Equipment
In Hot Water: Do Active Heating Systems Increase The Risk of DCI?
Active thermal heating systems will keep you warm in cold water and improve diver safety, but can they also increase your risk of getting bent? Our science geek Reilly Fogarty reviews the current conflicting research, teases out the factors involved, and identifies a ‘Best Practices’ strategy for those intrepid souls preparing to make the jump into very cold water.
by Reilly Fogarty
Header image: A Navy diver undergoing a thermal experiment at the US Navy Experimental Diving Unit (NEDU) in Panama City, Fl. Photo by Stefan Frink
Heating solutions for divers have come a long way in the past two decades. Not long ago a diver’s only option for active heating underwater was a hot water suit, complete with the logistical limitations of surface or habitat supplied water. Equipment and tenders made the suits difficult to put to use and divers were limited to exploring the seafloor only as far as their hot water hose could reach. These challenges made active heating accessible only to a small subset of the commercial diving industry, and nearly impossible for recreational divers to use except for some notable but extraordinarily rare exceptions.
Limited by thermal exposure on long dives in warm water and short excursions in wintry waters alike, recreational divers began using hot-packs, hot water bottles, and any number of similar solutions to heat their drysuits with typically underwhelming results. The evolution of electrical heating systems however, brought active heating within reach for a huge number of new divers. The first iterations were fickle and expensive, and many home-brew solutions involving heated motorcycle vests and DIY-battery packs were concocted, but the recreational industry adopted the technology in relatively short order. Now divers have a wealth of options for heated undergarments, from minimalist and self-contained systems that wear like a t-shirt and can be used in a wetsuit to full-body undergarments with gloves and booties powered by external battery packs.
Recreational divers have adopted these heated undergarments rather quickly, but the total market share is not yet widespread enough to allow much in the way of statistical analysis. The technology has made diving a winter sport for many, but the proliferation without adequate research has brought some serious concerns about decompression stress to the forefront. While these new tools make it possible to comfortably endure harsher climates and longer exposures, if they are used incorrectly, they can dramatically increase decompression stress. Here’s what you should know as you decide whether to heat your next dive.
Heating’s Double Edged Sword
The crux of the concern surrounding heated undergarment use lies in the effect of temperature on decompression sickness risk. A number of aptly named studies have laid the statistical groundwork for what most of us already believe to be true—temperature has a significant effect on our ability to absorb and eliminate inert gases.
Cold immersion gives us a number of things to contend with. Vasoconstriction, the narrowing of blood vessels, helps shunt blood to the core to maintain core temperature but leaves hands and feet cold and quick to numb. Slow perfusion in these tissues can slow both the uptake and removal of inert gases, the latter of which increases decompression stress. The body will also attempt to eliminate fluid via urination, promoting dehydration, and in some cases breathing rate can be increased via cold water shock or increased metabolic drive to keep the body warm. These factors are familiar to divers, but they all contribute to decompression stress.
Active heating systems—used properly—can address these factors. Keeping a diver warm can minimize vasoconstriction and improve perfusion, improving inert gas elimination in extremities. Warm divers will shunt less fluid to their core, produce less urine and face fewer concerns from cold-induced physiological reactions. It’s the potential to increase total inert gas load via warming throughout a dive, or allowing efficient gas loading and then hampering decompression via the failure or removal of heat on the ascent portion of a dive that can put a diver at serious risk. Not only are these devices prone to failure just by nature of being electrical in an underwater environment, but even properly functioning, their inappropriate application can leave a diver with significantly more decompression stress than they would have faced on a dive without their heating solution of choice.
It’s the severity of these risks in the real world coupled with the conflicting data that makes this a tough topic to tackle for recreational divers. Heated undergarments make an enormous difference on long technical dives, they have the potential to make a dive not only more comfortable but safer, but they can also put divers in needless risk.
