epidemiological study of dysbaric diving ......often happens during mandatory free-scape practices...

EPIDEMIOLOGICAL STUDY OF 146 DYSBARIC DIVING ACCIDENTS

J. Desola AI; and A. C a r c i a San Pedro

The C.R.I.S. (Underwater Recovering and Resea rch C e n t e r ) was founded in Barcelona in 1954. Initially a l l dysbar ic diving acc iden t s produced in t h e Cata lonian and Balearian Coas t s w e r e t r e a t e d in a single monoplace chamber unti l 1964, when t h e present Mult iplace Hyperbar ic Chamber (MHC) was built (Fig. 1). The f i r s t case, however, was t r e a t e d in 1967.

Up t o May 1983, 146 Dysbaric Diving Accidents (DDA) have been t r e a t e d in our Hyperbaric Therapeut ic Unit (HTU), placed in t h e Red-Cross Hospital of Barcelona*.

Troubled d ivers have been received f rom a zone of m o r e than 200 Kms. around, even f rom t h e "Costa Brava", in t h e Nor th ( t h e bes t and main tour is t ic Spanish coas t s for spor t diving), and a lso f rom t h e c o a s t s of Tarragona, in t h e south ( t h e mos t i r r~por t an t zone of c o m n ~ e r c i a l diving), where seve ra l off-shore ins ta la t ions a r e placed.

1 .- NUMBER OF CASES STUDIED

The number of DDA has increased in t h e l a s t f e w yea r s s ince underwater spo r t ac t iv i t i e s b e c a m e ex t r eme ly popular in Spain. In t h e f i r s t t e n yea r s only 38 DDA w e r e t r e a t e d in t h e HTU. The o t h e r 108 cases took p lace in t h e las t f ive yea r s 1978-1 983 (Fig. 2).

2.- TYPE OF DDA

The mos t impor t an t group of cases (107, 86.20%) correspon- ded t o type I1 (neurological) Decompression Sickness (DS). The number of cases of t y p e I DS (17, 13.70%) was compara t ive ly very low, probably because a lo t of spor t d ivers did no t recognize l imb pain (bends) and skin rashes as symptoms of DS and they neglec t t h e recompression.

The number of cases of Burst Lung (BL) was re la t ive ly high (26, 17,00%) compared wi th commerc ia l and mi l i ta r diving, due t o t h e inexper ience of s o m e beginners in case of emergency. BL o f t e n happens during mandatory free-scape p r a c t i c e s in SCUBA courses. Some very impor t an t diving f a t a l i t i e s produced t h e addit ion of both e n t i t i e s (Table I).

(*) Until 31st December 1983 the number of DDA treated was 154.

Fig. I : Hyperbarlc Mult~place Chamber of the C.R.I.S. placed in the Red-Cross Hospital of Barcelona.

Fig. 2 : Number of diving accidents treated in the Hyperbaric Multiplace Chamber of the C.R.I.S. since 1967 to - 1983.

Type o f D i v i n g A c c i d e n t n %

Decompress i on S i c k n e s s

Type 1

Type I 1

B u r s t Lung 2 6 17.80

Decompress i on S i c k n e s s + B u r s t Lung

TABLE I : Type of diving accidents.

3.- ORIGIN

Only 14 DDA (9,6%) occurred to members of t h e CRIS. The majority of t h e cases developed from members of o the r Spanish spor t diving associations (92, 62.10%) all grouped in t h e Spanish Federation of Underwater Activit ies (FEDAS), although several DDA (28, 18.90%) occurred t o non authorized (illegal) divers.

An important number of DDA (20, 13.50%) corresponded t o foreign divers, and a final small number (8, 5.40%) t o commercia l divers* (Table 11).

O r i g i n n %

F.E.D.A.S.

Non a u t h o r i z e d

F o r e i g n e r s

Commerc i a l s

TABLE I1 : Origin of the l46 troubled divers.

(*) This number was duplicated in the last months of 1983 and the first of 1984.

120 J. Desola and A. Garc ia

4.- DIVERS EXPERIENCE LEVEL

DS was mos t common in e x p e r t and in t e rmed ia t e d ivers and was r a r e in beginners. J u s t t h e opposi te happened wi th BL which in t h e major i ty of cases occurred t o beginners during f r e e scapes in t raining cour ses (Table 111).

