Since 1997
In-Water Recompression
by DAN Medical Team on March 1st, 2016

​In the absence of a recompression chamber, does DAN recommend treating a "bent" diver with in-water recompression?
​DAN does not recommend that symptomatic divers be recompressed while breathing standard air in the water. In some areas of the world, divers are treated with in-water recompression because of a lack of chamber facilities.

At one time, divers were treated in recompression chambers using the U.S. Navy treatment tables and breathing air instead of oxygen. The failure rate was high. It is unlikely that in-water recompression using air is more effective than those old treatment tables. In-water recompression with the diver breathing oxygen instead of standard air has been used successfully in some areas.

However, in-water recompression has its own dangers and should not be attempted without the necessary training and equipment, or in the absence of someone who can assess the diver medically. The resources required for in-water recompression usually exceed the ability of those at the scene to properly assist the injured diver.

In-water recompression of any type is not currently recommended by DAN.

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Justin - March 19th, 2016 at 2:21 AM
So if there is no chamber near by surely trying anything would be better than doing nothing ?
Graham - March 19th, 2016 at 5:58 AM
One would think so Justin.

Graham - March 19th, 2016 at 6:01 AM
One would think so Justin.

Michael Partridge - March 19th, 2016 at 10:22 AM
In water recompression is viable so long as the attendants, surface support and the injured diver have been trained and certified for in water recompression. IANTD SA run an excellent IWR course for technical divers
DAN Medical Team - March 29th, 2016 at 5:40 AM
Thank you for these comments.

Is anything better than nothing? A very good question!

The answer, however, is not quite that simple: Effective and safe IWR on O2 requires a professional, coordinated team-effort, appropriate equipment and appropriate experience (training). Also, by implication, initiating IWR incurs significant professional or personal liability for those providing it - particularly if the outcome is poor or if there are complications. Current international diving medical recommendations do not favor the unplanned use of IWR. As such, DAN cannot recommend it in such cases -- irrespective of the circumstances. In fact, the more dire the situation, the less advisable it becomes (e.g., with a severely disabled diver with DCS or AGE). Even at the best of times it is potentially hazardous and fraught with many unforeseen practical and environmental difficulties - especially in terms of ensuring qualified supervision, air-way protection, effective communication, sufficient oxygen supply and effective delivery, stable depth control with gradual decompression, fluid and caloric input, and the necessary thermal protection.

Generally speaking, surface oxygen first aid is an accepted industry standard of care, safer, more feasible and - although not necessarily fully therapeutic - it does appear to improve the chances for a good outcome ultimately. Conversely, unplanned and/or poorly performed IWR is not a recognised standard-of-care, is likely to incur significant medical and legal liability, and may compound DCI injuries or even prove to be fatal.

In summary: In-water oxygen-recompression on oxygen cannot be recommended unless there has been proper preparation, planning and training.
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