Report on Decompression Illness, Diving Fatalities and Project Dive

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Appendix A: Injury Case <strong>Report</strong>smade safety stops on all dives, and he usedcompressed air. He had no problem duringascents or with his equipment.About 20 minutes after he reached the surfaceand removed his gear, he noticed an ache,much like a stomach cramp in his abdomen. Itgradually moved up his chest and encircledhis lower trunk. He then noticed numbnessand weakness in his left arm, followed by backpain.The boat crew noticed that he could not communicateeffectively. He was immediatelystarted on high flow oxygen. Crew memberscontacted DAN for assistance in arranging anevacuation to the U.S. mainland. The divevessel was seven hours from the nearest land.A rescue helicopter was arranged to pick thediver up at sea and carry him to the nearesthospital and hyperbaric facility.The diver reached the hospital approximatelysix hours after he had surfaced from his dive.When he was admitted, he had weakness inhis legs and was unable to walk. His abdominalpain and left arm numbness and weaknesshad almost cleared. His mental status was stillaltered. Shortly after admission, he receivedTT6. He received a second TT6 later the sameday and a third the following day. Each timehe received some resolution of his symptoms.All symptoms resolved except for his backpain.On his third and final day of treatment hereceived two, two-hour treatments that didnot resolve his back pain. He was dischargedwith continuing mild pain.This is a case of serious paralytic form of DCS,which sometimes results in permanent disability.In this case, neurological symptomsresolved completely except mild back painthat may have been unrelated to diving. Thismay be due to beneficial effects of surface oxygenthe diver received early. He was also fortunatethat he received emergency assistancesoon enough from a helicopter during thedaylight hours. Thus, the diver could be transportedover a considerable distance. He wasable to return to scuba instruction and recreationaldiving.Case 7 — Spinal Cord DCI after a misseddecompression stopThe diver was a 46-year-old female, who hadbeen certified for three and a half years, hadmade more than 100 dives, 30 of whichoccurred in the past 12 months. She was physicallyfit, had no health concerns and was veryactive. She lived in the Caribbean and divedweekly.She performed a single dive to 130 feet (40meters) using her dive table. It was a multilevel,open-circuit scuba dive on air with asafety stop. Unfortunately, a later calculationfound that, given her total bottom time, sheshould have done a decompression stop.Approximately 15 minutes after leaving thewater, she began experiencing a sharp pain inher back, which shot around through her ribcage. This caused her to have difficulty breathing.She experienced altered vision like flashinglights, but she had no headache or sinusrelatedsymptoms. She then developed numbnessand tingling on the right side of her body,from her rib cage down her arm and leg.Thinking she must be having a migraineeadache, she continued with her day. She puther dive gear in the car and prepared to drivehome. During the drive home, she becamedizzy and nauseated. Friends then drove herto thehospital. While she was en route to the hospital,her dizziness and shortness of bre a t hbecame more extreme; she eventually lost consciousness.After a brief evaluation, she was placed in thehyperbaric chamber and a TT6 was adminis-DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition 103
Appendix A: Injury Case <strong>Report</strong>stered, during which all symptoms improved.After her treatment, her symptoms continuedto improve during the evening. The followingmorning, they were mild to minimal. She wastreated on a TT5, with resolution of all symptoms.She was diagnosed with spinal cordDCI and a possible inner ear DCI.The diver was fortunate in that she lived veryclose to an island recompression chamber andthat her friends recognized her symptoms asserious. After the diver recovered she felt thatshe had been too tired and dehydrated to divethat day. She had had quite a lot to drink thenight before. She did not have any return ofsymptoms and returned to diving thre emonths later.Case 8 — Flying with pain-only symptomsthat worsen after flyingThe diver, a 44-year-old female who has beencertified for 12 years, was a regular diver, with60 dives in the past 12 months. She was in goodhealth, on no medication and her only healthconcern was occasional lower back pain.During her annual dive vacation to theislands, she performs 16 dives over six daysusing air and open-circuit scuba. Midweek,her deepest dive was to 112 feet (34 meters).Her final day of diving she did three dives:the first dive was to 95 feet (29 meters); thesecond was to 90 feet (27 meters); and the lastwas to 79 feet (24 meters).She used a dive computer to plan her multilevelprofiles and her surface interval times.The last day of diving was complicated by thefact she was cold on all three dives and herbuoyancy compensator device (BCD) periodicallyinflated. This took her up and down inthe water column several times, but not all theway to the surface.Shortly after exiting the water on her last dive,she began to experience sharp pain in herright hand, especially around the joint in herright thumb. In the next four hours, this grewfrom a mild achiness or soreness to pain andgradually involved her right forearm, elbowand shoulder. She attributed the discomfort tomuscle strain and continued on with the restof her day. Except for diving, she had notexerted herself. The following day when sheawoke, the pain had resolved. This confirmedto her that this was simply pain due to musclestrain.On the second day after diving, she awokewith a mild ache in the joints of her right arm.Again, she wasn’t concerned. Almost 48 hoursafter diving and the onset of her originalsymptoms, or mild achiness in her joints, sheflew out the afternoon of the second day.Her first flight to the United States took twohours. On this flight, she developed painsymptoms similar to those after her dives.The second flight took a little more than fourhours, and her right arm pain worsened andreached its highest level of severity. She experiencedno change in her symptoms when shelanded. After two days of continuous pain,which was unaffected by positioning or movementof the extremity, she called DAN forassistance.A DAN medic referred her for evaluation tothe local hospital with a recompression chamber.She saw the dive physician the followingmorning and received a TT6; her arm paingreatly improved. Over the course of the day,it again worsened, but the pain did not reachits pretreatment level. After her original treatment,she was given a TT5 each day for twodays. Each time the symptoms lessened tosome degree. She was left with some mild discomfortfor several weeks after recompression104DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition
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1. INTRODUCTIONDivers Alert Network
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Section 1. Introduction1.3 Diving F
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2.2 PDE 2003This report includes da
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Section 2 - Project Dive Exploratio
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Figure 2.4-2 describes the breathin
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Figures 2.5-2 and 2.5-3 indicate th
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Towards the end of the series, PDE
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Case #2The diver was a 29-year-old
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3. Dive InjuriesSection 3 - Dive In
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Section 3 - Dive InjuriesFigure 3.1
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Section 3 - Dive Injuriesmost sever
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Section 3 - Dive Injuries3.3 Physic
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Page 58 and 59: Section 3 - Dive InjuriesFigure 3.5
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Page 68 and 69: 4. Dive FatalitiesDeath while divin
Page 70 and 71: Section 4 - Dive FatalitiesFigure 4
Page 74 and 75: Section 4 - Dive FatalitiesOur data
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Page 82 and 83: Figure 4.4-2Report
Page 84 and 85: Section 4 - Dive FatalitiesConclusi
Page 86 and 87: Figure 5.1-2 shows the proportion o
Page 88 and 89: Figure 5.1-6 shows a comparison of
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Page 132 and 133: Appendix C: Breath-Holding Incident
Page 134 and 135: Glossarymatical models to compute d
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Page 138 and 139: 2004 Publications2004 PublicationsR
Page 140 and 141: NotesDAN’s Report</strong
Page 142: The only 24-hour, worldwide dive em
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