RR550 - Time to treatment for decompression illness

Hyperbaric oxygen treatment (HBO) is the standard and definitive treatment for divers with decompression illness (DCI). There is conflicting evidence in the medical literature on whether DCI is more responsive to early rather than late treatment with hyperbaric oxygen (HBO). The main aim of this study is to investigate the influence of time to treatment with HBO in divers with neurological DCI.

Here we show that early HBO treatment in divers with neurological DCI is robustly associated with a better outcome. There is a suggestion in this study that divers with DCI are less responsive if HBO treatment is delayed for 350 minutes or more (or approximately six hours) after surfacing from the incident dive. An interesting observation in this study is that if normobaric oxygen is administered before HBO, it tends to protect divers against delay in treatment with HBO. An additional analysis provides medical evidence that time limits for HBO as specified in the current ACOP1 should remain in place.

This study recommends that a time to treatment action plan (TTT action plan), which specifies what to do when a diver develops suspicious DCI symptoms, will help to ensure that divers have prompt HBO treatment. Divers with serious DCI should be given the appropriate level of medical care in a hospital setting.

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

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Updated 2021-04-21