L e v e l D . S . B .L . T o t a l

E x p e r t s

I n t e r m e d i a t e s

B e g i n n e r s

TABLE Ill : Levels of experienceof the l 46 troubled divers (percentage).

5.- DIVING DEPTH

The spec ia l conf igura t ion of t h e Cata lonian coas t s fo rces diving t o re la t ive ly deep imme, sions considering spo r t prac t ice . Three q u a r t e r s of t h e DDA w e r e produced a f t e r immersions deeper t han 40 m e t e r s depth. Only t h e cases of BL developed a f t e r shallow dives. The mean dep th was 34.40 m e t e r s (Table IV).

M e t e r s d e p t h n %

TABLE 1V : Mean depth o f the lrnrnerslons that produced the accidents.

6.- CAUSES OF ACCIDENT

A g r e a t major i ty of acc iden t s were due t o human e r r o r in following decompress ion schedules o r o the r negligible reasons, in sp i t e of t h e f a c t t h a t t hey o f t en do not a c c e p t it . Very f e w cases a r e due t o unavoidable causes (break of regula tors , d a m a g e

EPIDEMIOLOGICAL STUDY O F 146 DYSBARIC ACCIDENTS 12 1

in a i r cylinders, etc.). A few well proved documented and be- lievable cases developed a f t e r apparent ly c o r r e c t and normal ' im- mersions (Table V).

Individual idiosynchratic fac tors , o f t en qu i t e d i f f e ren t f rom t h e human profi les of mil i tary and commerc ia l divers, m a y be t h e reason of those non understandable DDA probably d u e t o t h e use of inadequate decompression tables for spor t diving.

Cause n %

D i v e r ' s e r r o r 135 91 .20

M e c h a n i c a l d e f e c t 2 1 .40

U n e x p l a n a b l e 11 7 . 4 0

TABLE V : Causes of diving accidents.

7.- ONSET OF SYMPTOMATOLOGY

In t h e major i ty of t h e cases of DS t h e symptoms appeared immedia t ly a f t e r end of t h e dive. Only some cases of type I DS ini t iated the i r symptomatology s o m e hours la ter , even m o r e than 24 hours (Table VI).

I m m e d i a t e a p p a r i t i o n 67 .70

B e f o r e t h e 1 s t Hour 18 .80

Be tween t h e 1 s t a n d t h e 6 t h h o u r s 12.50

Be tween t h e 6 t h and t h e 2 4 t h h o u r s 12 .50

A f t e r t h e 2 4 t h h o u r s 1 .10

TABLE V1 : Time elapsed until the onset of the symptomatology (percentage).

8.- ELAPSED TIME UNTIL RECOMPRESSION

Few divers ar r ived t o t h e HTU sooner than t h r e e hours a f t e r t h e end of t h e dive. Approximately half of t hem las ted be tween 3 and 12 hours, and more than a third p a r t arr ived l a t e r than 24

J. Desola and A. Garcia

hours a f t e r the onset of the symptomatology. The mean of t h e t ime elapsed. until t h e arrival t o t h e chamber was of 16 hours and 20 minutes (Table vII).

N u m b e r o f h o u r s n %

TABLE V11 : Time elapsed until t h e 'arrival t o t h e chamber.

9.- SYMPTOMATOLOGY

Spinal cord symptoms and bends were t h e symptoms most commonly observed in DS, of ten adopting the form of a Brown- Secquard Syndrome (Table VIII).

S y m p t o m s n %

B e n d s P a r a p a r e s i s B l a d d e r p a r a l y s i s M o n o p a r e s i s V e r t i g o S k i n r a s h H e a d a c h e P a r a p l e g i a

TABLE V111 : Symptomatology observed in t h e 124 cases of Decompression Sickness.

EPIDEMIOLOGICAL STUDY OF 146 DYSBARIC ACCIDENTS 123

Air embolism (AE) was present in t h e majority of t h e BL cases, some of them with very serious cen t ra l neurological dis- turbances.

Differing with classical references ( I , 2, 3) pneumotorax and haemoptisis were observed in very ra re occasions. Pneumomedias- tinum-pneumopericardium was present in almost al l cases of AE. The subcutaneous emphysema was also commonly observed (Table IX).

