Type II DCS in the Maldives

A 64-year old DAN member with more than 800 dives traveled to the Maldives in 2019 to embark on a liveaboard dive vacation. He completed two days of diving, each day making three, one-hour dives to depths between 82 and 98 ft (25 and 30 M) on nitrox. He made safety stops after each dive.

About 15-20 minutes after surfacing from his last dive, he began to experience vertigo, shoulder pain, tingling sensations in his left leg, and a marbled rash on his back and abdomen. He then experienced nausea and vomiting over the next hour and a half, with pain in both shoulders and his neck. He was taken to a local health clinic where he presented with a loss of consciousness, responses to pain, drowsiness, joint pain, bluish bands both side of chest, and vomiting.

He was put on continuous oxygen and transported 9-hours via boat to the nearest emergency room and hyperbaric center for further treatment. When he arrived he was unable to stand or even sit stably without help. After checking his vital signs, conducting a neurological examination and reviewing his medical history. This diver had previously suffered two cases of DCS in 2002 and 2004 respectively.

After his initial examination he was given IV fluids and anti-nausea medication then transported to a hyperbaric chamber within 50 minutes. His first hyperbaric treatment improved his symptoms of pain, paresthesia, and marbled skin rash but did not resolve or improve his dizziness and he still required assistance to walk.

Because his symptoms persisted and his skin rash reappeared he was given second hyperbaric treatment the following afternoon, which improved all symptoms other than his unsteady walk. Four additional treatments were administered daily over the next two days and the diver reported feeling better, however, he still experienced some symptoms of vertigo and continued to have an unsteady walk. This led the attending physician to conclude that an inner-ear DCS was contributing to these symptoms.

This diver was discharged from care and advised not to continue diving. He was strongly cautioned regarding a return to diving without an intensive fitness-to-dive examination and evaluation by several specialists. 48 hours later he was cleared to fly home with a non-medical escort and motor cart or wheelchair assistance between gates.

In addition to the medical expenses he incurred as a result of his diving accident, this DAN member and his wife also lost 4 of the 7 days of their pre-paid non-refundable liveaboard trip, incurred cancellation fees for a future dive vacation trip to Australia and incurred extra hotel and meal expenses during his out-patient treatment.

DAN TravelAssist benefits paid for his emergency medical evacuation by boat to the emergency clinic, covered phone calls, translation services, pre-arranged medical repatriation for the diver and his wife, and pre-authorized ground transport expense reimbursement for transport to the airport from the hospital.

This member’s Guardian dive accident insurance plan paid for his treatments at a Recompression Chamber Network, one that is a preferred provider in DAN’s referral network for hyperbaric treatment, covered lost liveaboard expenses for him and his travel companion for their trip interruption, reimbursed him for trip cancellation fees for the forfeited deposit on a future dive trip to Australia, and covered extra accommodations fees.