Return to Diving After DCI

I was recently treated for decompression illness (DCI) after two days of diving. On my last diving day, two of my dives went to 40-50 feet / 12-15 meters for no longer than 35 minutes each. Minimum surface interval between dives was one and a half hours between the first two dives, and three hours before my final dive to 80 feet / 24 meters. During the ascent of my final dive, my weight belt came off, and I had a rapid ascent from 45 feet. I ended my dive at 8:45 p.m. At around 10 the next morning, I experienced pain that moved down my arm to my elbow, followed by numbness and tingling. I knew these were symptoms of DCI, and I was evaluated and treated that afternoon. My symptoms have completely resolved except for a soreness, like a bruise, in my elbow. I want to return to diving after I see my local physician.

What is the current recommendation for returning to diving after experiencing DCI?
One of the most difficult things divers face is admitting that symptoms they experience may be a result of DCI. You did the right thing in seeking immediate evaluation and treatment.

Divers often adopt a “wait and see” attitude before they accept the reality of decompression illness. In some cases, this delay in treatment can affect the outcome. In the most recent DAN Report on Decompression Illness and Diving Fatalities: Year 2000 Edition, 50 percent of the injured divers analyzed received treatment within the first 20 hours they experienced symptoms. Several hundred DAN members are treated for DCI each year.

Regarding the return to diving after DCI, advice varies: it depends upon the specific symptoms a diver experiences, as well as their duration. Only 70 percent of injured divers experience an immediate and complete recovery; 30 percent will continue to experience either partial or temporary relief, from a few days to several weeks after treatment.

The response to treatment depends upon the severity of symptoms and the delay to recompression. The majority of mild residual symptoms, which are often due to inflammation, will resolve over a few days to a few weeks after an accident. Occasionally, persistent pain can be due to a bone infarct (i.e., a blood vessel that supplies a portion of the bone is occluded). If a portion of the joint is involved, then further diving is usually not recommended.

Although United States Navy “return to diving” policy was not written for recreational divers, it does give us the following guidelines to consider (specific Navy policy recommendations are in quotes):
  1. “Divers with uncomplicated, pain-only DCI cases and whose symptoms resolve completely after 10 minutes breathing oxygen at 60 feet / 18 meters can return to diving after 48 hours of being symptom-free.” This is probably a little too aggressive for recreational diving. Two to four symptom-free weeks is usually recommended for recreational divers.
  2. “In uncomplicated pain-only DCI, divers who have had a completely normal neurological exam prior to recompression and whose symptoms took longer than 10 minutes to resolve, the Navy allows a two-week wait before a return to diving.” This may be too soon for recreational divers, who may return to multiday repetitive diving. A minimum wait of four weeks is a more conservative option.
  3. “If divers have had cardiorespiratory or neurological symptoms such as weakness or numbness, the Navy recommends a four-week waiting period.” A six-week symptom-free minimum wait may be more appropriate for recreational divers.
  4. “In more complicated DCI cases, in which symptoms seem to resist treatment or in which long treatment tables such as Table 4 or Table 7 are required, the Navy requires a minimum of a three-month layoff from diving. Diving may resume only after a thorough review by a Diving Medical Officer.” For recreational divers who experience DCI this severe, giving up diving altogether may be appropriate. At any rate, recreational divers should take a six-month hiatus from diving, followed by a thorough examination by a dive physician.


For recreational divers who want to dive after experiencing DCI, here is the best advice:
Wait until you have been free of symptoms for four weeks;

  • Seek evaluation by a physician to determine whether there is some predisposition to decompression illness.
  • Remember, you’re diving for fun and recreation - practice safe guidelines so you can enjoy it for many years to come.


