Sight Search

Getting Decompression Sickness while Freediving

TEXT By Andrew Khvetkevich

Getting Decrompression sickness (DCS) while freediving is uncommon. Unlike when breathing compressed gas, freedivers typically do not accumulate enough nitrogen to provoke DCS. Over the past few years only a few cases of DCS during freediving have been reported, and they all were associated with repeated deep dives over a short time. Since there is little information, statistics or research about DCS occurring while freediving, most freedivers pay little attention to the problem. Until recently, I did not take seriously the possibility of DCS happening to me.

During 2019 I dedicated myself to training and participating in freediving competitions, and I set several U.S. national records. The season was intense, and I hoped to set three more records that fall at the last competition of the year in Indonesia, where I planned to dive to 328 feet (100 meters) using bifins.
Arriving in advance, I had enough time for my usual one or two days of training followed by a rest day. Five days before the competition I planned three challenging dives without a day of rest, which was a mistake.

To give myself confidence, I wanted to repeat my current record dives in training. The three-day plan was to freedive to 325 feet (99 meters) using bifins, 233 feet (71 meters) without fins and 312 feet (95 meters) pulling the rope, and then have two days of rest before the competition. Everything went according to plan, but after the third day I began to feel weird.

I failed my surface protocol by showing the OK sign and saying, “I am OK” after 22 seconds, when the time allowed is 15 seconds. The delay occurred because I was hypoxic, meaning that my body had inadequate oxygen. After getting to the platform, I felt weak and immediately began to breathe oxygen, which is a routine practice after a deep dive. The doctor noticed that something was  wrong and told me to continue breathing the oxygen for about 30 minutes instead of the usual five minutes.

I returned to shore, where my pulse, blood pressure and oxygen saturation levels were checked and found to be a bit off but still within normal limits. I felt tired and returned to my hotel, where I soon noticed numbness and tingling in the entire left side of my body and the thumb and forefinger of my right hand. I didn’t know much about DCS and didn’t understand the seriousness of the situation, so I decided to try to sleep it off, but the weird sensations did not disappear with rest.

While showering a little later, I noticed that the left side of my body did not recognize the water temperature. The next morning, my left hand stopped
tingling, and the numbness subsided, so I decided to sleep all day, expecting
that all the symptoms would soon pass. But my symptoms remained the same the following morning. Understanding that I wouldn’t be able to compete now, I told the organizer about my problem.

The symptoms indicated DCS, which meant that I needed to start a hyperbaric chamber treatment as soon as possible. I have DAN® insurance, so the competition’s organizers immediately contacted DAN. No evacuation could happen that day since the local airport closed at 5 p.m., so I would depart the next morning.

An ambulance took me straight from the hotel to the airport, and I was on a plane 72 hours after my dive. The aircraft was a private medical jet, and the staff and pilots understood that I had DCS, so the plane flew at the lowest possible altitude. During the flight they monitored my oxygen saturation, and
the medical staff was ready to provide oxygen if needed. The flight and
transportation to the Kuala Lumpur hospital took about three hours. About 80 hours after my symptoms began, I was in a hyperbaric chamber in Kuala Lumpur. Now I know that if DCS symptoms appear, it is critical to start a chamber treatment as soon as possible.

I spent nine days in the Management and Science University Medical Centre in Kuala Lumpur, and during that time I had six sessions in a hyperbaric chamber for a total of 23 hours and 32 minutes of treatment. I felt better after each session, and by the end of the sixth session my symptoms had almost disappeared.

After I returned home, my symptoms worsened, and I called DAN again. I received five more sessions in the chamber at Mercy Hospital in Miami, Florida. My symptoms have almost disappeared again, and the doctors expect the symptoms will be gone within three months. I spent a total of 47 hours and 17 minutes in hyperbaric chambers over 11 sessions, and if I did not have DAN dive accident insurance, the medical bills would have been more than $20,000.

