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Diving Hyperb Med. 2018 Mar 31;48(1):45-55. doi: 10.28920/dhm48.1.45-55.

Pre-hospital management of decompression illness: expert review of key principles and controversies.

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Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Department of Anaesthesiology, School of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand,
University of New South Wales, Sydney, Australia.
International SOS, Aberdeen, United Kingdom.
Joint Trauma System, Defence Center of Excellence for Trauma, San Antonio, USA.
University of Auckland, Auckland.
Virginia Mason Medical Centre, Seattle, USA.
National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Poland.
ORPHY Laboratory EA4324, Université de Bretagne Occidentale, Brest, France.


Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled "Management of mild or marginal decompression illness in remote locations". A contemporary review was initiated by the Diver's Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; first aid strategies for DCI; remote triage of possible DCI victims by diving medicine experts; evacuation of DCI victims; effect of delay to recompression in DCI; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Meeting, discussion by registrants at that workshop and finally several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis on resolving controversies around the definition of "mild DCI" arising over 12 years of practical application of the 2004 workshop's findings, and on the controversial issue of in-water recompression. The guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication.


Arterial gas embolism; Decompression sickness; First aid; In-water recompression (IWR); Recompression; Remote locations; Transport


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