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Decompression, Deep Stops and the Pursuit of Precision in a Complex World

In this first of a four-part series, Global Underwater Explorers’ (GUE) founder and president Jarrod Jablonski explores the historical development of GUE decompression protocols, with a focus on technical diving and the evolving trends in decompression research.

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by Jarrod Jablonski

Introduction:

This four-part series will explore the historical development of Global Underwater Explorers’ (GUE) decompression protocols with a focus on technical diving and the evolving trends in decompression research. The series will include aspects important in recreational diving but with a greater focus on the variables affecting technical divers. Those with less technical experience will hopefully benefit from a substantial number of reference materials linked throughout the series. These support materials and the balanced perspectives I am striving to present are designed to encourage a broader grasp of this complex subject. I also wish to take a few chances with this series by presenting some controversial positions in the hope they will stimulate open discussion and deeper consideration on all sides. 

In the interest of disclosure, I would like to foreground my belief that it is impossible to reach a definitive conclusion regarding the most efficient or the safest decompression procedures, though such determinations depend largely on how you define these terms. Indeed, it is a lack of certainty that motivates me to write this series since most of us will experience our entire diving careers with uncertain knowledge and while evaluating contradictory advice. It is my intent to provide a balanced overview while asserting that one should pursue a measured response to the dictates of pundits on all sides of the debate, myself included. Most importantly, I will explore the idea that many details may not be as significant as we typically imagine. For the sake of informed consideration, we will even explore the idea that both sides—in fact, all of us—are wrong and that we might know less about decompression sickness than it appears. 

One last word on the structure of this series. My intent here is more about establishing a broad perspective and less about arguing a narrow view of this elaborate subject. To this end, I hope you will join the discussion by posting in our comments, or that some of these ideas might stimulate discussions in your various communities. Let’s get started.

Part One: Contextualizing the problem of decompression.

Humans have been exploring the underwater world for hundreds of years, driven by a seemingly insatiable curiosity to reach ever farther below the mysterious surface. The brevity of early breath-hold dives gave way to technology with advances in diving bells in the 16th and 17th century and led to the development of independent diving with the Fleuss rebreather unit around 100 years later. The Fluess device was a self-contained underwater breathing apparatus (scuba) and helped develop the future of untethered diving, although excursions would remain short and/or shallow for many years to come. 

Developing technology that could support extended time while working underwater was a necessary part of the construction of bridges such as the Brooklyn Bridge during the 1870s. This was accomplished by constructing underwater rooms that were pressurized to keep them dry. Few people would think of these immersions as “diving,” but the extended time breathing gas at pressure highlighted a problem that would become known as decompression sickness, which was later included as one of two distinct pathophysiologies.

The Brooklyn Bridge under construction.
J.S. Haldane

The desire to understand and ultimately prevent the occurrence of decompression-related injury spans the life and interest of many researchers, nations, and individuals. In order to better appreciate some historical context, we can refer to the early work of Robert Boyle (1627 – 1691) who identified pressure-related problems when he spotted bubbles in the eye of a decompressed snake. Those not familiar with Robert Boyle may be familiar with  J.S. Haldane (1860 – 1936) who is credited with establishing the first set of decompression tables while under commission by the Royal Navy. 

Albert Buhlmann

Meanwhile, individuals like Albert Buhlmann (1923 – 1994) helped develop the science of decompression during a rich university career, including work for military, commercial, and even recreational diving interests. Decompression enthusiasts are likely familiar with early work done by researchers like Brian Hills (1934 – 2006) who focused on incorporating the formation of bubbles into decompression algorithms. Certainly, these few people do not properly represent the science of decompression, and we could list dozens of other important individuals who heavily shaped the science. My intent here is only to highlight the span of more than 5,000 years during which humans have been reaching ever farther below the watery surface. This history also includes roughly 200 years of research by a wide range of individuals, organizations, and governments seeking to understand the complications of breathing gas under increased pressure.  

The development of decompression practices proved successful even in their first use with caisson work, notably reducing the problems associated with breathing gas while under pressure. This progress extended into diving activity, and included the first tables produced by Haldane in 1908 for the British Admiralty. His tables remained in use by the Royal Navy until 1955. These developments supported longer and more aggressive diving activity, inaugurating a new age of discoveries and their associated challenges. 

