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Philip, As to your question about DCI developing/occurring during decompression- This is fairly easy to discuss if the subject is in a chamber, but a real bear if the subject is in the water. Major concerns include: 1)At what depth did the symptoms occur? 2)Are these symptoms occurring during a normal decompression scenario, or are they occuring during a dive with violations of the table/computer/ or during omitted decompression procedure? 3)What kind of symptoms (pain only vs. more severe symptoms, and if more severe, how severe)? 4)Water temperature and thermal protection status of the diver. 5)Is a full facemask being used or available? 6)Is oxygen enriched breathing mixtures available to the diver? If so, then how much? 7)Where does the diver stand as to OTU exposure and CNS toxicity dosage? 8)Is surface support crew available, or is it just the diver and his buddy (if he has one)? 9)Just how close is the nearest chamber? If the symptoms occur shallower than 30ft, I think I would consider the Australian inwater recompression plan (provided that I had full face mask, adequate oxygen supplies and adequate thermal protection). Of course, the question comes up of what to do when the 20 and 10ft stop times exceeds the time required to complete the Australian inwater plan? However, this kind of dive would probably already have the diver with significant OTU exposure, and with a CNS "clock" that is near or will exceed 100% during this scenario. If the symptoms occur deeper than 30ft, then the problem is one of - 1)Do we go deeper to relieve the symptoms (and what do we do if the symptoms do NOT abate)? If we go deeper and get relief, now how do we get to the surface. We obviously cannot go back into the dive tables after this incident, so what do we do? Again, remoteness from a chamber might swing the decision towards trying to treat in the water, but again we have to consider gas supplies, thermal considerations, OTU and CNS dosages, the availability of full facemask, etc. The bottom line is that trying to treat while inwater is probably an alternative if the symptoms are minor (ie, pain only, no progression to CNS or pulmonary symptoms), but when the symptoms are minor is not the situation where we are really concerned with treatment in water. The severe cases in remote locations are the ones that we would prefer to treat in water, and are the ones that probably do not lend themselves to being treated due to the patient. I know that this has not really shed any more light on this subject, but am just discussing this off the cuff (so to speak). Am looking forward to hearing other input on this subject (are you listening Rich??). John Crea Submariner Research, Ltd. (johncrea@de*.co*)
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