Decompression Sickness

Decompression Sickness

The Maldives, a picturesque archipelago nestled in the Indian Ocean, is renowned for its stunning coral reefs and vibrant marine life. However, its unique geography also presents a challenge for scuba divers: the risk of decompression sickness. Commonly known as "the bends," this condition occurs when divers ascend too quickly from deep dives, causing nitrogen bubbles to form in the bloodstream and tissues. Decompression sickness can lead to severe pain, paralysis, and even death if left untreated. Thus, the Maldives urgently requires hyperbaric chambers to provide essential medical treatment to divers affected by this potentially life-threatening condition.

I'm sharing this not to instil fear, but rather to ensure your safety. If you're a seasoned diver, you will have been taught the proper techniques for ascending safely in the water. However, if it's been some time since your training, your resort may request that you undergo a refresher lesson or course to renew your memory before embarking on any group dives. For those new to diving, rest assured that you'll be under the guidance of an instructor throughout your dives, learning everything necessary for the depths you'll be exploring.

You've probably come across decompression sickness, however, it's worth noting that there are actually three types of injuries associated with pressure changes during diving. In addition to decompression sickness, there's also barotrauma and nitrogen narcosis.

What is decompression sickness?

Decompression sickness occurs due to nitrogen. The compressed air divers breathe underwater contains nitrogen gas, which is absorbed into the body's tissues at high pressure.

Let's liken it to a carbonated drink: When the pressure inside a bottle is released by opening it, the dissolved gas escapes as bubbles and rises to the surface. Similarly, during a dive, as a diver spends time at low depths underwater, nitrogen from the compressed air they breathe dissolves into their body tissues. However, if the diver ascends too quickly, the dissolved nitrogen forms bubbles within the body, which can lead to decompression sickness. This analogy helps illustrate how the process of dissolved gas behaving in a carbonated drink mirrors the potential risks of rapid ascent for divers, emphasizing the importance of proper decompression procedures to avoid decompression sickness.

As long as the diver ascends at the correct speed, the nitrogen can safely and gradually leave the body through the lungs during decompression. However, if the diver ascends too quickly, the bubbles formed can obstruct blood vessels and nerves, leading to pain, joint stiffness, numbness, and in severe cases, neurological damage or even death. Prompt medical intervention will need to be carried out, but luckily the Maldives have that covered.

What should I do in an emergency?

In the event of decompression sickness, it's imperative to seek medical assistance from a doctor immediately. However, there are several actions you can take to help alleviate symptoms and support the diver until medical help arrives. If the diver's body temperature shows signs of dropping, ensure they are dried and warmed with blankets. Administer fluids to combat dehydration, but avoid giving aspirin or other pain killers as it may mask symptoms. If oxygen is available, apply a mask to the diver as soon as possible. During transportation, ensure the diver lies in a horizontal position, and if air transport is necessary, maintain cabin pressure below 1,000 feet or pressurize it to sea level pressure. Use high-flow oxygen continuously until the diver reaches the hyperbaric chamber. These measures can help support the diver and improve their chances of recovery while awaiting professional medical treatment.

Every resort in the Maldives ensures access to medical professionals, either on the same island or a neighbouring one. All medical staff working within Maldives resorts undergo training on diving-related injuries, equipping them with the knowledge to advise on whether medical intervention and the use of a hyperbaric chamber are necessary. This proactive approach ensures that divers experiencing any complications can swiftly receive appropriate medical care, including access to hyperbaric oxygen therapy if required, thereby enhancing the safety and well-being of visitors to the Maldives.

What does it feel like? Will I know if I need help?

For individuals who aren't experienced divers, you will be accompanied by a qualified diving instructor. These professionals are trained to assess symptoms and provide appropriate guidance. Mild symptoms of decompression sickness may include itchy skin mottling, fatigue, and pains in joints and muscles. However, more severe symptoms can manifest as unsteadiness, spinning sensations, numbness, tingling, chest pain, and difficulty breathing. In such cases, it's crucial to seek immediate medical attention. Diving instructors play a critical role in recognising these symptoms and taking necessary actions to ensure the safety and well-being of divers under their supervision.

Decompression sickness (DCS) can manifest rapidly after a dive, but interestingly, in over half of all cases, symptoms may not become apparent for at least an hour. In some extreme instances, symptoms can arise before the dive concludes. Both the U.S. Navy and Technical Diving International, a prominent technical diver training organisation, have compiled a table documenting the time it takes for the onset of initial symptoms. Notably, this table doesn't distinguish between different types of DCS or symptom types.

Here's the breakdown of the time to onset of symptoms and the corresponding percentage of cases:

• Within 1 hour: 42%
• Within 3 hours: 60%
• Within 8 hours: 83%
• Within 24 hours: 98%
• Within 48 hours: 100%

This data underscores the variability in the onset of DCS symptoms and highlights the importance of vigilance and prompt medical attention for divers, even hours after they've resurfaced. Such insights are invaluable for divers, instructors, and medical professionals alike in understanding and addressing the complexities of DCS occurrence.

Where are the hyperbaric chambers in the Maldives?

