IFRC International First Aid and Resuscitation Guidelines 2011

International Federation of Red Cross and Red Crescent Societies
International first aid and resuscitation guidelines 2011
Scuba diving decompression illness
Introduction
Scuba diving has become a very popular sport in the last 20 years in many
parts of the world. As with most sports activities, scuba diving can cause health
problems.
Summary of scientific foundation
One large retrospective case study showed that scuba divers experiencing decompression
injury require fewer decompressions and have a greater likelihood
of complete recovery if first aid includes normobaric oxygen.
Reference: 550
Guidelines
• In cases of decompression illness (DCI, see below), first aid providers should administer
oxygen (if available), which may reduce the symptoms substantially
(recommendation**).
• First aid providers should call for EMS immediately and indicate the likelihood
of DCI so that transport of the victim to a decompression chamber can be arranged
as soon as possible, because the only real treatment for DCI is recompression
in a decompression chamber (recommendation**).
Implementation considerations
First aid providers should have information on local resources for diving emergencies
and access to hyperbaric therapy if indicated. Diver Alert Network
(DAN) can be reached 365 days a year, 24 hours a day, at +1-919-684-9111.
Decompression illness (DCI)
DCI results from a reduction in the ambient pressure surrounding a body. It
encompasses two conditions: decompression sickness (DCS) and arterial gas
embolism (AGE). DCS is thought to result from bubbles growing in tissue and
causing local damage, while AGE results from bubbles entering the circulation,
traveling through the arteries and causing tissue damage at a distance by
blocking blood flow at the small vessel level.
The main risk factor for DCI is a reduction in ambient pressure, but other risk
factors include deep or long dives, cold water, hard exercise at depth and rapid
ascents.
Decompression sickness (DCS):
Decompression sickness is the result of inadequate decompression after exposure
to increased pressure. During a dive, the body tissues absorb nitrogen
from the breathing gas in proportion to the surrounding pressure. As long as
the diver remains at pressure, the gas presents no problem. But if the pressure
is reduced too quickly, the nitrogen comes out of solution and forms bubbles in
the tissues and bloodstream. This commonly occurs as a result of violating or
approaching too closely the diving table limits, but it can also occur when accepted
guidelines have been followed.
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