In-Water Recompression

Red Sea Explorer · May 25th, 2006, 03:40 PM

I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing.

This is the dive profile that bent a diver. The diver came out feeling very week, vomiting, peeing a lot and with red spots all over the legs.

Bending dive.jpg

After an hour on Oxygen the symptoms eased up but now there was pain and a numbing feeling starting in the legs. The closest recompression chamber was 7 hours away and with the prevailing sea and wind conditions it might have been more. So we opted for in-water recompression. Below is the profile for the in water recompression. All of it was done on 100% pure oxygen.

treatment.jpg

After this all the symptoms went and the diver was fine although fatigued and needing lots of sleep. We contacted the chamber doctor informed him of what we had done and he said there is no need to bring the diver in for a check up but we had to wait 48 hours before the diver can dive again. Two days later he/she was diving again.

Disclaimer: Do not try this at home.

mstroeck · May 25th, 2006, 03:51 PM

Quote: (Originally Posted by Red Sea Explorer)

I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing.

This is the dive profile that bent a diver.

I, for one, would really appreciate if you could go into at least some specifics. Where there other divers with the same profile? How did they feel? Gases?

MonkSeal · May 25th, 2006, 04:03 PM

I can only say: congratulations on good work! How many support divers did you have with bent diver during IWR?

Best regards,
Emir

Mal Bridgeman · May 25th, 2006, 04:15 PM

Hi

I would also be interested in the anonymous info, bottom gases, switch depths, etc, what was used to plan the dive and whether the dive ran to schedule. It seems to my limited knowledge to be a short run time for such a period at depth.

Did you run air breaks during the IWR? How are the guy's lungs after spending all that time at 9m on O2?

Congratulations though on a successful outsome. Any lessons learned should you need to do it again?

Regards
Mal

Red Sea Explorer · May 25th, 2006, 04:16 PM

We were three divers on this dive only one of us got bent. Actually Dave and I had been on a 35 meter dive right before this dive with no surface interval. He then went for another 30 meter dive right after this dive also with no surface interval. But we did not get bent we felt fine. Actually we have done such profiles many times before.
But the hit diver was a new comer and not part of the standard team.

We attributed the DCS hit to these main factors.

- Carelessness on behalf of the team having opted for an aggressive deco profile. We decided to ignore the fact that we were 3 meters deeper than the planned Average depth.
- Slow and untimely assent due to the fantastic things we saw on this virgin wreck in the 85 and 80 meter range. (It can be seen on the profile.)
- Predisposition of the hit diver due to dehydration having had several drinks the night before and not had any water or food prior to the dive.
- A Semi dry suit that was so tight it took two people to get the diver into. It was so tight that t-shirts stayed dry under it. It was constricting the circulation of the blood thus hindering Decompression.

During the In-water recompression there was two support divers and three other divers ready to jump in any time.

JS1scuba · May 25th, 2006, 04:17 PM

We have an in-water recompression protocol for all our off-shore trips and have used it a few times sucessfully.

Reviewing other cases is always a touchy thing, so please take my comments as suggestions.

(FYI - I ran a hyperbaric center for divers in NY for 3 years in the mid 1990s and supervised more than 250 treatments)

Your results were good this time. The key that worked for you was the rapid recompression and the oxygen. The recompression profile you used was similar to a typical "mono-place" chamber treatment. 2atm of oxygen for 30 min with a 60 minute ascent.

Some future things to have to make this "safer"

Build a kit that has in it the following.

Full Face Mask for patient (with coms would be best)
Hose with strength member for FFM (60 feet 20 meters of hose), and dry suit in flator.
Miller harness to put on diver with line attached (strength member of hose)
Bossons seat on the harness rig with weights (40-50 lbs)
Bag Dry suit that can fit most anyone (thermal protection)

The FFM protects the patient should they have oxygen convulsion. This is a critical issue when doing IWR. It also gives the patient some level of security that they cant drown. This is good for the psyche.

Rotate your tenders to the patient every 20 minutes, this keeps everyone in a no-stop zone. Make sure your tenders do 5-10 min of oxygen breathing at 10 fsw / 3 msw just as a clean up.

