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Looking at the dearth of chambers, and considering remote locations, how bad does it have to be before you choose an in-water recompression vs a long ride to a chamber?
If someone is inclined enough to create a meaningful poll, that'd be great. I have a sick kid and am only on my cellphone, so...
The question to me is not the long chamber ride it is how fast can a chamber be found when you are dealing with an emergent situation. What has happened in quite a few cases is there is significant delay between onset of symptoms and getting recompressed, and this could be related to being triaged in the ER while looking for a facility that will take you, then transport there. That can be as much as 12 hours before treatment has begun. So you may encounter a long chamber ride,because at this point you are treating damaged tissue as result of latent treatment. My thoughts are to be a knowledgeable consumer and know in advance what chambers are online and will take divers,because you may have to guide the caregivers in what steps to take to get you treated. But,over the years I have seen the list of available chambers shrink that will treat dive injuries. The bottom line, it is not profitable to recompress one diver while paying staff OT, when they can treat a couple wound care patients at the same time. So I really think this problem will get worse, and I think knowing IWR for cases that aren't overly complicated,may be the solution.Quote:
Originally Posted by Danseur
if treatment is more than 6 hours away and I have access to enough O2, in the water we go. I will almost always try for IWR first due to the location and hassle of chambers. If symptoms go away at half pressure, then we'll do as much deco as we can and then call it a day. This is for mild dcs, i.e. joint pain, tingling, etc. If you have some legit symptoms where getting in the water isn't safe, heigh-ho heigh-ho it's off to the chamber we go
What resources are available for those interested in learning the most effective procedures?
I was present for one serious situation involving dcs and my buddy collapsed why we were filling tanks. We had been diving Bozel and had gotten out of the water, changed out of our drysuits, rode back on a nice leisurely boat ride and driven back to the shop before he experienced any symptoms I was aware of. I am guessing we were up for about 1.5 hours. I got him laid down and grabbed his O2 bottle. When I handed him the reg he couldn't put it in his mouth. In this case in water recompression was out of the question because there was no water readily available and I don't think it would have been safe.
Now I was in Truk Lagoon about 4 or 5 years ago and we had been doing deco dives for 3 days or so. The wrecks there are mostly on the deeper side so we were doing 4 or 5 dives a day and I was doing about an hour or so of deco on most dives. This was on 28% with no O2. The water is 83 degrees and most of the wrecks have stuff to look at all the way up to 30 or 40 feet so deco isn't bad. We went and did the Oite Destroyer which is 210' ish and doesn't have a lot of relief. Rob McGann had taken a buddy and I there even though we were on the Odyssey. After the dive we got back to the Odyssey and I felt like I had been runover by a truck. Splitting headache and I couldn't hardly lift my arms as my sholders were hurting. The next dive was on a ship that was about 160' to the sand. I forved myself to go and once I got to about 60' I felt fine. I went all the way to the sand and through a torpedo hole at about 154' I really took my time working my way up the ship. There were king posts that came to within 30' or so of the surface. I slowly went up them looking at all the small critters. I finally got onto the hang bar on the back of the Odyssey and stayed there till I was almost empty in my 108's. I think my dive was over 3 hours and I had cleared deco well before getting on the hang bar. I finally got out of the water and I felt great. I really padded my deco on the rest of the dives for the remaining trip and didn't have any more issues.
I believe in water recompression works for minor problems but for someone who is really having issues I would be concerned. Now in a remote area where a chamber isn't an option I would recommend a full face mask if the diver is really having issues.
There is some info here: http://rubicon-foundation.org/in-water-recompression/Quote:
Originally Posted by Aotus
and they have posted some of their info on the wikepedia listing:https://en.wikipedia.org/wiki/In-water_recompression
I also seem to recall some articles and discussions (on cdf) on this topic several years ago. Bill
Oct 2014
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I encourage everyone to read our research article on the topic. It can be downloaded at researchgate.
https://www.researchgate.net/publica..._recompression
Sorry, cut and paste didn't work... our IWR paper is at this address: https://www.researchgate.net/publica..._recompression
Kelly - are chambers turning away divers with severe neurological hits?
