Objectives: Due to presence of extensively fascinating coral reef ecosystem in the continental shelf of Andaman and Nicobar Islands, people from all over the world visit these islands of India to indulge in recreational diving. An increased participation figure has also elevated the number of divers at risk for Decompression Sickness (DCS). Despite this, no scientific data are available on DCS incidents from India. Present study is aimed to evaluate the DCS incidents reported in these islands, treatment provided, and the outcome of the treatment. An attempt has also been made to calculate the approximate frequency of DCS in comparison to the participation figure. Methods: Study design is retrospective data analyses of a recompression chamber. Naval Diving Unit Port Blair has the only active decompression chamber available in the islands, and Govind Ballabh Pant Hospital Port Blair was used to collect information on DCS incidents that occurred during the mentioned period. Due to lack of authenticated generalized documents of divers’ health history and dive logs, the scanty information was gathered from the dive centres on the basis of personal interviews/communications among the SCUBA diving instructors. Results: A total of nine cases were reported during the span of last four and half years, and thus approximate frequency of DCS in Andamans was 0.2/10000 divers year. All of the patients recovered completely after receiving the Hyperbaric Oxygen Therapy (HBOT), with no residual symptoms. Conclusions: Incident rate of DCS in Andamans is lower than that in many other parts of the world; possible reason could be under-reporting of less severe DCS cases. During the study period, the number of DCS type II incidents presented for the treatment was higher than that of DCS type I incidents. HBOT proved a complete success in treating DCS cases in the island.
Decompression sickness, a dreaded condition for divers all over the world, is one of the four major pathologies associated with diving apart from Barotraumas, Pulmonary Oedema, and toxic effects of gases on increased partial pressure [
Sport of Self Contained Underwater Breathing Apparatus (SCUBA) diving is relatively new to India but has shown tremendous growth in past few years and likely to grow further. However, recompression chamber facility in Andaman and Nicobar Islands, which provides Hyperbaric Oxygen Therapy (HBOT) to the DCS patients, is available only with Clearance Diving Unit (CDU) of Naval Diving Unit Port Blair. Any civilian cases are first presented to G.B. Pant Hospital, Port Blair and then referred to CDU, if required.
Andaman and Nicobar Islands, with many active dive centres, are becoming a popular dive destination among the divers around the world [
Present study is a retrospective analysis of routine data from a decompression chamber.
Data on Decompression Sickness case reports were retrieved from the Clearance Diving Unit (CDU) of Naval Diving Unit, Port Blair and G.B. Pant Hospital, Port Blair.
Since no written records of total number of participation or number of dives performed per year are available with any of the dive centres, an approximate estimation was reached by enquiring various dive centre owners and managers.
Individual reports were studied and classified on the bases of incident date, age, nationality, gender of the patient, type of DCS, treatment table used, and outcome of the treatment.
Present study was reviewed and approved by DS College Ethics Committee in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) for humans and animals.
There were more than 16 dive centres in Andaman and Nicobar Islands and the list was growing every year. On an average one lakh divers participated in the sport per year, majority of them were not certified divers but Discover SCUBA Divers (DSDs). About 125000 dives were performed per year on these islands.
Nine patients were given Hyperbaric Oxygen Therapy (HBOT) for DCS in the islands, from 1st January 2011 to 31st June 2015. The frequency of DCS incidents on these islands was about 0.2/10000 dive persons. Majority of the cases were type II DCS, most common symptoms were tingling in left hand and numbness in left leg. All the patients were presented to the hospital at least six hours after the onset of the symptoms. Royal Navy table 61 or 66 was used to treat the patients [
All the nine patients recovered completely without any residual symptoms, after receiving HBOT [
Frequency of DCS per thousand dives/divers varies all over the world due to myriad reasons. Major problem in calculating DCS incident rate per dive is incomplete records on total number of divers, and dives throughout the world.