S y m p t o m s n %

P n e u m o m e d i a s t i n u m B l a d d e r p a r a l y s i s T e t r a p l e g i a H e m i p a r e s i s H e a d a c h e R h i n o l a l i a S u b c u t a n e a l e m p h y s e m a V e r t i g o C o n v u l s i o n s H a e m o p t i s i s C o m a H e m i p l e g i a P n e u m o t o r a x T r e m o r

TABLE U( : Syrnptomatology observed in the 26 cases of Burst Lung.

10.- HEMATOLOGICAL AND BIOCHEMICAL ALTERATIONS

In al l cases of DDA we followed t h e analytical protocol w e presented in Cambridge in 1982 during t h e V11 Congress of t h e E.U.B.S. (4).

The higher number of observations presently accumulated have not changed those conclusions, and only a few analytical para- m e t e r s showed significant a l tera t ions as a evidence of neuromus- cular damage, and haemodinamic, metabolic, and coagulating dis- turbances somet imes clinically hidden (Table X).

As w e s t a t e d then, t h e absence of biochemical o r haematolo- gical a l tera t ions was considered as a sign of good prognosis, in

P a r a m e t e r O.S. B .L . T o t a l

H a e m a t o c r y t ( 1 ) 20 .70 14.20 20 .30

P l a t e l e t s ( 1 1 39.60 42 .80 3 7 . 5 0

F.O.P. ( 1 ) 35.80 71 .40 39 .10

L.O.H. ( 1 ) 3 2 . 1 0 42.80 31 .20

G.O.T. ( 1 ) 9 .40 28 .50 7 . 8 0

C.K. ( 1 ) 50.90 57.10 50 .00

TABLE X : Percentage of analytical alterations detected in Decompression Sickness and Burst Lung.

spi te of the f a c t of having important neurological symptoms, and vice-versa.

1 1 .- TREATMENT

a. Pharmacologic.

Classical medical t r e a t m e n t ( 5 , 6, 7) was prescribed in a lmost all cases. Dextran 70.000 ( to begin) or 40.000 (later) was perfused in all serious neurological cases, and in those with important haematological o r haemodinamical alterations.

Salicylates were administered in almost all cases of bends. Occasionally and according t o the symptomatology of each case , steroids, diazepan, tyamine, hepar in , cynarizine, and vessel ac t ive substances were also administered.

b. Hyperbaric.

Until 1980 only a i r - t rea tment tables were used due t o technical reasons. Af te r the organizing of the current facilities, making sorne modifications in our old chamber, and allowing permanent 24 hours/day medical assistance, U.S. Navy oxygen tables were used (Table XI).

1 2.- EVOLUTION

In sp i t e of t h e f a c t of t h e delay in t h e beginning of t h e t r ea tment , t h e evolution was sat isfactory in t h e majori ty of t h e cases.

T a b l e n %

TABLE XI : Air -Oxygen therapeutic tables used.

The improvement was d ramat ic in t h e cases of DS t r ea ted during t h e f i rs t 6 hours a f t e r the onset of the symptoms.

In the other cases some neurological sequelles usually remained and they needed complementary Hyperbaric Oxygen Therapy (OHB) during t h e following days until full or satisfactory recupe- rat ion was obtained (Table XII).

E v o l u t i o n A i r O x y g e n

T o t a l i m p r o v e m e n t

M i l d i m p r o v e m e n t

No c h a n g e

W o r s e n i n g

D e a t h

TABLE XU : Evolution after recompression (percentage).

The results were obviously poor in t h e most delayed cases. However re la t ive good recuperation was obtained in some cases of type I1 DS t r ea ted even two days a f t e r the onset of t h e sympto- matology. Two cases of type I (only bends) DS t r ea ted more than 8 days a f t e r t h e dive obtained a full improvement a f t e r t h e f i rs t OHB treatment .

126 J. Desola a n d A. G a r c i a

Two cases of s e v e r e AE a f t e r f r e e scape, t h a t a r r ived t o t h e HTU more than 24 hours a f t e r t h e dive, died in t h e c r i t i c a l c a r e unit of t h e hospital, s o m e hours a f t e r having finished t h e Tab le IV.

