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

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CONTENTS Acknowledgments 5 CONSENSUS STATEMENTS 6 EXECUTIVE SUMMARY David J. Doolette 10 OPENING REMARKS Simon J. Mitchell 14 MANAGEMENT OF MILD OR MARGINAL DECOMPRESSION ILLNESS IN REMOTE LOCATIONS: AN INTRODUCTION TO THE PROBLEM. Preliminary Decision Tree Simon J. Mitchell, David J. Doolette 15 DIAGNOSING DECOMPRESSION ILLNESS IN REMOTE LOCATIONS Richard E. Moon, Guy de L. Dear, Daniel Nord 23 THE NATURAL HISTORY OF UNTREATED DCI David H. Elliott 31 COST-BENEFIT ANALYSIS AND RISK ASSESSMENT IN THE MANAGEMENT OF EQUIVOCAL DCI IN REMOTE LOCATIONS Alison Drewry 50 BENEFIT OF SURFACE O2, FLUIDS AND DRUGS AS ALTERNATIVES TO RECOMPRESSION FOR MILD DCI: NON-RECOMPRESSION THERAPY Alfred A. Bove 59 IS THERE EVIDENCE FOR HARM FROM DELAYS TO RECOMPRESSION TREATMENT IN MILD CASES OF DCI John J. Freiberger, Petar J. Denoble 71 CAN DIVERS WITH MILD SYMPTOMS OF DCI FLY ON COMMERCIAL AIRLINERS Richard D. Vann., Christopher J. Wachholz, Daniel Nord, Petar J. Denoble, George Macris 91 GROUND TRANSPORTATION OF DIVING INJURIES TO TOWNSVILLE David Griffiths, Robert Webb 101 Management of Mild or Marginal Decompression Illness in Remote Locations Workshop Proceedings 3
TREATMENT IN REMOTE LOCATION HYPERBARIC CHAMBERS AND IN-WATER RECOMPRESSION James Francis 112 THE RISK OF AEROMEDICAL EVACUATION Michael Bennett 126 THE RISK OF RELAPSE FROM FLYING AFTER RECOMPRESSION THERAPY FOR DECOMPRESSION ILLNESS: AN OVERVIEW Richard D. Vann, John J. Freiberger, Petar J. Denoble, Joel Dovenbarger, Daniel Nord, Peter Winkler, Philip Bryson, Marguerite St. Leger Dowse, Robyn Barnes 134 EVOLVING CLINICAL PROBLEMS All Participants 143 THE LAWYER’S VIEW ON REMOTE MANAGEMENT OF MILD DCI Richard Lesser 176 CONSENSUS DISCUSSION All Participants 184 APPENDIX A. TREATMENT OF DCS CASES IN REMOTE LOCATIONS: A 1965-1990 SUBJECTIVE POSITION PAPER, ILLUSTRATING THE TRAPS, MISTAKES AND LESSONS LEARNT Carl Edmonds 224 APPENDIX B. Presenters, Discussants, and Attendees 235 APPENDIX C. Agenda 238 4 Management of Mild or Marginal Decompression Illness in Remote Locations Workshop Proceedings
Page 1 and 2: Management of Mild or Marginal Deco
Page 3: Dedication Anthony Slark, M.D. Surg
Page 7 and 8: FINAL CONSENSUS STATEMENTS Discussa
Page 9 and 10: Consensus Statement 5 The workshop
Page 11 and 12: EXECUTIVE SUMMARY David J. Doolette
Page 13 and 14: Treatment options in remote locatio
Page 15 and 16: MANAGEMENT OF MILD OR MARGINAL DECO
Page 17 and 18: the cost-efficacy of medical interv
Page 19 and 20: Diagnostic criteria for DCI. It is
Page 21 and 22: Flying home after remote treatment
Page 23 and 24: DIAGNOSING DECOMPRESSION ILLNESS IN
Page 25 and 26: Table 1. Characteristic manifestati
Page 27 and 28: Numbness & Tingling Pain Muscular W
Page 29 and 30: RICHARD MOON: Yes. No, I was not tr
Page 31 and 32: THE NATURAL HISTORY OF UNTREATED DC
Page 33 and 34: ologically normal and said that she
Page 35 and 36: • Bouhy reported that joint pains
Page 37 and 38: Latency and Progression Areview of
Page 39 and 40: The amount of omitted decompression
Page 41 and 42: that a textbook concept of time sca
Page 43 and 44: Some cases have emerged of individu
Page 45 and 46: 22. Denoble P. Personal communicati
Page 47 and 48: DAVID ELLIOTT: It’s a loose assoc
Page 49 and 50: RICHARD MOON: Could I go back to th
Page 51 and 52: equirement to maximize patient thro
Page 53 and 54: illness" include a time considerati
Page 55 and 56:
15. Gorman DF, Edmonds CW, Parsons
Page 57 and 58:
KLAUS TORP: We had a similar situat
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BENEFIT OF SURFACE OXYGEN, FLUIDS A
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Table 1. Inflammatory mediators, th
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Lung Injury Although the most evide
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References 1. Ferris EB, Engle GL.