With reports by Dr. Ed Thalmann

Posted in

No Comments


Categories

 2019
 2018
 2016
Accidents Acid reflux After anaesthesia Air Quality Air exchange centre Air hose failure Airway control Altitude changes Altitude sickness Ama divers Amino acids Anaerobic Metabolism Annual renewal Apnea Apnoea Arterial gas embolism Arthroscopic surgery Aurel hygiene BCD BLS Back adjustment Back pain Back treatment Backextensors Badages Bag valve mask Bandaids Barbell back squat Basic Life Support Batteries Bench press Blood flow Blurred vision Bone fractures Bouyancy compensators Boyle's Law Boyle\'s Law Bradycardia Brain Breast Cancer Breath Hold Diving Breath hold Breath-hold Breathing Gas Breathing Broken bones Bruising Buoyancy Burnshield CGASA CMAS CO2 CPR Cabin pressure Camera settings Cancer Remission Cancer treatments Cancer Cannabis and diving Cannabis Cape Town Dive Festival Cape Town Carbon dioxide Cardio health Cardiomyopathy Chamber Safety Chamber science Charging batteries Charles' Law Charles\' Law Charles\\\' Law Charles\\\\\\\' Law Charles\\\\\\\\\\\\\\\' Law Chemotherapy Chest compressions Chiropractic Citizen Conservation Cleaning products Coastalexcursion Cold Water Cold care Cold Compressed gas Conservation Contaminants Contaminated air Corals Courtactions Crohns disease Crystal build up Crystallizing hoses Cutaneous decompression DAN Courses DAN Profile DAN Researchers DAN medics DAN report DCI DCS Decompressions sickness DCS theories DCS DEMP DM training DReams Dalton's Law Dalton\'s Law Dalton\\\'s Law Dalton\\\\\\\'s Law Dalton\\\\\\\\\\\\\\\'s Law Deco dives Decompression Illness Decompression Sickness Decompression illsnes Decompression treatment Decompression Diaphragms Diseases Dive Chamber Dive H Dive Industry Dive Instruction Dive Instructor Dive Pros Dive Research Dive Training Dive Travel Dive accidents Dive buddies Dive computers Dive excursions Dive fitness Dive gear Dive health Dive medicines Dive medicine Dive operators Dive safety Dive safe Dive staff Diveleader training Diveleaders Diver Profile Diver infliencers Diver on surface Divers Alert Diving Kids Diving Trauma Diving career Diving emergencies Diving emergency management Diving guidelines Diving injuries Diving suspended Diving Dizziness Domestic Donation Dowels Dr Rob Schneider Drysuit diving Drysuit valves Drysuits EAPs EAP Ear pressure Ear wax Ears injuries Education Electronic Emergency action planning Emergency decompression Emergency plans Emergency underwater Oxygen Recompression Emergency Enviromental Protection Environmental factors Environmental impact Environmental managment Equipment care Evacuations Evacuation Evaluations Even Breath Exercise Exhaustion Extended divetime Extinguisher Extreme treatments Eye injuries FAQ Failures Fatigue Faulty equipment Fire Coral Fire Safety Firefighting First Aid Equipment First Aid Training First Aid kits Fish Fitness Training Fitness to dive Fitness Flying Francois Burman Free Student cover Free diving Free flow Freedive Training Freediver Freediving performance Gas Density Gas laws Gas mixes GasPerformance Gases Gastoeusophagus Gastric bypass Gastroenterologist Gear Servicing Gordon Hiles Gutt irritations HELP HIRA Haemorhoid treatment Hazard Description Hazardous Marine life Hazardous marinelife Health practitioner Heart Attack Heart Health Heart Rate monitor Heart rate Heart Heat stress Helium High temperatures Hip strength Hot Humans Hydrate Hydration Hydrogen Hydroids Hydrostatic pressure Hyperbaric Chamber Hyperbaric research Hypothermia Hypoxia Immine systems In Water Recompression Indemnity form Indian Ocean Indonesia Inert gas Infections Instinct Instruction Instructors Insurance Integrated Physiology International travel International Interval training Irritation Joint pain KZN South Coast Kidneys Kids scubadiver KwaZulu Natal Labour laws Laryngospasm Learning to dive Legal advice Legislation Leukemis Liability Risks Liability releases Liability Life expectancy Lifestyle Live aboard diving Low blood pressure Low pressure deterioration Low volume masks Lung function Lung injuries Lung surgery Lung MOD Maintenance