One case of DS wi th possible c r a n e a l t r aumat i sm, rece ived m o r e than 12 hours a f t e r t h e dive, died inside t h e c h a m b e r a f t e r t h e f i r s t 10 hours of t r e a t m e n t .

T h e evolut ion of ano the r 3 cases of AE t r e a t e d wi th t h e t a b l e 6A and c r i t i c a l c a r e intensive techniques pe r fo rmed inside t h e c h a m b e r w e r e sa t i s fac tory .

Our expe r i ence of t h i s kind i s no t ful l enough t o obta in s ignif icant conclusions, bu t t h e evolut ion of t h e m o s t ser ious cases s e e m s t o be much b e t t e r s ince w e use t h e oxygen tab les , special ly in t h e p a t i e n t s rece ived seve ra l hours a f t e r t h e onse t of t h e symptoms.

13.- COMPARISON WITH OTHER S P O R T FATALITIES

These d a t a a r e n o t r ep resen ta t ive of t h e t o t a l number of DDA in Spain, but i s ce r t a in ly approx ima te because i s along t h e Cata lonian C o a s t s where t h e g r a t e r number of both spo r t and commerc ia l d ives t a k e place.

Compar ing t h e m e a n number o f all t y p e o f s p o r t diving a c c i d e n t s p e r y e a r f r o m 1971 t o 1975, and f r o m 1976 t o 1980, wi th t h e m e a n of t h e total number of d ive r s during those periods, we obta in t h e INDEX OF MORBIDITY.

Compar ing t h e mean number of diving d e a t h s wi th t h e m e a n number of a c c i d e n t s during those s a m e periods, w e ob ta in t h e INDEX OF LETHALITY.

Compar ing finally wi th t h e s a m e procedure t h e number o f d e a t h s wi th t h e total number o f divers, t hen w e obta in t h e INDEX OF MORTALITY.

Studying with th i s s a m e technique s o m e popular and heal th- considered s p o r t s in Spain, and compar ing wi th those resul ts , w e m a y observe t h a t t h e spo r t diving (including in th i s c o n c e p t a l l t y p e of s p o r t underwater ac t iv i t ies ) produce t h e lowes t Index o f Morbidity of a l l s p o r t s (Table XIII).

We m u s t cons ider however t h a t t h e Indexes o f L e t h a l i t y a n d Morta l i ty are t h e highest , uppered only fo r t h e Hang gliding and o t h e r flying s p o r t s (Table XIV).

1 4.- CONCLUSIONS

SCUBA s p o r t diving produces in Spain a low number of acc iden t s , a l though with high Indexs of Letha l i ty and Mortal i ty.

The inc idence of DDA is obviously higher in spo r t t h a n in

No. of sportsmen No. of accidents Morbidity Index Sports 1971-75 1976,80 1971-75 1976-80 1971-75 1976-80

Diving Flying sports Athletism Automobilism Basket-ball Hand-ball Cycling Skiing Hockey Judo Montanism Motor-cycling Rugby Tennis

TABLE X1II : Morbidity Indexes from several sports showing the lowest one for diving.

Sport No. ofdeaths Lethality Mortality

1971-75 1976-80 1971-75 1976-80 1971-75 1976-80

Diving Flying sports Athletism Automobilism Basket-ball Hand-ball Cycling Skiing Hockey Judo Montanism Motor-cycling

Rugby Tennis

TABLE XIV : Corr.parison of the lndexes of Lethality and Mortality from several sports.

128 J. Desola and A. Garc ia

commerc ia l o r mi l i ta ry diving, due, in t h e major i ty of t h e cases, t o ignorance of diving secur i ty procedures, and inadequate , o r omi ted , decompress ion schedules.

The f r e e s c a p e mus t be well t augh t in theory t o t h e beginners, and a lso p rac t i ced in swimming pools, o r f rom shal low d e p t h s in t h e sea. But t h i s dangerous p rac t i ce mus t be forbidden as a p lace of usual t raining prac t ice .