Conflicting Research
Even the best data on thermal status fails to give us more than correlations with DCS symptoms, which makes estimating risk nearly impossible. There is, however, a respectable body of research that indicates divers using hot water suits may experience DCS at a higher rate than their counterparts. One study from 1951 on hot water suit use among surface decompression dives indicated that each 10°C increase in water temperature increased the odds ratio of DCS by 1.96 and that this effect was most pronounced on shorter dives in the study. A later review of that study however, indicated that the probability of some of the DCS symptoms, specifically the Type 2 symptoms could have been “better explained by the dive profile than by the temperature” (Leffler, 2001). Another work by the same author indicates a significant increase in DCS risk among divers who are warm at depth, specifically pointing to vasodilation induced promotion of on-gassing efficiency. This correlation between hot water suit use at depth and DCS risk was also found among divers working on the TWA Flight 800 recovery in 1997.
It’s worth noting that hot water suits and electrical heated undergarments may not be entirely identical systems. Hot water suits have a much greater heating potential and have been shown to cause some fluid loss in divers, primarily from sweat. In real-world applications however, both can be used in a similar enough fashion that many of the lessons learned from research into hot water suit use can be carried over to more modern systems.
The real conflict in data and theory comes in both the application of the heating systems, and the balance of heat needed to maintain dexterity and complete a mission, and decompression risk. Even working from a foundation of data that suggests the following:
- Being warm during a dive increases post-dive bubble scores
- Hot water suits are associated with higher DCS risk
- Post-dive cooling could prolong the period of elevated risk for Type 1 DCS
There is still some room for the safe application of active heating to improve both safety and comfort. A 2007 NEDU study showed a significant decrease in DCS incidence in a group of divers performing a 150fsw/60 minute dive on U.S. Navy Standard Air tables that were kept cold during compression phases (descent and bottom time) and warmed during decompression, compared to a group from a prior study that was kept cold throughout their dive, despite the “cold” group decompressing for nearly 2.5 times as long.
This study was able to create a dataset that included more than 400 dives to a depth of 120 feet of seawater, a standard decompression profile and varying thermal exposures, providing a profile that can be reasonably extrapolated to recreational profiles. The principal of this study was the comparison of DCS incidence odds ratios between these thermal exposures, resulting in a 23.8% DCS odds ratio for a 10C increase in temperature during compression, and decreased DCS occurrence and VGE scores (although postdive VGE scores were only weakly associated with DCS occurrence).
A group of physicians and researchers did take issue with some of the results, hoping to temper recreational divers from extrapolating data directly, but their editorial was not without rebuttal from their colleagues. The study’s authors eventually waded into the academic dispute with their own response clarifying that while the thermal stresses experienced by recreational divers are likely less than found in his experiment, the responses would likely be similar but in lesser magnitude. Because of this, they contend that it would be unwise to ignore the trends they found, and the data could have a profound effect on the larger diving community, remarking that, “We wish to clarify that our study does have implications for recreational and technical divers, implications that should not be ignored.”
Much in the way that the original U.S. Navy Dive Tables were adapted for the recreational market, so too can this data provide valuable lessons to divers who do not necessarily resemble the hyper-fit Navy Dive standard.
Best Practices
With the limited data we have and the considerable academic dispute over the cumulative effects of various heating applications, it seems that the best course of action is to draw from a combination of the NEDU study, community engrained platitudes about thermal status, and a healthy dose of theoretical modeling. Pollock, Clark et. al, and the NEDU all agree at some level that active heating can be applied to improve divers safety. In this application, the NEDU study would seem to indicate that the most appropriate application would be to keep divers cool during the compression phases (during descent and the working portion of the dive), and gently warm them during the ascent to aid in decompression. In situations where the working portion of the dive requires heating at a “minimal level” can likely be safely applied, but excessive heating on ascent should be avoided to prevent dehydration or decompression that is too aggressive.
