Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies

Undersea Hyperb Med. May-Jun 2018;45(3):273-286.

Abstract

(Mitchell SJ, Bennett MH, Bryson P, Butler FK, Doolette DJ, Holm JR, Kot J, Lafère P. Pre-hospital management of decompression illness: expert review of key principles and controversies. Diving and Hyperbaric Medicine. 2018 March;48(1):45е.doi.10.28920/dhm48.1.45-55.) Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled "Management of mild or marginal decompression illness in remote locations." A contemporary review was initiated by the Divers Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; 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; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Scientific Meeting, discussion by registrants at that workshop and, finally, several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis 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 guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication.

Keywords: arterial gas embolism; decompression sickness; first aid; in-water recompression (IWR); recompression; remote locations; transport.

Publication types

  • Practice Guideline

MeSH terms

  • Consensus*
  • Decompression Sickness / classification
  • Decompression Sickness / diagnosis*
  • Decompression Sickness / therapy*
  • Diving / adverse effects*
  • Emergency Medical Services / standards*
  • First Aid / methods
  • First Aid / standards
  • Humans
  • Neurologic Examination*
  • Symptom Assessment
  • Telemedicine
  • Transportation of Patients
  • Triage