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eceive with mild symptoms prove to
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FRED BOVE: I absolutely agree. If y
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IS THERE EVIDENCE FOR HARM FROM DEL
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were noted with: (a) the definition
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ecompressed as soon as possible" (5
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2.5 Odds of Residual (Relative to C
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Median Delay to Recompression 40 30
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enced by: 1) the severity and urgen
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special senses; (3) pulmonary or ca
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The SERF is a one-page digital form
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3. Francis TJ, Pearson RR, Robertso
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One thing you didn’t pick up on,
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CAN DIVERS WITH MILD SYMPTOMS OF DC
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40% Divers with Indicated Case Seve
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Continental Micronesia Airlines pro
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dive exploration: 2003 edition (bas
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flew more than 24 hours after sympt
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GROUND TRANSPORTATION OF DIVING INJ
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. Rotary or fixed wing air ambulanc
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DAN Diver Retrieval Data Only 18 (4
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Table 4. Delay from symptom onset t
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8. HMU divers with moderate or mild
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DAVID GRIFFITHS: If they’re going
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Original features of these tables w
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• A bunk for the patient and a se
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In addition to being satisfied that
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eturn to the surface at any time. S
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with severe, progressive, or relaps
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ED KAY: I chaired a workshop in 200
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DAVID ELLIOTT: You suggested that "
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given the rugged topography within
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Figure 1. Reduction of atmospheric
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It is the business of this workshop
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JOHN ROSS: Before the chamber opene
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The specific questions we sought to
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Because the baseline relapse rate i
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adverse effect of altitude exposure
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2. Uguccioni D, Dovenbarger J, Hobg
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EVOLVING CLINICAL PROBLEMS All Part
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sion wouldn’t be appropriate for
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DAVID ELLIOTT: I have got a questio
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FRANS CRONJE: Forgive me if I sound
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in a way that we could put it on pa
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does this diver get home And as we
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ing treatment within one hour. So t
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JERRY CHIA: I’ll say that this so
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dration, before you actually are ab
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JOHN ROSS: So this guy is fetched u
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DAVID ELLIOTT: I entirely support t
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tant enough to sort of make a spect
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way of us thinking about the steps
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SIMON MITCHELL: Agreed, but the tre
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arrow saying, "on the basis of revi
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SIMON MITCHELL: Let’s say we’re
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Diver with symptoms 1. Case of DCI
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symptoms. He began to get symptoms
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It gets the attention of diving ins
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RICK LESSER: True. CHRIS WACHHOLZ:
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standard physical exam, such as the
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In terms of the purpose of the work
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you exhibit the dogmatic views that
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Secondly, I brought this up yesterd
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DES GORMAN: So what you’re arguin
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got "has been excluded by medical e
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CARL EDMONDS: I don’t disagree wi
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FRANS CRONJE: Would the use of the
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DAVID ELLIOTT: I’m happy with a f
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DES GORMAN: Thank you. Does anyone
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DES GORMAN: Alf, I think the point
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DES GORMAN: We’ll put it there fo
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we move on to try to thrash out Sta
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DES GORMAN: In fact, that statement
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DES GORMAN: Yeah, sure. But the abi
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RICK LESSER: When you put in "peopl
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JOAN TAYLORS: Please. JOHN LIPPMAN:
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een treated. I think the issue here
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GEORGE MACRIS: If individuals who d
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Is that correct Our experience in A
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and say, "We actually don’t know"
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Under these conditions, most cases
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Occasional, unpredictable side effe
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In the pre-90s, there was little sc
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Another regimen still not adequatel
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ast then subjects the patient to mo
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APPENDIX B. PRESENTERS, DISCUSSANTS
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Henrik Nimb Dale O’Halloran Matth
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NOTES 238 Management of Mild or Mar
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UNDERSEA & HYPERBARIC MEDICAL SOCIE
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