Logistically, this addresses the worst-case scenario, a diver intending to run active heating throughout a dive who experiences a failure on ascent, leading to a warm compression and cold decompression phase. It also makes it possible to use heating to some extent in the exploration of harsh environments and maintain comfort and dexterity not possible with passive thermal protection. It does not, however, address the fact that decompression models do not account for thermal status, let alone change in thermal status during a dive. Additional conservatism must be applied by the diver, because the addition of an active heating system provides one more variable in amongst the milieu of uncertainty in decompression risk.
Using heated undergarments in this “cold/warm” fashion seems to be the takeaway for Pollock, the NEDU, and many of their colleagues. The NEDU study goes so far as to say that their group following the “cold/warm” pattern experienced a benefit similar to halving their bottom time, compared to the group that was kept cold throughout the dive and decompressed for 2.5 times as long. The potential for enormous benefit is there, but applied incorrectly it seems likely that the opposite is also true. “Dramatic results demand serious attention” is how Pollock put it, and it’s worth keeping that in mind as you weigh your options, and your wallet, this spring.
References:
1. Effect of ambient temperature on the risk of decompression sickness in surface decompression divers
2. Effect of ambient temperature on the risk of decompression sickness in surface decompression divers
3. Recompression treatments during the recovery of TWA Flight 800
4. Time and temperature effects on body fluid loss during dives with the open hot-water suit
5. Re: Don’t dive cold when you don’t have to (Pollock)
6. The Influence of Thermal Exposure on Diver Susceptibility to Decompression Sickness
7. Don’t Dive Cold When You Don’t Have To (TDI)
8. On diver thermal status and susceptibility to decompression sickness (letter)
9. Thermal stress and diver protection.
Dive Deeper:
Alert Diver: Deep in the Science of Diving: The Navy Experimental Diving Unit by Michael Menduno
Reilly Fogarty is a team leader for risk mitigation initiatives at Divers Alert Network (DAN). When not working on safety programs for DAN, he can be found running technical charters and teaching rebreather diving in Gloucester, MA. Reilly is a USCG licensed captain whose professional background includes surgical and wilderness emergency medicine as well as dive shop management.
Equipment
InDEPTH’s Holiday Rebreather Guide 2023
Making a list. Checking it twice. Gonna find out which breathers are naughty or nice. That’s right! It’s time again for InDEPTH’s Holiday Rebreather Guide. This year, we are featuring 32 models of back, sidemount and chest mounted rebreathers, including five new units for your shopping enjoyment. So, get out your Pre-Buy Checklist, and that Gift Card (you do have a gift card don’t you?!?), and buy the breather of your dreams. Ho, ho, hose!
by Michael Menduno, Amanda White and Kenzie Potter. Holiday images by Jason Brown, BARDO CREATIVE.
A Guide to Backmount, Sidemount and Frontmount Rebreathers
6 Dec 2023 – Ho ho ho! InDEPTH’s Holiday Rebreather Guide continues to pick up steam (machines). This season we added Mares Horizon semi closed rebreather and Lombardi Undersea Research’s new RD1 back mounted oxygen rebreather. We also added Lungfish Dive Systems “Lungfish,” And iQSub Technologies’ new FX-CCR front mounted breather along with the Flex2 sidemount CCR. As such we believe the Guide is the most complete one on the market! Pst, pst Mr. Scammahorn, are you still there? Happy shopping divers! Ho ho hose!
Remember you can find all of the Rebreather Forum 4 presentations here on GUE.tv: REBREATHER FORUM 4
1 Dec 2022 – Ho ho ho! Once again, we have updated InDEPTH’s Holiday Rebreather Guide adding two new rebreathers; the new Gemini sidemount, needle valve mCCR from Fathom Systems, and the Generic Breathing Machine (GBM) front mounted, needle valve mCCR, with a dive computer-compatible, solid state oxygen sensor from Scubatron. We also updated the features on the Divesoft Liberty sidemount, and the JJ-CCR. This year, Vobster Marine Systems was acquired by UK-based NAMMU Tech, which plans to rename and re-issue a version of the VMS Redbare. See link below.
