DCI Recognition and Diver Denial
Introduction
The risk of getting decompression illness (DCI) is very remote. This can be gauged from the intelligence gathered for a government agency detailing that the number of dives (exposures to pressure) completed annually by UK divers is between 2 and 2.5 million, while the number of reported treated cases of DCI is around 200pa. Taking the lower of the
two numbers; the risk of getting decompression illness (DCI), if true, it is around one in 10,000 give or take a few.
However, it is impossible to be precise because the number of dives or so-called exposure to pressure is only an estimate taken from that survey. The risk of DCI is ever present and intrinsic in every dive. Given that this is a fact of life
it is wise to train and plan to deal with it. There is no doubt that a stricken diver’s best chance of surviving a DCI hit without residual problems (eg brain damage, paralysis, sexual dysfunction, death etc) is prompt recognition, first aid and treatment. This makes it imperative that dive teams are well trained and appropriately equipped to deal with this and other types of emergencies.
The Magic Bullet
Decompression illness is caused by inert free-gas (bubbles), usually nitrogen, within the blood and tissues disrupting the body’s normal functions. The key to resolving the problem is to encourage this gas to diffuse out of the bubbles and dissolve into the blood so that it can exit the body in the normal way, by breathing. In the first instance, first aid must be given to the stricken diver. The magic bullet or wonder gas that does this trick is pure oxygen, which is given to the casualty to breathe.
Since oxygen contains no nitrogen (N2), the N2 pressure gradient increases forcing the free-gas to exit the bubbles into the blood so that it can leave the body via the lungs. Sounds simple, well it is, but that’s not the complete story. To achieve a satisfactory outcome, all suspected DCI casualties must be taken to a recompression facility to receive professional medical treatment from a qualified hyperbaric doctor
Decompression illness is a multi-faceted problem that has a considerable number of manifestations. The following is a list of common symptoms and signs, but this is not an exhaustive list:
Symptoms (what the diver tells you)
Pain in limbs joint or joints Dizziness
Skin itching Numbness
Unusual or extreme fatigue Pins and needles
Mental confusion Loss of sensation
Visual disturbance (tunnel vision) Paralysis or weakness
Chest pains Shortness of breath
Staggering Nausea
Collapse Unconsciousness
Loss of bladder and/or bowel functions
Signs (what you can see)
Blotchy red or blue skin rash Staggering, Choking Loss of sensation, Loss of strength Paralysis, Collapse Unconsciousness
It’s a Sports Injury
A simpler truth needs to be adopted: DCI is not a foolish thing. It’s a sports injury and we need to deal with it as such – there must be no stigma. Furthermore, it is, in fact, a survival thing of a different kind: early recognition and treatment avoids permanent disability or worse. Keep in mind that if the diver comes up from a dive with an ailment not taken into the water; it could be DCI. Treat all such situations as DCI, apply DCI First Aid and call for advice from a hyperbaric doctor.
Oxygen Administration Training
We all owe a duty of care to our buddies, diving mates, families and ourselves. To help fulfil this duty you should attend an SAA Oxygen Administration Course to learn about DCI recognition, first aid and the important safety aspects associated with using pure oxygen.
It’s not Rocket Science
Keep in mind that a diver exiting the water from a dive with symptoms not taken into the water should be treated for DCI until a doctor says otherwise. Keep it simple, don’t waste time with a pseudo medical examination. Promptly apply basic DCI first aid by giving:
• pure oxygen
• non-alcoholic fluid, and at the same time get someone to contact the emergency services.
IMPORTANT
It is important to remember that divers are NOT qualified to say that symptoms are not DCI, only hyperbaric doctors can do that.
Kind regards and safe diving
Bob Cole,
SAA Decompression Officer, CMAS Technical Director.