Why not treat DCS yourself?

[KeithG]

If you don't have the required stuff (sufficient oxygen supply, full face mask, surface guy and in-water guy), then you aren't prepared for proper IWR. If you can't manage the thermal stress then you aren't a candidate for IWR.

If you're serious about IWR as an option on the table take the steps needed to do it right.

Good info.

So how does someone go about handling the thermal stress? Is there anything that can be done? In my experince in general there is sometimes 1 person that does the week of LOB diving with no wetsuit. Maybe they could be a IWR candidate if we jammed them in a suit? Everyone else is already cold with their wetsuit. Are they all non candidates?

 

[PfcAJ]

Good info.

So how does someone go about handling the thermal stress? Is there anything that can be done? In my experince in general there is sometimes 1 person that does the week of LOB diving with no wetsuit. Maybe they could be a IWR candidate if we jammed them in a suit? Everyone else is already cold with their wetsuit. Are they all non candidates?

It depends. Drysuit? Heated vest? One of those wetsuit heater things? Put on a wetsuit and hood? Water temp? So many variables. If you're for real about IWR and following one of the published protocols, its already a bunch of money to have the kit ready to go.

But its serious stuff and deserves serious consideration.

I think the posted guidelines do a pretty good job of spelling out the current subject-matter-expert thinking on IWR, but I always wonder about the benefit (or lack thereof) of a partial treatment. If it must be truncated due to some issue (weather, thermal stress), is it better to do what you can in that case?

Heavy topics.

 

[KeithG]

It depends. Drysuit? Heated vest? One of those wetsuit heater things? Put on a wetsuit and hood? Water temp? So many variables. If you're for real about IWR and following one of the published protocols, its already a bunch of money to have the kit ready to go.

But its serious stuff and deserves serious consideration.

I think the posted guidelines do a pretty good job of spelling out the current subject-matter-expert thinking on IWR, but I always wonder about the benefit (or lack thereof) of a partial treatment. If it must be truncated due to some issue (weather, thermal stress), is it better to do what you can in that case?

Heavy topics.

Good point about the heated vest. A couple had them on our last LOB and loaned them out to other divers for a few dives. I have no idea what their run-time is.

 

[doctormike]

If you're serious about IWR as an option on the table take the steps needed to do it right.

Exactly. Perfect.

I don't think that anyone in this thread has said IWR should never be done under any circumstances. It is clearly the least worst option in many situations. But if you are going to put it in your armamentarium, then the obligation is on you to learn how to do it, WHEN to do it, and carry the appropriate gear to do it.

It should be part of the dive contingency plan. Sure, you didn’t plan on getting bent. But you did plan on diving somewhere that a chamber evacuation was going to be difficult and delayed. So if that’s the case, then it’s not ok to say “well, I read on scubaboard that IWR” is a good option so I’ll just jump in the water with some O2”. You should prepare for IWR if you are going to use it if necessary.

It’s a lot like deco and tech training. If you are an OW diver and you blow past your NDL, sure you are going to follow your dive computer and do your best. But that’s not the same as having the gear and training to do deco safely.

 

[Lorenzoid]

. . .
It should be part of the dive contingency plan. Sure, you didn’t plan on getting bent. But you did plan on diving somewhere that a chamber evacuation was going to be difficult and delayed.

Isn't this the difficult part of making the decision to prepare for IWR? How "difficult and delayed" is enough to justify the training/preparation and the gear? I'm thinking of liveaboards, where it is always going to be on the order of hours to a recompression chamber. Should rec-diving liveaboard crews have the training and equipment to do it, given how unlikely DCS is in the first place? Many liveaboards operating far from chambers already encourage divers to dive conservatively. Forgive me if this was discussed upthread--I have been reading this thread only intermittently.

 

[doctormike]

Isn't this the difficult part of making the decision to prepare for IWR? How "difficult and delayed" is enough to justify the training/preparation and the gear?

Absolutely right!

It’s a trade off. All I’m saying is to do some of this analysis ahead of time and bring appropriate gear if it’s an option for you. Don’t just wing it.

 

[Lorenzoid]

I get it, but I just don't see how it's an option for most divers. Most of us are diving with a dive operation, not on our own, so it would have to be the dive op that does the analysis and brings the gear. Those who do dive on their own and have the mindset and gear to do it are mostly tech divers. The idea of IWR is not new to them.

 

[Michael Guerrero]

For a missed safety stop, and surface symptoms of DCS, you should use surface O2 and get to a recompression chamber.

For omitted deco, it is acceptable to descend under safe conditions and follow your agencies protocol. The big difference here is that you are trained to safely use O2 and perform decompression procedures underwater. If you encounter DCS symptoms after you follow procedures, you should get to a chamber.

If you are trained, equipped (mentally and physically), and practiced in performing IWR and are too far away from a chamber for timely treatment, then IWR may be a reasonable response.

 

[100days-a-year]

In all likelihood IWR will be feasible for less than 1% of divers and even them it is not always going to be the best option.
But in some cases it will be the only rational option given that damage that could have been prevented by IWR may well become permanent by the time someone is flown to a chamber.
I recently had a friend helo'd out off Charleston when they suspected a neurological hit.Roughly 4 hours from the time he surfaced till he was at a chamber.However,had that helo been busy on another rescue it could likely have been 12 or more.
When given the option of possibly fixing myself vs possibly being permanently paralyzed or worse,an immediate IWR doesn't seem nearly as far fetched.

 

[GJC]

For a missed safety stop, and surface symptoms of DCS, you should use surface O2 and get to a recompression chamber.

For omitted deco, it is acceptable to descend under safe conditions and follow your agencies protocol. The big difference here is that you are trained to safely use O2 and perform decompression procedures underwater. If you encounter DCS symptoms after you follow procedures, you should get to a chamber.

If you are trained, equipped (mentally and physically), and practiced in performing IWR and are too far away from a chamber for timely treatment, then IWR may be a reasonable response.

This should be a significant factor in decision making in deciding to attempt IWR:

How bad is the DCS hit?

Missed safety stop, within NDL, and with no symptoms = no IWR

Did safety stop, within NDL, mild symptoms = surface O2, seek medical care, no IWR

Exceeded NDL just a little, mild symptoms = this one's a toss up, leaning toward O2, medical care and no IWR

Exceeded NDL significantly, mild to severe symptoms, chamber far away, got all the right equipment and support for IWR= now leaning more toward IWR

Major deco obligation missed, severe symptoms, got all the right equipment and support for IWR = IWR probably best bet, but big risk of drowning if symptoms worsen needs to be considered

Please do not construe the above to be recommended medical advice. This is all just hypothetical off the top of my head.

Edit -Yes, this approach as outlined is wrong. Read all the following posts