Advancement tends to remove some or even many risks but also creates the possibility for new problems. These might develop from the ability to push boundaries farther or because more people can become involved in a given activity. We tend to build upon early success, refining safety protocols and treating a progressively smaller subset of incidents. Over time, the strategies to reduce injury become more refined and, to some extent, more individualized. 

For example, early cities were very dangerous places before fire protection, building standards, health codes, and similar protections. These practices became more refined, focusing on workers, home dwellers, children, and others. Most advanced societies are now quite safe, and additional levels of refinement continue to tease individual safety concerns while striving for the elimination of accidents—requiring notably more effort and expense to remove progressively smaller amounts of risk. It is hard to clearly identify our place on this curve when it comes to decompression sickness, but we appear fairly well into the diminishing returns part of the process. 

Exploring high-pressure environments began when elaborate mining, tunneling, and bridge-building projects resulted in problems of unknown origin. In subsequent years, we identified an arguably well-defined illness with a relatively clear causality. Many details remain vague, but our ability to characterize the problem supported the development of decompression strategies that significantly reduced injuries associated with breathing gas under pressure. These developments resulted in algorithms that predicted safe exposures and were codified into decompression tables and used for progressively deeper diving excursions. 

Today, decompression-related problems are extremely uncommon, especially within the recreational diving community. We now find ourselves mostly managing problems within a small subset of incidents. We strive for clarity among these low-probability injuries, seeking to improve or at least maintain safe guidelines while expanding our understanding. We typically acknowledge some influence from pre-existing conditions that, for whatever collection of reasons, might make a person more susceptible to injury.  We also strive to discourage diving activity that violates defined ascent speed or time limits while trying to establish a solid understanding of the constellation of problems we call decompression sickness. 

Meanwhile, the safety of decompression among those who use algorithms within uncharted territory remains less certain. Individuals who dive very deep and/or over very long times may be outside the range where safe dives can be predicted. For example, a decompression algorithm developed for dives up to 30m/100 ft for immersions as long as one hour may or may not extrapolate for dives of longer duration and depth. It requires a great many dives in order to verify that a particular exposure will result in low risk for most people. Given the high cost, added complexity, and safety risk, these important data points are particularly limited with dives that are very deep and/or long. This is something we return to in a later discussion. 

For the moment, we are mostly focused on dives with good supporting data and where notable improvement appears unlikely. Much of the sometimes raucous debate over decompression “correctness” involves teasing arguably minor benefits from already very low levels of risk. Can we change this reality? Can we find something that brings substantial improvement, perhaps allowing much longer dives with even shorter decompressions?

In thinking about the “problem” of decompression, we understand that scuba diving increases the pressure around us, also known as increased ambient pressure.  We are now breathing gas that is at a higher pressure than normally exists in our body. The molecules we are breathing become dissolved in our blood, where they are transferred during normal circulation and accumulate in the tissues of our body. This occurs until the tissues are “full” or, more precisely, until they are saturated at the new inspired gas pressure. Reductions in the surrounding pressure reverse the gradient and encourage the molecules to leave the tissues through the blood. 

Algorithms that strive to characterize this process are known as dissolved gas models. The transfer of dissolved gas from the tissues often results in the formation of bubbles in a way that is similar to releasing pressure from a carbonated beverage. Dissolved gas models do not ignore the risk of bubbles but also do not attempt to directly control their development. Attempts to directly limit the formation and development of bubbles are known as bubble models. 

We imagine that both dissolved gas and bubbles are relevant and also that other individual factors play some role. The problems in finding the best strategy are numerous, but most will be managed in a later discussion. For now, I wish to highlight that tracking of dissolved gas has been our primary strategy, consuming all but a relative handful of the many decompression experiments through the history of decompression research. 

Modeling bubbles is inevitably more theoretical and based upon mathematically derived predictions about bubble behavior, sometimes supported by lab experiments that measure the likelihood of bubble formation under certain conditions. Models can also be crafted as “dual-phase,” meaning they anticipate bubble development but also track dissolved gas, striving to ensure that both are within safe parameters. In all cases, we tend to develop more confidence in models that are tested empirically, though they may also be compared to a database of outcomes, supporting evaluation and calibration of the model particulars.  The most modern approach is trending toward probabilistic models, and we will explore these in future treatment.  

The presence of bubbles during decompression is well known, and to some extent is measurable by Doppler testing, which can detect bubbles in the venous part of the circulatory system. The venous system receives blood from tissues that are eliminating gas absorbed while diving, so the presence of at least some bubbles are expected. Unfortunately, there are many complications to the use of Doppler as a means to gauge decompression efficiency. Measures of venous bubbles may be useful for predicting decompression stress in populations of divers, but it fails to be a reliable measure of symptoms in an individual diver.  