After patient is up 30 min of post treatment surface oxygen is a good thing to do. NSAIDS -- Non Steroidal Anti Inflamatory Drugs (celebrex, aleve ) is also a good thing if the patient is not contra-indicated or any anti-inflamatory (Motrin) is good following treatment, plus a lot of water.

Sleep is the most common side effect post treatment, and can usually last 4-8 hours.

You got lucky this time. Good Job.

Cheers

Red Sea Explorer · May 25th, 2006, 05:43 PM

The planned dive was for 10 to 15 at 90 meters.

The gas was 12/60 for Bottom, 1 bottom stage and a pumped set of double ALu 80 and 50 and 100% for Deco.
Min gas was 180 Bar on the back gas. Basically right after the stage.

The original Deco plan was 45 minutes. We added 5 minutes to the deco during the ascent to compensate for the extra bottom time and Depth. Should have added 15.

Dave and I have done this dive many times before. Maybe because we dive often our body is use to aggressive deco profiles. But our guest did not take it so well.

Thanks Joe for the advice on the In-water recompression rig. I believe it is a must on every tech diving boat. I myself am a strong believer in in-water recompression. We did administer oxegen on the surface a few times at diffirent intervals the day after.

JS1scuba · May 26th, 2006, 06:09 AM

Quote: (Originally Posted by Red Sea Explorer)

The planned dive was for 10 to 15 at 90 meters.

The gas was 12/60 for Bottom, 1 bottom stage and a pumped set of double ALu 80 and 50 and 100% for Deco.
Min gas was 180 Bar on the back gas. Basically right after the stage.

The original Deco plan was 45 minutes. We added 5 minutes to the deco during the ascent to compensate for the extra bottom time and Depth. Should have added 15.

Dave and I have done this dive many times before. Maybe because we dive often our body is use to aggressive deco profiles. But our guest did not take it so well.

Thanks Joe for the advice on the In-water recompression rig. I believe it is a must on every tech diving boat. I myself am a strong believer in in-water recompression. We did administer oxegen on the surface a few times at diffirent intervals the day after.

I'm truly amazed you all did not get wacked and hard. The profile is so agressive its scary. A 15 min bottom time after a direct descent requires at least 70 minutes of decompression using a bubble model. I don't know where the profile you used came from but not a single model i have gives me that short a deco. Even if you only did 10 min on the bottom 50 min of deco would be in order.

The gas mixes you are using for decompression are way to shallow. Staying on the LOW po2 that long just does not give a clean efficient decompression. You may want to look at doing a gas shift to EAN 36 instead of 50% -- you will save some bottom mix and get to a more efficient off-gasing earlier.

But that's just my comments on it.

Cheers

*JGrogan* · May 26th, 2006, 09:25 AM

Many thanks for posting this. It reminded me of a similar experiece about 5 years ago.

We were diving in a remote location at altitude about 9 hours drive from the nearest chamber. Our last dive was 90-100m for 35 minutes with about 3.5 hours in the water. The shape of our profile was similar to yours but with more deep stops.

About 10-15 minutes after hitting the surface, my buddy complained of a sore shoulder. Due to the remoteness, we decided to assume it was a type 1 bend coming on, so before he got out of his kit, we strapped a fresh oxygen bottle to him and got a support diver to take him down to 9m for 20 mins, then 6m for 20, then 3m for 20. There was a complete resolution of symptoms.

This was the sixth day of diving at this location with each dive getting progressively deeper. It also involved carrying a lot of kit down to the waters edge daily. We put the hit down to the build-up over the 6 days, the hard work each morning and evening getting bottles in and out and just a stressed shoulder!

Best,
John.

Quote: (Originally Posted by Red Sea Explorer)

I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing.

This is the dive profile that bent a diver. The diver came out feeling very week, vomiting, peeing a lot and with red spots all over the legs.

Attachment 135

After an hour on Oxygen the symptoms eased up but now there was pain and a numbing feeling starting in the legs. The closest recompression chamber was 7 hours away and with the prevailing sea and wind conditions it might have been more. So we opted for in-water recompression. Below is the profile for the in water recompression. All of it was done on 100% pure oxygen.