Now that I better understand the risks of developing DCS while freediving, I intend to be more careful by doing the following:
  • not diving to my maximum depth for more than two days in a row
  • taking as many rest days as necessary to fully recover between deep dives
  • avoiding repeated dives to my maximum depth on the same day
  • not taking a static breath-hold at a depth several times in a row
  • not doing any depth freediving after scuba diving or any deep dives after static training or consuming recovery oxygen underwater
  • breathing oxygen for five minutes at a depth of 16 feet (5 meters) after any dive deeper than 197 feet (60 meters) to dissolve the accumulated nitrogen in the tissues.

Full lung packing leads to injuries associated with the rupture of lung tissue. I can fully pack my lungs with 25 extra breaths, but during deep dives I take 20 breaths to leave about 20 percent less than my maximum free for extra safety. Remember that for recreational freediving, lung packing is not necessary, and you must have specialized training to pack the lungs.
I learned that I should immediately call DAN when DCS symptoms appear, because the probability of a full recovery depends on how quickly you get your first hyperbaric treatment. I can rely on DAN for valuable help with evacuation, travel and dive-related medical expenses — and you can, too.

Article from Alert Diver Magazin 1st Quarter, 2020


immersion and bubble formation Accidents Acid reflux Acute ailments After anaesthesia Air Quality Air exchange centre Air hose failure Airway control Air Alert Diver Magazine Alternative gas mix Altitude changes Altitude sickness Aluminium Oxide Ama divers Amino acids Anaerobic Metabolism Annual renewal Apnea Apnoea Archaeology Arterial gas embolism Arthroscopic surgery Aspirin Aurel hygiene BCD BHP BLS BWARF Back adjustment Back pain Back treatment Backextensors Badages Bag valve mask Bahamas Balancing Bandaids Barbell back squat Barometric pressure Barotrauma Basic Life Support Batteries Bench press Benign prostate hyperplasia Beth Neale Black Blood flow Blood thinners Blue Wilderness Blurred vision Boat safety Bone fractures Bouyancy compensators Boyle's Law Boyle\'s Law Bradycardia Brain Breast Cancer Breath Hold Diving Breath holding Breath hold Breath-hold Breathing Gas Breathing gas contamination Breathing Breathold diving Broken bones Bruising Bubbleformation Buddy Exercise Buddy checks Buoyancy Burnshield CGASA CMAS CO2 COVID-19 COVID CPR Cabin pressure Caissons diseas Camera settings Cancer Remission Cancer treatments Cancer Cannabis and diving Cannabis Cape Town Dive Festival Cape Town CapeTown Carbon Monoxide Carbon dioxide Cardio health Cardiological Cardiomyopathy Chamber Safety Chamber science Charging batteries Charles' Law Charles\' Law Charles\\\' Law Charles\\\\\\\' Law Charles\\\\\\\\\\\\\\\' Law Charlie Warland Chemotherapy Chest compressions Chiropractic Chlorophll Citizen Conservation Cleaning products Coastalexcursion Cold Water Cold care ColdWater Cold Commercial diving Commercial schools Compressed Air Compressed gas Consercation Conservation Contaminants Contaminated air Coral Conservation Coral Reefs Coral bleaching Corals Core strength Corona virus Courtactions Crohns disease Crowns Crystal build up Crystallizing hoses Cutaneous decompression DAN Courses DAN Profile DAN Researchers DAN medics DAN members DAN report DCI DCS Decompressions sickness DCS theories DCS DEMP DM training DNA DReams Dalton's Law Dalton\'s Law Dalton\\\'s Law Dalton\\\\\\\'s Law Dalton\\\\\\\\\\\\\\\'s Law Danel Wenzel Dauin island Dean's Blue Hole Deco dives Decompression Illness Decompression Sickness Decompression Stress Decompression illsnes Decompression treatment Decompression Deep diving Deep water exploration Delayed Offgassing Dental Diaphragms Diseases Dive Chamber Dive Computer Dive Destinations Dive H Dive Industry Dive Instruction Dive Instructor Dive Medical Form Dive Medical Dive Pros Dive Research Dive South Africa Dive Training Dive Travel Dive accidents Dive buddies Dive computers Dive