Troubled d ivers o f t e n de lay t h e acces t o t h e recompression chamber again due t o ignorance o r negligence. They should be exhaust ively ins t ruc ted a b o u t t h e impor t ance of t h e ce l e r i t y of t h e t r anspor t t o t h e n e a r e s t hyperbar ic medical cen te r .

Oxygen t r e a t m e n t t ab l e s conf i rm in our modes t expe r i ence t o be m o r e e f f e c t i v e in t h e t r e a t m e n t of spo r t diving acc idents .

Off ic ia l inst i tut ions, federa t ions , and c lubs of SCUBA spor t diving should a s sume t h e s e conclusions and ought t o emphas i ze the i r d ivers t o become m o r e cautious, avoid unnecesary f r ee - scapes, forbid t h e m t o beginners, and proceed wi th t h e mos t urgency in t h e t r anspor t of t roubled d ivers t o t h e n e a r e s t hyper- bar ic medica l cen te r .

ACKNOWLEDGEMENT : The au tho r s wish t o expres s the i r know- ledge t o Drs. Josep Brull and Josep Prim t h a t reviewed t h e 72 f i r s t cases of t h i s s tudy; t o Miss Roser Cano and Miss Mont se r r a t ~ a r c i a , nurses of our serv ice , who cont r ibuted t o t h e review of t h e o t h e r 74 cases; and t o t h e Spanish "Mutualidad Gene ra l Deport iva" whose d a t a on spo r t f a t a l i t i e s have been consulted.

S U M M A R Y

Since 1967, 146 Dysbaric Diving Accidents (DDA) have been a t t e n d e d at t h e U.H.T. of t h e C.R.I.S. The major i ty of t hese w e r e spor t ing acc iden t s which took place on t h e C a t a l a n and Balear ic coasts. The principal d a t a of epidemiological i n t e re s t s tudied w e r e (age, level of exper ience , in terval of t i m e e lapsed be fo re t r e a t m e n t , de lay in t ranspor t ing t h e pat ient , etc.) a s well a s o t h e r c l in ica l and the rapeu t i c informat ion ( f rom t h e t r e a t m e n t given, medicat ion, etc.) and t h e pe rcen tages of cu res , par t ia l improvement o r residual e f f ec t s . Some of th i s d a t a has been compared wi th f igures f rom o t h e r sports. The following conclusions w e r e ab le t o be made. Diving shows t h e lowest Morbidity lndex of a l l spo r t s in Spain, although both t h e Lethal i ty and t h e Morta l i ty indices a r e high. Breath-hold diving produces the highest number of accidents . Decompression acc iden t s t ends t o hap- pen t o e x p e r t o r v e t e r a n divers. Burst Lungs predominate in new in i t i a t e s in to diving and o f t e n occur during t h e training courses. C e r t a i n Spor t c e n t e r s have a much higher Morbidity lndex t h a n others . The acc iden t v i c t ims tend t o delay

EPIDEMIOLOGICAL STUDY OF 146 DYSBARIC ACCIDENTS 129

going to the Hyperbaric Medical Center becouse of indecision or ignorance. The majority of DDA's are a result of human rather than mechanical or accital causes. In spite of the delay in treatment, the majority of accident victims respond favorably i f recompression with air (tables IA, 2A, 3 and 4 USN) is ini- tiated before 6 hours after the onset of the symptomatalogy, or before 12 hours i f hyperoxigenated treatment (tables USN 5,6 and 6A) is given.

