21-1 Introduction

Purpose. This chapter covers recompression therapy. Recompression therapy is indicated for treating omitted decompression, decompression sickness, and arterial gas embolism.

Scope. The procedures outlined in this chapter are to be performed only by personnel properly trained to use them. Because these procedures cover symptoms ranging from pain to life-threatening disorders, the degree of medical expertise necessary to carry out treatment properly will vary. Certain procedures, such as starting IV fluid lines and inserting chest tubes, require special training and should not be attempted by untrained individuals. Treatment tables can be executed without consulting a Diving Medical Officer (DMO), although a DMO should always be contacted at the earliest possible opportunity. Four treatment tables require special consideration:

  • Treatment Table 4 is a long, arduous table that requires constant evaluation of the stricken diver.

  • Treatment Table 7 and Treatment Table 8 allow prolonged treatments for severely ill patients based on the patient’s condition throughout the treatment.

  • Treatment Table 9 can only be prescribed by a Diving Medical Officer.

Diving Supervisor’s Responsibilities. Experience has shown that symptoms of severe decompression sickness or arterial gas embolism may occur following seemingly normal dives. This fact, combined with the many operational scenarios under which diving is conducted, means that treatment of severely ill individuals will be required occasionally when qualified medical help is not immediately on scene. Therefore, it is the Diving Supervisor’s responsibility to ensure that every member of the diving team:

  1. Is thoroughly familiar with all recompression procedures.

  2. Knows the location of the nearest, certified recompression facility.

  3. Knows how to contact a qualified Diving Medical Officer if one is not at the site.

Emergency Consultation. Modern communications allow access to medical expertise from even the most remote areas. Emergency consultation is available 24 hours a day with:

  • Primary:
    Navy Experimental Diving Unit (NEDU)
    321 Bullfinch Road
    Panama City, FL 32407-7015

  • Secondary:
    Navy Diving Salvage and Training Center (NDSTC)
    350 South Craig Rd.
    Panama City, FL 32407-7015

Telephone numbers are listed in Volume 1, Appendix C.

Applicability of Recompression. The recompression procedures described in this chapter are designed to handle most situations that will be encountered operationally. They are applicable to both surface-supplied and scuba diving, whether on air, nitrogen-oxygen, helium-oxygen, or 100 percent oxygen. For example, the treatment of arterial gas embolism has little to do with the gas being breathed at the time of the accident. Because all possible conditions cannot be anticipated, additional medical expertise should be sought in all cases of decompression sickness or arterial gas embolism that do not show substantial improvement on standard treatment tables. Treatment of decompression sickness during saturation dives is covered separately in Chapter 15 of this manual. Periodic evaluation of U.S. Navy recompression treatment procedures has shown they are effective in relieving symptoms over 90 percent of the time when used as published. Deviation from these protocols shall be made only with the recommendation of a Diving Medical Officer.
 

Recompression Treatment for Non-Diving Disorders. In addition to individuals suffering from diving disorders, U.S. Navy recompression chambers are also permitted to conduct hyperbaric oxygen (HBO2) therapy to treat individuals suffering from cyanide poisoning, carbon monoxide poisoning, gas gangrene, smoke inhalation, necrotizing soft-tissue infections, or arterial gas embolism arising from surgery, diagnostic procedures, or thoracic trauma. If the chamber is to be used for treatment of non-diving related medical conditions other than those listed above, authorization from MED-21 shall be obtained before treatment begins (BUMEDINST 6320.38). Any treatment of a non-diving related medical condition shall be done under the cognizance of a Diving Medical Officer.

The guidelines given in Table 21-1 for conducting HBO2 therapy are taken from the Undersea and Hyperbaric Medical Society’s Hyperbaric Oxygen (HBO2) Therapy Committee Report—1996: Approved Indications for Hyperbaric Oxygen Therapy. For each condition, the guidelines prescribe the recommended Treatment.Table, the frequency of treatment, and the minimum and maximum days of treatment.

Primary Objectives. Table 21-2 gives the basic rules that shall be followed for all recompression treatments. The three primary objectives of recompression treatment are to:

  1. Compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow,

  2. Allow sufficient time for bubble resorption, and

  3. Increase blood oxygen content and thus oxygen delivery to injured tissues.

Guidance on Recompressed Treatment. Certain facets of recompression treatment have been mentioned previously, but are so important that they cannot be stressed too strongly.

  • Treat promptly and adequately.

  • The effectiveness of treatment decreases as the length of time between the onset of symptoms and the treatment increases.

  • Do not ignore seemingly minor symptoms. They can quickly become major symptoms.

  • Follow the selected treatment table unless changes are recommended by a Diving Medical Officer.

  • If multiple symptoms occur, treat for the most serious condition.

In-Water or Air Recompression. Recompression in a facility equipped for oxygen breathing is preferred. However, the procedures covered here also address situations where either no chamber is available or where only air is available at the recompression facility. In-water or air recompression treatments are used only when the delay in transporting the patient to a recompression facility having oxygen would cause greater harm.

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