Finally, Innerspace Systems’ founder Leon Scamahorn agreed to work on getting us the needed information to add the storied Megalodon to the Guide. Scratch last year’s coal, Xmas cookies for you Mr. Scamahorn! Happy holidays shoppers, here is our updated rebreather guide! Mind those PO2s!
17 Dec 2021 – Ho Ho Ho! We have updated our Holiday Rebreather Guide with new rebreathers and updated features. Despite repeated requests, the only major closed circuit rebreather we are missing is Innerspace Systems’ Megalodon and its siblings. Tsk, tsk Leon Scamahorn, you’ve been a naughty boy! Behold, here is our updated guide. Mind those PO2s!
Sport diving rebreathers have come a long way since storied explorer Bill Stone trialed his 80 kg/176lb fully-redundant “Failsafe Rebreather For Exploration Diving” (F.R.E.D.), and spent a cool 24-hours underwater as part of his paradigm-shifting 1987 Wakulla Springs Project. In retrospect, looking back over the last 30-some years, the “Technical Diving Revolution,” which emerged in the late 1980s to late 1990s, was ultimately about the development and adoption of rebreather technology.
However, it took the fledgling tech community at least a decade to adapt mixed gas technology for open circuit scuba, including establishing the necessary supporting infrastructure, which was the first and necessary step in the move to rebreathers. A little more than a decade after Stone showcased FRED, British diving entrepreneur Martin Parker, managing director of then AP Valves, launched the “Buddy Inspiration,” the first production closed circuit rebreather designed specifically for sport divers, earning him the moniker, the “Henry Ford of Rebreathers.” [The brand name later became AP Diving] KISS Rebreathers followed a little more than a year later with its mechanical, closed circuit unit, now dubbed the KISS Classic. The rest as they say, is history, our history.
Today, though open-circuit mixed gas diving is still an important platform, rebreathers have become the tool of choice for deep, and long exploration dives. For good reason, with a greatly extended gas supply, near optimal decompression, thermal and weight advantages, bubble-free silence, and let’s not forget the cool factor, rebreathers enable tech divers to greatly extend their underwater envelope beyond the reach of open circuit technology.
As a result, divers now have an abundance of rebreather brands to choose from. Accordingly, we thought it fitting this holiday season to offer up this geeky guide for rebreather shoppers. Want to find out whose breathers are naughty or nice? Here is your chance.
Your Geeky Holiday Guide
The idea for this holiday guide was originally proposed to us by Divesoft’s U.S. General Manager Matěj Fischer. Thank you Matěj! Interestingly, it doesn’t appear to have been done before. Our goal was to include all major brands of closed circuit rebreathers in back mount and sidemount configuration in order to enable shoppers to make a detailed comparison. In that we have largely succeeded. We also included Halcyon Dive Systems’ semi-closed RB80 and more recent RBK sidemount unit, which are both being used successfully as exploration tools.
Absent are US-based Innerspace Systems, which makes the Megalodon and other models, as well as Submatix, based in Germany, which manufactures the Quantum and sidemount SMS 200, neither of which returned our communications. M3S, which makes the Titan, declined our invitation to participate, as they recently discontinued their TITAN CCR—they will be coming out with a replacement unit, the TITAN Phoenix CCR in the near future. We did not include the MARES Horizon, a semi-closed circuit rebreather that is aimed at recreational divers. No doubt, there may be brands we inadvertently missed. Our apologies. Contact us. We can update.
Update (22 Jul 2021) – French rebreather manufacturer M3S contacted us and sent us the specs for their updated chest-mounted Triton CCR, which are now included in the guide.
Update (9 Dec 2020) – Submatix contacted us and the Guide now contains their Quantum (back mount) and SMS 200 (sidemount) rebreathers. We were also contacted by Open Safety Equipment Ltd. and have added their Apocalypse back mounted mechanical closed circuit rebreather. We will add other units as they are presented to us by the vendors.
