Management of Mild or Marginal Decompression Illness in Remote ...

CARL EDMONDS: I don’t disagree with anything that Des has said or will say in the
future. However, it does worry me. I’m a bit like David. I am worried about the guy
with two numb feet. I am worried about the guy with a hemidysesthesia, and I am
worried about the guy with homonymous hemianopia, and I am worried a little bit
about the guy who’s just lost his hearing because that will come under sensory
changes.
SIMON MITCHELL: Yes, but they’re objective.
DES GORMAN: I would hope, Carl, that they’ll be picked up by that second
Statement. But the very first vote we’ll take, Carl and David, will be on the way in
which sensory change is expressed here. That’s the first thing we’ll vote on, because
there seems to be reasonable consensus about the rest – so we’ll vote on that first, but
then we’ll vote on them as total comments.
MICHAEL BENNETT: I’m probably just going to make the same point that the chap
who rings us up from the airport (with the progressive numbness in his feet) is not
going to have been examined and can’t possibly fall into this description. That’s my
point.
DES GORMAN: Before we take the first vote, I’d invite people from the wider audience
to pass any sort of opinion or comment or illustration they’d like of these first two
statements. Bob, I’d like you to see them together as a conjoint. One of the things,
David, we may need to talk about later on is actually merging them, so that they’re
actually not two statements but one statement and one qualifies the other, which I
think would preclude that division that sort of the forces of darkness might present to
us in the legal setting.
BOB WEBB: In terms of the second part of Statement 1, I see this as a beginning to
changing the way that we deal with the divers out there. We will be working with the
dive industry, and I can see that if that second part is such a critical part of the definition,
we might look at ways of trying to get some sort of neurological examination
done where the diver is. Whether that means training our people, or whether we train
divemasters…. I’m wondering whether the term "medical" is going to limit us to a particular
avenue. Maybe we should change it to "clinical" or some other term which
allows us to use other avenues to exclude that neurological dysfunction.
DES GORMAN: The Americans in the audience will tell you that the United States
Navy has had just that sort of approach in their divemasters for a long, long time.
They’ve actually taught them, I thought, quite a sensible neurological examination
which focused on the important things like gait which are where all the clues are anyway.
GLENN HAWKINS: One thing that I was concerned about was lack of progression.
Shouldn’t there be in part of the second statement that the symptom is not progressing
Because regardless of what you’ve got, if the person’s constitutionally getting
194 Management of Mild or Marginal Decompression Illness in Remote Locations Workshop Proceedings