[abstract] Current Practices In Flying/ High Altitude Travel After Treatment For Decompression Illness

Abstract

BACKGROUND: Increasingly divers who suffer decompression illness (DCI) are obliged to undertake high altitude travel after hyperbaric treatment. Studies have demonstrated an increased rate of developing DCI with altitude provocation post-diving, the risk increasing with reduced pre-flight surface interval. Few studies have observed any relationship with recurrences or complications of DCI with altitude provocation after treatment. Anecdotal evidence suggests chambers give varying advice regarding the safe time to fly after treatment. The aims of this study are to collate current advice, and the basis on which it is given. METHOD: Questionnaires investigating current trends in advice on high altitude travel after treatment, and the rationale behind these trends were mailed to 19 treatment chambers internationally. RESULTS: 6 chambers completed the questionnaire and reported treating 161 divers (over a 2 year period) who then undertook high altitude travel. 5 of these chambers have relevant guidelines. The advised "time to fly after treatment" time differed at all chambers, varying from 72 hours to 6 weeks. 3 of the chambers based advice on local opinion, one on advice from Divers Alert Network and another on research (presented HTNA 1998). Only 2 chambers followed up divers after treatment. Repeated contact with chambers revealed many units did not keep adequate records, or did not have the staffing available to collate the information requested by this study. CONCLUSION: Guidelines on high altitude travel after treatment for DCI vary radically between chambers, and are rarely evidence based. Additionally, implications in terms of personal and insurance costs are unpredictable. Few chambers follow up patients after treatment, leading to absence of data regarding complication/recurrence rates following 'return home'. Standards of record keeping and staffing levels vary widely between chambers, limiting the success of this type of research. All chambers approached were interested in an evidence based standard policy.