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

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Percent Complete Relief After Treatment 80 70 60 50 40 30 20 10 0 Did Not Fly Flew With Sx in >24 hrs Flew With Sx in
Continental Micronesia Airlines provides scheduled air transport throughout the South Pacific islands. In the absence of local air ambulance services and national health care, Continental has recognized the need for accommodating sick or injured passengers and has developed medical guidelines for off-island fitness to travel. These guidelines recognize the unique nature of diving injuries. The DAN Medical Staff has consulted with Continental at short notice on a number of occasions to arrange for the transport of injured divers. Medical escort, reduced flight elevation, and emergency high-flow oxygen during flight were key considerations. From 1999-2002, DAN assisted in the transport of 12 divers with DCI from Truk, primarily to Guam where the nearest recompression chamber is located at a flying time of 1.5 hours. Five cases were evacuated from Truk by air ambulance and seven cases by Continental Micronesia Airlines. The choice of transport mode was governed by case severity and availability of an air ambulance as compared with regularly scheduled air service. Some patients who flew commercially were accompanied by one of the authors (GM), a trained diving physician. Four of the five cases transported by air ambulance were classified as Serious Neurological. Four of the seven cases transported by commercial air were classified as Serious Neurological, and all were stable. The mean estimated preflight surface interval for commercially transported cases was 40 hours (range 21-57 hours). All 12 cases received surface oxygen, and in-flight oxygen (2-4 L/min) was available for many commercial cases. Cabin altitudes for the commercial cases were about 7,300 feet. Five of the seven cases transported by commercial air reported complete relief of all signs and symptoms. Of two commercially transported cases that were classified as Serious Neurological, one had Mild Neurological symptoms after recompression and the other had Pain (occasional shoulder tightness). In another Serious Neurological case, the diver flew from Truk to Florida, against medical advice, instead of to Guam but had complete relief after recompression, nonetheless. One Serious Neurological case transported commercially became worse in-flight but had complete relief upon recompression. Discussion Mild Neurological cases were most common in the DAN diving injury data followed by Serious Neurological, Pain, and Cardiopulmonary cases (Fig. 1). For divers who flew with symptoms, recompression therapy was less effective in both Serious Neurological and Mild Neurological cases if the divers waited for 24 hours or less (Fig. 2). For divers with symptoms who waited longer than 24 hours before flying, recompression therapy was as effective as for divers with symptoms who did not fly. These results apply to the limited number of cases in the DAN data and are not necessarily representative of all divers who fly with DCI symptoms. Cases evacuated from Truk were generally consistent with these observations, although there were too few to support statistical comparison. Surface oxygen, in-flight oxygen, reduced cabin altitude and medical support were usually available, and most of the 94 Management of Mild or Marginal Decompression Illness in Remote Locations Workshop Proceedings
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Management of Mild or Marginal Deco
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Dedication Anthony Slark, M.D. Surg
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TREATMENT IN REMOTE LOCATION HYPERB
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FINAL CONSENSUS STATEMENTS Discussa
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Consensus Statement 5 The workshop
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EXECUTIVE SUMMARY David J. Doolette
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Treatment options in remote locatio
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MANAGEMENT OF MILD OR MARGINAL DECO
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the cost-efficacy of medical interv
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Diagnostic criteria for DCI. It is
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Flying home after remote treatment
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DIAGNOSING DECOMPRESSION ILLNESS IN
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Table 1. Characteristic manifestati
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Numbness & Tingling Pain Muscular W
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RICHARD MOON: Yes. No, I was not tr
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THE NATURAL HISTORY OF UNTREATED DC
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ologically normal and said that she
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• Bouhy reported that joint pains
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Latency and Progression Areview of
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The amount of omitted decompression
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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
Page 59 and 60: BENEFIT OF SURFACE OXYGEN, FLUIDS A
Page 61 and 62: Table 1. Inflammatory mediators, th
Page 63 and 64: Lung Injury Although the most evide
Page 65 and 66: References 1. Ferris EB, Engle GL.
Page 67 and 68: eceive with mild symptoms prove to
Page 69 and 70: FRED BOVE: I absolutely agree. If y
Page 71 and 72: IS THERE EVIDENCE FOR HARM FROM DEL
Page 73 and 74: were noted with: (a) the definition
Page 75 and 76: ecompressed as soon as possible" (5
Page 77 and 78: 2.5 Odds of Residual (Relative to C
Page 79 and 80: Median Delay to Recompression 40 30
Page 81 and 82: enced by: 1) the severity and urgen
Page 83 and 84: special senses; (3) pulmonary or ca
Page 85 and 86: The SERF is a one-page digital form
Page 87 and 88: 3. Francis TJ, Pearson RR, Robertso
Page 89 and 90: One thing you didn’t pick up on,
Page 91 and 92: CAN DIVERS WITH MILD SYMPTOMS OF DC
Page 93: 40% Divers with Indicated Case Seve
Page 97 and 98: dive exploration: 2003 edition (bas
Page 99 and 100: flew more than 24 hours after sympt
Page 101 and 102: GROUND TRANSPORTATION OF DIVING INJ
Page 103 and 104: . Rotary or fixed wing air ambulanc
Page 105 and 106: DAN Diver Retrieval Data Only 18 (4
Page 107 and 108: Table 4. Delay from symptom onset t
Page 109 and 110: 8. HMU divers with moderate or mild
Page 111 and 112: DAVID GRIFFITHS: If they’re going
Page 113 and 114: Original features of these tables w
Page 115 and 116: • A bunk for the patient and a se
Page 117 and 118: In addition to being satisfied that
Page 119 and 120: eturn to the surface at any time. S
Page 121 and 122: with severe, progressive, or relaps
Page 123 and 124: ED KAY: I chaired a workshop in 200
Page 125 and 126: DAVID ELLIOTT: You suggested that "
Page 127 and 128: given the rugged topography within
Page 129 and 130: Figure 1. Reduction of atmospheric
Page 131 and 132: It is the business of this workshop
Page 133 and 134: JOHN ROSS: Before the chamber opene
Page 135 and 136: The specific questions we sought to
Page 137 and 138: Because the baseline relapse rate i
Page 139 and 140: adverse effect of altitude exposure
Page 141 and 142: 2. Uguccioni D, Dovenbarger J, Hobg
Page 143 and 144: 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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