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Desola:
Experience suggests that the more serious the signs
or symptoms, the worse the prognosis, regardless of the delay
to recompression. It was believed more severe cases could be
completely resolved if recompressed within the first few minutes,
but this is rarely possible, even in military or professional diving
and never in recreational diving. On the other hand, most mild
cases resolve completely regardless of treatment delay.
Intuitively, recompression must be applied as soon as
possible, within the rational local limitations. This is the
message that must be given to divers at all times. However,
today we know of many divers recovering satisfactorily
despite having received hyperbaric oxygen therapy (HBOT)
hours or even days after onset of the symptoms. In contrast,
there are also cases of DCS with a poor outcome despite
being treated within few hours after symptom onset.
Van Hoesen:
It may. As described above, there is probably a
subset of patients with more severe DCS that do better with
early treatment. The natural history of mild DCS is that it
tends to improve with time regardless of time to treatment.
HBOT should still be considered the standard of care for all
cases of DCS.
Considering the increased risk of accidents with
unscheduled flights, what conditions must a patient meet
for you to decide to use an emergency air evacuation
versus a scheduled flight on a commercial aircraft or
ground transportation?
Van Hoesen:
Each case of DCS needs to be considered
individually and should be discussed with a DAN
®
medic or
consulting physician. Anyone meeting the criteria for severe
DCS described above should be considered a candidate for
emergency air evacuation. Ground transportation for individuals
with mild, pain-only DCS may be suitable. Flying on a
commercial airliner with mild, pain-only DCS might also be the
most appropriate approach, depending on the situation.
Desola:
If divers’ vital functions are stable and no life-
threatening complications are expected, they may be
transported with a scheduled flight on a regular airliner. This
includes cases of skin and muscular DCS, mild neurological
DCS and even spinal cord DCS in which the lesion is likely
incomplete, affecting only mobility and/or sensitivity of the
limbs without causing bladder or bowel paralysis. The patient
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