Report on Decompression Illness, Diving Fatalities - Divers Alert ...

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FAD — Flying After DivingAn altitude exposure within 48 hours after ending a dive. FAD exposures includemountain travel and flying in pressurized or unpressurized aircraft.FRC — Field Research CoordinatorVolunteers who assist divers in collecting and reporting data for PDE.MedianThe mid-point in a group of measurements such that half the measurements are lessthan the median and half are greater.MeanThe "average." The sum of all measurements in a group divided by the number ofmeasurements. A few extreme measurements may make the mean greater or lessthan the median.PDE — Project Dive ExplorationPDE is a prospective observational study of dive profiles and medical outcomesin recreational diving.PSI — Perceived Severity IndexA system for classifying the severity of diving injuries based on a perceived, butarbitrary, ordering of the severity of reported signs and symptoms. PSI first appearedthe in 2002 <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration.Technical DivingFor this report, dives on heliox, trimix or a rebreather, regardless of gas mix. This doesnot mean that the divers making technical dives were certified technical divers or werefollowing guidelines of the technical diving agencies.DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition 101
Appendix A: Injury Case <strong>Report</strong>sIntroductionIn 2001, close to 1,000 treated cases of decompression illness (DCI) were reported to DAN by the DANworldwide network of referral hyperbaric chambers.Many cases of decompression illness demonstrate similar patterns of symptoms and presentation, butdive profiles are often quite diverse. Instances of DCI can range from mild pain-only cases to severe neurologicalsymptoms or complete paralysis. Despite similar symptoms, these cases had different responsesto recompression. Why some cases are more resistant to treatment is not completely understood.Surprisingly, although decompression illness and its symptoms are well known to most divers, thesedivers are often hesitant to report their symptoms or seek evaluation. The more moderate or mild symptomscan be confused easily with pre-existing injuries or other recent activities and may also contributeto the delay.The following cases represent common examples of the variety of symptoms in decompression illness,symptom severity and outcomes after treatment. These cases were chosen randomly based on symptompresentation. Although complete dive profiles are not given here, they generally help in making a definitivediagnosis.All cases were diagnosed as DCI, and this was the first episode of DCI for each diver. Two cases representtwo DCI episodes in one year. In these cases, there was always more than one diver in the water atthe time of injury, but only the diver mentioned in each case reported having any symptomsCase 1. Serious Neurological DCI withNeurological Symptoms Prior to the LastDive — With Complete ResolutionThe diver was a 56-year-old male in reasonablygood health. He had a vague history ofback problems from more than 25 years agoand had not smoked in approximately fiveyears. He was physically active withoutrestrictions. He had been scuba diving forapproximately one month and completed 13dives. This was his first dive vacation, wherehe made nine dives over four days.On his next-to-last day of diving, he surfacedfrom the last dive and experienced numbnessin his right hand and tunnel vision in his righteye. These symptoms gradually lessened andfinally resolved in less than 10 minutes. Hehad never experienced either symptom before,and he did not report his symptoms to his divingcompanion or to the boat captain. On thefinal day of diving, he started the day with a102-foot (30.6-meter) dive. Within minutes ofexiting the water, he experienced a completeright-sided paralysis.The crew provided 100 percent oxygen as soonas they had removed his gear and placed himin a safety position. The diver reported noproblems with his dive, which included a slowascent and safety stop. Within an hour hecould move his right arm and leg but wasexperiencing extreme weakness, generalfatigue and lethargy. While still breathing oxygen,he was transported by helicopter to thenearest available recompression chamber. Hewas recompressed approximately five and ahalf hours after his symptoms began with aU.S. Navy Treatment Table 6. He experienceda near-total resolution of his symptoms. A secondTable 6 the following day resulted in completeresolution.102DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition
Page 1 and 2:
Report onDecompres
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Dedicated toDr. Peter B. BennettThe
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AcknowledgmentsData for the 2002 <s
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International DAN OfficesDAN Americ
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When divers have questions about th
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Flying After Diving (FAD) StudyIn 1
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In 2002, DAN trained six interns fr
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DAN Training ProgramsOxygen First A
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DAN members are also eligible for d
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DAN Diver Identification System (DI
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Instructors who don’t have access
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Of 522 reports submitted in 2001, 5
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2. Dive Injuries2.1 Injury Data Des
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Arterial Gas Embolism (AGE)• Symp
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The pre-existing medical problems o
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Figure 7 shows the number of self-r
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As shown on Figure 11, most diving
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As in previous years, the largest p
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Figure 19 shows number of days divi
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Figure 23 shows the maximum depth o
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2.4 Signs and Symptoms in Injured D
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Figure 29 shows symptoms reported b
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Fig 32Distribution ofcases by PSI.E
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Figure 35 shows the administration
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Figure 37 shows the type of recompr
Page 51 and 52: 2.6 Therapeutic OutcomeFigure 40 sh
Page 53 and 54: Figure 43 shows that AGE was more l
Page 55 and 56: 3. Dive FatalitiesDAN is not the pr
Page 57 and 58: Figure 49 shows the gender and cert
Page 59 and 60: Figure 53 shows the time of day at
Page 61 and 62: Figure 57 shows the distribution of
Page 63 and 64: Figure 61 shows the limited informa
Page 65 and 66: 4. Project DiveExplorationPDE is an
Page 67 and 68: Fig 65Cumulativenumber of PDEdives
Page 69 and 70: Table 10Number ofseries per diver.T
Page 71 and 72: Figure 69 illustrates the certifica
Page 73 and 74: 4.4 DivesMost PDE data (97 percent)
Page 75 and 76: 4.5 Dive SeriesPDE recorded 1,960 d
Page 77 and 78: The maximum depth of the dive serie
Page 79 and 80: The workload reported by divers in
Page 81 and 82: The pre-flight surface interval (PF
Page 83 and 84: Fig 88Percentageof dives bycertific
Page 85 and 86: Figure 90 shows the month in which
Page 87 and 88: All PDE divers were asked to report
Page 89 and 90: The incidence of DCS was different
Page 91 and 92: Figure 94 shows the proportion of m
Page 93 and 94: Fig 98Comparison ofdive purpose byp
Page 95 and 96: Figures 102 and 103 show how the po
Page 97 and 98: 6. Mixed-Gas DivingThis section off
Page 99 and 100: Figure 110 shows that injured diver
Page 101: GlossaryAGE — Arterial Gas Emboli
Page 105 and 106: During the second day of diving, th
Page 107 and 108: Case 6. Delayed Onset of Mild Neuro
Page 109 and 110: Case 9. One Diver Treated Twice in
Page 111 and 112: Appendix B: Fatality Case R
Page 113 and 114: Proximate Cause: Drowning / AirEmbo
Page 115 and 116: Proximate Cause: Cardiac01-05 Divin
Page 117 and 118: the water with the instructor and a
Page 119 and 120: 01-22 Public safety diver who was o
Page 121 and 122: dock. Fifteen minutes into the dive
Page 123 and 124: end of the dive, but seemed to be d
Page 125 and 126: 01-67 Inexperienced diver, diving s
Page 127 and 128: 01-61 Novice diver lost control of
Page 129 and 130: entry into a freshwater lake for a
Page 131 and 132: 2002 PublicationsBennett PB, Rostai
Page 133 and 134: Notes132DAN’s Report</str
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