Despite the complications, most researchers agree that bubbles (though not necessarily those detectable in the venous blood) are a critical part of the causal chain. The consensus seems to be that these bubbles either directly cause decompression sickness and/or contribute to its severity. Even if we assume bubbles cause all decompression-related symptoms, predicting their effects might be overly complicated. Albert Buhlmann, a great contributor to dissolved gas models, knew about and acknowledged the relevance of bubbles. He nonetheless focused upon refining dissolved gas strategies as a way to minimize risk of decompression sickness. We don’t yet know if this is the best strategy, but it has been quite successful at allowing a very low level of risk during most dives. 

Tracking other markers that might affect symptoms of decompression sickness is conceivable and is part of a body of research that seeks to better understand the full scope of decompression problems. For example, researchers are exploring immune-response factors, including genetic influences that might be involved in the body’s reaction to decompression. We might also learn more about heart rate variability (HRV), which has become popular as a way to measure physiological stress in the world of sport and exercise, and its potential involvement in DCS. These or other techniques could conceivably be used to establish upper limits on the stress accumulation that occurs during decompression, presumably avoiding some upper threshold before symptoms become problematic. 

We might also find ways to reduce decompression time by eliminating or changing the gas at the source of the problem. For example, we might eventually manage to use a liquid carrier for the oxygen that sustains our lives. By eliminating or greatly reducing use of gases like nitrogen or helium, we should be able to notably change the relevance of bubbling during changes in pressure. Or, we might develop ways to prevent or greatly reduce the risk of bubble formation by using drugs or other prophylactics that could physically alter the circumstances under which bubbles form. These ideas and many others have been explored and may hold promise, but nothing that greatly departs from current practice appears likely in the foreseeable future. 

Jarrod Jablonski with during deco. Photo by David Rhea.

Despite reasonable uncertainty about many details in decompression sickness, including the exact incident rate of DCS, which is unknown, divers following conventional decompression tables and diving within well-established limits have a very low risk of injury with rates of  0.01-0.1% per dive or about 1-10 incidents per 10,000 dives (the higher end reflecting rates for commercial dives, the lower end reflecting technical, scientific, and recreational dives). The risk is greater for certain types of very aggressive dives, but we will explore that aspect in a later discussion. Regardless of the actual risk, few divers would knowingly choose a less efficient ascent profile if a better option was available. 

The pursuit of decompression efficiency is particularly relevant for the group of divers known as technical divers. For these divers, arguably small differences can involve additional hours decompressing in the water. These divers have been particularly interested in the problem of bubbles that might develop during long ascents in deep water.  Many tech divers followed early research that concluded slower ascents from depth could greatly reduce decompression time. For some years, the convention of using “deep stops” to slow a diver’s ascent seemed to be the best way forward. Yet, new research argues they are actually part of the problem. Whether or not you feel sure about the value of deep stops, I hope you will join us for some engaging online discussions and especially for future sections as we dig deeper into areas that do not commonly appear in discussions orbiting decompression or deep stops. I look forward to reading your thoughts in the comments section and hope you will join part two of our series: “Tech Divers, Deep Stops, and the Coming Apocalypse”.

Please come back in two weeks when we release the next part in this series from President Jarrod Jablonski.


Jarrod is an avid explorer, researcher, author, and instructor who teaches and dives in oceans and caves around the world. Trained as a geologist, Jarrod is the founder and president of GUE and CEO of Halcyon and Extreme Exposure while remaining active in conservation, exploration, and filming projects worldwide. His explorations regularly place him in the most remote locations in the world, including numerous world record cave dives with total immersions near 30 hours. Jarrod is also an author with dozens of publications, including three books.

Diving Safety

Why Do Divers Run Out Of Gas?

Not surprising, the answer is more complicated than simply, they neglected to look at their gauges. Here Aussie diving medical researcher and former editor of DAN’s Annual Diving Report, Peter Buzzacott dives into several deep datasets including DAN’s Incident Reporting System (DIRS) and nearly four decades of cave diving incident data, to tease out some insights on gas emergencies and get a handle on the risks. Don’t stop those S-drills!

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by Peter Buzzacott

See companion story for a guestimate of the risk: What is the Risk of Running Out of Gas?

