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

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U.S. facility. He was placed in the chamber fora third treatment, a U.S. Navy TT6 approximatelytwo days after his first treatment. Afterthis recompression he was nearly free ofsymptoms. He was recompressed and onceagain the following day on a two-hour treatmentschedule that completely alleviated anyremaining symptoms.Case 5. Mild Neurological SymptomsOccurring after the Dive, with Late Onset ofAdditional Symptoms, Including Slowingof Mental Activity — With CompleteResolutionThe diver was a 36-year-old female who was anon-smoker and in good health. She was takingmedication for a hypothyroid condition.These were her first two days as a certifieddiver. On the first day she made two dives,both shallower than 60 feet (18 meters) withno problems. On her second day of diving, shemade three short dives. Her third dive wasdeepest, at 64 feet (19.2 meters) for 22 minutes.During the ascent on her last dive, she lostcontrol of her buoyancy at about 40 feet (12meters). She made a faster-than-normalascent, missing her safety stop. She had madeall previous dives with safety stops at 15 feet(4.5 meters). Other than feeling a little tiredbefore her final dive, and noting her buoyancyproblem and panic, her two days of divingwere uneventful. She had no symptomsimmediately after her dive. She packed up hergear and drove home.Approximately three hours after her last dive,she began experiencing very mild tingling inher lower leg and foot. Seven hours after herdive, she also began feeling mild tingling fromher left elbow to her fingertips. Although shewas concerned about her symptoms, she didnot contact anyone for assistance or explanation.The following day, more than 24 hoursafter her dive, she experienced a dull ache inher left hip and knee, along with the persistenttingling. That evening she also developed amild headache and felt as though she was notas sharp mentally as she had been before herdives. She decided to wait until the morningand gauge her symptoms then.On the second day after her dives, approximately48 hours after her symptoms firstbegan, she called the DAN Diving EmergencyHotline for advice. She received an immediatereferral to a local hyperbaric physician forevaluation and possible recompression. Onadmission, her symptoms had neither lessenednor intensified. She received a U.S. NavyTreatment Table 6; she experienced resolutionof all symptoms except for a very mild tinglingin her left arm and leg. On the followingtwo days she received two additional treatments,and was eventually discharged fromthe hospital symptom-free.The mildness of this diver’s symptoms andher relative newness to scuba diving probablyplayed a major role in her delay to seekingemergency care. This diver had never experiencedprolonged tingling or joint pain in herlife and was involved in no other activity atthe time such as running or weightliftingwhich might produce symptoms of an injury.Indeed, her attitude of “waiting to see” if thesymptoms would go away before calling iscommon among divers. Her decreased mentalcapacities occurring the evening after her divingis not usual, but could have been due tocauses other than decompression illness.Fortunately, her mild symptoms respondedwell to hyperbaric therapy more than twodays after they had begun.DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition 105
Case 6. Delayed Onset of Mild NeurologicalSymptoms — With Residual SymptomsThe diver was a 50-year-old male advancedopen-water diver, in good health and a nonsmoker.He had been certified for seven yearsand had made approximately 150 lifetimedives. He had made three dives in the past 12months. He scheduled a two-day dive weekendin the Great Lakes. His first two dives onSaturday were without problems.He began his second day with an 81-foot (24.3-meter) dive for 32 minutes and a one-hour surfaceinterval. His second dive was a 50-foot(15-meter) dive for 41 minutes, followed by atwo-hour surface interval. His third dive wentto 76 feet (22.8 meters) for 39 minutes. After aone-hour surface interval, he performed hisfourth and final dive to 45 feet (13.5 meters)for 37 minutes, exiting the water at approximately4:30 p.m. He made a total of six divesover two days. All dives were trouble-free,allowable by his computer, and other than alittle fatigue that he described as normal, thediver felt fine.At approximately 3 a.m., more than 10 hoursafter his last dive, he began experiencing tinglingin his right hand. By 9 a.m. the followingmorning, his left leg, from his knees to histoes, began tingling. Shortly after that, bothfeet and both hands were tingling. He alsoexperienced some nausea during this period.Because he felt his symptoms were gettingworse, he contacted the local hospital, wherehe was evaluated and referred for recompressiontherapy. After a U.S. Navy TreatmentTable 6, he experienced full resolution of hissymptoms and had a normal neurologicalexam.The following morning when the diver wokeup, the tingling sensation in his hands and feethad returned. He was referred back to hisoriginal treatment facility, where he was treatedfor a second time. He emerged symptomfree.Over the course of the following threeweeks, however, the tingling in his hands andfeet continued to return for brief periods oftime; it then resolved on its own. More than ayear after his treatment, he occasionally experiencedtingling in his fingers after doing agreat deal of manual labor.It is not unusual for symptoms to persist afterhyperbaric therapy has been completed.Symptoms can often wax and wane beforefinally resolving.Cases 7 and 8. Two Cases of Mild Pain andNeurological Decompression Illness in theSame Diver in One YearThe diver was a 34-year-old male who hadmade a total of 70 dives in three years. A divemaster,he had made nine dives in the past 12months — in the course of one month (May)on the west coast of the United States. He hadbeen in perfect health until March of the sameyear, when he was ill with pneumonia. Thisproduced an asthmalike condition; he used aninhaler. He was on no other medication, was anon-smoker and very active.His dive series consisted of three dives overtwo days. On his first day of diving he went tono deeper than 40 feet (12 meters) for approximately45 minutes. During the second day ofdiving he completed a 40-foot dive, with anhour-plus surface interval. He then made adive to 35 feet (10.5 meters). He made safetystops during both dives on this second day;each dive was at least 45 minutes in duration.His dives were allowable by his computer, andseveral dive buddies were doing the sameprofile. He exited the water at approximately 2p.m. and felt fine. As the afternoon wore on,he began to experience some fatigue, a littlestiffness and soreness in his shoulders, knees,elbows and ankles. He had never experiencedthese symptoms before, but they were mild.The only physical activity he experienced duringthe week was the three scuba dives.106DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition
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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
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2.6 Therapeutic OutcomeFigure 40 sh
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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 and 102: GlossaryAGE — Arterial Gas Emboli
Page 103 and 104: Appendix A: Injury Case Rep
Page 105: During the second day of diving, th
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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