NAUI Master Scuba Diver 168 Decompression and Recompression modifications of the treatment schedules or to “lock in” to assume monitoring and acute care of the subject. In the commercial diving industry, diving is well controlled and monitored and decompression sickness is usually detected early and treated immediately. Were the same true of recreational diving, decompression sickness would be rare and treatment outcomes would be better. Because of the variables involved with the recreational diver, a physician consultation is very desirable. This physician should be versed in the diagnosis and treatment of diving accident injuries and should have access to other consultants when necessary. Because of poor diving habits and delays in seeking or obtaining treatment, scuba diving accident victims can require protracted courses of treatment and long-term therapy and rehabilitation. Early physician involvement can sometimes improve outcomes (figure 5-22). Operational Procedures Treatment schedules for decompression sickness and air embolism are standardized in the U.S. Navy format in the United States, so the operational procedures for most chamber facilities are similar. The same is likely to be true of other countries, such as the U.K. with the British Navy, etc. An initial victim assessment is made to establish the severity of the problem at that point in time. If the condition is not life-threatening, a more thorough history and examination is conducted before placing the victim in the chamber. A “non-life-threatening” recompression treatment schedule will usually be run at 60 fsw (18 msw) pressure, utilizing alternating oxygen and air breathing periods. Typical treatments last from 5 hours to days. Treatments may go even longer and can reach days of saturation in the commercial diving industry. Specific Safety Concerns Before beginning a treatment schedule, safety concerns must be addressed. These include fire, toxins, and patient condition. Fire. Fire is a potential hazard because of the use of pure oxygen, particularly at the increased pressures involved. The problem is most significant if the total chamber environment is oxygen, as in monoplace medical chambers. If an air-filled multiplace chamber with oxygen breathing masks or hoods incorporating “overboard dumps” is involved, the problem is still a concern. Chambers can be equipped with fire suppression systems to dowse fires, but the prevention of fires is the first priority. To create a fire, three ingredients must be present: a burnable material, an oxygen-like supporter of combustion, and an ignition source. To reduce chamber fire risk, as many of these elements as possible must be controlled. Chambers, gas equipment, and anything which enters the chamber is kept “oxygen clean,” that is, all greases and oils are eliminated. Combustibles are minimized within the chamber by special attention to clothing and supplies used. Sources of ignition are eliminated by keeping electronic devices and electrical circuits outside the chamber or completely sealed. Lighting is through portholes or fiber optic cables where possible. All who enter the chamber are inspected for potential hazards. In chambers where oxygen breathing equipment is used, overboard dumps are incorporated to direct exhaled gas out of the chamber, thereby keeping excess oxygen out of the chamber. In addition, oxygen analyzers are employed to monitor for oxygen spillage into the chamber. In chambers where pure oxygen is used to pressurize and run the chamber, FIGURE 5-22. PATIENT INSIDE CHAMBER
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