S2k guideline for diving accidents.

For the purposes of this guideline, a diving accident is defined as an event that is either potentially life-threatening or hazardous to health as a result of a reduction in ambient pressure while diving or in other hyperbaric atmospheres with and without diving equipment. This national consensus-based guideline (development grade S2k) presents the current state of knowledge and recommendations on the diagnosis and treatment of diving accident victims. The treatment of a breath-hold diver as well as children and adolescents does not differ in principle. In this regard only unusual tiredness and itching without visible skin changes are mild symptoms. The key action statements: on-site 100% oxygen first aid treatment, immobilization/no unnecessary movement, fluid administration and telephone consultation with a diving medicine specialist are recommended. Hyperbaric oxygen therapy (HBOT) remains unchanged as the established treatment in severe cases, as there are no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa.

Telemedicine in the management of diving accidents: correlation of phone-assessed symptom severity with clinical findings.

INTRODUCTION: The object of this study was to evaluate to what extend the severity of decompression illness (DCI) assessed by a diving medicine specialist over the phone correlates with actual clinical findings. METHODS: The phone protocols of calls received by a diving medical hotline between January 2008 and December 2009 were analysed. Each case was followed up after completion of the treatment and categorized into one out of four severity groups according to the same standard protocol used for categorisation at the time of the initial hotline call. RESULTS: In 47 of 151 calls, DCI was suspected by the hotline experts. The initial estimation was coherent with the clinical findings in 37 cases, 9 were overestimated and one was underestimated. With the 95% bootstrap confidence interval 0.551 to 0.864 and computed weighted Cohen's κ coefficient = 0,721, the coherence between hotline assessment and clinical assessment can be considered as good. The five divers with minimal symptoms who were categorised as "no DCI possible" could not be followed up. CONCLUSION: We conclude that, despite some limitations to the study, particularly the limited sample size, a reliable assessment of the severity of DCI can be provided by a specialist-based telephone hotline.

Problems of a preclinical treatment algorithm for diving accidents: analysis of the Swiss hyperbaric situation.

Following recent changes in the medical infrastructure in Switzerland, the number of hyperbaric facilities fell from ten to two, and the existing algorithms for telemedical assistance of divers required review. A retrospective study of decompression illness (DCI) from 2004 to 2008 showed that many divers were asymptomatic at the start of hyperbaric treatment. Because of this and recent publications, we may need to modify in the future the decision to recompress a diver. The descriptive nomenclature for DCI was used to determine the probability that symptoms represent DCI. Secondly we evaluated the probability that symptoms may be due to other pathologies or of psychosomatic origin, and thirdly the potential of symptoms for sequelae and their degree of invalidism was estimated. This process will result in one of three therapeutic decisions. An absolute indication for hospital-based hyperbaric treatment. Immediate recompression if available or normobaric oxygen (NBO) with telemedical supervision and adequate monitoring; in exceptional situations, on-site chamber recompression or in-water recompression may be considered. NBO as a preventive measure for two hours and 'bends watch' for 24 h. A prospective study should confirm evidence of good treatment practice. The key for further improvements will be to better understand ambiguous symptoms and to differentiate so-called 'mild' neurological symptoms. As a consequence of the reduction in hyperbaric facilities, longer transfer and treatment delays have resulted. Therefore, there is a need for careful evaluation of the indications for hyperbaric treatment of injured divers and also of the need to install on-site chambers for professional diving operations.