Dive_Man_ChangeA

Navy Diving Manual
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CHAPTER 21 — Recompression Therapy Change A 21-29 21-6.3 Inside Tenders. Treatment table profiles place the inside tender(s) at risk for decompression sickness. After completing treatments, inside tenders should remain in the vicinity of the recompression chamber for 1 hour. If they were tending for Treatment Table 4, 7, or 8, inside tenders should also remain within 60 minutes of a recompression facility for 24 hours. 21-6.4 Flying After Treatments. Patients with residual symptoms should fly only with the concurrence of a Diving Medical Officer. Patients who have been treated for decompression sickness or arterial gas embolism and have complete relief should not fly for 72 hours after treatment, at a minimum. 21-6.4.1 Emergency Air Evacuation. Some patients will require air evacuation to another treatment or medical facility immediately after surfacing from a treatment. They will not meet surface interval requirements as described above. Such evacuation is done only on the recommendation of a Diving Medical Officer. Aircraft pressur- ized to one ata should be used if possible, or unpressurized aircraft flown as low as safely possible (no more than 1,000 feet is preferable). Have the patient breathe 100 percent oxygen during transport, if available. 21-6.4.2 Tender Surface Interval. Tenders on Tables 5, 6, 6A, 1A, 2A, or 3 should have a 24-hour surface interval before flying. Tenders on tables 4, 7, and 8 should not fly for 72 hours. 21-6.5 Treatment of Residual Symptoms. After completion of the initial recompression treatment and after a surface interval sufficient to allow complete medical evalua- tion, additional recompression treatments may be instituted. For persistent Type II symptoms, daily treatment on Table 6 may be used, but twice-daily treatments on Treatment Tables 5 or 9 may also be used. The treatment table chosen for re-treat- ments must be based upon the patient’s medical condition and the potential for pulmonary oxygen toxicity. Patients surfacing from Treatment Table 6A with extensions, 4, 7, or 8 may have severe pulmonary oxygen toxicity and may find breathing 100 percent oxygen at 45 or 60 feet to be uncomfortable. In these cases, daily treatments at 33 feet may also be used. As many oxygen breathing periods (30 minutes on oxygen followed by 5 minutes on air) should be administered as can be tolerated by the patient. Ascent to the surface is at 20 feet per minute. A minimum oxygen breathing time is 90 minutes. A practical maximum bottom time is 3 to 4 hours at 33 feet. Treatments should not be administered on a daily basis for more than 5 days without a break of at least 1 day. These guidelines may have to be modified by the Diving Medical Officer to suit individual patient circum- stances and tolerance to oxygen as measured by decrements in the patient’s vital capacity. 21-6.5.1 Additional Recompression Treatments. Additional recompression treatments are indicated as long as they are prescribed by a Diving Medical Officer. In treating residual symptoms, no response to recompression may occur on the first one or two treatments. In these cases, the Diving Medical Officer is the best judge as to the number of treatments. Consultation with NEDU or NDSTC may be appro- priate (phone numbers are listed in paragraph 21-1.4). As the delay time between completion of initial treatment and the beginning of follow-up hyperbaric treat-

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