After a diving incident, then what?
On Gozo, as a dive professional of Instructor or Divemaster rating, you’re trained to respond and identify emergencies. Part of your training during your Emergency First Response course relates to surfacing and removing an injured diver from the water. Emergency medical care is very important for victims and is vital to their survival. Once the ambulance crew take over, the injured diver disappears inside the ambulance and we know little of what happens next to that person. Questions arise as to what happens next to the victim, between both diving Pro’s, divers and onlookers. This is often guesswork and mostly inaccurate, so let’s take a look at what really happens;
The first stop for the victim;
This is not necessarily the hyperbaric chamber on Gozo. The victim requires a thorough evaluation by a physician to access any life-threatening issues that may contraindicate recompression. Post-dive symptoms are variable and time is of the essence to recompression of the injured diver. However, it is of utmost importance to make sure the victim has no other underlying medical problems. Once the evaluation is completed by the emergency physician the diver is sent to the hyperbaric chamber for further examination.
On arrival, the doctor and staff will record medical history, conduct a brief physical examination and general health. The chamber staff will try to collect as much information about the patient as possible during this time. It is vital that the patient gives the following;
- An honest description of the events leading up to the injury and a thorough description of symptoms present
- How many dives have been completed over the last few days?
- Depths, times, gas mixes and any other information regarding the last dives
- Rapid ascents, breathing difficulties or chest pains during any of these dives should be mentioned
- Send in the dive computer for evaluation
- Omitted decompression stops or violation of safety stops
Further Testing and Diagnostic;
After a thorough examination, the doctor can tailor a treatment to the injury sustained by the patient. The data acquired allows the doctor to form a structure in which he/she can form a diagnostic. The gathered detailed patient’s history, the identification of abnormalities during the examination, observations and a physical examination allow the doctor to form a differential diagnosis. This type of diagnosis differs from a clinical diagnosis in a way that definitive test results are sometimes not possible to obtain. DCI can be very difficult to diagnose in an injured diver.
A Differential Diagnosis;
This type of diagnosis may indicate the need to intervene or a need for further testing. If symptoms are serious, there might be a need for more blood testing, vital signs and pain monitoring. Doctors will check for organ functionality and passing of urine. These type of checks are relatively common in cases of DCI that are deemed serious.
Chest X-rays may be required to rule out pneumothorax (collapsed lung) as well as ultrasound, CT scans and ECG’s. Once all this data is collected, a diagnosis and treatment plan will be passed to aid the patient.
DCS or Arterial Gas Embolism (AGE)
If the diagnosis confirms the patient is suffering from DCS or AGE, and there are no other medical contraindications to hyperbaric treatment, hyperbaric therapy will be indicated.
The process, in general, involves administering 100 % oxygen during the compression phase in a hyperbaric unit. The therapy is relatively safe and effective at resolving DCS and AGE symptoms. However, not all diving-related injuries warrant a recompression therapy, such as a pneumothorax. Some injuries can exacerbate through the use of recompression therapy.
Treatment plans do differ and may involve multiple sessions in a hyperbaric unit. Examinations will be repeated to ensure the patient is recovering or determine whether the doctor needs additional intervention methods. After treatment and follow-up examinations, it will be decided if the patient can return home to rest and follow post-treatment procedures. This may include follow-up examinations and a discussion if the diver can make a return to diving or not? Severe cases will be admitted to the hospital for additional treatment of persistent symptoms. Often additional treatment measures taken inside the hospital will not include the hyperbaric unit with oxygen therapy.
The End Result;
This will differ from patient to patient. Most of them make a full recovery and can return, at a later date to the diving community. In more severe cases, there will be life-long side effects, some in neurological areas, others with balance problems and movement discrepancies. For such cases, there will be no return to the diver community. This is a hard blow for some diving instructors, but sadly this is reality and a measure taken to safeguard that person from further harm.
Things to remember;
Dive within a depth that you are comfortable with. Make sure you are hydrated, fit and well. All equipment to be used on the up-coming dive should be in full working order. The entry and exit points are satisfactory and suit the diver level. If in doubt of the weather conditions for that particular site, change to plan B and use another dive site.
Remember, the weather conditions on Gozo can change rapidly, making some exit points impossible to use.
We are all looking forward to diving again as soon as these unprecedented times allow us to do so! Stay safe everyone!