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Decompression Illness (DCI) - Delay vs. Denial

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Paul Ballard, a British expat living here in Phuket, and a PADI scuba diving instructor.  Paul is a Certified Hyperbaric Chamber Operator and Tender at the SSS Recompression Chamber, located at Phuket International Hospital, and is sharing some of his experiences in order to help inform the diving community, and to raise awareness of the importance of safe diving practices.

SSS-Chamber-Phuket
Suffering from Decompression Illness (DCI) is a taboo subject amongst the diving industry. It is commonly perceived as something which occurs due to diver error or recklessness, therefore it is one of those things that no-one wants to admit, and generally will not publicise.  The consequence is that people can go to great lengths, and can even put themselves at further risk, rather than accepting up front that there may be a problem, and getting themselves checked out.

For a diving professional DCI can be career-ending, sometimes due to prejudice on the part of employers and peers, which can result in them being shunned by the dive community. Worse still, for any diver, DCI can significantly affect their health, for example a patient can experience neurological problems, or lack of mobility.  These symptoms can be temporary, though in severe cases, can be permanent.

Earlier this month, SSS Recompression received a patient suffering from symptoms of DCI, who, if it weren’t for the stigma associated with DCI, could potentially have saved both themselves and the medical staff administering treatment, prolonged angst.

The patient in this instance was a PADI scuba diving instructor, working Phuket, who had worked for 28 days, non-stop – this is not at all uncommon amongst diving professionals during high-season.  This instructor initially noticed tingling and numbness, known symptoms of DCI, though on the first day that they occurred, decided that sleep was the best course of action.  The next morning, the symptoms had subsided, and the confined water (swimming pool) training session scheduled for that day went ahead as planned.  After training, the original symptoms returned, however denial continued to play its part and the instructor again decided to sleep on it.  

The following morning the symptoms were still present, so finally, 3 days after the original symptoms started, the instructor called the SSS Recompression Chamber and unsurprisingly, was duly advised to come in immediately for an assessment.  Despite this advice, the instructor still did not want to accept that they may have DCI, so phoned the Divers Alert Network (DAN) for a second opinion.  DAN’s advice was in line with that given by the staff at SSS – go to the chamber as soon as possible to get checked out.

At 7pm that evening, after much discussion by phone with the SSS and DAN, and at the end of the working day, the instructor arrived at SSS Recompression Chamber at the Phuket International Hospital.  Medical assessments quickly confirmed that yes, DCI was present, and later that night the instructor entered the hyperbaric chamber for recompression treatment, which would last for several hours.   

In total, two recompression treatments were administered, including a necessary 8 hour break between treatments.  By the end, the patient was understandably exhausted, both physically and emotionally, and had incurred medical fees of several thousand Thai Baht.  Thankfully, professional diver’s insurance covered the financial cost, but the delay in treatment caused by stubborn denial was costly to both the chamber staff and the instructor in other ways.  Most importantly, in this case, the treatment was successful, but it is important to note that the longer the time between surfacing and receiving treatment, the less clear are the benefits of recompression. 

Sadly, in the short time that Paul has been at the chamber, he has learned that this scenario is not uncommon.  Treatment is often delayed due to pride and denial, and in some cases due to financial constraints, for example patients have been known to wait several days before seeking help, whilst waiting for confirmation that their insurance will cover their medical expenses.  

The key message from the staff at SSS Recompression Network is that if you experiencing symptoms of DCI, and are in any doubt, get yourself checked out - as soon as possible!  Waiting could significantly impact the benefits of treatment, and potentially your future.

If you have any questions or comments on this article, please leave a comment below, or contact us.
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Guest Sunday, 02 March 2014

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