Attachment 133

After this all the symptoms went and the diver was fine although fatigued and needing lots of sleep. We contacted the chamber doctor informed him of what we had done and he said there is no need to bring the diver in for a check up but we had to wait 48 hours before the diver can dive again. Two days later he/she was diving again.

Disclaimer: Do not try this at home.

mstroeck · May 26th, 2006, 10:23 AM

Quote: (Originally Posted by JS1scuba)

I don't know where the profile you used came from but not a single model i have gives me that short a deco. Even if you only did 10 min on the bottom 50 min of deco would be in order.

I agree. Theoretically, that seems very aggressive. I'm glad it works for them, though, just goes to show you how little we really know about decompression.

Red Sea Explorer, I guess you use your own form of ratio deco, with a deeper setpoint than usually? Do you use 90m as your 1:3 setpoint? If so, why, and why do you opt not to carry the 35/25 for the deeper stops?

Whatever you use, I guess you are right that you should have added 15 minutes :-) Your BT was around 20, no?

EDIT: Sorry, I misread the chart, it's only 10 minutes BT. So to answer your question Joel, they seem to be using more or less exactly the deco approach described by AG here: http://www.5thd-x.com/xducation/pdf/ratiodeco.pdf

May 25th, 2006, 03:40 PM	#1 (permalink)
Red Sea Explorer(Offline) New Member Join Date: Jan 2006 Location: Red Sea Posts: 242	I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing. This is the dive profile that bent a diver. The diver came out feeling very week, vomiting, peeing a lot and with red spots all over the legs. Bending dive.jpg After an hour on Oxygen the symptoms eased up but now there was pain and a numbing feeling starting in the legs. The closest recompression chamber was 7 hours away and with the prevailing sea and wind conditions it might have been more. So we opted for in-water recompression. Below is the profile for the in water recompression. All of it was done on 100% pure oxygen. treatment.jpg After this all the symptoms went and the diver was fine although fatigued and needing lots of sleep. We contacted the chamber doctor informed him of what we had done and he said there is no need to bring the diver in for a check up but we had to wait 48 hours before the diver can dive again. Two days later he/she was diving again. Disclaimer: Do not try this at home. __________________ You watch me switch. www.redseaexplorers.com

May 25th, 2006, 04:15 PM	#4 (permalink)
Mal Bridgeman(Offline) New Member Join Date: Nov 2005 Location: Suffolk, UK Posts: 674	Hi I would also be interested in the anonymous info, bottom gases, switch depths, etc, what was used to plan the dive and whether the dive ran to schedule. It seems to my limited knowledge to be a short run time for such a period at depth. Did you run air breaks during the IWR? How are the guy's lungs after spending all that time at 9m on O2? Congratulations though on a successful outsome. Any lessons learned should you need to do it again? Regards Mal __________________ Opinions and beliefs are correct at the time of posting but are subject to change without any notice or obligation on the part of the author.

May 25th, 2006, 04:16 PM	#5 (permalink)
Red Sea Explorer(Offline) New Member Join Date: Jan 2006 Location: Red Sea Posts: 242	We were three divers on this dive only one of us got bent. Actually Dave and I had been on a 35 meter dive right before this dive with no surface interval. He then went for another 30 meter dive right after this dive also with no surface interval. But we did not get bent we felt fine. Actually we have done such profiles many times before. But the hit diver was a new comer and not part of the standard team. We attributed the DCS hit to these main factors. - Carelessness on behalf of the team having opted for an aggressive deco profile. We decided to ignore the fact that we were 3 meters deeper than the planned Average depth. - Slow and untimely assent due to the fantastic things we saw on this virgin wreck in the 85 and 80 meter range. (It can be seen on the profile.) - Predisposition of the hit diver due to dehydration having had several drinks the night before and not had any water or food prior to the dive. - A Semi dry suit that was so tight it took two people to get the diver into. It was so tight that t-shirts stayed dry under it. It was constricting the circulation of the blood thus hindering Decompression. During the In-water recompression there was two support divers and three other divers ready to jump in any time. __________________ You watch me switch. www.redseaexplorers.com