Malaria Mammalian Dive Response Mammalian effect Marine Scientists Marine parks Marinelife Master scuba diver Maximum operating depth Medical Q Medical emergencies Medical questionaire Medical statement Middle ear pressure Mike Bartick Military front press Mixed Gas Mono Fins Mooring lines More pressure Motion sickness Muscle pain Mycobacterium marinum Nausea Nautilus Neurological assessments Nitrogen build up Nitrox No-decompression Non-rebreather Mask Normal Air Nosebleeds O2 providers O2 servicing OOxygen maintenance Ocean pollution Open water divers Orbital implants Oronasal mask Out and about Oxygen Cylinder Oxygen Units Oxygen deficit Oxygen deicit Oxygen dificiency Oxygen ears Oxygen equipment Oxygen masks Oxygen supply Oxygen therapy Oxygen P J Prinsloo PFI PJP Tech Part 3 Phillipines Photography Pistons Planning Plastic Pneumonia Pneumothorax Pollution Pool Diving Preparation Prepared diver Press Release Professional rights Provider course Pulmanologist Pulmonary Bleb Pulse Punture wounds Purge RAID South Africa RCAP Radio communications Range of motion Rashes Rechargeable batteries. Recompression chamber Recompression treatment Recompression Recycle Regulator failure Regulators Regulator Remote areas Renewable Report incidents Rescue Procedure Rescue breathing Rescue breaths Rescue training Rescue Resume diving Risk Assessments Risk assesments Risk assessment Risk elements Risk management SABS 019 Safety Stop Safety Saturation Diving Save our seas Science Scombroid Poisoning Scuba Air Quality Scuba Injury Scuba Instructor Scuba children Scuba dive Scuba health Scubalearners Sealife Shark conservation Shark diving Sharks Shoulder strength Sideplank Signs and Symptoms Sit-ups Skin Bends Skin outbreak Skin rash Snorkeling Snorkels Sodwana Bay South Africa Spinal pain Splits Squeezes Standars Step ups Stroke Submerged Sulawesi Supplemental oxygen Surfaced Surgeries Surgery Suspension training TRavel safety Tabata protocol Tattoes Technical Diving The Bends The truth Thermal Notions Tides Tips and trick Transplants Travel tips Travel Tweezers Unconsciousness Underwater photographer Underwater pho Vaccines Vagus nerve Valsalva manoeuvers Vape Vaping Vasvagal Syncope Venting Volatile fuels Washout treatments Wastewater Water Resistance Water Weakness Weigang Xu West Papua Wetsuit fitting Wetsuits White balance Winter Woman in diving Work of Breathing Workout Wound dressings Wreck dive Wreckdiving Yoga Youth diver abrasion air-cushioned alert diver altitude anemia antibiotics antiseptics bandages bent-over barbell rows body art breathing air calories burn carbon dioxide toxicity cardiovascular checklist chemo port child clearances closed circuit scuba currents cuts dead lift decompression algorithms decongestants dehydration dive injuries dive medicing dive ready child dive reflex dive tribe diver in distress diver rescue diver training dive diving attraction doctors domestic travel dri-suits drowning dry mucous membranes dry suits dry e-cigarettes ear spaces elearning electrolyte imbalance electroytes emergency action plans emergency assessment equalizing exposure injuries eyes fEMAL DIVERS fire rescue fitnes flexible tubing frediving gas bubble gas poisoning gastric acid health heartburn histidine hospital humidity immersion pulmonary edema (IPE join DAN knee longevity lower stress marine pathogens medical issues medical procedures medical risk assesment medications mental challenge micro-organisims minor illness mucous membranes nasal steroids nasal near drowning nematocysts newdivers nitrogen bubbles off-gassed operating theatre operations orthopeadic outgas pain perforation phillippines physical challenges pinched nerves plasters polyester-TPU polyether-TPU post dive posture preserve prevention pulmunary barotrauma rebreather mask rebreathers retinal detachment risk areas safety stops saturation scissors scuba equipment scuba single use sinus infections smoking snorkeling. spearfishing stings strength sub-aquatic swimmers ears tattoo care tecnical diver thermal protection toxicity training trimix unified standards vision impaired warmers water quality