Case study: persistent mild symptoms result in evacuation

Mild but persistent symptoms… a reminder that post-dive symptoms do not need to be extreme before a call is placed to DAN for advice/assistance.

Man holding shoulder in pain shutterstock_247634263

Mild but persistent symptoms… a reminder that post-dive symptoms do not need to be extreme before a call is placed to DAN for advice/assistance.

Recently, DAN managed an incident involving a 31-year-old male diver who called the DAN DES Hotline from Coron, Philippines. He was on the first day of his dive trip and completed three dives without incident:

  • Dive 1: Max depth of 28m for 30 minutes with a Surface Interval (SI) of 1 hour.
  • Dive 2: Max depth of 19m for 30 minutes, SI of 1 hour.
  • Dive 3: Max depth of 19m for 50 minutes.

Three to four hours after the last dive he developed numbness in his entire left arm, and shortly after pain developed in his shoulder and back. When he called DAN the following day he rated the pain as 2 out of 10.

DAN advised him to breathe oxygen and called the dive operator on his behalf to advise the required flow rate and duration. The oxygen was set at a flow rate of 15 litres per minute for two hours and provided via a simple face mask. He was also advised to take ibuprofen.

In the meantime, DAN commenced inquiries regarding air transport to Manila, in case it was determined the diver required Chamber treatment.

When DAN spoke to the diver after two hours the arm numbness was nearly gone but the shoulder and back pain persisted. He was advised to remain breathing oxygen for another two hours, and then call DAN for another update. He ended up breathing oxygen for a total of six hours at which point his symptoms had resolved. He was asked to call DAN one hour after waking in the morning to discuss how he was feeling and to see if symptoms had returned.

In the morning, the diver advised that he still had mild symptoms, so the decision was made to evacuate him via Air Ambulance to Manila for recompression.

DAN co-ordinated with the Chamber as to when the diver would be arriving, so the team would be ready to recompress the diver.

Below is the flight/transport schedule for this mission. The air ambulance was sent from Manila to pick up the diver and then returned straight back to Manila:

1200H – Departure of air ambulance from Manila.
1300H – Arrival of air ambulance in Busuanga airport to collect patient.
1330H – Departure of air ambulance from Busuanga.
1430H – Arrival of air ambulance in Manila with medical team and patient.
1445H – Departure from Manila Airport via road to Advance Hyperbaric Medical Center
1545H – Arrival of Medical team and patient at Advance Hyperbaric Medical Center.

Diagnosis: DCI

Treatment: The diver underwent a single Table 6 chamber treatment with improvement.

He was advised not to fly back to Australia for at least 72-hours. Fortunately, the diver had family in Manila, and was able to rest for a full week before returning home symptom free.

Lessons Learnt

This case serves as a reminder that post-dive symptoms do not need to be extreme before a call is placed to DAN for advice/assistance. If you are concerned about symptoms post-dive we encourage you to call a DAN Hotline quickly.

Had DAN been called the day the symptoms first presented, and oxygen first aid promptly commenced, it may have resolved the symptoms and prevented chamber treatment.

While oxygen is highly effective, a delay in treatment can hinder the effectiveness in resolving symptoms, even if they are minor. So the advice is always to call DAN at the first onset of symptoms and to commence breathing oxygen as soon as possible.

REMINDER: Symptoms You Should Not Ignore After Diving

Common Signs and Symptoms of DCI

  • Numbness
  • Headache
  • Dizziness
  • Nausea
  • Pain
  • Weakness
  • Unusual fatigue
  • Difficulty walking
  • Itching / rash

Other Signs and Symptoms of DCI

  • Difficulty breathing
  • Visual disturbance
  • Decreased skin sensation
  • Restlessness
  • Paralysis
  • Muscle twitching
  • Unconsciousness
  • Speech disturbance
  • Personality change
  • Altered level of consciousness
  • Bladder / bowel problems
  • Convulsions
  • Hearing loss / ringing ears

2 thoughts on “Case study: persistent mild symptoms result in evacuation”

  1. There is no information whether the diver was breathing air or Nitrox during mentioned dives, nor any information regarding the nature of the three dives (sometimes accessible from the computer log): were any of these sawtooth profiles? Rapid ascent? Were any safety stops done?

    Another interesting question is why the Safari/boat operator carried the dives with only 1 hour Surface Interval? Was there no other alternative? Short day?

    Since there is not much information provided about the mentioned above, I’d probably add to the “Lessons learnt” other than “call DAN earlier” maybe some preventative recommendations such as do longer SI’s, if possible, use Nitrox (even better- without extending the bottom times), perform adequate ascent rate and safety stops and last but not least- rest and drink between dives- after all most divers reach the boat after prolonged flights without much rest…

    Like

    1. Thank you for your comment. This diver did not complete sawtooth profiles or undertake a rapid ascent but he did complete a five minute safety stop on each dive.

      All the ‘Lesson’s Learned’ you have identified are spot on. We did not raise these for this particular incident as the purpose of this case review was to highlight that mild symptoms should not be ignored and to reinforce prompt oxygen first aid even in mild cases. We appreciate your contribution.

      Like

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