Dive Pacific Iss 171 Oct- Nov 2019

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INCIDENTINSIGHTS WITH THE DIVERS ALERT NETWORK (DANAP] By DAN World Symptoms return after flying: Did the diver fly too soon? In this incident a diver was evacuated for recompression, but flew home sooner than DAN advised and, unfortunately, the symptoms returned and persisted for some time. Could this have been avoided if the diver had delayed his flight home? The dives A 28-year-old dive instructor completed a long 45m dive on mixed gas with decompression. The next day he completed a dive (on air) to 26m for 65 minutes, and afterwards noted that he felt more tired than usual. Symptoms present The following day, more than 24 hours since his final dive, he felt an ache/ burn in his right shoulder, and the next day, when DAN was called, he had some altered sensation in his hip and elbow. By then he had been receiving oxygen first aid for six hours without any significant improvement when the call to DAN was made. DAN’s advice The DAN Diving Emergency Service (DES) doctor was not certain the diver was experiencing DCI based on the information provided. The diver was asked to continue breathing oxygen for a few more hours that evening and take Ibuprofen, and in the morning, he would be re-assessed. As the diver was in Timor where there are no chamber facilities he would need to be evacuated for treatment if symptoms did not improve. When DAN spoke to the diver the following day he told them that he remained on oxygen for an additional six hours and continued breathing pure oxygen for an hour that morning. He thought the Ibuprofen relieved the ‘pressure’ he felt in his lower back but mentioned that pain in his right shoulder and the hypersensitivity in his shoulder, arm and chest area were still present. He also mentioned that he was continuing to experience discomfort in his right hip, felt waves of pain flow through his right elbow and had a stiff right little finger. When he attempted some light activities with his clients he had difficulty breathing and experienced shortness of breath. Evacuation required The DAN doctor recommended the diver be seen by a Hyperbaric Medical Specialist and told him that recompression treatment was a possibility. DAN determined that the closest facility capable and available to treat this diver at the time of his accident was in Singapore, so DAN began to coordinate his evacuation. While waiting to be evacuated to Singapore the diver breathed oxygen for another three hours and reported feeling much better. In fact, he felt so much better that he considered calling DAN to say he was better. But that evening his symptoms returned. 52 Dive New Zealand | Dive Pacific
Treatment Once in Singapore the diver was evaluated and ended up receiving two recompression treatments. His symptoms mostly resolved but he did express to the doctor that he still had shoulder discomfort post treatment. The doctor felt it wasn’t DCS and he was discharged from the hospital. Conflicting ‘Do Not Fly’ advice The diving doctor advised the diver not to fly for three days, but DAN advised that this was insufficient and that he should wait at least a week before flying back to Timor given the remoteness of his destination. The diver ended up flying home back there four days after treatment and upon his return he advised DAN that he was again experiencing residual symptoms in his hip, shoulder and elbow. The DAN doctors advised the diver to continue taking Ibuprofen for several days to help with the residual inflammation, remain hydrated, and refrain from exercising, or going to altitude. The diver’s condition did not deteriorate further. However his improvement was very slow, to his frustration. Cost: Emergency Evacuation USD$34,500 DAN comments While the diver’s symptoms in this case were mild, they were persistent. The diver was evacuated to Singapore and received two treatments and, unfortunately, DAN’s advice to avoid flying for at least a week was not followed. In many cases divers are cleared to fly after three days from their final treatment if they remain asymptomatic. This is often fine and many divers following this advice have no further issues - although a small number will. In this case, DAN’s recommendation was more conservative than the doctor’s recommendation as DAN factored in the remoteness of the diver’s location. The reason behind this more conservative approach stemmed from the fact that once the diver flew home to Timor, he would be back in the same situation should symptoms reappear: Stuck in a location not equipped with the necessary medical facilities or equipment, including a chamber, to treat his injuries. It is not surprising that flying prematurely aggravated this diver’s condition because it is likely he had residual bubbles in his system. When divers have residual bubbles it often takes a longer time for persistent symptoms to fully resolve. This case serves as an important reminder to adhere to the advice of DAN as our case managers factor in all aspects of a diver’s situation when providing advice. Visit “Diving Safety” at DANAP. org for more diving health and safety information, including DAN Doc. YOUR LEADER IN GLOBAL DIVE SAFETY. + 39 Years Divers Helping Divers + 24/7 Emergency Medical Services + 150,000 Emergency Calls Managed + 2,000,000 Members Served Worldwide Experience Matters. Join DAN DANAP.org For more diving health and safety articles DANinsider.org for weekly posts discussing recent incidents, and diving health and safety content. Visit: daninsider.org and follow us on Facebook by searching DAN World. Need more information? Send DAN World an email (info@danap.org) or call +61-3-9886 9166 www.dive-pacific.com 53
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Dive Pacific Iss 171 Oct- Nov 2019

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