It’s The Concept, Stupid
The plan was to focus on the feature sets of the various rebreathers to provide an objective means to compare various units. But features by themselves do not a rebreather make. As Pieter Decoene, Operations Manager at rEvo Rebreathers, pointed out to me early on, every rebreather is based on “a concept,” that is more than just the sum of its features. That is to say that the inventors focused on specific problems or issues they deemed important in their designs; think rEvo’s dual scrubbers, Divesoft’s redundant electronics, or integration of open and closed circuit in the case of Dive Rite’s recently launched O2ptima Chest Mount. Shoppers, please consider that as you peruse the various offerings. My thanks to Pieter, who helped us identify and define key features and metrics that should be considered.
Though not every unit on the market has been third-party tested according to Conformitè Europëenne (CE) used for goods sold in the European Union, we decided to use CE test results for some of the common feature benchmarks such as the Work of Breathing (WOB), and scrubber duration. For vendors that do not have CE testing, we suggested that they use the figures that they publicize in their marketing materials and asked that they specify the source of the data if possible. As such, the guide serves as an imperfect comparison, but a comparison nonetheless.
Also, don’t be misled by single figures, like work of breathing or scrubber duration as they serve only as a kind of benchmark—there is typically a lot more behind them. For example, whether a rebreather is easy to breathe or not is a function of elastance, work of breathing (WOB) and hydrostatic imbalance. In order to pass CE, the unit must meet CE test requirements for all three issues in all positions from head down, to horizontal trim, to being in vertical position (Watch that trim!), to lying on your back looking upwards. It’s more difficult to pass the tests in some positions versus others, and some units do better in some positions than others.
The result is that some of the feature data, like WOB, is more nuanced than it appears at first glance. “The problem you have is people take one value (work of breathing for instance) and then buy the product based on that, but it just isn’t that simple an issue,” Martin Parker explained to me. “It’s like people buying a BCD based on the buoyancy; bigger is better, right? Wrong! It’s the ability of the BCD to hold air near your centre of gravity determines how the BC performs. With rebreathers you can have good work of breathing on a breathing machine only to find it completely ruined by it’s hydrostatic imbalance or elastance.”
Due to their design, sidemount rebreathers are generally not able to pass CE requirements in all positions. Consequently, almost all currently do not have CE certification; the T-Reb has a CE certification with exceptions. However, that does not necessarily mean that the units haven’t been third-party tested.
Note that the guide, which is organized alphabetically by manufacturer, contains the deets for each of their featured models. In addition, there are two master downloadable spreadsheets, one for back mounted units and one for sidemount. Lastly, I’d also like to give a shout out to British photog phenom Jason Brown and the BARDOCreative Team (Thank you Georgina!), for helping us inject a bit of the Xmas cheer into this geeky tech tome [For insiders: this was Rufus and Rey’s modeling debut!]. Ho, ho, hose!
With this background and requisite caveats, we are pleased to offer you our Rebreather Holiday Shoppers’ Guide. Happy Holidays!!
Note – Most prices shown below were specified by manufacturer before tax.
Backmount Rebreathers
**Typical scrubber duration using AP Tempstik increases practical duration to more than double CE test rate figures – as the AP Tempstik shows scrubber life based on actual work rate, water temperature and depth.
*** The work of breathing is the effort required to push gas around the breathing circuit BUT that figure alone is meaningless without knowing two other parameters: Hydrostatic load and elastance. Note that AP Diving rebreathers meet the CE requirements in all diver attitudes for both Hydrostatic Imbalance 0 degrees (horizontal, face down) and Hydrostatic Imbalance +90 degrees (vertical, head up.)
**** APD’s handset offers a “dual display” feature showing data from both controllers on the same handset. The user can also see the gradient factors chosen and the mVolt outputs of the cells by holding a button down.
**For CE certification the recommended Apocalypse Type IV CCR scrubber duration is 2hr 45min to a maximum dive profile surface to surface of 100m in 4’C water to 2.0% SEV (20mb) at the mouth.
