .

Cost is one thing that is a very real problem. The darned things are hideously expensive.

Training is another. You do have to know at least a little bit about how to run it.

The next bit is incorrect. You are bent. You need help. A doctor with knowledge of diving medicine and hyperbarics is best. You may (probably) will not get that even when you get to an Emergency Room.

In the field, with no doctor present, but with a portable recompression chamber and someone who knows how to use it handy, what are you going to do, refuse treatment? Fortunately, most places in the world have the equivalent of a "Good Samaritan" statute that protects First Responders and the like.

The key to all of these questions is ALWAYS situational. Where are you when it happens, and what are the local conditions, and how far away (in real time) is professional help.

Please note: By professional help, I DO NOT MEAN YOUR ORDINARY EMERGENCY ROOM!

 

[DA Aquamaster]

one reason is cost another is training another is space --primary reason may be once you are bent and need treatment it is now a medical problem and you need a doctor--ever hear of medical malpratice?? pratice without a license and you open up yourself to all kinds of problems.. In this day and age you cannot hand someone an asprin without a chance of being sued..Better to place the problem with the diver himself/herself who most likely(not always) caused the problem to themselves ...Having a chamber available is not considered due standard of of care for a recreational resort to support and for the non medically trained to use .

There's irony for you. It's better to deny any treatment than offer potentially effective treatment as you might get sued if the person dies.

That's actually what is wrong with bystander CPR as well. If I give CPR and my certification is current, I'm covered liability wise if you still die. But if I render CPR and my certification expired yesterday I can get sued if you die. So if I take your lead on this, if I my certification is one day out of date, I guess I am supposed to do the "prudent" thing and just stand there and let you die. I guess that's ok for me, because after all, again borrowing from your example, you probably caused your own coronary eating at McDonalds. But doing it your way really sucks for you - and your spouse and kids. The problem is not having too few doctors, the problem is having too many lawyers and perhaps rather than denying "medical" procedures that are of proven effectiveness we need to just think tort reform and liability waivers.

I don't think it is coincidence that at least one company sells their portable recompression chamber "for use by divers" for "surface decompression". So I guess if I am bent, we are several days or even several hours sailing from being within range of an evacuation helicopter and we have a chamber on board but no doctor, I'd prefer you go ahead and run the chamber for my Table 4 "surface decompression". I'll sign a waiver.

 

[oly5050user]

There's irony for you. It's better to deny any treatment than offer potentially effective treatment as you might get sued if the person dies.

That's actually what is wrong with bystander CPR as well. If I give CPR and my certification is current, I'm covered liability wise if you still die. But if I render CPR and my certification expired yesterday I can get sued if you die. So if I take your lead on this, if I my certification is one day out of date, I guess I am supposed to do the "prudent" thing and just stand there and let you die. I guess that's ok for me, because after all, again borrowing from your example, you probably caused your own coronary eating at McDonalds. But doing it your way really sucks for you - and your spouse and kids. The problem is not having too few doctors, the problem is having too many lawyers and perhaps rather than denying "medical" procedures that are of proven effectiveness we need to just think tort reform and liability waivers.

I don't think it is coincidence that at least one company sells their portable recompression chamber "for use by divers" for "surface decompression". So I guess if I am bent, we are several days or even several hours sailing from being within range of an evacuation helicopter and we have a chamber on board but no doctor, I'd prefer you go ahead and run the chamber for my Table 4 "surface decompression". I'll sign a waiver.

of course obviously if one is available and someone knows how to use go for it..but most incidents are in a area that is relatively close to a chamber ,one that is open and staffed..But in really remote areas be prepared to accept risks that there may not be one available and you either do try iwr or stay on o2 and hope for the best..

 

[2Tours N Iraq`]

As a management major, the biggest reason why there aren't chambers aboard charters is cost. It does not make much economical sense to have an expesnive chamber on board that might be used every once in a while. Additionally, there is the maintenance cost associated with keeping the chamber in good working order. Thirdly, should the chamber not be operational (whether due in part to negligence, neglect, or an accident), the legal cost would be sky high.

Second, most dive charters do not have space aboard their vessels to house such a large piece of equipment and still have room for their passengers and gear. Generally, the only charters large enough to put a recompression chamber on board would be live-aboards but again, those too have precious little space.

Finally, most charters have an excellent safety record and there just isn't a need for vessels to be outfitted with chambers. It is cheaper and more practical for a charter to attempt a LAST DITCH effort with in-water recompression than to have all the additional responsibilities of maintaining a chamber onboard given the high safety records.

Just my 2 cents worth.

 

[String]

The number of incidents really are tiny with the % of total diving carried out so it isnt cost effective. That said i wonder about the use of the 1 person portable chambers on liveaboards given these tend to operate that bit further from land.

Its definately not cost effective or worth having a full scale chamber on a charter boat for normal rec. type dives.

 

[DA Aquamaster]

That is I think pretty much the point of the discussion. No one is advocating a portable chamber aboard a six pack that is less than an hour from the dock. But for destination live aboards that may be at remote locations or for boats that take dedicated wreck/tech divers to deep wrecks where decompression is common and where a DCS hit is much more likely, they begin to make sense particularly when the cost of a boat's liability insurance gets excessive after a fatal accident or two.

Plus, I think it could be a good marketing tool both directly by being aboard and indirectly by improving a boat's safety/fatality record over the course of a few seasons.

I have not looked at stats lately but my conclusion from 2003 DAN accident data and estimates of numbers of tech divers at the time was that tech divers were 27 times more likely to experience a DCS hit than the average wreck diver. So for a boat servicing deep wreck bound technical divers, a portable chamber may make a great deal of sense.