Next year it will be 30 years since I first learned to dive. At the time, I had no idea that diving would occupy such a large part of my life. I distinctly remember kneeling on the sandy bottom end of the Great Barrier Reef, sharing a regulator with my buddy, and seeing sunlight rippling down through crystal clear water. On one of these “confined water” dives we had to swim horizontally for 10 m/30 ft holding our regulators out of our mouths and blowing a steady stream of bubbles. This wasn’t as easy as it sounds and we had to ration our bubbles to make it the whole way. Then, on an open water dive, the instructor took turns holding us with one hand and gripping a rope with the other while we took a breath, took the second stage out of our mouths, and then went for the surface, breathing out all the way. Up, down, up, down, the instructor went, with each student—one at a time. 

Courtesy PADI Worldwide. Copyright 2021, used with permission.

Most of today’s recreational dive courses do not include buddy breathing, they teach gas sharing with an alternate air source (AAS). Even before COVID-19, the buddy breathing skill had disappeared from most recreational training programs. The controlled emergency swimming ascent (CESA) has also disappeared from some programs. 

When I became an instructor, I made many hundreds of these but, now that I think about it, I don’t recall ever seeing anyone actually make one for real after running out of gas. These days everyone dives with two second stage regulators. In technical diving, we even dive with at least two cylinders; so, I wonder, do technical divers run out of gas and, if they do, then why?

What Do The Experts Say?

Some years ago, I asked a panel of 27 diving experts a similar question regarding recreational divers in general.1 The panel consisted of nine diving/hyperbaric doctors who had treated hundreds of injured divers; nine expert dive guides, most of whom were instructors; and nine expert recreational divers who had dived all over the world and written hundreds of feature articles for dive magazines. 

At the time, I suspected divers mostly ran out of gas because they didn’t pay attention to their gauge. But, to my surprise, the experts suggested about 20 reasons, such as diving deeper than usual, diving in a current, not wanting to end the dive for their buddy, using a smaller tank than their buddy, being underweighted, and many others, all of which sounded plausible. 

I sent the whole list of potential causes back to the group and asked them to rank, in their opinion, the five most likely causes. Then I gave five points to everyone’s most likely potential cause, four points to the second most likely, and so on. I added up all of the points and then ranked all the causes according to the total score. Then I sent this ranked list back to the group for one last review and asked them to consider the “weight of opinion” from the group as a whole, and to reconsider their top five reasons. 

As an expert panel, the group moved toward consensus. Just as I’d suspected, failing to monitor the gauge was the number one proposed potential cause of running out of gas, followed by inexperience, overexertion, inadequate training, and poor dive planning. Other than perhaps an unexpected current or underweighting leading to overexertion, the proposed reasons leaned toward human factors rather than the other two types of factors in the classic diving injury causal triad—those being environmental factors and equipment factors (Figure 1).2,3,4

Figure 1: The classic diving injury causal factors triad 2,3,4

The process I’d followed to gather expert consensus of opinion is called a “Delphi” process, which was originally developed by International Business Machines Corporation (IBM) to make forecasts on matters about which there was considerable uncertainty i.e. where there is little data. Opinions aren’t solid evidence; however, they can point towards a direction worth investigating. 

Next, I visited Divers Alert Network(DAN) as an intern and worked on an analysis of diving fatalities within a subset of technical divers—cave divers. More on that later, but while there, I had the opportunity to examine a large dataset of recorded dives from Project Dive Exploration, headed by Drs. Richard Vann and Petar Denoble. 

The dataset we had at that time revealed over 50,000 dives recorded by more than 5,000 recreational divers, (including an unknown number of technical divers). We examined these data in two ways. First, to control for environmental and equipment factors, and to focus on demographic (or human) factors, we counted each diver just once and compared those divers who had reported running out of gas, (during any recorded dive in that dataset), with divers who had not run out of gas. Surprisingly (to me), having run out of gas was more common than expected among older females (males were more likely to report other problems, like rapid ascent). 



Next, to control for the human factors, we looked at just the dives made by divers who had made both at least one dive where they ran out of gas, and at least one dive where they did not run out of gas. I wanted to know what it was about those dives that might have caused the divers to run out of gas. Well, it turned out the out-of-gas dives were deeper, shorter (probably because they were deeper), often made from a live-aboard or charter boat, and involved a higher perceived workload.5 Hmmm… Perhaps overexertion was a factor after all.