May 25th, 2006, 04:17 PM	#6 (permalink)
JS1scuba(Offline) New Member Join Date: Nov 2005 Location: Arizona, USA Posts: 82	We have an in-water recompression protocol for all our off-shore trips and have used it a few times sucessfully. Reviewing other cases is always a touchy thing, so please take my comments as suggestions. (FYI - I ran a hyperbaric center for divers in NY for 3 years in the mid 1990s and supervised more than 250 treatments) Your results were good this time. The key that worked for you was the rapid recompression and the oxygen. The recompression profile you used was similar to a typical "mono-place" chamber treatment. 2atm of oxygen for 30 min with a 60 minute ascent. Some future things to have to make this "safer" Build a kit that has in it the following. Full Face Mask for patient (with coms would be best) Hose with strength member for FFM (60 feet 20 meters of hose), and dry suit in flator. Miller harness to put on diver with line attached (strength member of hose) Bossons seat on the harness rig with weights (40-50 lbs) Bag Dry suit that can fit most anyone (thermal protection) The FFM protects the patient should they have oxygen convulsion. This is a critical issue when doing IWR. It also gives the patient some level of security that they cant drown. This is good for the psyche. Rotate your tenders to the patient every 20 minutes, this keeps everyone in a no-stop zone. Make sure your tenders do 5-10 min of oxygen breathing at 10 fsw / 3 msw just as a clean up. After patient is up 30 min of post treatment surface oxygen is a good thing to do. NSAIDS -- Non Steroidal Anti Inflamatory Drugs (celebrex, aleve ) is also a good thing if the patient is not contra-indicated or any anti-inflamatory (Motrin) is good following treatment, plus a lot of water. Sleep is the most common side effect post treatment, and can usually last 4-8 hours. You got lucky this time. Good Job. Cheers __________________ Joel Silverstein, VP, COO www.techdivinglimited.com a division of Scuba Training and Technology Inc. NAUTILUS DIVE PLANNER CYLINDER SPEC CHART

May 25th, 2006, 05:43 PM	#7 (permalink)
Red Sea Explorer(Offline) New Member Join Date: Jan 2006 Location: Red Sea Posts: 242	The planned dive was for 10 to 15 at 90 meters. The gas was 12/60 for Bottom, 1 bottom stage and a pumped set of double ALu 80 and 50 and 100% for Deco. Min gas was 180 Bar on the back gas. Basically right after the stage. The original Deco plan was 45 minutes. We added 5 minutes to the deco during the ascent to compensate for the extra bottom time and Depth. Should have added 15. Dave and I have done this dive many times before. Maybe because we dive often our body is use to aggressive deco profiles. But our guest did not take it so well. Thanks Joe for the advice on the In-water recompression rig. I believe it is a must on every tech diving boat. I myself am a strong believer in in-water recompression. We did administer oxegen on the surface a few times at diffirent intervals the day after. __________________ You watch me switch. www.redseaexplorers.com Last edited by Red Sea Explorer; May 25th, 2006 at 05:45 PM..

May 25th, 2006, 03:51 PM	#2 (permalink)
mstroeck(Offline) New Member Join Date: Nov 2005 Location: Vienna, Austria Posts: 156	Quote: (Originally Posted by Red Sea Explorer) I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing. This is the dive profile that bent a diver. I, for one, would really appreciate if you could go into at least some specifics. Where there other divers with the same profile? How did they feel? Gases?

May 25th, 2006, 04:03 PM	#3 (permalink)
MonkSeal(Offline) Old Member Join Date: Feb 2006 Location: Zagreb, Croatia Posts: 532	I can only say: congratulations on good work! How many support divers did you have with bent diver during IWR? Best regards, Emir