As of 2024, there are six hyperbaric chambers, also known as decompression chambers, distributed across five islands in various regions throughout the Maldives. These crucial facilities serve to provide essential medical treatment to individuals affected by diving-related injuries, including decompression sickness. The locations of these hyperbaric chambers are as follows:

• Kuredu Island Resort (Lhaviyani Atoll)
• Bandos Maldives (North Malé Atoll)
• Kuramathi Maldives (North Ari Atoll)
• Kandima Maldives (Dhaalu Atoll)
• ADK Hospital* in Malé – the capital city of the Maldives.

*Hyperbaric treatment unit with two chambers.

The strategic placement of these hyperbaric chambers ensures comprehensive coverage and accessibility for divers across different areas of the Maldives, further enhancing the safety and security of diving enthusiasts exploring the captivating underwater landscapes of this tropical paradise.

What do hyperbaric chambers look like?

Hyperbaric chambers in the Maldives typically resemble cylindrical or rectangular walk-in structures constructed with robust materials such as steel. These chambers are designed to withstand high pressures and provide a controlled environment for hyperbaric oxygen therapy. They feature airtight doors and windows made of tempered glass, allowing medical staff to monitor patients undergoing treatment while maintaining the necessary pressure inside. The chambers are equipped with comfortable seating or stretchers for patients, as well as medical equipment and oxygen supply systems. While their external appearance may vary slightly, the primary focus is on functionality and safety, ensuring that divers receive effective treatment for decompression sickness and other diving-related injuries.

How do Hyperbaric chambers work?

Hyperbaric oxygen therapy, administered in hyperbaric chambers, is the primary treatment for decompression sickness. By exposing the patient to increased atmospheric pressure and pure oxygen, these chambers help dissolve the nitrogen bubbles, alleviate symptoms, and promote healing.

Inside the chamber, patients breathe 100% oxygen under pressures greater than atmospheric levels. This high-pressure environment mimics conditions experienced during deep-sea dives, enabling the body to eliminate nitrogen more efficiently. Additionally, hyperbaric oxygen therapy stimulates the release of growth factors and enhances tissue oxygenation, facilitating the healing process for injured divers. As such, these chambers serve as critical facilities in managing decompression sickness and other diving-related injuries.

What are decompression stops when scuba diving?

Decompression stops in scuba diving are designated pauses during the ascent to the surface, where divers linger at specific depths to allow accumulated inert gases, primarily nitrogen, to safely dissolve and exit the body. These stops are crucial for preventing decompression sickness. During a dive, as pressure increases with depth, nitrogen from the compressed air breathed by the diver dissolves into body tissues. As the diver ascends, pressure decreases, causing the dissolved nitrogen to form bubbles in the bloodstream and tissues. Decompression stops provide time for these bubbles to off-gas harmlessly, reducing the risk of decompression sickness. The duration and depth of decompression stops are determined by dive tables, dive computers, or decompression software, considering factors such as dive depth, bottom time, and ascent rate. Proper execution of decompression stops is essential for the safety of scuba divers undertaking dives requiring decompression.

Do free divers need to decompress?

Unlike scuba divers who breathe compressed air from tanks, free divers rely solely on the oxygen stored in their lungs. As scuba divers slowly ascend, the pressure decreases, allowing the excess nitrogen in their bodies to be naturally released through exhalation. Since free divers do not introduce additional nitrogen into their systems through compressed air, they do not experience the same risk of decompression sickness. However, it's essential for free divers to practice safe diving techniques and monitor their ascent to avoid shallow water blackout and other potential risks associated with breath-holding dives.

How long should I wait between scuba diving and flying?

Both the Professional Association of Diving Instructors (PADI) and the Divers Alert Network (DAN) advocate for a minimum pre-flight surface interval of at least 12 hours following a single dive, and 18 hours for repetitive dives or multiple days of diving. This interval allows for the off-gassing of nitrogen accumulated during the dive, reducing the risk of decompression sickness during flight. Additionally, the National Association of Underwater Instructors (NAUI) recommends waiting 24 hours after any dive before flying to altitude, providing further caution to ensure diver safety. These recommendations aim to mitigate the potential health risks associated with flying after scuba diving, particularly in relation to decompression sickness.

Diving after flying does not inherently pose a risk of decompression sickness, as long as divers haven't engaged in excessive flying before diving. Consequently, there are no established guidelines specifying when divers can safely make their first dive after flying. However, it's essential for divers to consider their overall physical condition, recent diving activities, and any potential effects of flying on their body before deciding to dive. While there may not be strict rules regarding this scenario, divers should exercise caution and assess their individual circumstances to ensure a safe and enjoyable diving experience.

Conclusion

The presence of hyperbaric chambers in the Maldives is essential not only for the safety of divers but also for the sustainability of its thriving tourism industry. With a significant portion of visitors attracted to the Maldives for its rich marine biodiversity and diving opportunities, ensuring proper medical facilities is paramount. Rapid access to hyperbaric oxygen therapy can mean the difference between life and death for divers experiencing decompression sickness. Moreover, having these chambers readily available enhances the destination's appeal by providing reassurance to tourists and diving enthusiasts regarding their safety while exploring the underwater wonders of the Maldives.

In conclusion, the Maldives must invest in hyperbaric chambers to safeguard the well-being of divers and sustain its tourism industry. Decompression sickness poses a significant risk to individuals exploring the depths of the Maldivian waters, and hyperbaric oxygen therapy is the most effective treatment available. By equipping the archipelago with these essential medical facilities, the Maldives demonstrates its commitment to prioritising diver safety and ensuring that visitors can experience its natural wonders with confidence and peace of mind.