After returning to Western Australia to undertake a PhD researching this, I spent the next few years recording 1,000 recreational dive profiles made by 500 divers. I recorded their start and end pressures, tank size, and noted factors such as current, how they felt their workload was (resting/light, moderate, or severe/exhausting), how many dive experiences they had, and what previous dive training they had completed. For the analysis, dives made by divers who exited with <50 bar/725 psi of pressure (needle in the red zone, n=183) were compared with other dives recorded at the same time at the same dive site (n=510) by divers who exited with >50 bar/725 psi pressure remaining (needle not in the red zone). 

Ending a dive low on gas was correlated with younger males with a longer break since their last dive, fewer lifetime dives, at deeper depth, and a higher rate of gas consumption (adjusted to an equivalent surface air consumption (SAC) rate, for comparison between dives made at different depths). Perhaps more tellingly, compared with 1% of the dives with >50 bar/725 psi at the exit, 11% of the low-on-gas divers reported being surprised at the end of the dive by how low their remaining gas pressure was.6 A more detailed analysis of the average workload associated with recreational diving, using this same dataset, identified that higher perceived SAC rate was not associated with sex but was associated with older age, lower dive certification, fewer years of diving, higher perceived workload, and other factors.7 

Technically Out of Gas

Returning to the topic of technical diving, a colleague and I re-examined the DAN cave diving fatality reports collection that I had worked with as an intern, and this time we concentrated on the previous 30 years of data: 1985-2015. Dividing it into two equal halves which we referred to as the “early” and “late” groups, reading each report carefully, and using a reliable cave diving fatality factors flow-chart previously developed,5 we classified factors associated with each cave diving fatality and then compared the two groups. 

In the late (more recent) group, the proportion of cave divers who were trained in cave diving had significantly improved, perhaps due to increased awareness of the need for proper cave diver training before entering a flooded cave. The majority of the 67 trained cave divers in our dataset were diving with two cylinders on their back (doubles), and the late group was diving further into the cave than the early group. Of the 67 trained cave divers, 41 (62%) had run out of gas. Looking at the five “golden rules” of cave diving, the “rule of thirds” was the most common (n=20) rule that was suspected to have been broken by the trained cave divers: the most lethal.9

So, it would seem that some technical divers do run out of gas, though thankfully that appears rare. We should bear in mind that cave divers may differ from other types of technical divers in their procedures, demography, and equipment; their environment (by definition) certainly differs from that of wreck divers. 

Currently, I know of no ongoing research into out-of-gas incidents among technical divers, other than the current Diving Incident Reporting System, hosted by DAN. An analysis of the first 500 reported incidents recently examined every incident—recreational and/or technical—during which the diver ran out of gas.10 The sample (n=38) was divided into two groups: those who made a controlled ascent (e.g. on a buddy’s donated regulator) and those who made rapid ascent (e.g. a bolt to the surface). 

Among divers who reported having run out of gas, but survived to report the incident, 57% of the rapid ascents resulted in a reported injury. Among the 24 controlled ascents, just 29% reported an injury.10

Among divers who reported having run out of gas, but survived to report the incident, 57% of the rapid ascents resulted in a reported injury. Among the 24 controlled ascents, just 29% reported an injury.10 This modern finding is in line with the statistics reported 27 years ago by Dr. Chris Acott when he analyzed more than 1,000 diving incident reports. Examining 189 out-of-gas incident reports, Dr. Acott found 89 made a rapid ascent, and 58% of those reported an injury. Among the 79 controlled ascents, only 6% reported an injury.11 

Table 1 shows the total number of dive incidents in each category, after adding both studies together. It seems to me that, while we have moved on from buddy-breathing and the controlled emergency swimming ascent, in the last 30 years the problem of running out of gas has not gone away. 

No Injury
(row %)
Injury
(row %)
Total
(col %)
Non-rapid ascent 91 (88)12 (12)103 (50)
Rapid ascent43 (42)60 (58)103 (50)
Total134 (65)72 (35)206 (100)
Table 1: Injuries among 206 out-of-gas dive incidents by ascent rate10,11

In conclusion, the evidence confirms what we all know: running out of gas is associated with diving injuries and fatalities. It appears that the level of correlation of demography information (like age and sex) with out-of-gas incidents may depend upon the study design, the pool of divers studied, and/or the specific potential causes of running out of gas being investigated. For example, in one study, older females were more likely to self-report out of gas problems; in another study, young males’ remaining gas was measured and observed to be low. In yet another study, SAC rate increased when perceived workload increased, regardless of sex. 