***iCCR (2009) 3x digital galvanic coax, iCCR (2021) x2 galvanic 1x solid state
****All performance data near near identical to single scrubber option other than increased scrubber duration of up to 5 hrs to 100 m profile in 4’C water)
Published Testing: https://www.opensafetyglobal.com/Safety_files/DV_OR_ScrubberEndurance_Retest_SRB_101215 .pdf https://www.opensafetyglobal.com/Safety_files/DV_OR_WOB_Respiratory_C1_101111.pdf https://www.opensafetyglobal.com/Safety_files/DV_DLOR_HydroImbal_101116.pdf
(FMECA) https://www.deeplife.co.uk/or_fmeca.php
** 40 m coldwater EN14143
*** Backmounted Trimix 10/70, 40M test: Backmounted Air
**** SE7EN+ Sport EU incl (harness, wing, computer, cylinders and sensors)
Note – Vobster Marine Systems were acquired by UK-based NAMMU Tech, which plans to rename and re-issue a version of the VMS Redbare (formerly the Sentinel) at some point in the future. See: Atlas CCR
Sidemount Rebreathers
Frontmount Rebreathers
**Tested with standard DSV, 45° head up/feet down orientation, 40 m depth, 40.0 lpm RMV, Air diluent
*** Micropore ExtendAir Cartridge:
180 liters of CO2 @ < 50 deg F [<10 C] (130 minutes @1.35lpm CO2)
240 liters of CO2 @ 50-70 deg F [10-20C] (180 minutes @ 1.35lpm CO2)
300 liters of CO2 @ >70 deg F [>20C] (220 minutes @ 1.35lpm CO2)
Test Parameters: 40 lpm RMV 1.35 lpm CO2130 fsw (40 m) depth Granular duration may be similar, but can vary greatly depending upon the type of granular and packing technique
Download our two master spreadsheets, one for back mounted units and one for sidemount to compare rebreathers.
Special thanks to Amy LaSalle at GUE HQ for her help assembling the feature spreadsheets.
Michael Menduno is InDepth’s editor-in-chief and an award-winning reporter and technologist who has written about diving and diving technology for 30 years. He coined the term “technical diving.” His magazine aquaCORPS: The Journal for Technical Diving (1990-1996), helped usher tech diving into mainstream sports diving. He also produced the first Tek, EUROTek, and ASIATek conferences, and organized Rebreather Forums 1.0 and 2.0. Michael received the OZTEKMedia Excellence Award in 2011, the EUROTek Lifetime Achievement Award in 2012, and the TEKDive USA Media Award in 2018. In addition to his responsibilities at InDepth, Menduno is a contributing editor for DAN Europe’s Alert Diver magazine and X-Ray Magazine, a staff writer for DeeperBlue.com, and is on the board of the Historical Diving Society (USA)
Amanda White is the managing editor for InDepth. Her main passion in life is protecting the environment. Whether that means working to minimize her own footprint or working on a broader scale to protect wildlife, the oceans, and other bodies of water. She received her GUE Recreational Level 1 certificate in November 2016 and is ecstatic to begin her scuba diving journey. Amanda was a volunteer for Project Baseline for over a year as the communications lead during Baseline Explorer missions. Now she manages communication between Project Baseline and the public and works as the content and marketing manager for GUE. Amanda holds a Bachelor’s degree in Journalism, with an emphasis in Strategic Communications from the University of Nevada, Reno.
Kenzie Potter Stephens is a production artist for InDepth as well as part of the GUE marketing team. She earned her BS degree in Industrial Engineering and Marketing at the Karlsruhe Institute of Technology (KIT) in Germany, which assists her in using her multicultural upbringing to foster international growth within the community. In addition to her activities as a yoga teacher and an underwater rugby trainer, she has completed her GUE Tech 1 and Cave 1 training and is on her way to becoming a GUE instructor. Not letting any grass grow under her feet, she has also taken on a second major in biochemistry in order to create a deeper understanding of our planet’s unique ecosystems as well as the effect of diving on human physiology.
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