Need for recompression chambers

[sandy]

THey might also be concerned about someone doing IWR for something that is not DCS related...

"I have this shooting pain in my left arm..."

Hmmm... Honey, I have a pain in my left arm. Think I'll go down to Peacock for a 90 minute IWR dive just in case.

[sandy]

Anyone remember NASDS? There was a space on the pre-dive page of your logbook to put the address and phone number of the nearest operating chamber. (We were told to ask around and confirm the info was up to date.)

I still keep a dive journal that accompanies me on every trip with all kind of extra information but not this. But I will add it tonight in addition to my phone. Thanks for the idea Russell.

[skip]

Just got off the phone with a Gentleman named Jim, he is a Tech at the Hyperbaric chamber in Albany. http://www.phoebeputney.com/PhoebeCo...e.aspx?nd=1377 He said that if you call them between 9 to 5 Mon thru Fri., they can get you treated for decompression sickness. BTW he was a Navy diver for 20 years, so I assume he knows what he is talking about. After hours he said go to the Emergency room and he was sure they would try to get a team up to treat you or they would call DAN and try to find you a chamber, but no-one is on call, there is no staff to support weekends or after hours.
He stressed if you are bent, call them on the way to the chamber, don't wait. The number for the chamber is (229) 312-7600.
Sounds like maybe before you leave to go anywhere, we need a card with the chamber telephone numbers to give them a heads up we are coming and confirm availability? Sort of a plastic card you can put in your wallet, credit card sized maybe? Call DAN of course, but it sounds like maybe you want to have someone call the chamber right after DAN tells you where to go?

Remember, DAN only pays IF you call them and have them arrange transportation or agree for you to drive or be driven.... You call DAN after the fact and you pay. So best to call DAN and tell DAN the number to Hospital/Chamber you think is best. DAN will verify and get back to you with an OK or alternate plan. You call the chamber directly, DAN is no longer required to pay.

Also, the chamber may or may not still be open for divers next month, so this is something that needs to be updated personally prior to every dive trip. What you read on the forum in November may not be true in December.

skip

[skip]

Let me see....IWR. What's the cost/benefit ratio? 20 feet deep on O2? 1.6 ppO2. How long? 20 minutes with air breaks... really? First off 20 feet won't do much to crush the bubbles small enough to do much good. You are better off on pure O2 on the boat or shore. You need at least 60 feet to reduce bubble size, and now what mix to breath? About any mix you choose will result in on-gassing of nitrogen. Not what you want to be doing. And even if you do go back into the water at 20 feet on O2... and symptoms get worse? Or you misdiagnosed and the real problem was your heart, or lungs, or your appendix.

Self-Diagnosis and Treatment. Why would anyone think that's safe?

Table 6 is 60 feet of depth, on pure O2. You get the reduced bubble size to ease off-gassing, and you get pure O2 to prevent on-gassing more nitrogen. this cannot be done in the water. IWR is a myth. Unless you are with a team that includes a diving doctor, a couple of diving EMT's, FFM, etc. Even then it's dang near useless. Getting those bubble down to small size is essential and 20 feet just doesn't do it.

skip

[PfcAJ]

Then go deeper. You don't HAVE to be on o2.

[diveconjeff]

Then go deeper. You don't HAVE to be on o2.

+1

Pretty interesting reading on how some of the IWR methodologies have been developed and deployed. Most of them appear to start with a decent on air to a depth sufficient to alleviate the symptoms, i.e. "crush the bubbles". Then only returning to O2 once you again approach the surface with a controlled ascent. YMMV

FWIW, IANTD offers this:

http://www.iantd.com/index.php/compo...pression-diver

Among other things it requires a full face mask, appropriate training, and so forth.

My first option? Get on O2 and Get to a chamber. However, I believe properly administered, IWR has a place in the toolbox.

How many hammers is too many?
Oh damn! I have too much ammo….
If only I could get bent with access to a fully staffed chamber.

Sometimes you may just have to play the cards in your hand, that's all I am saying.

[Kelly Jessop]

Let me see....IWR. What's the cost/benefit ratio? 20 feet deep on O2? 1.6 ppO2. How long? 20 minutes with air breaks... really? First off 20 feet won't do much to crush the bubbles small enough to do much good. You are better off on pure O2 on the boat or shore. You need at least 60 feet to reduce bubble size, and now what mix to breath? About any mix you choose will result in on-gassing of nitrogen. Not what you want to be doing. And even if you do go back into the water at 20 feet on O2... and symptoms get worse? Or you misdiagnosed and the real problem was your heart, or lungs, or your appendix.

