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

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1.3 Project Dive ExplorationProject Dive Exploration (PDE) is a prospective investigation of themedical history, depth-time exposure, and medical outcome of asample of the diving population. PDE seeks to estimate the incidenceof decompression illness (DCI) in this population and toinvestigate the relationship of DCS (see glossary for definitions ofDCS, AGE and DCI) probability to the depth-time profile and divercharacteristics. PDE also provides an injury-free control populationthat can be compared with the injury and fatality populations.The PDE is funded by Divers Alert Network membership anddonors. It was made possible by the development of the downloadabledive computer and depth-time recorders. PDE became practicalwith the support of the manufacturers Cochran, DiveRite,Suunto, Scubapro / Uwatec and ReefNet, who made their divecomputers and recorders PDE-compatible.Figure 3 shows the number divers who volunteered for PDE sincedata collection began in 1995 through 2001, the number of divesthey made, and the number of divers who were recompressed forDCI. To date, there have been more than 36,000 dives by 3,750divers, of whom 22 were recompressed. There has also been onefatality.# Dives or Divers40000350003000025000200001500010000DivesDiversDCIDCI/10,000 dives252015105# DCI or DCI / 10,000 DivesFig 3Project DiveExplorationprogress.500001995 1996 1997 1998 1999 2000 20010YearDAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition 23
2. Dive Injuries2.1 Injury Data DescriptionIn 2001, DAN received reports from 76 hyperbaric chambers thattreated 525 injured divers. As in previous years, cases were includedin the database if they met the following criteria:(a) diving was involved and the injury required recompression;(b) the injury was not a re-treatment of a previous injury(522 cases);(c) the injured diver was a U.S or Canadian resident engagedin recreational diving (474 cases); and(d) the report was complete or the follow-up provided requiredinformation.Each case was submitted with a diagnosis assigned by the treatingchamber. In previous years, reported diagnoses were accepted withoutreviewing the agreement between diagnosis and case information.As discrepancies were not uncommon, the diagnosis and caseinformation were reviewed this year, and the diagnosis was updatedif significant disagreement was noted, according to the definitionsand criteria listed below.The purpose of the review was to improve the accuracy of the diagnosesand, in particular, to better distinguish AGE from DCS, so thatthese injuries could be studied independently. In addition to caseinformation submitted with the Diving Injury <strong>Report</strong> Form (DIRF),information was added from emergency call notes to DAN and subsequentfollow-up calls by DAN medics to chambers and injureddivers.To support the diagnosis review, we used the arbitrary severity classificationsystem introduced in the 2002 <strong>Report</strong> on DecompressionIllness, Diving Fatalities and Project Dive Exploration. For this report, itis called the Perceived Severity Index (PSI). The PSI classifies casesaccording to our perception of their severity. The classifications arehierarchical. In order of assigned severity, they are:1) Serious Neurological 4) Pain2) Cardiopulmonary 5) Lymphatic / Skin3) Mild Neurological 6) Constitutional / Non-SpecificEach case was assigned to the category corresponding to its mostsevere symptom as indicated in Table 1. For example, an injureddiver with paresthesias of the feet (mild neurological symptom)would be categorized as a Serious Neurological case if bladder24DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2003 Edition
Page 1 and 2: Report onDecompres
Page 3 and 4: Dedicated toDr. Peter B. BennettThe
Page 5 and 6: AcknowledgmentsData for the 2002 <s
Page 7 and 8: International DAN OfficesDAN Americ
Page 9 and 10: When divers have questions about th
Page 11 and 12: Flying After Diving (FAD) StudyIn 1
Page 13 and 14: In 2002, DAN trained six interns fr
Page 15 and 16: DAN Training ProgramsOxygen First A
Page 17 and 18: DAN members are also eligible for d
Page 19 and 20: DAN Diver Identification System (DI
Page 21 and 22: Instructors who don’t have access
Page 23: Of 522 reports submitted in 2001, 5
Page 27 and 28: Arterial Gas Embolism (AGE)• Symp
Page 29 and 30: The pre-existing medical problems o
Page 31 and 32: Figure 7 shows the number of self-r
Page 33 and 34: As shown on Figure 11, most diving
Page 35 and 36: As in previous years, the largest p
Page 37 and 38: Figure 19 shows number of days divi
Page 39 and 40: Figure 23 shows the maximum depth o
Page 41 and 42: 2.4 Signs and Symptoms in Injured D
Page 43 and 44: Figure 29 shows symptoms reported b
Page 45 and 46: Fig 32Distribution ofcases by PSI.E
Page 47 and 48: Figure 35 shows the administration
Page 49 and 50: 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
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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
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GlossaryAGE — Arterial Gas Emboli
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Appendix A: Injury Case Rep
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During the second day of diving, th
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Case 6. Delayed Onset of Mild Neuro
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Case 9. One Diver Treated Twice in
Page 111 and 112:
Appendix B: Fatality Case R
Page 113 and 114:
Proximate Cause: Drowning / AirEmbo
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Proximate Cause: Cardiac01-05 Divin
Page 117 and 118:
the water with the instructor and a
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01-22 Public safety diver who was o
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dock. Fifteen minutes into the dive
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end of the dive, but seemed to be d
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01-67 Inexperienced diver, diving s
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01-61 Novice diver lost control of
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entry into a freshwater lake for a
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2002 PublicationsBennett PB, Rostai
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Notes132DAN’s Report</str
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