Although the most-significant risk factors for decompression sickness (DCS) are dive time, depth, and ascent rate, it’s worth noting that most cases of DCS occur in divers who dived within their no-decompression limit. You don’t have to do anything wrong to get DCS. Here is an account by a DAN member who experienced symptoms after diving in Cozumel:
When we returned to the boat, I felt a sudden tingling in my right foot followed by a dull ache in my knee, as if I had just finished a long run. I assumed the worst: DCS.
When I reviewed the dive in my mind, however, that seemed impossible. I’ve done similar or more challenging dives hundreds of times. I was even diving nitrox. So I dismissed my initial concerns and continued diving.
The next day the tingling in my foot was gone, but my knee continued to be bothersome. At this point I was beginning to appreciate the old saying that the first symptom of DCS is denial.
When I returned to my hotel, I called DAN. The DAN medic patiently noted my dive profiles and symptoms and then calmly but firmly said, “You need to get to a hospital.”
By the time I arrived, DAN had already contacted them, and Dr Jorge Darío Gómez Castillo was waiting for me. He performed some balance and reflex tests.
He told me to close my eyes and hold my hands in front of me with palms up. I was sure I could do that, but I almost fell over, and he had to catch me. I finally realized how bad my condition was.
Sure enough, I had a mild case of DCS. They immediately put me on IV fluids and 100 percent oxygen and recommended a U.S. Navy Treatment Table 6 in the hyperbaric chamber. My knee pain lessened throughout the treatment.
My case of DCS was mild, but it could have easily been much worse. When I recall my dive and actions leading up to it, I draw a blank regarding what triggered the incident. There was no violation on my dive profile and no exacerbating circumstances.
The reality is that not identifying a cause should not change your response to experiencing symptoms. Dr Gomez said that 80 percent of the patients he treats for DCS were diving within safe profiles.
I should not have waited until the second day to get treatment simply because I thought it was impossible for me to have DCS.
I have two pieces of advice for my fellow divers. First, if you think you have DCS, there’s a good chance you are correct.
Just because you followed every rule and dived conservatively doesn’t mean it can’t happen to you. Follow your gut instinct and call DAN. Don’t try to rationalize your way out of making the smart choice for your health.
Second, make sure your DAN membership and dive accident insurance are current. I can’t say enough about how quickly and thoroughly DAN handled my case, helping me navigate health care in a country where the logistics would have been daunting.
Not having to be concerned about paying out of pocket for medical care was a huge load off my mind.
For an extensive range of diving health and safety information and downloadable resources, research studies, incident summaries, and free e-Learning courses, take the time to explore the DAN website.
FAQ: Decompression Sickness (DCS) Case Study
Q: Can you get decompression sickness even if you dive within safe limits?
A: Yes. Most DCS cases occur within no-decompression limits. Factors beyond depth and time can contribute, and sometimes no clear cause is identifiable.
Q: What are the early symptoms of DCS?
A: Tingling, joint pain, dizziness, or unusual fatigue may indicate DCS. In this case, knee pain and balance issues were early warning signs.
Q: What should a diver do if they suspect DCS?
A: Stop diving, breathe 100% oxygen if available, hydrate, and contact DAN or local emergency services immediately. Delaying treatment can worsen symptoms.
Q: What is the recommended treatment for DCS?
A: Most divers are treated in a hyperbaric chamber using the U.S. Navy Treatment Table 6 protocol, alongside oxygen and IV fluids.
Q: How often do divers get DCS despite following safety protocols?
A: According to Dr. Jorge Darío Gómez Castillo, around 80% of his DCS patients were diving within safe profiles.
Q: Why is DAN membership important?
A: DAN provides immediate medical support, hyperbaric coordination, and insurance coverage, which can remove financial stress during emergencies abroad.
This article was originally published in Scuba Diver Magazine
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A friend got bent on the first dive of his vacation on a liveaboard in the Bahamas. They returned to the harbor and he got treatment in a deco chamber. His DAN insurance got him and his wife med evaced at a low level to Miami for more time in a chamber. They took a train home.
When he came out of the water he couldn’t walk. Now you don’t know he ever was paralyzed. DAN came through for him.
Slow Tissue supersaturation, over several days of deep diving -even within NDL of Nitrox32- all it takes is physical exertion (kicking into a Cozumel current in this instance for example) or an inadvertent fast ascent on the incident dive, and that can precipitate bubble formation in soft tissue/joint spaces leading to classic “unexpected/unexplained” DCS type I acute symptoms some 30 to 90 minutes later post-dive. You must take a lot more extra time on your Safety Stops, especially over several dive days of deep or aggressive diving, to effectively clear these stubborn Slow Tissues enough to gain some preventative, anti-DCS margin. Ideally if you are Advanced Nitrox & “techreational” Open Circuit trained, utilise Oxygen in a small separate deco cylinder to augment your “Safety Stops”, even still and especially after several dive days of deep/aggressive *NDL* diving. . .