Helping A Diver With Suspected Decompression Illness A Comprehensive Guide

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Decompression illness (DCI), also known as “the bends,” is a serious and potentially life-threatening condition that can occur when a diver ascends too quickly from a dive. Understanding how to respond effectively to a diver with suspected DCI is crucial for anyone involved in diving activities. This article will provide a detailed guide on the necessary steps to take, ensuring the diver receives the best possible care and increasing their chances of a full recovery. It is essential to remember that prompt and appropriate action can significantly impact the outcome for a diver suffering from DCI.

Understanding Decompression Illness (DCI)

Before diving into the specific steps for assisting a diver with suspected DCI, it’s vital to have a clear understanding of what DCI is and how it occurs. Decompression illness arises from the formation of nitrogen bubbles in the tissues and bloodstream. During a dive, the body absorbs nitrogen from the compressed air in the scuba tank. At depth, this isn't usually a problem, but as the diver ascends, the pressure decreases. If the ascent is too rapid, the nitrogen comes out of solution too quickly, forming bubbles. These bubbles can obstruct blood flow, damage tissues, and trigger a range of symptoms.

Causes and Risk Factors of DCI

Several factors can contribute to the development of DCI. These include:

  • Rapid Ascent: The most common cause of DCI is ascending too quickly from a dive. This doesn't allow the nitrogen enough time to be safely released from the body.
  • Exceeding Dive Limits: Staying too deep for too long increases the amount of nitrogen absorbed by the body.
  • Multiple Dives: Doing multiple dives in a day or over several days can lead to a buildup of nitrogen in the tissues.
  • Dehydration: Being dehydrated can thicken the blood, making it harder for nitrogen to be released.
  • Physical Exertion: Strenuous activity during or after a dive can increase the risk of bubble formation.
  • Pre-existing Conditions: Certain medical conditions, such as heart problems or respiratory issues, can increase susceptibility to DCI.
  • Cold Water: Cold water can constrict blood vessels, hindering nitrogen elimination.

Symptoms of DCI

The symptoms of DCI can vary widely, depending on the severity of the condition and the location of the bubbles. Common symptoms include:

  • Joint Pain: This is the most common symptom, often described as a deep, throbbing pain in the shoulders, elbows, knees, or ankles.
  • Skin Rash: A mottled or itchy rash may appear on the skin.
  • Fatigue: Unusual tiredness or weakness.
  • Numbness and Tingling: These sensations may occur in the limbs.
  • Dizziness and Vertigo: Feeling lightheaded or having a spinning sensation.
  • Headache: A persistent headache.
  • Shortness of Breath: Difficulty breathing or chest pain.
  • Paralysis or Weakness: Muscle weakness or inability to move limbs.
  • Unconsciousness: Loss of consciousness in severe cases.

Recognizing these symptoms is crucial for prompt intervention. If a diver exhibits any of these signs after a dive, it should be considered a potential case of DCI until proven otherwise. Early recognition and treatment are essential for minimizing the long-term effects of DCI.

Steps to Assist a Diver with Suspected DCI

When faced with a diver exhibiting symptoms of DCI, a systematic approach is necessary to ensure the best possible outcome. Here are the critical steps to take:

A. Monitor the Diver's Breathing and Provide CPR as Necessary

This is the first and foremost priority. The diver's airway, breathing, and circulation (ABCs) must be assessed immediately. Ensure the diver is breathing adequately. If the diver is not breathing or has an irregular breathing pattern, initiate rescue breathing or CPR (cardiopulmonary resuscitation) if you are trained to do so.

  • Check for Responsiveness: Gently tap the diver and ask loudly if they are okay. If there is no response, proceed to check for breathing.
  • Assess Breathing: Look for chest rise and fall, listen for breath sounds, and feel for air movement near the diver’s mouth and nose. If breathing is absent or inadequate, begin rescue breathing.
  • Administer CPR if Necessary: If there is no pulse, start chest compressions and continue CPR until medical help arrives or the diver shows signs of life. CPR involves chest compressions and rescue breaths, typically performed in a 30:2 ratio.

Maintaining adequate oxygenation is crucial in managing DCI. Oxygen helps reduce the size of nitrogen bubbles and improves tissue oxygenation. Using supplemental oxygen, if available, is highly recommended while waiting for emergency medical services.

B. Contact Emergency Medical Care

Immediately contact emergency medical services (EMS) or the local equivalent. Time is of the essence in DCI cases, and prompt medical attention is critical. When calling for help, provide the following information:

  • Your Location: Give the precise location of the incident, including any landmarks or GPS coordinates.
  • The Diver's Condition: Describe the diver's symptoms and vital signs, such as breathing rate and level of consciousness.
  • The Dive Profile: Provide details about the dive, including the maximum depth, bottom time, and ascent rate.
  • Your Contact Information: Leave a phone number where you can be reached.

It is also advisable to contact the Divers Alert Network (DAN), a non-profit organization that provides medical information and assistance for diving-related emergencies. DAN can offer expert advice and coordinate with local medical services. DAN operates a 24-hour emergency hotline and can be reached at +1-919-684-9111.

