Similar to the Manado case last week, in this case study, a diver in the Philippines suffers numbness in hands and received one recompression treatment, but this could have avoided recompression treatment, if DAN had been called first and the advice of our diving doctors followed.
DAN was contacted by a doctor at the Chamber in Cebu requesting a guarantee of payment for a diver that had presented for treatment.
The diver had been diving in Malapascua for 3-days and completed a total of 7-dives. On the third day she completed three dives:
- Dive 1: Maximum depth of 31m for a total dive time of 53 minutes.
- Dive 2: After a surface interval of 4:30 she completed a dive to 24m for 52 minutes.
- Dive 3: After a surface interval of 3:30, she completed a final dive to 28m for 52 minutes.
All dives were completed on Nitrox 31%.
After the final dive she felt a little numbness in her hand. Ten minutes later it had increased and she had some altered sensation in her face. The operator commenced oxygen first aid. The DAN Diving Emergency Service (DES) Hotline was called after the diver had been breathing oxygen for one hour.
At this time the instructor had already arranged for the diver to be transported to the Chamber in Cebu for recompression. However, given the mild symptoms, the DAN Diving Doctor’s recommendation was for the diver to continue breathing high-concentration oxygen for at least two more hours, then re-assess the diver and determine if the symptoms resolved with oxygen first aid.
As the diver presented at the Chamber with symptoms, having not breathed oxygen for the duration of the trip to the Chamber, she underwent a single Table 5 Treatment and all symptoms fully resolved.
The diver was advised not to dive for the next 6-weeks given she had received recompression. The diver flew home 72-hours later and advised there was no recurrence of symptoms and that she would be seeing a diving doctor for dive clearance.
The profiles that were dived by this member are considered to be quite normal in this area. The longer surface intervals are wise given the depths dived and the duration of the dives. There needs to be some consideration given in remote areas to the availability of services to treat DCI should it occur.
It’s great that the operator was prepared with oxygen first aid. Ideally, DAN should have been called immediately, especially as the diver was a Member, in order to receive advice and direction from our diving doctors regarding a treatment plan. If the diver had been kept on high-concentration oxygen first aid for 2-3 consistent hours, it could have alleviated the symptoms negating the need for recompression. Immediate oxygen first aid is often sufficient in resolving symptoms, particularly if they are mild as was the case here.
As we discussed last week, while there are many chambers dotted throughout the Asia-Pacific region, simply presenting at a Chamber can be a risk to the diver’s health, because it may not be open, operational, available, or staffed and ready to receive a diver.
Given the distance to the Cebu chamber, around 5-6 hours, the call to DAN should have been made when the symptoms presented, and the advice of the diving medical experts followed. And if recompression was required, DAN would have contacted the Chamber and made sure they were ready to receive the diver; and we would have recommended that the diver continued to breathe oxygen for the duration of the journey to the Chamber.