Report on Decompression Illness, Diving Fatalities and Project Dive

Appendix A: Dive Injury Case <strong>Report</strong>sAppendix A: Injury Case <strong>Report</strong>sCase 1 — Aggressive dives in teenage diverwith pain only symptoms and full resolutionThe diver was a 14-year-old male who hadbeen certified for approximately two years,making 30 dives per year. He was in goodhealth and had no history of illness.He performed two dives on one day; bothincluded safety stops. The first dive was to 90fsw (27 msw), with a one-hour surface interval,and the second dive was to 80 fsw (24msw). He used open circuit scuba, air and adive computer to calculate his dive profiles.His dives were uncomplicated and within thelimits of his dive computer.After surfacing from his last dive, he experiencedmild pain in his left knee. He also experienceddizziness, which he felt was quitesevere. Within 10 minutes he began feelingmoderate pain in his right elbow and a fairlysevere headache. At that time, he was placedon surface oxygen.After 20 minutes on oxygen, his symptomshad stabilized and had begun to subside. Afterone hour of oxygen, all symptoms were minimal.During transport to a local hospital, hewas without oxygen, and he felt some recurrenceof elbow pain. His symptoms weregreatly reduced by the time he reached thehyperbaric facility and completely resolvedduring a standard U.S. Navy Treatment Table6 (TT6).The diver had no problems with joints andhad never had these types of symptomsbefore. The immediate onset of pain anddizziness concerned other divers and frightenedthe injured diver. First aid oxygen at 15liters per minute via a non-rebreather maskseemed be effective in reducing and almosteliminating symptoms before treatment. Toprevent a worsening or a return of symptoms,oxygen should be maintained until divers arereleased to professional medical care .Symptoms occurring immediately after thedive indicate a potentially severe injury andshould be addressed early as in this case.Neurological symptoms may have been presentin this case, but a brief neuro exam was notdone on-site.Case 2 — Teenage diver with pain-onlysymptoms in first two dives after certificationThe diver was a 19-year-old male in goodhealth and physically fit. He had no history ofrecent illness or injury. To complete his openwatercertification, he first performed twodives to 30 feet (9 meters). On the followingday — his first day of diving as a certifieddiver — he performed two dives, the first wasto 80 feet (24 meters) for 20 minutes with athree-minute safety stop at 20 feet (6 meters).After a 60-minute surface interval, he made adive to a maximum of 70 feet (21 meters) for20 minutes, with a three-minute safety stop at20 feet (6 meters). When he left the water, hehad no symptoms and reported no problemsduring the dive. All ascents were normal andthere were no equipment problems.The diver continued on with his day afterthese dives, without symptoms until approximately10 hours later when he had the gradualonset of left knee and ankle pain, then rightelbow pain. In the next hour, his symptomsincreased in severity, and he contacted hisdive instructor. He was then referred to thelocal hospital for evaluation.He was placed on high flow oxygen in anemergency department and transferred to thehyperbaric center. He experienced minimalDAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition 99