Therefore, I’d suggest it is prudent to consider everyone potentially at risk of running out of gas and, in order to mitigate this risk, both recreational and technical divers should be proficient in gas planning and monitoring their remaining gas, regardless of age and/or sex. 

[Ed.note—Most agencies today require some level of proficiency in managing emergency out of gas scenarios. For example, GUE requires divers at all levels to train regularly for this eventuality. This training also emphasizes gas management strategies like “minimum gas reserves” and the related “one third” rule to ensure divers always have enough supply to share gas aka buddy breathe from any point in the dive, and all the way to the surface. Violation of these strategies risks insufficient gas in all environments.]

Influencers

The influence of workload is interesting, and technical divers who perceive an elevated workload may well remember that this has been associated with both higher rates of gas consumption and unexpectedly running low on gas. So, when detecting a current or perceiving an elevated workload, I recommend keeping a closer-than-usual eye on the remaining gas and, if a current is suspected before the dive, then plan for an elevated SAC rate. 

The influence of training/certification consistently appears to be associated with the risk of running out of gas, as does having made fewer lifetime dives. Highly trained and experienced divers might bear this in mind when diving with buddies who are newer to our sport. Offer them opportunities to gain experience and recommend additional training when they are ready. We were all inexperienced once.

Technology has improved in recent years; for example, tank pressure transponders are more reliable today than ever before. It is possible that in the future these resources, coupled with audible alarms, may prove to be highly effective at preventing technical divers from running out of gas. Until we know how effective such alarms are at preventing out-of-gas dives, our best course of action is to dive within the limits of our training and experience, and to keep an eye on our remaining gas. 

See companion story for an estimate of the risk: What is the Risk of Running Out of Gas?

Do you think that it could it happen to you?

References

1. Buzzacott P, Rosenberg M, Pikora T. Using a Delphi technique to rank potential causes of scuba diving incidents. Diving and Hyperbaric Medicine. 2009;39(1):29-32.

2. Edmonds, C. and Walker, D. Scuba diving fatalities in Australia and New Zealand: The human factor. SPUMS J. 1989;19(3): 94-104.

3. Edmonds, C. and Walker, D. Scuba diving fatalities in Australia and New Zealand: The environmental factor. SPUMS J. 1990;20(1): 2-4.

4. Edmonds, C. and Walker, D. Scuba diving fatalities in Australia and New Zealand: The equipment factor. SPUMS J. 1991;21(1): 2-5.

5. Buzzacott P, Denoble P, Dunford R, Vann R. Dive problems and risk factors for diving morbidity. Diving and Hyperbaric Medicine. 2009;39(4):205-9.

6. Buzzacott P, Rosenberg M, Heyworth J, Pikora T. Risk factors for running low on gas in recreational divers in Western Australia. Diving and Hyperbaric Medicine. 2011;41(2):85-9.

7. Buzzacott P, Pollock NW, Rosenberg M. Exercise intensity inferred from air consumption during recreational scuba diving. Diving and Hyperbaric Medicine. 2014;44(2):74-8.

8. Buzzacott P, Zeigler E, Denoble P, Vann R. American cave diving fatalities 1969-2007. International Journal of Aquatic Research and Education. 2009;3:162-77.

9. Potts L, Buzzacott P, Denoble P. Thirty years of American cave diving fatalities. Diving and Hyperbaric Medicine. 2016;46(3):150-4.

10. Buzzacott P, Bennett C, Denoble P, Gunderson J. The Diving Incident Reporting System. In: Denoble P, editor. DAN Annual Diving Report 2019 Edition: A Report on 2017 Diving Fatalities, Injuries, and Incidents. Durham (NC): Divers Alert Network; 2020. p. 49-67.

11. Acott C. Diving incidents – Errors divers make. Safe Limits: An international dive symposium; 1994; Cairns: Division of Workplace Health and Safety.

12. Buzzacott P, Schiller D, Crain J, Denoble PJ. (2018). Epidemiology of morbidity and mortality in US and Canadian recreational scuba diving. Public Health 155: 62-68. 

13. Buzzacott P. (editor) (2016). DAN Annual Diving Report 2016 Edition: A report on 2014 data on diving fatalities, injuries, and incidents. Durham, NC, Divers Alert Network

14. Buzzacott P (editor) (2017). DAN Annual Diving Report 2017 Edition: A Report on 2015 Diving Fatalities, Injuries, and Incidents. Durham (NC), Divers Alert Network.

