By John Lippmann. Founder, Chairman & Director of Research, Divers Alert Network Asia-Pacific.
The following email was recently received by DAN AP about a 25 year-old diver who was diving in “a developing country”. The names and location has be en withheld.
I am Sally’s mother Anny and not a DAN member but desperate to find some information about my daughter’s decompression sickness. Sally was diving in “a developing country” with “Operator X “. She had completed a couple of courses then briefly lost consciousness after surfacing on a dive. She was totally disorientated. Sally was given oxygen therapy but the staff at the diving centre said it wasn’t decompression sickness and let her dive two days later – a “fun dive”.
After this dive, Sally became paralysed from the waist down. She was subsequently given oxygen and admitted to the local International hospital. She has already had five recompression chamber treatments and now is starting five more. She is also having daily physiotherapy. Sally now has some sensation in one leg but none in the other and no feeling around her waist.
I would really appreciate any information as to how long recovery might take and if we can hope for total recovery. Has the diving centre been negligent in not diagnosing the first episode? Thank you so much for anything you can tell me.
As you have just read, this was obviously a tragic accident. It is important to review any such accident and to try to determine what, if anything, could have been done to prevent it, or to manage it in the best possible manner. In doing so, it’s useful to ask yourself, what would I have done in similar circumstances?
A few thoughts have occurred to me and I’ll share these. Maybe many readers would have had similar thoughts.
Making decisions about the severity of a problem.
I have often mentioned in talks and articles how important it is for dive professionals not to try to diagnose whether a diver in their care has suffered a significant diving injury. Unless medically qualified and trained or adequately orientated in diving medicine, most dive professionals simply don’t have the expertise and experience to diagnose a medical problem.
There are a variety of first aid-related courses available through diver training agencies as well as general first aid training organisations, and DAN. Although these are valuable for all divers and essential for dive professionals, they are focussed on the provision of first-line care, which is by definition first aid. They do not provide sufficient knowledge or training to diagnose anything but a very basic illness or injury with certainty. That is why, unless the problem is very minor and it is blatantly obvious what the issue is, it is important to contact a diving medical specialist for advice for any medical problems that have developed during or after scuba diving.
You might wonder why advice from a diving doctor is usually preferred …?
The diving environment exposes a diver to a variety of physical and physiological changes as a result of increased pressure, the effects of immersion, breathing compressed gas, and certain other factors. Most medical training includes little or no education on diving medicine and, as a result, the vast majority of doctors have little idea of the impact of these changes, especially in divers with certain pre-existing medical conditions (e.g. epilepsy, diabetes, heart disease, among others).
Sally’s mother later told me that the dive operator did not seek medical advice. I have no idea whether or not this was the case. However, it seems unlikely that they had, given the fact that Sally was diving again two days after becoming unconscious. In such circumstances, it is essential that the diver be properly examined and assessed. Unconsciousness soon after diving is often associated with decompression illness, but can also result from a variety of other factors, including non-diving-specific medical conditions. All of these need proper medical investigation, especially before further diving is contemplated.
DAN Asia-Pacific funds a Diving Emergency Hotline which is available 24 hours a day, 7 days a week to provide advice to divers, dive professionals and medical professionals in a situation where a diver has symptoms after diving. The call is directed to a diving medical specialist (who is usually a diver themselves) who will give advice on the appropriate first aid and appropriate follow-up assessment and treatment. The injured diver or caller doesn’t need to be a DAN member to get advice – it is available to anyone for free. The difference is that with a DAN Member, DAN will then become involved in the management of the situation.
It is certainly wise for dive professionals to use this service to help achieve the best outcome for divers in their care. It also transfers the decision-making from the dive professional to the doctor, removing the opportunity for the dive professional to make a bad decision and reducing potential liability.
Calls to the hotline are toll-free within Australia by dialling 1800-088200. The hotline can be reached from outside Australia by dialling +618-8212 9242 although these calls aren’t toll-free. There is no charge for the service as the doctor provided their services for free.
The importance of good oxygen first aid.
The administration of as near as possible to 100% oxygen is the cornerstone of first aid for decompression illness. Prompt and appropriate oxygen first aid will likely reduce the number of required treatments and accelerate recovery from DCI.
The only encouraging thing to read in Anny’s email was that oxygen first aid was available and that Sally was given oxygen. However, no details are provided to determine the adequacy of this.
After many treatments, Sally can manage to “hobble a few steps at a time” and is currently waiting to be repatriated to her home country for on-going treatment and likely many months of constant physiotherapy. It is far too early to know to what level she will recover.
I sincerely hope that this case report provides some good “food for thought” and discussion and will serve to reduce the chances of a problem like this re-occurring.
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