Technical
stable reference line. Control of the diver symptomatic
diver and in water tender should follow the principles outlined below. A community database of IWR
incidents & outcomes will be maintained by Duke University (
dukedivemedicine.org) for Gallant Aquatic Ventures International and the general public. This information will be shared freely with all interested parties. The group determined the most
important information required during assessment of an injured diver and IWR is a timeline or chronology of events, along with key relevant data describing the symptomatic diver and circumstances of the incident. The following information should be captured: Point of contact information for
further details:
1 Age. 2 Race. 3 Gender. 4 Symptomatic diver training level (Recreational / Technical / None).
5 Dive profile / Breathing gas(s) 6 Time of symptom onset. 7 Order of symptom progression 8 Time of symptom resolution. 9 Surface oxygen use and duration. 10 IWR Protocol / complications, Temperature / thermal protection.
11 Free narrative space. 12 Outcome/degree of recovery
(Complete / Partial / None) and whether diver was referred for evaluation, hyperbaric emergency response, etc.
13 Name and contact information of reporter.
Diver Control Principles: 1 Some form of positive contact
with the diver/symptomatic diver is mandatory. The diver / symptomatic diver must never be un-tethered. Examples of Positive Control: a Diver / symptomatic diver is connected to the down line with a separate line.
b Diver / symptomatic diver is tethered to the accompanying diver with a line.
c The use of a quick release (snap) shackle in either case is reasonable.
2 The surface support team and tender should be prepared for a sudden deterioration of the diver/ symptomatic diver.
3 If reasonably foreseeable adverse conditions cannot be mitigated,
56 Magazine
the IWR protocol should be terminated.
Appendix I: Tier System Tier I Common non-specific
symptoms that may not be DCI and do not represent a significant threat. Lethargy Nausea Headache
Tier II Symptoms and signs that are likely to be DCI but which are not likely to result in permanent injury nor death. Lymphatic obstruction (swelling under the skin) Musculoskeletal pain (Note: When pain arises in the hip [especially both hips at once], abdomen or spine. This may be referred from spinal cord involvement.
Be particularly alert for progression to Tier III symptoms in these patients) Rash (May vary from fine red rash to blotchy bruised appearance, and may be itchy or sore. The rash is often localized to one body area, but may be more generalized) Subjective sensory changes
(Altered skin sensation and “tingling”)
Tier III Symptoms and signs that are likely to be DCI (or arterial gas embolism) and which indicate a risk of permanent injury or death.
Changes in consciousness or obvious confusion Difficulty with speech Walking or balance disturbance Sensory loss (such as numbness)
Photo: Leanna Rathkelly
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