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From: "Sean T. Stevenson" <ststev@un*.co*>
To: "techdiver@aquanaut.com" <techdiver@aquanaut.com>,
     "Ingemar Lundgren"
Date: Fri, 04 Sep 1998 09:33:05 +0800
Subject: Re: Cold water risk
	With direct reference to your post, Ingemar, I don't know how far from the
cave entrance 
your decompression stops begin, so the following text may be inapplicable.  If,
as you suggested, a 
habitat is required for this contingency, I think a dry habitat would be best,
not only 
logistically, but for the fact that core rewarming (discussed below) as well as
other medical 
treatments can be administered during the decompression.  Cave diving certainly
does pose some 
unique problems.  I have assembled some thoughts on the suit flood problem,
although they are 
probably more applicable to divers who can get to the surface reasonable
quickly...

	As with any system component failure, the loss of suit integrity is something
that will 
almost certainly occur at some point in time.  Many methods of decreasing the
probability of a suit 
failure are in widespread use; however, most off these produce characteristics
that are detrimental 
to the normal operation of the diver, such as excessive drag, non-ideal
buoyancy or increased 
system complexity.  The probability of a suit failure is best reduced by
selection of a suit 
appropriate to the environment (and consistent with all other suit selection
criteria), with good 
puncture and abrasion resistance, and possibly reinforcing panels in areas
where abrasion is 
anticipated.  Having said that, management of a flooded suit is something we
should all be prepared 
for, specifically in cold water environments where heat loss can become
critical in a short period 
of time.  Suit undergarments should be fabricated from non-absorbent material. 
In the case of a 
slow or minor leak, such an undergarment will still retain much of its
insulating value.  The 
undergarment should also be properly fitted.  This will not only facilitate
full mobility of the 
diver, but in the case of a complete suit flood will limit the amount of water
circulation proximal 
to the diver's skin.  A diver with a significant decompression obligation who
encounters a flooded 
suit will immediately begin to exhibit physiological changes due to the onset
of hypothermic 
conditions, which will reduce the effectiveness of the decompression.  In cold
water where the 
advance of hypothermia is quite rapid, the diver is best to follow a bailout
involving the use of 
%100 oxygen to get out of the water (before the onset of any critical symptoms)
and seek medical 
attention.  Obviously, a portable surface recompression chamber would be an
invaluable asset in 
this case.  Alternately, when an additional suit and set of undergarments is
available, the diver 
may opt to interrupt the decompression to don the second suit and return to the
water to deco, or 
to attempt in-water recompression.  For the details of both of these practices
as I would employ 
them I refer you to one of my old posts with the subject :Interrupted Deco.  I
wish to make clear, 
however, that this should only be attempted if the diver is not exhibiting any
apparent symptoms of 
hypothermia (probably rare given the scenario).  As regards the treatment of
the hypothermic diver 
at the surface, care should be taken not to apply heat to the extremities, as
this could result in 
a shunt (due to enlargement of previously restricted blood vessels) of cold
blood to the core, 
which can induce or speed up core cooling.  There is a device that is widely
available to permit 
core rewarming on site, which is powered by a rechargeable battery and which
will accept the flow 
from your oxygen kit, heat and humidify it to saturation before delivering it
to the patient.  In 
my experience this has been very effective in preventing the advancement of
hypothermia while 
transporting a patient.

-Sean


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