R E S U M

ESTUDI EPIDEMIOL~C~C DE 146 ACCIDENTS DISBARICS D'IMMERSI~. J. Desola A I ~ i A.Gar~ia San Pedro. Des de 1967 s'han ftes a la Unita: de Terapiutica ~ i p e r b i r i c a (UTH) del C.R.I.S. 146 AccidenJs Disbarics d'lmmersio (ADI), la rnajoria esportiste:, precedents. del l i toral catala i i l l en~ . S'han estu!iat les principals dades d'interes epiderniologic (edat, nivell d'experiencia, procedencia, int:rval de temps Iliure, tardanqa en el trasllat, etc.) i els percentatges de curacio, , de n i l lor ia parcial, o de seqiiel.les residuals. Algunes d'aquestes dades s'han comparat arnb les xifres procedent~ d'altres esports. Aquest estudi permet obtenir les conclusions segents. L'irnmersio produieix a Espanya e l rnenor Index de Morbilitat (IM) de tot? els esports, si rnes no els lndexs de Letalitat i de Mortalitat son alts. L'irnrnersio en, apnea produieix el rnbs gran nombre d'eccidents dintre de les Activitats Subaquatiques. Els Ac- cidents de Descornpressio es produieixen preferentment en escafandristes experts o veterans. Els de Sobrepressi6, predorninen en debutants i sovint es prodyieixen durant els cursets de formacio. Alguns centres espyrtius tenen IM rnolt rnes alts que d'altres., EIS eccidentats ,solen demorar innecesariament el trasllat a la UTH per indecisio ? be per ignorancia. La rnajoria dels AD1 obeiexen a causes hu; manes rnol t mes que mecaniques o accidentals. Malgrat la tardanqa en I'aplicacio del tractament hiperbaric,, la majoria dels accidentats evolucionen favorablement si s'inicia la recompressio amb aire (taules lA, 2A, 3 i 4 USM) abans de les 6 hores del inici de la sirnptornatologia, o de les 12 hores si s'apliquen taules hiper- oxigenades (5,6 i 6A USN).

R E S U M E N

ESTUDIO EPIDEMIOLOGICO DE 146 ACCIDEN~I-ES DISBARICOS DE BUCEO. J. Desola A l i y A. Garcia San Pedro. Desde 1967 se han atendido en la Unidad Terapeutica ~ i p e r b i r i c a (UTH) del CRIS. 146 Accidentes Disbsricos de Buceo (ADB), la rnayoria deportivos, procedenfes del l i toral Catalsn y Balear. Se han estudiado 10s principales datos de interes epi- derni016~ico (edad, lugar de procedencia, nivel de experiencia, interval0 de fiempo libre, demora en el traslado, etc.) asi corno, otros datos clhicos y terapeuticos (modalidad de tratemiento aplicado, rnedicacion complementaria, etc.) y 10s por- centajes de curacion, rnejoria parcial o de secuelas residuales. Algunos de estos datos se han cornparado con las cifras procedentes de otros deportes. Este estudio permite obtener las siguientes conclusiones. E l buceo produce en Espaiia el menor Indice de Morbilidad (IM) de todos 10s deportes, si bien sus tasas de Letalidad y Mortalidad son altas. Las disciplinas de buceo en apnea producen el mayor nirnero de accidentes. Los accidentes de Descornpresi6n ocurren preferenternente en buceadores expertos o veteranos. Los de Sobrepresi6n Pulmonar pre!orninan en debutantes y a rnenudo se producen, durante cursillos de forrnacion. Algunos centros deportivos tienen IM mucho mas altos que otros. Los accidentados suelen

130 J. Desola and A. Garcia

demora r innecesa r i amen te e l t r a s l ado a la UTH por i n d e ~ i s i b n o ignorancia. L a moyoria d e 10s ADB obedecen a caysas humanas y no mecan icas o accidenta les . A pesar d e la demora e n . l a apl icacion de l t r a t amien to , la rvayorla d e 10s acciden- t ados evolucionan f avorab lemen te s i s e inicia la recompres ion con a i r e ( t ab la s USN IA, 2A, 3 y 4) a n t e s d e las 6 horas, o d e las 12 horas s i s e aplican t ab la s hiper- oxigenadas (USN 5, 6 y 6A).

