Updated: Pre-Hospital Management of DCI Guidelines and 'Mild' DCI

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Updated: Pre-Hospital Management of DCI Guidelines and 'Mild' DCI

April 27, 2018 - 10:47

The lead author is Professor Simon Mitchell, Head of Anaesthesiology at the University of Auckland, New Zealand and a EUROTEK stalwart.

The guidelines for pre-hospital management of decompression illness (DCI) have not been formally revised since 2004 when a workshop was held and five consensus points were agreed.

Thirteen years have passed, and therefore aspects of the management of DCI in the field have been reviewed by a multinational committee.

The key issues addressed were:

  • First aid strategies for DCI
  • Remote triage of possible DCI victims by diving medicine experts
  • Evacuation of DCI victims
  • Effect of delay to recompression in DCI
  • In-water recompression

These subjects were discussed at a dedicated workshop at the 2017 UHMS Annual Meeting in Florida, and at subsequent meetings of the expert committee.

An emphasis was placed on resolving controversies around the definition of “mild DCI” arising over 12 years of practical application of the 2004 workshop’s findings, and on the controversial issue of in-water recompression.

The expert group conducted a thorough literature review and contributed a lot of objective evidence, all of which is cited.

'Mild' DCI signs and symptoms include:

  • Fatigue
  • Musculoskeletal pain
  • Some skin sensory changes
  • Rash
  • Subcutaneous (under the skin) swelling

Some Key points

All divers who become unwell after diving should be discussed with a diving medicine physician as soon as possible

100% oxygen is a beneficial first aid strategy in suspected DCI, and should be administered as early as possible after symptoms arise.

Where possible, a horizontal position should be encouraged / maintained, including during evacuation, if practical. (If the patient is unconscious, the recovery position is recommended).

Provided the patient is fully conscious, hydration is recommended. Fluids should be non-carbonated, non-caffinated, non-alcoholic and preferably isotonic. Drinking water is acceptable.

Keep the patent thermally comfortable - warm - but not hyperthermic (too hot). Avoid exposure to the sun, unnecessary activity or excess clothing.

Recompression and hyperbaric oxygen therapy is the gold standard treatment for DCI. However some divers with symptoms or signs meeting the definition of mild DCI may be managed without recompression therapy.

Determination that a case is “mild” and that the patient can be managed without recompression can only be made by a diving medicine physician on a case by case basis.

In DCI cases arising in locations without ready access to a suitable recompression chamber, In water Recompression using oxygen at a maximum depth of 9 msw / 30ft can be considered provided:

  • the team is trained, certified, practiced, and suitably equipped
  • the patient is not suffering from hearing loss, vertigo, vomiting, altered state of consciousness, shock, respiratory distress, or a degree of physical incapacitation that makes return underwater unsafe.

It should be noted that IWR may not result in a complete resolution of DCI and all divers undergoing IWR should be discussed with a diving medicine physician as soon as practicable.

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