Dive accident insights: Malady in the Maldives

Incident report for an Australian living in India who was on a diving holiday in the Maldives, 550 dives completed over a 30-year period.

The Trip: A 6-day diving holiday.
The Dives: Five dives completed within 36 hours. All dives were between 22m and 31m and all were on air and approximately 60 min- utes in duration. On all dives the computer was set to default settings with no added conservatism, despite multiple days of planned diving at depths between 20m and 30m.

Dive Profiles
Day 1

• Dive 1: 30.6m, 55 minutes, Surface Interval (SI): 1hr 56 mins Dive 2: 30.6m, 56 minutes, SI: 5h 18mins
  
• Dive 3: 22m, 64 minutes
  

Day 2
After a surface interval of just under 13 hours

• Dive 1: 31.3m, 60 minutes, SI: 1 hr 58 mins
  
• Dive 2: 31.2m, 65 mins
  

Onset of Symptoms
Several minutes after surfacing from the second dive on Day 2, the diver experienced numbness and tingling on the right side of her body, including her arm, side and leg.

• The numbness and tingling extended to the left leg and under the right breast.
  
• The boat crew commenced oxygen first aid quickly. The symptoms partially resolved after 25-30 minutes, and fully resolved in her left leg after 60 minutes of breathing oxygen.
  
• The boat crew contacted the hyperbaric chamber on an island near Male and she was transferred there for evaluation and, if needed, further treatment.
  

Diagnosis
Decompression illness (DCI) with peripheral neurological symptoms.

Treatment
The diver underwent two recompression treatments: 25th March at 1530: Comex18 Treatment 26th March at 0730: HBO US Navy Treatment Table 5

Recovery
Thirty minutes into the first treatment the diver’s symptoms resolved, except for the abnormal skin sensation of “‘insects crawling’ on her right leg and under the right breast. After the second treatment, the chamber declared the diver fit to fly back to Mumbai after only 24-hours despite having some residual symptoms. The diver was informed about possible therapy required for symptoms presenting during the flight.

DAN AP on-call staff and the on-call DES doctor both expressed con- cern at this short period and suggested that the diver wait a mini- mum of 72 hours between treatment and flying. In fact, given that she had residual symptoms the time should have been significantly extended. The diver would have likely benefited from additional treatment. Despite DAN’s advice, the diver was determined to fly, and flew home less than 24 hours after her second treatment.

Fortunately, the diver’s symptoms did not substantially worsen on the flight, or subsequently, however, she still had a small numb patch on her leg and some residual tingling in the right leg that required additional treatments in Mumbai.

Initial Costs

• Chamber Treatment 1: US$4,500
  
• Chamber Treatment 2: US$2,500
  
• Doctor’s Fee: US$570
  

TOTAL (inclusive of GST): US$8,474.40.

After returning to Mumbai, the diver received four further chamber treatments and various other medical services. As a DAN AP Member with dive injury insurance, the costs relating to the treatment of her DCI and transportation were covered by DAN.

Incident Analysis
This diver probably worsened the outcome by flying home so soon after her initial treatments, especially with unresolved symptoms. There was also a delay of four days between the treatment in the Maldives and subsequent treatments in India.

Delays in treatment, and flying prematurely, can both result in a worsening of symptoms and/or decrease the benefits of subsequent treatments. Had she remained longer in the Maldives (with or without further care) she may not have required further treatment on return- ing home.

DCI in places such as the Maldives can be quite an issue for the diver given the remoteness of many of the dive sites and potential delays in getting to treatment. This diver was fortunate that she was able to be treated so quickly after the appearance of her symptoms; how- ever this is not always the case. Divers who choose to dive in locations such as the Maldives where the treatment may not be readily avail- able should take actions to help reduce the possible incidence of DCI. Some of these actions include:

• Adjusting the personal or altitude settings on your dive computer to increase the conservatism.
  
• Increasing surface intervals to more than two hours (particularly when diving deeper or doing multiple dives or multiple days of diving).
  
• Following the dive computer in terms of ascent rates and any stops required.
  
• Staying hydrated and well rested
  

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