May 26th, 2006, 06:09 AM	#8 (permalink)
JS1scuba(Offline) New Member Join Date: Nov 2005 Location: Arizona, USA Posts: 82	Quote: (Originally Posted by Red Sea Explorer) The planned dive was for 10 to 15 at 90 meters. The gas was 12/60 for Bottom, 1 bottom stage and a pumped set of double ALu 80 and 50 and 100% for Deco. Min gas was 180 Bar on the back gas. Basically right after the stage. The original Deco plan was 45 minutes. We added 5 minutes to the deco during the ascent to compensate for the extra bottom time and Depth. Should have added 15. Dave and I have done this dive many times before. Maybe because we dive often our body is use to aggressive deco profiles. But our guest did not take it so well. Thanks Joe for the advice on the In-water recompression rig. I believe it is a must on every tech diving boat. I myself am a strong believer in in-water recompression. We did administer oxegen on the surface a few times at diffirent intervals the day after. I'm truly amazed you all did not get wacked and hard. The profile is so agressive its scary. A 15 min bottom time after a direct descent requires at least 70 minutes of decompression using a bubble model. I don't know where the profile you used came from but not a single model i have gives me that short a deco. Even if you only did 10 min on the bottom 50 min of deco would be in order. The gas mixes you are using for decompression are way to shallow. Staying on the LOW po2 that long just does not give a clean efficient decompression. You may want to look at doing a gas shift to EAN 36 instead of 50% -- you will save some bottom mix and get to a more efficient off-gasing earlier. But that's just my comments on it. Cheers __________________ Joel Silverstein, VP, COO www.techdivinglimited.com a division of Scuba Training and Technology Inc. NAUTILUS DIVE PLANNER CYLINDER SPEC CHART

May 26th, 2006, 09:25 AM	#9 (permalink)
JGrogan(Offline) GUE Join Date: May 2006 Location: London Posts: 582	Many thanks for posting this. It reminded me of a similar experiece about 5 years ago. We were diving in a remote location at altitude about 9 hours drive from the nearest chamber. Our last dive was 90-100m for 35 minutes with about 3.5 hours in the water. The shape of our profile was similar to yours but with more deep stops. About 10-15 minutes after hitting the surface, my buddy complained of a sore shoulder. Due to the remoteness, we decided to assume it was a type 1 bend coming on, so before he got out of his kit, we strapped a fresh oxygen bottle to him and got a support diver to take him down to 9m for 20 mins, then 6m for 20, then 3m for 20. There was a complete resolution of symptoms. This was the sixth day of diving at this location with each dive getting progressively deeper. It also involved carrying a lot of kit down to the waters edge daily. We put the hit down to the build-up over the 6 days, the hard work each morning and evening getting bottles in and out and just a stressed shoulder! Best, John. Quote: (Originally Posted by Red Sea Explorer) I am not going to get into the details of what, how, who, why or where. Nonetheless I think it is worth sharing. This is the dive profile that bent a diver. The diver came out feeling very week, vomiting, peeing a lot and with red spots all over the legs. Attachment 135 After an hour on Oxygen the symptoms eased up but now there was pain and a numbing feeling starting in the legs. The closest recompression chamber was 7 hours away and with the prevailing sea and wind conditions it might have been more. So we opted for in-water recompression. Below is the profile for the in water recompression. All of it was done on 100% pure oxygen. Attachment 133 After this all the symptoms went and the diver was fine although fatigued and needing lots of sleep. We contacted the chamber doctor informed him of what we had done and he said there is no need to bring the diver in for a check up but we had to wait 48 hours before the diver can dive again. Two days later he/she was diving again. Disclaimer: Do not try this at home.

May 26th, 2006, 10:23 AM	#10 (permalink)
mstroeck(Offline) New Member Join Date: Nov 2005 Location: Vienna, Austria Posts: 156	Quote: (Originally Posted by JS1scuba) I don't know where the profile you used came from but not a single model i have gives me that short a deco. Even if you only did 10 min on the bottom 50 min of deco would be in order. I agree. Theoretically, that seems very aggressive. I'm glad it works for them, though, just goes to show you how little we really know about decompression. Red Sea Explorer, I guess you use your own form of ratio deco, with a deeper setpoint than usually? Do you use 90m as your 1:3 setpoint? If so, why, and why do you opt not to carry the 35/25 for the deeper stops? Whatever you use, I guess you are right that you should have added 15 minutes :-) Your BT was around 20, no? EDIT: Sorry, I misread the chart, it's only 10 minutes BT. So to answer your question Joel, they seem to be using more or less exactly the deco approach described by AG here: http://www.5thd-x.com/xducation/pdf/ratiodeco.pdf Last edited by mstroeck; May 26th, 2006 at 12:31 PM..