excursions Dive fitness Dive gear Dive heallth Dive health Dive medicines Dive medicine Dive operators Dive planning Dive safety Dive safe Dive staff DiveLIVE Diveleader training Diveleaders Diver Health Diver Profile Diver infliencers Diver on surface Divers Alert Diving Divas Diving Kids Diving Trauma Diving career Diving emergencies Diving emergency management Diving fit Diving guidelines Diving injuries Diving suspended Diving Dizziness Dolphins Domestic Donation Dowels Dr Rob Schneider Drysuit diving Drysuit valves Drysuits Dyperbaric medicines EAPs EAP Ear pressure Ear wax Ears injuries Eco friendly Education Electronic Emergency action planning Emergency decompression Emergency plans Emergency underwater Oxygen Recompression Emergency Enviromental Protection Environmental factors Environmental impact Environmental managment Equalisation Equipment care Evacuations Evacuation Evaluations Even Breath Exercise Exhaustion Extended divetime Extinguisher Extreme treatments Eye injuries FAQ Factor V Leiden Failures Fatigue Faulty equipment Female divers Fillings Fire Coral Fire Safety Firefighting First Aid Equipment First Aid Kit First Aid Training First Aid kits Fish Identification Fish Fitness Training Fitness to dive Fitness Flying Fractures Francois Burman Fredive Free Student cover Free diving Free flow Freedive INstructor Freedive Training Freediver Freediving performance Freediving Gas Density Gas consumption Gas laws Gas mixes GasPerformance Gases Gastoeusophagus Gastric bypass Gastroenterologist Gear Servicing Gordon Hiles Great White Sharks Gutt irritations HCV HELP HIRA HMS Britanica Haemorhoid treatment Hazard Description Hazardous Marine life Hazardous marinelife Health practitioner Heart Attack Heart Health Heart Rate monitor Heart rates Heart rate Heart Heat stress Helium Hepatitis C Hepatitus B High temperatures Hip strength Hip surgery Hippocampus History Hot Humans Hydrate Hydration Hydrogen Hydroids Hydrostatic pressure Hyperbaric Chamber Hyperbaric research Hyperbarics Hypothermia Hypoxia IdentiFin Immersion Immine systems In Water Recompression Indemnity form Indian Ocean Indonesia Inert gas Infections Infra red Imaging Injections Instinct Instruction Instructors Insurance Integrated Physiology International travel International Interval training Irritation Joint pain Junior Open Water Diver KZN South Coast Kidneys Kids scubadiver KwaZulu Natal Labour laws Laryngospasm Lauren Arthur Learning to dive Legal advice Legislation Leukemis Liability Risks Liability releases Liability Life expectancy Lifestyle Lightroom editing Live aboard diving Liver Toxicity Liver diseas Low blood pressure Low pressure deterioration Low volume masks Lung Irritation Lung function Lung injuries Lung squeeze Lung surgery Lung MOD Maintenance Malaria Mammalian Dive Response Mammalian effect Marine Biology Marine Scientists Marine conservation Marine parks Marinelife Masks Master scuba diver Maximum operating depth Medical Q Medical emergencies Medical questionaire Medical statement Medication Mehgan Heaney-Grier Mermaid Danii Mesophotic Middle ear pressure Mike Bartick Military front press Mixed Gas Mono Fins Mooring lines More pressure Motion sickness Mozambique Muscle pain Mycobacterium marinum Nausea Nautilus Neck pain Neurological assessments Nitrogen Narcosis Nitrogen build up Nitrox No-decompression Non-rebreather Mask Normal Air Nosebleeds O2 providers O2 servicing OOxygen maintenance Ocean Research Ocean pollution Oil contamination Open water divers Orbital implants Oronasal mask Osteonecrosis Out and about Outreach Oxygen Cylinder Oxygen Units Oxygen deficit Oxygen deicit Oxygen dificiency Oxygen ears Oxygen equipment Oxygen masks Oxygen supply Oxygen therapy Oxygen P J Prinsloo PFI PJP Tech Part 3 Partner Training Philippine Islands Philippines Phillipines Photography Physioball Physiology Physiotherapy Pills Pistons Planning Plastic Pneumonia Pneumothorax Poison Pollution Pool Diving Post-dive Pre-dive Predive check Preparation Prepared diver Press Release Professional rights Provider course Psycological