Return to Diving After DCI

I was recently treated for decompression illness (DCI) after two days of diving. On my last diving day, two of my dives went to 40-50 feet / 12-15 meters for no longer than 35 minutes each. Minimum surface interval between dives was one and a half hours between the first two dives, and three hours before my final dive to 80 feet / 24 meters. During the ascent of my final dive, my weight belt came off, and I had a rapid ascent from 45 feet. I ended my dive at 8:45 p.m. At around 10 the next morning, I experienced pain that moved down my arm to my elbow, followed by numbness and tingling. I knew these were symptoms of DCI, and I was evaluated and treated that afternoon. My symptoms have completely resolved except for a soreness, like a bruise, in my elbow. I want to return to diving after I see my local physician.

What is the current recommendation for returning to diving after experiencing DCI?

One of the most difficult things divers face is admitting that symptoms they experience may be a result of DCI. You did the right thing in seeking immediate evaluation and treatment.

Divers often adopt a “wait and see” attitude before they accept the reality of decompression illness. In some cases, this delay in treatment can affect the outcome. In the most recent DAN Report on Decompression Illness and Diving Fatalities: Year 2000 Edition, 50 percent of the injured divers analyzed received treatment within the first 20 hours they experienced symptoms. Several hundred DAN members are treated for DCI each year.

Regarding the return to diving after DCI, advice varies: it depends upon the specific symptoms a diver experiences, as well as their duration. Only 70 percent of injured divers experience an immediate and complete recovery; 30 percent will continue to experience either partial or temporary relief, from a few days to several weeks after treatment.

The response to treatment depends upon the severity of symptoms and the delay to recompression. The majority of mild residual symptoms, which are often due to inflammation, will resolve over a few days to a few weeks after an accident. Occasionally, persistent pain can be due to a bone infarct (i.e., a blood vessel that supplies a portion of the bone is occluded). If a portion of the joint is involved, then further diving is usually not recommended.

Although United States Navy “return to diving” policy was not written for recreational divers, it does give us the following guidelines to consider (specific Navy policy recommendations are in quotes):

1. “Divers with uncomplicated, pain-only DCI cases and whose symptoms resolve completely after 10 minutes breathing oxygen at 60 feet / 18 meters can return to diving after 48 hours of being symptom-free.” This is probably a little too aggressive for recreational diving. Two to four symptom-free weeks is usually recommended for recreational divers.
2. “In uncomplicated pain-only DCI, divers who have had a completely normal neurological exam prior to recompression and whose symptoms took longer than 10 minutes to resolve, the Navy allows a two-week wait before a return to diving.” This may be too soon for recreational divers, who may return to multiday repetitive diving. A minimum wait of four weeks is a more conservative option.
3. “If divers have had cardiorespiratory or neurological symptoms such as weakness or numbness, the Navy recommends a four-week waiting period.” A six-week symptom-free minimum wait may be more appropriate for recreational divers.
4. “In more complicated DCI cases, in which symptoms seem to resist treatment or in which long treatment tables such as Table 4 or Table 7 are required, the Navy requires a minimum of a three-month layoff from diving. Diving may resume only after a thorough review by a Diving Medical Officer.” For recreational divers who experience DCI this severe, giving up diving altogether may be appropriate. At any rate, recreational divers should take a six-month hiatus from diving, followed by a thorough examination by a dive physician.

For recreational divers who want to dive after experiencing DCI, here is the best advice:
Wait until you have been free of symptoms for four weeks;

• Seek evaluation by a physician to determine whether there is some predisposition to decompression illness.
• Remember, you’re diving for fun and recreation - practice safe guidelines so you can enjoy it for many years to come.

With reports by Dr. Ed Thalmann