Decompression Sickness or Dysbarism

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Section 6 - TRAUMA



  • There are two primary types of decompression sickness:
    • Fast onset (Arterial Gas Embolism [AGE]) develops within 10 minutes of the dive
    • Delayed onset usually within 1 - 12 hours after diving
  • Signs and Symptoms:
    • Rapid change in mental status or unconscious upon surfacing
    • Rapid changes in breathing pattern or apnea
    • Extreme fatigue
    • Difficulty in thinking
    • Vertigo
    • Progressive muscle paralysis
    • Bloody sputum
    • Tinnitus or severe ringing in the ears
    • Severe, throbbing pain involving the muscles, joints and abdomen
    • Nausea and/or vomiting
    • Pruritus and mottling of the skin

INITIAL TRAUMA CARE, (2.02) OXYGEN @ 100% via NRB mask or assist with BVM.

  • Obtain IV access and INFUSE NORMAL SALINE, 1000 ml over 30 minutes.
    • Stop infusion if signs of system overload appear
  • If nausea or vomiting is present, ADMINISTER Ondansteron (Zofran) 4 mg IVP.
    • PROMETHAZINE may be used as a second agent to treat nausea or if intractable vomiting is present.
  • Consider facility with hyperbaric services as primary destination.
  • Contact receiving facility early to allow them time to gather and prepare Hyperbaric Team.
  • Transport patient in left lateral position.
    • Avoid head down position – it causes an increased ICP, elevates intrathoracic pressure and complicates patient movement.
  • Inquire from patient or bystanders the following dive profile information:
    • Type of dive (rescue, commercial, recreational)
    • Type of gases used (compressed air, nitrox, heliox)
    • Water Type (Fresh, salt or contaminated)
    • Number of dives and the approximate depths if possible.
    • Total dive time for each dive completed today (this is extremely important for hyperbaric treatment).
If the patient is presenting with an altered mental status the Paramedic should notify the appropriate facility from the scene to make arrangements for the hyperbaric chamber and inquire if the patient is to go directly to the hyperbaric chamber for immediate treatment.

Traditionally SCEMS Practice Parameters emphasize pain management. In the case of decompression sickness/dysbarism pain management utilizing narcotic pain medications MUST BE AVOIDED.


The use of air transport shall be carefully evaluated – if air transport must be utilized the pilot must be notified as typical EMS rotorcraft are not pressurized. The flight plan must be adjusted to the lowest allowable altitude to prevent further complications for the patient.

If other significant injuries exist, follow Trauma Transport Protocol or appropriate Practice Parameters.


  • Florida Hospital South, Orlando
  • UF Health System (Shands) Hospital, Gainesville
  • Holmes Regional Medical Center, Melbourne