In two recent cases, immediate oxygen first aid resolved symptoms and kept the divers out of the chamber.
Case 1: Solomon Islands
A female diver was on a weekend liveaboard trip. She completed two dives on the first day:
- Dive 1: 33m for 42 minutes, surface interval of 2.5 hours
- Dive 2: 24m for 40 minutes.
Both ascents were slightly faster than normal, she had issues with bouncing and missed all safety stops.
Thirty minutes after the final dive she noted a rash over her abdomen that felt bruised; as well as swollen tender breasts. She was given only 30 minutes of oxygen first aid and the pain and swelling continued when the oxygen stopped. The dive operator contacted the DAN DES Hotline and it was recommended that the diver breathe oxygen for at least two hours and keep up her fluids. She started feeling better while breathing oxygen so DAN advised that they get the diver to a local clinic/hospital for a review and so she could continue breathing oxygen. The local chamber operator was aware of the case and would be ready to recompress the diver if needed. Breathing oxygen completely resolved the rash, but she still had some residual pain in her abdomen, hips and breast. The DAN DES Doctor requested another two hours on oxygen. With the rash not reappearing, the pain gone, and the diver feeling better, she did not need to be recompressed. The following day DAN was advised that the diver had some residual oedema that was not bothering her; the rash was completely gone, she had normal strength in all limbs, no dizziness or nausea. She was advised not to dive for six weeks or fly for a week. She was also advised to have a dive medical review to consider testing for a patent foramen ovale (PFO) as her symptoms were typical of this.
Case 2: Indonesia
A 32-year-old male had completed two technical divers to 40m for 25 minutes on 21/35 mix and completed 25 minutes of deco on 50% oxygen. Immediately upon surfacing he felt weakness and was given oxygen first aid for 25 minutes. His symptoms resolved. However, when he stopped breathing oxygen the weakness returned and he also developed elbow and shoulder pain. When the call came into DAN he had been back on oxygen for an hour with some minor improvement. Likely to be experiencing DCI, the diver was advised to present at the local chamber for evaluation and possible recompression. He arrived at the hospital symptom free and feeling much better having breathed oxygen for around 4-hours by the time he arrived at the hospital. The hospital was not certain of a DCI diagnosis. He was given oxygen at a flowrate of 10 litres per minute, and fluids. When evaluated the next morning he was asymptomatic and advised not to fly for 72 hours. He will refrain from diving until he has received a follow-up evaluation and clearance from a diving doctor.
DAN Comment
These two cases are a great example of just how effective oxygen first aid can be when it is provided as soon as symptoms present following diving. It is also highlights that a duration of 25-30 minutes breathing oxygen is not sufficient in relieving symptoms and preventing them from re-appearing. Fortunately, in both these cases, the DES/DAN hotline was contacted relatively quickly, and the operators followed the advice provided by the diving doctors.
DAN statistics tell us that prompt, appropriate and sustained provision of near-100% oxygen by either a demand valve or a high-concentration (preferably at a flow rate of between 12-15 litres per minute) constant flow mask can decrease the severity and longevity of symptoms associated with DCI.
All divers should be asking the operators they dive with, not only if they have oxygen, but how much oxygen they have available, and whether staff are trained in the provision oxygen first aid. All important factors in effectively managing a diver presenting DCI-related symptoms. However, Oxygen is NOT a replacement for medical advice – always call DAN / DES hotline for any symptoms that appear after diving.
As you can see, it is possible to avoid recompression in a Chamber: A little preparedness, and contacting DAN for advice early, can go a long way.
DAN Insider 
The message that oxygen can be extremely effective first aid is an important one. However I wouldn’t want people to take away the message that surface oxygen is an alternative to recompression. This might be reasonable to treat cutaneous manifestations of DCI in absence of other significant symptoms (as in the first case), but if a diver has significant symptoms I would want to recompress them if possible, even if the symptoms resolve completely, because the risk of recurrence following oxygen treatment alone is quite high. So the other key part of the message here is if you develop symptoms always contact appropriate specialist diving medical advice (such as DAN or your local recompression unit). Medical staff in general hospitals often have little or no knowledge and understanding of decompression illness.
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Thank you for your comment Dr Cope. Agreed, we certainly don’t want that to be the take away message. As we noted in concluding the post “Oxygen is NOT a replacement for medical advice – always call the DAN / DES hotline for any symptoms that appear after diving.” The intention with this piece is to highlight the importance of being prepared with oxygen first aid. We encourage all divers to contact DAN for advice should symptoms present post diving, so that their individual circumstance can be discussed with a diving doctor and their symptoms closely monitored. That way an informed decision can be made as to the need for recompression. In the Solomon’s case, the local Chamber Operator had been alerted and was ready to receive the diver had it been required.
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Just as important is to ask your dive operator for a copy of their EAP/ERP for the dive site, which should obviously include emergency O2, recompression chamber, DAN’s contact details, etc. Amazing how many dive operators don’t have an EAP
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