Remote-location diving: The systems keeping us safe
Last updated: 28/03/2017
Yachting and diving go hand-in-hand; one lets you enjoy being on the ocean, the other lets you enjoy being in the ocean. It’s no surprise that many yacht owners and charterers look to enjoy some diving during their week or two on board, and some charter trips are even advertised as ‘yacht diving breaks’ with full-time instructors as part of the crew.
This ever-increasing trend led us to take a look at the world of diving medicine – medical treatment involving the patient breathing oxygen in a pressurised environment — and how it is becoming an increasingly important reality of remote diving in the superyacht industry.
Decompression sickness after scuba diving
You may have heard of people getting ‘the bends’ after diving; this is the informal term for decompression sickness (DCS), a syndrome caused by bubble formation and growth in the blood and other tissues, usually due to inadequate decompression – the inability of the dissolved inert gas to leave the tissues during the ascent phase.
Since bubbles can form in any body tissues, DCS can produce many symptoms, and its effects may vary from joint pains and skin rashes to paralysis, and in very rare cases, even death.
The risk of a scuba diver developing decompression sickness (DCS) is an accepted hazard associated with compressed gas diving, although DCS is actually a relatively rare occurrence, estimated to be around 1 in 10,000 dives, at least in recreational diving.
There are techniques, procedures and approaches to help mitigate the risk in recreational diving. If a diver is stricken by a severe case of DCS, and is not promptly and adequately treated, the condition could lead to permanent residual symptoms, or even disability.
Hyperbaric medicine on board yachts
Diving in remote diving locations is usually attractive due to either pristine conditions, or the remoteness itself. Under these circumstances, access to adequate hyperbaric medical facilities is rarely a realistic option. Where recompression therapy becomes a medical necessity, treatment often needs to begin within hours to be effective.
When remote diving conditions involve a likely decompression risk, the availability of an on-board recompression chamber and properly trained medical staff might be appropriate. Recompression therapy is a medical treatment, provided in a hyperbaric chamber, in which oxygen is delivered to an injured diver (who is then regarded as a medical patient) whilst being exposed to pressures, equivalent to between 9 and 18 MSW (metres sea water). In rare cases, treatment pressures could be as high as 50 MSW.
By pressurising the patient and then having them breathe pure oxygen, the size of the inert bubbles is reduced as they are dissolved back into the bloodstream. While in-water recompression (IWR) is often cited as an emergency treatment plan for remote dive operations, the reality is that this is a limited option that carries significant safety risks and logistical challenges.
The SOS Hyperlite™ system, is a portable, light-weight and compact transport chamber, that could meet the needs of smaller vessels. Twin-lock chambers are the preferred medical devices to deliver such treatments. However, such chambers require larger vessels, due to size and weight considerations.
Preparations for crew when diving remotely
Diving expeditions in remote locations are not simple to run, and even a single diving day requires several trained and qualified personnel to ensure everything runs smoothly. In addition, any medical complications need to be dealt with in an efficient manner.
Francois Burman of Divers’ Alert Network (DAN), took us through the first steps of the risk assessment and key points that must be carried out and considered before any dive:
- How deep will you be diving and what are the expected dive times, or in other words, are the dive exposures (depth/time) expected to be mild, moderate or aggressive?
- What type of diving is intended (technical, mixed gases, rebreather, scientific diving)?
- What is the expected medical and physical fitness of the divers?
- How many divers will be on board and what is the expected number of dives?
- Where will you be diving and how remote is this likely to be; both regarding the availability of emergency medical services, as well as time and distance to the next level of medical care?
- How far is it to the nearest definitive medical facility (where there is a capable hyperbaric treatment facility)?
- An injured diver is a medical patient and not just a diver. Any medical decisions must be made by a medical doctor with at least basic knowledge of diving medicine.
- Will there be a doctor on-board or available in real-time via a telecommunications link?
- Treatments may not necessarily or exclusively include recompression – again, this is a medical decision.
- There may be jurisdictional issues (diving within a sovereign country’s waters).
- These can include the practice of medicine – especially if you are going to rely on a local doctor to assist.
- Some countries require a medical doctor to be licensed in that country to be able to practice medicine – this might apply to the on-board doctor or the telemedicine doctor.
- In some countries, if you’re registered or licensed to operate a vessel under a sovereign county’s flag, then you might be exempt from this jurisdictional issue
Francois finished by offering some general but valuable advice, saying:
- “The most important aspect to consider, prior to making any decision, is whether there is a sound culture of safety on the vessel, so as to minimise any decompression injuries, other accidents or incidents.
- The vessel should have sufficient and appropriate first-aid supplies, including surface oxygen kits with sufficient oxygen supplies and any other medical support equipment used to treat divers until reaching a place of professional care. This implies that the diving support personnel need appropriate and in-date training to be able to administer basic medical support.
- And remember that DAN is available 24/7/365 anywhere in the world – be sure to keep the relevant DAN hotline number handy for the region you intend travelling to.”