R E S U M E

ETUDE EPIDEMIOLOCIQUE DE 146 ACCIDENTS DYSBARIQUES DE PLONCEE. J. Desola Ala et A. C a r c i a San Pedro. Depuis 1967 o n t 6t6 t r a i t & la UTH. du CRIS. 146 Acc iden t s Dysbariques d e plong6e (ADP), la p lypar t spor t i fs? e t , p r o v e n a n t du l i t t o ra l C a t a l a n y t d e s Balgares. Les principales donnees d1int6r:t epidemiologique (lieu d'origine, d e g r e d1exp&rien?e, in tervalJe d e t e y p s libre, de l a i d e >ransport , etc.) a ins i q u e d ' au t r e s ,donnees cliniques et the rapeu t iques (modal i te djppplication du t r a i t e m e n t , medicat ion cymplemen tp i r e , etc.) et les taux d e re tabl issement , ame l io ra t ion pa r t i e l l e PL! sequel lcs residuellcs o n t f a i t I 'objet d 'examen. Certain: d e c e s ch i f f r e s o n t ete compar6s a v e c ceux p rovenan t ,d fau t r e s sports. L a plongee provoque e n Espagne l e plus fa ib le 1ndi:e d e Morbilife (IM) p?r ~ a p p o r t aux a u t r e s sports; kien q u e 1:s t aux d e ~ 6 t a l i t e et Mor ta l i t e so i en t eleves. Les disciplines d e Flongee e n a p n e e e n t r a i e n t le plu,s ,grand nombre d'accidents. Les ,Maladiys d e Dycpmpression sur- v iennent d e p re fe rence c Q e z les plongeurs expyr imen tes ou veterans. Ceux d e Surpression Pulmonaire predominent c h e z les debu tan t s et, apparaissent souven t lors d,es yours d e format ion. C e r t a i n s , cen t r e s spor t i fs possedent un IM beaucoup plus e l eve que d 'aut res . Les acc iden tes o n t cou tume d e di f f6rer l e t r anspor t a I'UTH par dou te oy ignorance. L a plupar t des ADP , ~ b & i s s e ? t H d e s causes hu- maines et non mecaniques ou accidente!les: Malgre le dela i d 'appl ica t ion du t r a i t emen t , la ma jeu re pa r t i e des acc iden tes evoluent f avorab lemen t s i I'on en t r e - prend l a recompress ion I'air ( tables USN IA, 2At 3 et 4) a v a n t 6 heures, ou a v a n t 12 heures dans les c a s d 'uti l isation d e tables a I'oxygene (USN 5, 6 et 6A).

R E F E R E N C E S

I .- Edmonds C . : Barotrauma. In, St rauss R . H. : Diving Medicine. Ed. C r u n e and S t r a t ton , New York, 1976 ; 49-61.

2.- F ruc tus X. and Sciarli R. : La plongee, santg-securit6. Ed. Mari t imes et d 'outre- mer , 1980; 119-121.

3.- U.S.Navy Diving Manual. Navy Depar tmen t , Washington D C 20362, 1978; 8-1 3.

4.- Desola ~ l a J., Brull Martore l l J., and Pr im Cu t ig r rez J. : Biochemical and haematological f indings in 21 c a s e s of decompress ion sickness. In, El l io t t D. H . : Report of proceedings of ELlBS annual sc ient i f ic mee t ing Cambr idge 198 1 . Ed. North Sea Medical C e n t e r , 1982; 324-333.

5.- Broussolle B. : T r a i t e m e n t mgdicamenteux d e la ma lad ie d e d6compression. In, Medical a s p e c t s of diving accidents . Congress of t h e EUBS. Ed. Commiss ion of of t h e European Communi t ies , Luxembourg, 1978. 77-94.

6.- Davis J. C . and El l io t t D. H. : T r e a t m e n t of t h e decompress ion disorders. In, Bennet P. B. and El l io t t D. H. : The Physiology and Medicine of Diving. Ed. ~ a i l l k r e Tindall , London, 3rd. ed., 1982; 473-488.

7.- Hills B.A : Decompression Sickness. Ed. John Wiley & Sons, Ch iches t e r , 1977; 228-234

DIVING AND HYPERUARIC MEDICINE. Proceedings of the 1X Congress of the E.U.B.S. Ed. 3. Desola, CRIS, Barcelona, 1984.

AND HYPERBARIC MEDICINE

4

Proceedings of the IX Congress of the Eyropean Undersea Biomedical Society

(E.U.B.S.)

English - Catala - Espaiiol - Francais

DIVING AND HYPERBARIC MEDICINE

PROCEEDINGS OF THE IX CONGRESS

OF THE

EUROPEAN UNDERSEA BIOMEDICAL SOCIETY

(E.U.B.S.)

l , Sponsored by

CENTRE DE RECUPERACIO I D'INVESTIGACIONS SUBMARINES (C.R.I.S.)

Edited by

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EDlClONS C.R.I.S., BARCELONA

0 Edicions C.R.I.S., 1984

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