Most organized source of data information on divers and diving incidents is from a few organizations, such as Divers Alert Network (DAN) America, Divers Emergency Service (DES) Australia, and American Academy of Underwater Science (AAUS) North America [
Ser | Date | Gender | Age | Nationality | DCS treatment | DCS table used | Post treatment remarks |
---|---|---|---|---|---|---|---|
1 | 18th Sep 2012 | Male | 19 years | Indian | Type I DCS | Fully recovered | |
2 | 06th Mar 2014 | Male | 62 years | British | Type II DCS | Fully recovered | |
3 | 14th Mar 2014 | Female | 24 years | Indian | Type II DCS | Fully recovered | |
4 | 14th Nov 2014 | Female | 26 years | Holland | Type II DCS | Fully recovered | |
5 | 19th Nov 2014 | Female | 32 years | Indian | Type II DCS | Fully recovered | |
6 | 19th Feb 2015 | Male | 27 years | Indian | Type II DCS | Fully recovered | |
7 | 08th Mar 2015 | Female | 27 years | Indian | Type II DCS | Fully recovered | |
8 | 12th Apr 2015 | Male | 40 years | USA | Type I DCS | Fully recovered | |
9 | 01st May 2015 | Female | 30 years | Indian | Type I DCS | Fully recovered |
According to DAN report 2009, frequency of DCS in dive volunteers, with 150739 captured dives in the year 2007, was 2.3 DCS incidents per 10,000 dives and out of all incidents of DCS, fifty percent were type I DCS [
Incidents of DCS reported in Andaman and Nicobar Islands were fewer than reported elsewhere in the world, except in South Africa [
It is indicated that some patients of apparently less serious type I DCS are going back home without HBOT. This could lead to undesired manifestations of the illness, later in their lives, since long term studies have not been performed on injured sport divers. Symptoms sometimes disappear even without treatment and sometimes they improve before markedly worsening [
DCS patients respond well to HBOT with complete or substantial relief in majority of cases, even in case of late presentations [
Andaman and Nicobar Islands have lower incident rate of Decompression Sickness as compared to many other areas of the world. One of the possible reasons could be underreporting of apparently less severe DCS I incidents by the patients. Since long term effects of untreated DCS have not been studied, and patients respond well to Hyperbaric Oxygen Therapy, awareness among divers is required to encourage them to undergo treatment, even in case of apparently less severe DCS.
・ Since studies on long term effects of DCS on recreational divers have not been performed, divers should be made aware of the possible effects of untreated DCS later in life.
・ In present study, HBOT proved a complete success in treating DCS patients, thus divers should be encouraged to undergo therapy, irrespective of the severity of symptoms.
Authors are thankful to the Clearance Divers Unit of the Naval Diving Unit and G.B. Pant Hospital, Port Blair, Andaman and Nicobar Islands for providing the necessary information for this study.
Paper | Country of origin | Type of diving | Data source | DCS incidents |
---|---|---|---|---|
DAN report 2009 [ | USA | Recreational | Dive logs of 1069 divers volunteering for PDE & 150739 dives captured in year 2007 | 4 cases of DCS reported or 2.3 DCI incidents per 10,000 dives |
Omhagen H et al. [ | Sweden | Recreational | Review of literature | 40 cases treated for recompression per year |
Landesberg PG [ | South Africa | Recreational | Diving accident reports from 1st Jan 1969-31st Dec 1977 in SA | 4 diagnosed for DCS |
Bessereau J et al. [ | France | All | 10 years records of diver patients admitted to Hyperbaric Medicine Department in France | 69 cases |
Marroni A et al. [ | Italy | All | DCI records of 11 hyperbaric facilities in Italy in 10 years | 209 cases |
Bierner RJ [ | USA | Navy | Routine US Navy dive logs | 5 DCS incidents per 10,000 dives |
Rice GM et al. [ | USA | Navy | Hypobaric exposures and cases from training reports, Naval Operational Medicine Institute | 97 cases of altitude DCI per 50,355 hypobaric exposures |
Dardeau MR et al. [ | USA | Scientific | 10 years diving records of AAUS | 33 incidents or .32 per 10,000 person dives |
The authors declare that they have no competing interests.
SheebaAhmed,AvijitRoy, (2016) A Short Report on Decompression Sickness Incidents in Andaman and Nicobar Islands. Journal of Biosciences and Medicines,04,101-106. doi: 10.4236/jbm.2016.41012