Grail's Journal: A Sad Story Of Reactionary Overreaction

I was very saddened to read Phil Greenspun's take on Decompression Illness. IMHO, he's overreacted a little to the incident, and has probably learned the wrong lessons from his experience.

Let me set the stage with my credentials. I'm a SCUBA diver too (SCUBA is an acronym - therefore it's always spelt with capital letters). I was trained using the SSI training system, by the good people at "The Scuba Store" in Lonsdale Street, Braddon (Canberra, Australia). I have done more than 60 dives (in fact, the reason I was trolling for SCUBA articles is because I'm trying to distract myself from transcribing some log details from my dive computer to my log book). I have not yet had the bends, and I've done long dives and deep dives (and long deep dives). I love SCUBA diving.

In my training, we were taught that various factors will increase the risk of DCI, including:

• Overexertion
• Fatigue
• Illness
• Stress

We were also taught that DCI can happen to anyone - regardless of dive profile or physical fitness. We were also informed of how the dive tables were set up - the US Navy recorded how long and how deep their divers were diving, and set the limits at the level that 1% of the dives resulted in DCI. So the dive tables already have a built-in expectation of 1% incidence of DCI. My dive computer (Aladin Air X, which has been superseded by the Aladin Air Z) uses an 8-tissue saturation model to predict what is happening in my body - but I don't have any statistics about how more or less successfull the "8-tissue model" is than the "1% bent divers tables".

Looking at the dive profile narrated by Phil, you can see the risk factors all over the place - he was fatigued from having no sleep, he was suffering from motion sickness (ie: his body chemistry was abnormal), and what is worse in my books - he swam against the current on the return leg of a dive.

I think his reaction to the incident is quite severe - practically swearing off all SCUBA diving in any except idyllic conditions. As a comparison, this is like accidentally reversing the car into the back wall of the garage, and thus swearing off all motorised trasport.

He doesn't appear to have bothered to check out the current thinking on DCI, nor has he taken the time to take a look at his dive profiles with the intent of learning what mistakes he made. So the following are the lessons I can take from his narrative.

First and foremost - he went straight out on a diving cruise after 6 years of inactivity. How many people do you know could spend six years away from any sport and just step back into the game without suffering some injury? My lesson is - dive regularly, or at least do a refresher course and then some easy, safe and possibly supervised dives. I have never been a fan of massively commercial dive charters - Mike Ball especially. They remind me of everything I hate about capitalism - take their money, don't worry about the consequences. I wonder if the dive charter ever asked Phil for his diving history, or if they even checked his log book before he started the cruise? I went to do two dives on the Swan wreck in Western Australia with Cape Dive. The dive leader (whose name, sadly, I forget) sat down with me and read through my dive log to check which tour he would take me on. So he knew exactly what my dive history was. Other dive operators haven't been so thorough about my dive history.

Second - if you have to exert yourself on the inbound leg of a dive, rest before ascending. There were spare tanks at the ascent points - I would have at least stopped to take a few breaths while holding on to the ascent line. This would have meant I was more relaxed for the ascent, and better prepared for the horrible surface conditions. Any time I find myself starting to worry, I use the "STOP" procedure - Stop, Think, Observe, Plan. Don't push on in the hope things will get better - they usually don't. Incidentally, the current training from SSI is that you always do a 5 minute stop at 5 metres, regardless of any other decompression stops you've done. This "5 at 5" stop is called a "safety stop" and the claim from SSI is that the 5@5 has reduced DCI risk by 50%.

Third - the balance test is just one of a battery of tests designed to detect neurological impairment or damage. Perhaps a better test for DCI is the eyeball bubble test discovered by Dr Mike Bennett of UNSW.

Fourth - stay hydrated. Whether you're seasick or taking seasickness medication, you'll end up being more dehydrated than someone who is neither. Always have a bottle full of water nearby, and drink from it regularly. I usually carry water with me on boat dives - I drink before I get in and again after I get out.

Fifth - get a second opinion. If you suspect you might have some life-threatening condition such as DCI, and the first doctor doesn't agree with you enough to send you to a specialist, get a second opinion.

Sixth - get travel insurance. Blue Cross might insure Citizens of the USA while they're in the USA, but I can't see why they would insure those same people in other countries. After all, if you're travelling, you're already at higher risk than someone who's staying at home and being a good hard-working Citizen, right? The same is true in Australia - Medicare (the public health insurance scheme) and private health insurance companies won't insure you for anything that happens when you leave Australia. They want travel insurance for that - mostly because the usual treatment for sickness overseas is medical evacuation to Australia. Australian doctors are extremely paranoid about Australians getting treated in poor-quality hospitals in places like the Pacific Islands or the USA (yes, that's just me being facetious - most Pacific Islands have excellent quality hospitals ;)

It's probably more dangerous to learn the wrong lessons, than it is to learn none. Reading the article made me think of so many posts I've seen to Slashdot, in fact!

I feel that Phil's reaction was a very emotional one - the old "once bitten, twice shy" syndrome. I hope that one day he will venture back into SCUBA diving and enjoy the sport - tempered perhaps by a little caution and the will to sit back and read instead of diving in atrocious conditions!

In the meantime, I'll learn what I can from other peoples mistakes and mishaps - in order to not suffer the same fate myself.