EMERGENCY
RECOMPRESSION
online
Tritonia is pleased to announce the launch of an alternative emergency hyperbaric treatment service in Oban, designed specifically to support commercial diving operations on the west coast of Scotland.
Read the full statement and details by following the link below
Emergency call-outs can be initiated through the Coastguard (999, Channel 16) or the Scottish National Helpline (0345 408 6008)
Decompression illness, or DCI, is a term used to describe illness that results from a reduction in the ambient pressure surrounding a body, typically when you are surfacing during or after a dive. DCI encompasses two diseases, decompression sickness (DCS) and arterial gas embolism (AGE).
AGE is considered the more serious form of DCI. In some cases the diver may have made a rapid ascent, or they may have held their breath during ascent. However, AGE can occur even if ascent appeared completely normal; pulmonary diseases for example, such as obstructive lung disease, may increase the risk of AGE.
The most dramatic presentation of air embolism is the diver who surfaces unconscious and remains so, or the diver who loses consciousness within 10 minutes of surfacing. In these cases, a true medical emergency exists, and rapid evacuation to a treatment facility is crucial.
DCS: the following list ranks the initial manifestations of DCS, from those most commonly to least commonly reported (Vann et al. 2011):
- Pain, particularly near the joints
- Numbness or paraesthesia
- Constitutional concerns — such as headache, light-headedness, unexplained fatigue, malaise, nausea and/or vomiting, or loss of appetite
- Dizziness or vertigo
- Motor weakness
- Cutaneous, or skin, problems — such as an itch, rash, or mottling (“cutis marmorata”)
- Muscle discomfort
- Impaired mental status
- Pulmonary problems — such as breathing difficulties (“the chokes”)
- Impaired coordination
- Reduced level of consciousness
- Auditory symptoms — such as hearing sounds that are not there or having a hard time hearing
- Lymphatic concerns — such as regional swelling
- Bladder or bowel dysfunction — such as retention of urine
- Compromised cardiovascular function
According to this recent review, pain and numbness, also known as paraesthesia, were reported initially in nearly two-thirds of cases of DCS, constitutional symptoms in approximately 40 percent of cases, dizziness/vertigo and motor weakness in approximately 20 percent, and cutaneous symptoms in approximately 10 percent (Vann et al. 2011).
Reference: “Decompression illness” by Richard D Vann, Frank K Butler, Simon J Mitchell, Richard E Moon. Lancet 2011; Volume 377, ISSUE 9760, P153-164.
In the event of a Diving Accident:
- Keep the casualty lying down
- Give 100% oxygen by tight fitting mask
- Rehydrate with electrolyte solution, or best possible alternative, e.g. sports drinks, water, etc.
- Keep the patient comfortable
Perform a Neurological Test if time allows and record responses.
Be ready to give the emergency services the following information:
- Age of Diver
- Condition – Improving/ Stable/ Worsening/ No problems
- Muscle Weakness – Can the diver stand/ walk, are their arms weak
Sea Diving: Call the Coastguard, DSC or VHF Channel 16/Dial 999 (24 hrs). Then call the National Diving Accident Helpline on 0345 408 6008 (24 hrs) in Scotland or 07831 151 523 (24 hrs) in England and Wales.
On Land: Call 0345 408 6008 (24hrs) in Scotland or 07831 151 523 (24 hrs) in England and Wales.
If the patient is seriously unwell or deteriorating rapidly, inform the emergency services promptly by dialing 999 on land or VHF Channel 16 if at sea. If you decide to proceed to your nearest Accident and Emergency Department you must still inform the emergency services.
British Hyperbaric Association
Our chamber is a founding member of the British Hyperbaric Association (BHA). The BHA promotes and supports the use of hyperbaric medicine in the British Isles. BHA membership is a core requirement for treating NHS patients.
Scottish Registration Services
Our chamber is a member of the Scottish Registration Service for Emergency Recompression, which comprises three units. In addition to our own chamber in Oban, there are also: The Orkney Hyperbaric Unit and The National Hyperbaric Centre (NHC) in Aberdeen.
The management and clinical governance for the Service is provided through NHS Grampian. Members of the Service meet on an annual basis to discuss and formulate standardised approaches to the provision of emergency recompression. The triage system exists within the Service to relocate patients to the most appropriate treatment centre where necessary.
Chamber Appraisal
Our chamber must undergo and adhere to the findings of a triennial appraisal of the technical and medical delivery of the treatment of diving emergencies. We currently manage the chamber appraisal programme for NHS England and NHS Wales in addition to providing the medical and technical appraisers for that programme.
Jointly with Mimir Marine Ltd, we designed a bespoke two-compartment chamber capable of being housed completely in a 20ft ISO container. The chamber was for the Natural Environment Research Council and was designed to be used in temperatures of between 40°C and minus 40°C. To date it has been deployed in support of diving operations at the British Antarctic Survey stations at Rothera on Adelaide Island, and King Edwards Point on South Georgia.