15. Buzzacott P and Denoble PJ. (editors) (2018). DAN Annual Diving Report 2018 Edition: A report on 2016 data on diving fatalities, injuries, and incidents. Durham, NC, Divers Alert Network

16. Denoble PJ. (editor) (2019). DAN Annual Diving Report 2019 Edition: A Report on 2017 Diving Fatalities, Injuries, and Incidents. Durham (NC), Divers Alert Network.

You can add a diving incident to the DAN database by name or anonymously here: Diving Incident Reporting System (DIRS).


Dr. Peter Buzzacott MPH, PhD, FUHM, is a former PADI Master Instructor and TDI Advanced Nitrox/Decompression Procedures instructor, having issued >500 diver certifications. Today he is an active cave diver, holding various advanced cave diver certifications including advanced (hypoxic) trimix diver, and he is gradually gaining experience with CCR diving. To finance this, he conducts research into diving injuries and decompression/bubble modeling at Curtin University in Perth, Western Australia.

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Latest Features

Diving tables prescribe time limits at various depths. Within a given time limit (known as a no-decompression limit or NDL) a diver can make a slow but direct ascent to the surface. When divers stay longer than the NDL they must engage in delayed ascents, usually stopping every 3m/10feet for the time prescribed on their table. Apps allow for calculation of various profiles in electronic format and these programs are also used in decompression computers to calculate limits, ascent rates, and stop time in real-time during the dive.

An algorithm is a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer: "a basic algorithm for division".

Decompression in the context of diving derives from the reduction in ambient pressure experienced by the diver during the ascent at the end of a dive or hyperbaric exposure and refers to both the reduction in pressure and the process of allowing dissolved inert gases to be eliminated from the tissues during this reduction in pressure. When a diver descends in the water column the ambient pressure rises. Breathing gas is supplied at the same pressure as the surrounding water, and some of this gas dissolves into the diver's blood and other fluids. Inert gas continues to be taken up until the gas dissolved in the diver is in a state of equilibrium with the breathing gas in the diver's lungs, (see: "Saturation diving"), or the diver moves up in the water column and reduces the ambient pressure of the breathing gas until the inert gases dissolved in the tissues are at a higher concentration than the equilibrium state, and start diffusing out again. Dissolved inert gases such as nitrogen or helium can form bubbles in the blood and tissues of the diver if the partial pressures of the dissolved gases in the diver get too high above the ambient pressure. These bubbles and products of injury caused by the bubbles can cause damage to tissues known as decompression sickness, or "the bends". The immediate goal of controlled decompression is to avoid the development of symptoms of bubble formation in the tissues of the diver, and the long-term goal is to also avoid complications due to sub-clinical decompression injury.

 

Source: https://en.wikipedia.org/wiki/Decompression_practice

1909: 

FJ Keays described 3,692 cases of decompression sickness. He established recompression as the treatment of choice. He showed that there was a persistence of symptoms in 14% of Caisson workers who were not recompressed compared with 0.5% in who were. However, he admitted that recompression often failed in “serious” cases. These data were published again in 1912.

Decompression Illness (DCI) encompasses:
-Decompression Sickness (DCS)
-Arterial Gas Embolism (AGE)
Decompression Sickness (DCS): Time spent diving causes an excess of inert gas, such as nitrogen, to dissolve in the body. When a diver surfaces this dissolved gas may form bubbles, which then cause local damage to body tissues or obstruct small blood vessels. This can result in a wide range of symptoms including pain, weakness, dizziness or tingling.

Arterial Gas Embolism (AGE): Most commonly occurs when diving as a result of lung over-expansion injury, also known as pulmonary barotrauma. Air passes directly from the lungs into the arteries, blocking them. This causes a variety of sudden onset, stroke-like symptoms depending on the site of the blockage, such as one-sided weakness or loss of consciousness.

The technology for these underwater rooms began in 1792 when Robert Weldon developed a Caisson Lock for movement of boat traffic. The term caisson is French as borrowed from Italian cassone and means "large box". The concept was extended by Jacques Triger who invented the air lock, allowing a worker to transfer from low-pressure to high-pressure environments. In1841 Triger documented the first cases of decompression sickness in humans when two miners involved in pressurized caisson work developed symptoms.