Self-Diagnosis and Treatment. Why would anyone think that's safe?

Table 6 is 60 feet of depth, on pure O2. You get the reduced bubble size to ease off-gassing, and you get pure O2 to prevent on-gassing more nitrogen. this cannot be done in the water. IWR is a myth. Unless you are with a team that includes a diving doctor, a couple of diving EMT's, FFM, etc. Even then it's dang near useless. Getting those bubble down to small size is essential and 20 feet just doesn't do it.

skip

Lets see,you call DAN and are told to go to hospital xyz,and that takes you an hour to get there,then you sit in their ER for 4 hours before someone says we can't recompress you in our chamber,so we have to send you somewhere else. They arrange transportation and then you get to hospital abc who need to evaluate you. By the time you have started treatment,8+ hours have elapsed. This isn't ficitional,but fairly common place. I am all about having a professional address my problem,but in light of the fact that nothing is guaranteed,why not IWR. My cave class in the 90's included the theory behind IWR,and how to do it. If I am going to have to wait 8 hours how much tissue trauma has already occurred versus doing IWR right away.

[a64pilot]

Skip,
First I don't plan on getting bent, but I don't have DAN, so for me it's not a concern if DAN will pay or not. I believe being bent is an emergency, I'll bet the chamber I call will believe so too, and if it's an emergency, I don't believe I have to have a mother may I slip from Tri-care, if I show up and a Doc says no emergency, then great!
From what it seems I'm hearing, DAN doesn't sound so good?
So if your relying on DAN, what's the problem with calling the chamber they tell you to go to? If the chamber says come on, then great, if they say we can't treat, call DAN back, you may have saved several hours.

[Jim Wyatt]

IANTD recently unveiled their IWR course.

[phreaticus53]

I've had two experiences (three if you count my buddy, as well as myself, on the same dive). One was a cave dive , with aforementioned buddy, to 140' for approx. :60 minutes...1981 or so, no DAN insurance available, no notrox, air at depth, O2 from 30 ft. (I Know, but it was acceptable at that time...everything was pretty much experimental or taken from Navy tables/procedures, etc.). Did the required deco, drove home, started getting increasing pains in left shoulder about two and a half hours after surfacing. Decided after about an hour I need to recompress, drove back to site, geared up (lots of gas in 104's left, plenty of 02)....went back down solo (couldn't get a hold of buddy, turns out he had symptoms as well, chos e an entirely different method of relief , which didn't work out as well) to 120' in the basin of the sink...immediate relief of symptoms. Took my time, approx. :40 minutes, up to 30', then about another :40 mins. on O2. Surfaced, waited in the water (about 3:00 a.m.) for about :15 mins....no issues. Scared the hell out of a local convenience store clerk when I walked in the door asking him to unzip my drysuit!
Ended up with some skin mottling on the shoulder (cutis marmotta (sp?), still have it to this day....fun to stump the dermatologists on annual checks, asking them to diagnose.
I've been tested for PFO....negative diagnosis.

Second time was just this summer....60 miles out in the Gulf, open water spearfishing, Short bottom time in 125', shot some red snapper, buddy (healthy, fit 45 year old ER doctor) did same, but stayed down a few minutes longer, I stayed 30-40 ft. above him, top cover...both did slow ascents to 30' or so then slower ascent to safety stop at :15' (computers both totally cleared). Got on the boat. He started to have increasing pains in the groin area, getting to the very painful stage, then he started to get numbness in the same leg. Put him on surface O2 (DAN kit)....still worsening. Decided to get him back down to depth...I suggested 60', then slow up to 30', then :20 mins or so up to surface. He went to only 30' or so (I was covering in the water), immediate relief there, then surfaced after only about :15 minutes or so. No more symptoms. I mentioned he should get tested for PFO, which he was obviously familiar with as a doc (and his wife is a nurse in a heart cath facility). He eventually did, and was tested positive for a small PFO.

My opinion only, but if a chamber is not available withing :90 mins. or so (earlier with extreme symptoms), IWR is preferable, as long as you have buddy support (in water), thermal protection , and enough/proper breathing gasses to accelerate off-gassing.