2 months ago

AD 2016 Q4

Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.


RESEARCH, EDUCATION & MEDICINE RESEARCHER PROFILE decompression schedules exactly as intended. This is the approach taken by the U.S. Navy. What should divers consider when choosing a dive computer? Unfortunately recreational divers probably do not have many choices of dive computers that implement a decompression algorithm subjected to the same level of human testing as the U.S. Navy dive computer. I am not an expert on recreational dive computers, but I know many implement variants of the ZH-L16 (Bühlmann) decompression algorithm, and the human testing of ZH-L16 is well documented. Deep stops have been of interest to the diving public — technical divers in particular. The disputes may not be settled yet, but your team contributed important evidence. Where do we stand regarding the efficacy of deep stops? We need to consider three types of deep stops. First is the use of deeper than traditional safety stops for recreational no-stop dives, where the total dive time, including the safety stop, is less than accepted no-stop limits. These deep safety stops probably do no harm, but the evidence is conflicting as to whether they are of any benefit compared to traditional safety stops at 10-15 feet of seawater. Second is the practice that was popular in the early days of technical diving of adding some brief, unscheduled decompression stops deeper than the first prescribed decompression stop and then recalculating (or letting the dive computer recalculate) the additional required decompression time. This will result in a longer total decompression time and, if the stops are not too deep, should be safer than the original schedule, but how much safer has never been rigorously tested. The third type of deep stop is when a decompression algorithm is designed to redistribute time from shallow decompression stops to deep stops; in other words, compared to a conventional decompression schedule, there are additional deep stops but the total decompression time is the same (or shorter). The theoretical premise is that the deep stops result in fewer and smaller bubbles and so the resulting deep-stops schedule should have lower risk of DCS than a conventional schedule. There is now considerable experimental evidence that these types of deep-stops schedules do not impart a lower risk of DCS than conventional schedules. How does body temperature affect decompression? Being very warm on the bottom or being very cold during decompression increases the risk of DCS. Presumably this results from increased blood flow to superficial tissues and therefore faster uptake of inert gas when warm and, conversely, reduced blood flow and slower removal of inert Doolette helps deploy equipment for dye-tracing the water flow in the Wakulla-Leon Sinks underwater cave system. gas when cold. This is probably not of great consequence for divers conducting no-stop dives and certainly not worth divers making themselves deliberately cold on the bottom and risking hyperthermia. For divers conducting decompression dives, however, it is worth considering. If a diver becomes very cold during decompression, the time required for decompression is increased. If divers have active heating, such as electrically heated drysuit undergarments, they should use these only enough to stay comfortable while on the bottom and conserve the battery to ensure they can use the heat during decompression. What should recreational divers do when dive conditions make them exert themselves more than usual? Work on the bottom increases blood flow and results in faster uptake of inert gas. This will increase the risk of DCS for a no-stop dive. Recreational divers who exert themselves more than usual on the bottom should add some safety by ascending before they reach their no-stop limit. We now have more ways to study the venous gas bubbles that may occur after diving. What are some of the tools and methods that allow this research? Venous gas emboli (VGE), the bubbles that occur in the body’s tissues, are transported by venous blood and can be detected in large veins or in the right side of the heart. The number of bubbles is commonly described semiquantitatively (i.e., by a grade on an ordinal scale). Many dives result in detectable VGE but do not result in DCS. VGE after a dive in no way indicates whether the diver will get DCS. In large compilations of experimental dives, however, there is a higher incidence of DCS among dives that resulted in high-grade VGE than in dives that resulted in low-grade VGE. This relationship leads people to use VGE as measure of JACKIE BOOTH 52 | FALL 2016

decompression stress (an index of DCS risk) in dives that do not necessarily result in DCS. This can produce useful information if VGE are the appropriate outcome measure, if the experiment is carefully designed and well executed, and if the results are thoughtfully interpreted. VGE, however, are not the appropriate outcome measure for all experiments related to decompression. VGE are only meaningful if the experiment is testing an intervention that changes bubble formation and growth in tissue and thereby influences DCS risk. Examples are tests of decompression schedules, diver exertion and diver thermal status. VGE are not an appropriate outcome measure for interventions aimed “downstream” of bubble formation and growth — at the pathophysiological responses to bubbles. An example would be evaluation of methods of treating DCS. VGE grades following identical dives are quite variable, both between divers and in the same diver on different occasions. Therefore, the VGE grade after a single dive in a single individual is not informative. Only after multiple repetitions of the same dive profile are VGE grades useful. The number of repetitions depends on the research question, but in my opinion there needs to be good justification for less than 20, and 50 would be preferable. There are two common experimental designs. VGE might be used to validate a decompression table by evaluating selected schedules. Each schedule is dived at least 20 times and “fails” if more than half of the dives results in high-grade VGE; otherwise it “passes.” A more common experimental design, and in my opinion the best use of VGE, is to compare two or more different decompression procedures. Each procedure is dived 50 times, and a significant difference in VGE grades indicates a difference in DCS risk. There are many technical challenges in executing a good VGE study, but one very important consideration is the frequency and timing of VGE measurements after diving. The only validated index of “decompression stress” is the peak VGE grade measured after diving. This peak might occur any time from immediately after surfacing to several hours later. It is usually practical to measure VGE only periodically, so these measurements need to begin soon after surfacing and continue frequently for two or more hours. One of many important considerations in interpreting results of VGE experiments is that while a significant difference in VGE grades between two procedures is evidence of a difference in DCS risk, it is not a reliable indicator of how large the difference is. Similarly, for many reasons, failure to find a difference in VGE grades between decompression procedures does not indicate there is no difference in risk of DCS. AD Galapagos N Turks & Caicos Maldives Unique liveaboard experiences. Exceptional value. Dive with us! N Saba/St. Kitts Silver Bank USA/Canada: 1.800.322.3577 +1.307.235.0683 ALERTDIVER.COM | 53