Pulmanologist Pulmonary Bleb Pulmonary Edema Pulse Punture wounds Pure Apnea Purge RAID South Africa RCAP REEF Radio communications Range of motion Rashes Rebreather diving Rechargeable batteries. Recompression chamber Recompression treatment Recompression Recycle Reef Conservation Reef surveyors Regulator failure Regulators Regulator Remote areas Renewable Report incidents Rescue Procedure Rescue breathing Rescue breaths Rescue training Rescue Resume diving Return to diving Risk Assessments Risk assesments Risk assessment Risk elements Risk management SABS 019 SafariLive Safety Stop Safety SaherSafe Barrier Salty Wanderer Sanitising Sara Andreotti Saturation Diving Save our seas Science Scombroid Poisoning Scuba Air Quality Scuba Injury Scuba Instructor Scuba children Scuba dive Scuba health Scubalearners Sea Horses Sealife Shark Protection Shark Research Shark conservation Shark diving Sharks Shoulder strength Sideplank Signs and Symptoms Sit-ups Skin Bends Skin outbreak Skin rash Snorkeling Snorkels Social Distancing Sodwana Bay Solomon Islands South Africa Spinal pain Splits Squeezes Stability exercise Standars Stay Fit Stents Step ups Stepping up Stroke Submerged Sudafed Sulawesi Supplemental oxygen Surface supplied Air Surfaced Surgeries Surgery Suspension training TRavel safety Tabata protocol Talya Davidoff Tattoes Technical Diving The Bends The truth Thermal Notions Tides Tips and trick Tooth squeeze Transplants Travel smarter Travel tips Travel Tropical Coastal Management Tunnelling Tweezers Ultrsound Umkomaas Unconsciousness Underground work Underwater hockey Underwater photographer Underwater photography Underwater pho University of Stellenbosch Urinary retention. Vaccines Vagus nerve Valsalva manoeuvers Vape Vaping Vasopressors Vasvagal Syncope Venting Virus infections Volatile fuels Washout treatments Wastewater Watchman device Water Resistance Water Weakness Weigang Xu Weights West Papua Wet diving bell Wetsuit fitting Wetsuits White balance Wide angles Winter Woman in diving Woman Women In Diving SA Women in diving Work of Breathing Workout Wound dressings Wreck divers Wreck dive Wreckdiving Wrecks Yoga Youth diver Zandile Ndholvu Zoology abrasion acoustic neuroma excision air-cushioned alert diver altitude anemia antibiotics anticoagulants antiseptics bandages barodontalgia bent-over barbell rows bioassays body art breathing air calories burn carbon dioxide toxicity cardiovascular cerebrospinal fluid checklist chemo port child clearances closed circuit scuba currents cuts dead lift decompression algorithms decongestants decongestion dehydration dive injuries dive medicing dive ready child dive reflex dive tribe diver in distress diver rescue diver training dive diving attraction doctors domestic travel dri-suits drowning dry mucous membranes dry suits dry e-cigarettes ear spaces elearning electrolyte imbalance electroytes emergency action plans emergency assessment equalising equalizing exposure injuries eyes fEMAL DIVERS fire rescue fitnes flexible tubing frediving freedivers gas bubble gas poisoning gastric acid gene expression health heartburn histidine hospital humidity immersion and bubble formation immersion pulmonary edema (IPE jaundice join DAN knee longevity lower stress malaise marine pathogens medical issues medical procedures medical risk assesment medications mental challenge micro-organisims minor illness mucous membranes nasal steroids nasal near drowning nematocysts neurological newdivers nitrogen bubbles off-gassed operating theatre operations orthopeadic outgas pain perforation phillippines physical challenges pinched nerves plasters polyester-TPU polyether-TPU post dive posture preserve prevention psychoactive pulmunary barotrauma rebreather mask rebreathers retinal detachment risk areas safety stops saturation scissors scuba equipment scuba single use sinus infections smoking snorkeling. spearfishing sterilising stings strength sub-aquatic swimmers ears tattoo care tecnical diver thermal protection toxicity training trimix unified standards vision impaired warmers water quality