C. Have the Diver Lie Down and Administer Oxygen

Contrary to the incorrect option of having the diver sit or stand, the proper positioning for a diver with suspected DCI is lying down. This position helps to minimize the effects of gravity on blood flow and reduces the risk of bubbles migrating to the brain or other vital organs.

  • Lay the Diver Flat: Place the diver on their back in a horizontal position. If the diver is vomiting, turn them gently onto their side to prevent aspiration.
  • Administer Oxygen: Provide the highest concentration of oxygen available. Use a non-rebreather mask if possible, as it delivers the highest concentration of oxygen. Oxygen helps to reduce the size of nitrogen bubbles and improve tissue oxygenation.

D. Provide Comfort and Support

Decompression illness can be a frightening experience for the diver. Providing reassurance and emotional support can help to reduce anxiety and improve cooperation with treatment. Stay calm and speak to the diver in a soothing voice. Let them know that help is on the way and that you are doing everything you can to assist them.

  • Reassure the Diver: Let them know that medical help is on the way and that they are in good hands.
  • Keep Them Warm: Cover the diver with a blanket or warm clothing to prevent hypothermia.
  • Monitor Vital Signs: Continue to monitor the diver's breathing, pulse, and level of consciousness until medical help arrives.

E. Document the Incident

Thorough documentation of the incident is crucial for medical personnel and for future analysis. Record the following information:

  • Dive Profile: Document the depth, bottom time, ascent rate, and any deviations from the dive plan.
  • Symptoms: Record the diver's symptoms, including when they started and their severity.
  • First Aid Provided: Note any first aid measures taken, such as CPR or oxygen administration.
  • Contact Information: Record the names and contact information of witnesses and emergency responders.

This information will be invaluable for medical professionals in diagnosing and treating the diver, as well as for identifying any factors that may have contributed to the incident.

Incorrect Actions to Avoid

There are several common misconceptions about treating DCI that can be harmful. It’s important to be aware of these and avoid them:

  • Do Not Have the Diver Sit or Stand: As mentioned earlier, this is incorrect. Sitting or standing can worsen symptoms by allowing bubbles to migrate to the brain. The diver should lie down.
  • Do Not Give the Diver Food or Drink: This can increase the risk of aspiration if the diver vomits or becomes unconscious.
  • Do Not Delay Seeking Medical Attention: Time is critical in DCI cases. Do not wait to see if symptoms improve on their own. Contact emergency services immediately.
  • Do Not Attempt In-Water Recompression: This is a dangerous and often ineffective practice that should only be attempted by trained professionals in specific circumstances. It is much safer to transport the diver to a medical facility for proper treatment.

Treatment for Decompression Illness

The primary treatment for DCI is hyperbaric oxygen therapy (HBOT). This involves placing the diver in a hyperbaric chamber, where the pressure is increased to several times normal atmospheric pressure. The diver breathes 100% oxygen, which helps to shrink the nitrogen bubbles and improve oxygenation of the tissues. HBOT is most effective when administered as soon as possible after the onset of symptoms. The sooner the diver receives treatment, the better the chances of a full recovery.

In addition to HBOT, other treatments may include:

  • Intravenous Fluids: To treat dehydration and improve blood flow.
  • Pain Medication: To relieve pain.
  • Supportive Care: To manage any complications, such as respiratory distress or seizures.

Prevention of Decompression Illness

While knowing how to respond to DCI is crucial, preventing it in the first place is even more important. Divers can significantly reduce their risk of DCI by following safe diving practices:

  • Plan Dives Carefully: Use dive tables or dive computers to plan dives within no-decompression limits.
  • Ascend Slowly: Ascend at a rate of no more than 30 feet per minute.
  • Make Safety Stops: Perform a safety stop at 15 feet for 3-5 minutes on every dive.
  • Avoid Dehydration: Drink plenty of fluids before and after diving.
  • Avoid Strenuous Activity: Avoid heavy exertion before, during, and after dives.
  • Wait Before Flying: Allow adequate surface interval time before flying or traveling to altitude.
  • Dive Within Your Limits: Be aware of your physical and mental limitations, and don't push yourself beyond them.

Conclusion

Responding effectively to a diver with suspected decompression illness requires prompt action, a clear understanding of the condition, and adherence to established protocols. By monitoring the diver's breathing, contacting emergency medical care, positioning the diver correctly, administering oxygen, and providing support, you can significantly improve the diver's chances of a positive outcome. Remember, time is of the essence in DCI cases, and every minute counts. This comprehensive guide aims to equip you with the knowledge and skills necessary to assist a diver in distress, but it is crucial to seek proper training in first aid and rescue techniques for diving emergencies. By being prepared and acting quickly, you can make a life-saving difference.

Disclaimer: This article is for informational purposes only and should not be considered a substitute for professional medical advice. Always seek the advice of a qualified healthcare provider for any medical concerns or emergencies.