Trouble in Galápagos

LOS SERVICIOS DE EMERGENCIA DE DAN RECIBIERON UNA LLAMADA via satellite phone from a liveaboard anchored off a remote island in the Galápagos. A DAN member was concerned about their bunkmate exhibiting symptoms following the day’s dive activities. The diver had completed four dives that day. Although she began to show symptoms following the second dive, the inexperienced diver wrote off her symptoms, did not seek help, and continued diving.

No hubo ningún evento significativo en ninguno de los buceos deportivos simples, pero había una corriente en la superficie, y la buceadora supuso que su dolor de hombro se debía al esfuerzo que había tenido que hacer para regresar a la embarcación. La buceadora negó haber experimentado falta de aire, apneas y problemas de flotabilidad o compensación.

Her dive buddy was the divemaster, who told her on the fourth dive to surface without completing the decompression obligation on the diver’s computer. According to information provided to DAN, the divemaster’s computer had different decompression obligations.

La buceadora había hecho un total de 40 buceos en toda su vida y estaba realizando una certificación de buzo avanzado en aguas abiertas. Estaba usando equipo alquilado y no estaba familiarizada con la computadora de buceo.

Cuando los miembros del personal médico de DAN recibieron la llamada, la buceadora manifestó que sentía dolor debajo de su seno izquierdo y en el hombro izquierdo, entumecimiento en la pierna derecha, una breve pérdida del conocimiento, náuseas y cutis marmorata (moteado de la piel) en el abdomen, la espalda y las piernas. No obstante, tanto la buceadora como la tripulación no parecían preocupados.

Los miembros del personal médico de DAN rápidamente se dieron cuenta de que la situación podía ser grave. Los síntomas y el lapso de tiempo se ajustaban al perfil de una presunta enfermedad por descompresión (EDC). Los síntomas, combinados con la descompresión obligatoria de 18 minutos no realizada, hicieron que la situación fuera grave y requiriera una respuesta rápida.

Ya sea que una EDC sea el resultado de no realizar una descompresión obligatoria o que se produzca a pesar de seguir protocolos correctos, tener un plan de acción de emergencia es una preparación de seguridad necesaria.

DAN recommended that the crew immediately activate their emergency action plan (EAP) and get the diver to definitive care. They started surface-level oxygen, but the vessel’s remote location meant they were roughly 18 to 20 hours from the closest medical facility.

A speedboat was dispatched from the mainland to rendezvous with the vessel while en route, but the speedboat’s trip out would still take five hours, with another five hours to return to port and make the transfer to local emergency services.

While rescue operations were underway, the diver’s condition continued to deteriorate. Her symptoms worsened, and she was in and out of consciousness. When conscious, she was in severe pain. The diver was numb in both legs and unable to urinate. Her vision became severely affected. With time becoming an increasingly important factor, the Ecuadorian Navy dispatched a helicopter to expedite the trip.

Los miembros del personal médico de DAN estaban en contacto con el médico que la recibiría, y la buceadora llegó al centro en muy malas condiciones. Estaba desorientada, en shock hipovolémico y tenía lesiones en la piel y signos de lesión en la médula espinal y el cerebro. Afortunadamente, mejoró gradualmente con el tratamiento.

Los buzos deben tener un PAE personal y asegurarse de que el operador con el que bucean tenga uno y los recursos necesarios para ejecutarlo. dan.diverelearning.com

Sus perfiles de buceo para el día habían sido los siguientes:

  1. 24,7 metros (81 pies), 54 minutos, aire enriquecido Nitrox (EAN) al 30 por ciento, parada de seguridad realizada, intervalo de superficie de 1,5 horas.
  2. 26,5 metros (87 pies), 50 minutos, EAN al 30 por ciento, parada de seguridad realizada, intervalo de superficie de 1,5 horas.
  3. 27 metros (89 pies), 54 minutos, EAN al 30 por ciento, parada de seguridad realizada, intervalo de superficie de 1,5 horas.
  4. 23,8 metros (78 pies), 57 minutos, EAN al 30 por ciento, parada de seguridad realizada, descompresión obligatoria de 18 minutos no realizada.

Algunos buzos pueden considerar erróneamente que estos son buceos deportivos normales, pero estos perfiles son agresivos. Cuatro buceos en un día es demasiado para cualquiera, y estos buceos son profundos. No realizar la descompresión contribuyó a este grave caso de EDC.

Following your dive computer’s recommendation doesn’t mean that you are safe and that any DCS while diving within parameters is undeserved. A dive computer is only a guide, not a wonder device that can measure inert gas loading in an individual. We are all physiologically different, and many factors contribute to DCS. Your dive computer can only try to quantify inert gas loading based on theoretical science. What works for some individuals does not work for others, and there is a risk every time we get in the water. In this case, the diver also ignored DCS symptoms after her second dive and did not follow the dive computer’s recommended decompression.

There are many takeaways from this incident. For starters, never write off symptoms that manifest after diving. If you dive with a computer, follow its recommendations and warnings. Know the difference between no decompression limit (NDL) and decompression diving, and don’t miss your decompression obligation.

Inert gas loading occurs because of depth and time. The longer we spend at depth, the more inert gas we accumulate. While a dive computer is a useful tracking tool, it doesn’t know anything about your overall health, the dive conditions, or any other factors that affect decompression stress. The closer you get to the NDL, the more inert gas builds up in your tissues, and that increased exposure also increases your DCS risk. More conservative dive planning is the only way to mitigate that risk.

If you are renting a dive computer or are unfamiliar with the one you are using, do your research. Many user manuals are available online from the manufacturer. Read the manual and know how to use your computer, as you should with all your dive equipment. If you have any questions, make sure you get the answers before diving. Never rely on your friend’s dive computer. Each diver should follow their own computer.

A comprehensive refresher course can help you better understand the importance of decompression and how the dive computer plays an essential role in determining your critical safety stops. It’s important to know the basics of recognizing and treating DCS, particularly before diving aggressively in a remote location with little or no medical support. Whether a lack of knowledge or other factors contributed to this diver’s denial, ignoring symptoms can turn a mild injury that is easy to manage onsite into a severe episode that requires an emergency response and can result in paralysis or death. That kind of situation impacts the diver, everyone on the dive boat, and everyone involved in a potentially hazardous, remote rescue.

Always know what you are getting yourself into, especially with a favorite but remote dive destination. What sort of EAPs does your dive operator have in place? Do they have enough resources on board? Do you know how long a rescue operation would take? What is the plan in case a rescue becomes necessary? What is the difference between rescue and evacuation, and when do those actions occur? These are all things to consider before diving, and it is the diver’s responsibility to know this information as part of their personal EAP.

Is your EAP ready to go? Learn how to prepare your EAP with DAN’s free E-Learning course at DAN.diverelearning.com/?courseNo=488. AD

© Alert Diver — Q3 2022

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