Institute of Underwater and Hyperbaric Medicine
 

Treatment of Diving Emergencies

    

Background

Diving activitites has increased tremendously in Malaysia due to the growth of marine-based industries (e.g. offshore petroleum), and marine tourism in Malaysia. This rapid increase in diving activity has resulted in an increasing numbers of diving injuries reported in recent years. The Royal Malaysian Navy has also recently increased its diving capabilities with the acquisition of new equipment and techniques (e.g. helium-oxygen diving and wet-bell diving system).
 
The Institute of Underwater and Hyperbaric Medicine (IUHM) at Armed Forces Hospital Lumut was established on 1st November 1996 to support the medical needs of military, commercial and recreational diving. This hospital-based recompression facility utilises a 3-compartment multiplace recompression chamber and is staffed by 2 diving physicians and 10 paramedics trained in underwater medicine. Up to 2006, more than 200 divers have been treated at IUHM.
   
 

Diving Injuries and Illnesses

Due to the pressure changes and the aquatic environment, diving may cause diseases which are unique and different than non-divers. Examples of these:

  • Decompression Sickness
  • Arterial Gas Embolism
  • Barotrauma
  • Dysbaric Osteonecrosis
  • Nitrogen Narcosis
  • Oxygen Toxicity
  • Hypoxia, Carbon Dioxide Toxicity and Breathing Gas Contamination
  • Drowning
  • Stings, Bites and Poisoning from Dangerous Marine Animals

Decompression Illness

During a dive, nitrogen from the compressed air that the diver breathes is dissolved into the blood and body tissues in accordance to Henry’s law. When the diver returns to the surface, nitrogen may come out of solution in the form of bubbles, due to the high gradient between the partial pressures of the nitrogen in the tissues and the environment.

The manifestations of DCS depend on the organs or tissues affected by bubble formation. The commonest presentations of DCS are generalized symptoms of weakness, tiredness, apathy and malaise. Musculoskeletal symptoms presents with pain, and limitation of movement of the affected joint. Neurological DCS presentations are varied with involvement of the cerebral, cerebellar, inner ear, vision and peripheral nerves. DCS may also present with cardiorespiratory and cutaneous involvement.

More recently, an umbrella term ‘acute decompression illness’ (DCI) is used for both DCS and Cerebral Arterial Gas Embolism (CAGE), as their presentation and treatment is similar.

Recompression treatment is the definitive treatment of both DCS and CAGE. Delay increases both morbidity and mortality. The increase in pressure during treatment reduces the bubble size (Boyle’s law), while oxygen hastens bubble resolution by enhancing the diffusion gradient between the bubble and its surroundings.

    

Malaysian Diving Emergency Hotline (05 - 930 4114)
Diving is frequently done at remote locations with limited medical facilities. During an emergency, divers frequently do not know where or how to get treatment, evacuation methods, the need for recompression therapy, locations of recompression chambers etc. Sometimes local doctors are unsure of appropriate initial treatment prior to evacuation and recompression therapy.

The Malaysian Diving Emergency Hotline was initiated by IUHM and Divers Alert Network (DAN) in order to facilitate diver evacuation and treatment. The 24-hour hotline allows divers and doctors to get advice on how to manage diving illnesses and also to facilitate the quickest and most appropriate way of getting to a recompression facility.

    
   

For Diving Emergencies contact
Malaysian Diving Emergency Hotline:
+605 - 681 9485 (24 hours)

 
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