The Diving Supervisor has two alternatives for recompression treatments when
the diving facility is not equipped with a recompression chamber. If recompression
of the patient is not immediately necessary, the diver may be transported to
the nearest certified recompression chamber for treatment..
Transporting the Patient. In certain instances, some delay may be unavoidable
while the patient is transported to a recompression chamber. While moving the
patient to a recompression chamber, the patient should be kept lying horizontally.
Do not put the patient head-down. Additionally, the patient should be kept warm
and monitored constantly for signs of blocked airway, cessation of breathing,
cardiac arrest, or shock. Always keep in mind that a number of conditions may
exist at the same time. For example, the victim may be suffering from both decompression
sickness and severe internal injuries.
Medical Treatment During Transport. Always have the patient breathe 100
percent oxygen during transport, if available. If symptoms of decompression sickness
or arterial gas embolism are relieved or improve after breathing 100 percent
oxygen, the patient should still be treated as if the original symptom(s) were still
present. Always ensure the patient is adequately hydrated. Give fluids by mouth if
the patient is able to take them. Otherwise, intravenous fluids should be started
before transport (paragraph 21-5.5.7). If the patient must be transported, initial
arrangements should have been made well in advance of the actual diving operations.
These arrangements, which would include an alert notification to the
recompression chamber and determination of the most effective means of transportation,
should be posted on the Job Site Emergency Assistant Checklist for
instant referral.
Transport by Unpressurized Aircraft. If the patient is moved by helicopter or
other unpressurized aircraft, the aircraft should be flown as low as safely possible,
preferably less than 1,000 feet. Any unnecessary altitude means an additional
reduction in external pressure and possible additional symptom severity or
complications. If available, always use aircraft that can be pressurized to one
atmosphere.
Communications with Chamber. Call ahead to ensure that the chamber will be
ready and that qualified medical personnel will be standing by. If two-way
communications can be established, consult with the doctor as the patient is being
transported.
In-Water Recompression. Recompression in the water should be considered an
option of last resort, to be used only when no recompression facility is on site and
there is no prospect of reaching a recompression facility within 12 hours. In an
emergency, an uncertified chamber may be used if, in the opinion of the Diving
Supervisor, it is safe to operate. In divers with severe Type II symptoms, or symptoms
of arterial gas embolism (e.g., unconsciousness, paralysis, vertigo,
respiratory distress, shock, etc.), the risk of increased harm to the diver from inwater
recompression probably outweighs any anticipated benefit. Generally, these
individuals should not be recompressed in the water, but should be kept at the
surface on 100 percent oxygen, if available, and evacuated to a recompression
facility regardless of the delay. To avoid hypothermia, it is important to consider
water temperature when performing in-water recompression.
Surface Oxygen Treatment. For less life-threatening cases, have the stricken
diver begin breathing 100 percent oxygen immediately if it is available on site.Continue breathing oxygen at the surface for 30 minutes before deciding to recompress
in the water. If symptoms stabilize, improve, or relief on 100 percent oxygen
is noted, do not attempt in-water recompression unless symptoms reappear with
their original intensity or worsen. Continue breathing 100 percent oxygen as long
as supplies last, up to a maximum time of 6 hours. If surface oxygen proves ineffective
after 30 minutes, begin in-water recompression.
In-Water Recompression Using Air. In-water recompression using air is always
less preferable than using oxygen.
1. Follow Treatment Table 1A as closely as
possible.
a. Use either a full face mask or, preferably, a surface-supplied UBA. Never
recompress a diver in the water using a scuba with a mouthpiece unless it
is
the only breathing source available.
b. Maintain constant communication.
2. Keep at least one diver with the patient at all times. Plan
carefully for shifting UBAs or cylinders. Have an ample number of tenders
topside.
3. If the depth is inadequate for full treatment according to
Treatment Table 1A:
a. Recompress the patient to the maximum available depth.
b. Remain at maximum depth for 30 minutes.
c. Decompress according to Treatment Table 1A. Do not use stops shorter than
those of Treatment Table 1A.
In-Water Recompression Using Oxygen. If a 100 percent oxygen rebreather is
available and individuals at the dive site are trained in its use, the following inwater
recompression procedure may be used instead of Table 1A:
1. Put the stricken diver on the UBA and have the
diver purge the apparatus at least three times with oxygen.
2. Descend to a depth of 30 feet with a standby diver.
3. Remain at 30 feet, at rest, for 60 minutes for Type I symptoms and
90 minutes for Type II symptoms. Ascend to 20 feet even if symptoms are
still
present.
4. Decompress to the surface by taking 60-minute stops at 20 feet and
10 feet.
5. After surfacing, continue breathing 100 percent oxygen for an
additional 3 hours.
6. If symptoms persist or recur on the surface, arrange for transport
to a recompression facility regardless of the delay.
Symptoms After In-Water Recompression. The occurrence of Type II symptoms
after in-water recompression is an ominous sign and could progress to severe,
debilitating decompression sickness. It should be considered life-threatening.
Operational considerations and remoteness of the dive site will dictate the speed
with which the diver can be evacuated to a recompression facility.
Symptoms During Decompression (No Chamber Available). Development of
decompression sickness in the water is uncommon when U.S. Navy decompression
procedures are followed, but when it does occur it is likely to be at shallow
stops. The symptoms are usually Type I and respond quickly to minimal recompression.
Follow the flowchart in Figure 21-3 for proper management. Only
recompress an additional 10 feet if no significant improvement was noted after the
first 10-fsw recompression. Remain at treatment depth 30 minutes in addition to
any required decompression stop time. If no decompression time is required at the
treatment depth, remain there for 30 minutes. Shift diver to 100 percent oxygen at
depths of 30 feet and shallower if possible. If symptoms persist after surfacing,
have the diver breathe 100 percent oxygen while arranging evacuation to a recompression
facility. Do not conduct in-water recompression for residual symptoms
after surfacing. Once a recompression facility is reached, any symptoms are
treated as a recurrence of Type II symptoms.