Barbara
It depends what time of day. A lot of chambers are only open during daylight hours now. They might not turn someone away if they were open, but...Quote:
Originally Posted by cavedivingwoman
One of the worst times is during the daytime hours. Those chambers don't sit idle waiting for an incident,but they have wound care patients that are undergoing treatment. I can't speak for different facilities,but you can't just stop treatment immediately and pull these people out, and then compress someone else. We have been going by the a false notion that M-F during the day, Shands in Gainesville would take a diver. I don't want to name the individual due to PHI,but someone got bent during the weekday at Ginnie, and went to Shands in the midafternoon, and got transferred to another facility.Quote:
Originally Posted by FW
Not sure of a specific answer. I do recall sitting in the Shands ER until 1am before it was decided that a friend would be sent to Tallahassee, and it was a type 2 hit. I have heard of other severe cases of DCS, where the individual was transported to another facility. The bottom line is if the hospital has a chamber,but they are unwilling or unable to call in HBO staff, then there is no other choice but to get transferred some where else. This list of facilities is potentially dynamic, and knowing who is online to recompress dive injuries is important,because no matter how great of a job that DAN does, they are frequently not notified on a regular basis.Quote:
are chambers turning away divers with severe neurological hits?
I'm not Kelly, but I slept in a Holiday Inn Express. The answer to your question is yes.Quote:
Originally Posted by cavedivingwoman
I think in theory all this talk of iwr is cool, but I don't see it become mainstream or commonplace. It seems like its more the "cool kid of the block" right now. I like the idea that its just a tool in the toolbox in case you need it. The reality from my discussions with people who have taken hits its that either it was really bad immediately post dive and I suspect them and their buddies would've been very uncomfortable going back down or it was so delayed between the dive and realizing you were bent that its too late to get back in the water.
In my two hits it took me several hours for the symptoms to fully hit and be recognized for what they are.
I suspect iwr is going to be talked about alot but probably rarely used. But that's just my hunch. I could be totally wrong.
If I can physically walk back to the water and have the mental capacity to do so, I will most certainly drive back to the site and get back in to try to re-compress myself. If the hit is really bad, then odds are that you're ****ed either way.
I don't see how memorizing a couple of iwr tables could possibly hurt. You don't need to get on 02 at 30ffw if you're by yourself. It would still be way more effective to run nitrox up to 30 and o2 from 20 immediately rather than wait 12 hours to get re-compressed in Alabama.
What you say probably provides realistic context.Quote:
Originally Posted by rddvet
I had three separate type I DCS incidents experienced on Truk Lagoon Trips in Oct-Nov 2014 -all were upper Right arm/Shoulder classical acute "pulsing" symptoms with increasing pain within 90min time post-dive, and occurring within three to four days of starting Open Circuit Deep Air bottom gas dives with 50% & O2 deco (two tech deco dives per day with a 3 hour SIT). Possible contributing factors were dehydration, insufficient "acclimatization" to the tropical environment, and no prior "work-up" practice deco dives to sensitize the body's immune/inflammatory response system to high FN2 saturation & resultant supersaturation in slow tissues & venous blood (first early AM deep dive with deco of that trip was San Francisco Maru at 51m ave depth, 45min BT and over two-and-a-half hours runtime, after long trans-pacific flight from Los Angeles arriving late in the night before). There were many CCR divers doing extreme profiles there at that time and I didn't want to tie-up the Chuuk Recompression Chamber for a relative "simple" pain only DCS type I pathology, just in case a Rebreather dive casualty came in with a more acute serious signs & symptoms of DCI/AGE.Quote:
Originally Posted by bamafan
All DCS type I Pain Symptoms at that time in Oct-Nov 2014 were resolved with In-Water-Recompression (IWR) sessions which were performed off the end of Truk Stop Hotel Pier. Lying prone & relaxed at 9m/30ft depth breathing standard open-circuit non-face mask regs, on a sandy bottom in 28 deg C/82 deg F water temp, the modified Australian Method IWR as taught by UTD was used -with either 30, 60 or 90min of elective prescribed O2 breathing therapy at 9m/30 ft depth (10min O2:with 5min Air Break); and then a slow 0.1mpm/0.3fpm ascent rate to surface (same breathing 10minO2:with 5min Air Break). Went with 60 minutes O2 time at 9m depth for a total bottom time of 90min including Air breaks; and for the slow 0.1mpm ascent rate breathing on O2 and stopping after every 1 meter of travel up for the 5 minute Air Break -a total time to surface of 135 minutes. Treatment took 90min bottom time plus 135min ascent time equaling a total of 225 minutes (3.8 hours), and used one AL80/11L cylinder of Oxygen and another of Air. . .
Frank, I really like you, but I question your mental capacity. To begin with, you go to UM. That says a lot right there. :PQuote:
Originally Posted by inverted_bear
I like you too, Ken...but can you remind me who's UF's version of Kenny Broad? :)Quote:
Originally Posted by kensuf
Go Gators! (And Titans)
He's studying finance. Warrington has a great program, and is only 30 minutes from High Springs.Quote:
Originally Posted by loquat149
I'd flunk out if I lived any closer. I'm already up there twice a month. No way I'd ever go to class if I was that close to the caves.Quote:
Originally Posted by kensuf
I know a lawyer that struggled with the same thing.