Treatment of Divers in Remote Locations

At the World Extreme Medicine Conference, Commander Joseph “Joe” Dituri (USN, ret.)—biomedical engineer, saturation diver and hyperbaric clinician—shares a clear, practical approach to looking after divers in remote locations.

Grounded in field reality, Joe explains how to recognise decompression sickness (DCS) early, stabilise on the surface, and—only when a chamber is not realistically reachable—how and when to consider in-water recompression (IWR) as a last-resort bridge to definitive care. Expect straight-talk on risks, team roles, kit, and abort points, plus checklists you can adapt for expedition SOPs.

This session covers:

- Recognising DCS and why symptom tempo/progression matters
- Initial surface management: oxygen, hydration, positioning, serial neuro checks
- IWR: indications, contraindications, and clear abort criteria
- Practical set-up: secure airway delivery, line/weighting, thermal protection, standby/tended diver, comms
- Evacuation planning, documentation, and handover to hyperbaric care

More Information

Intended Learning Outcomes

By the end of this session, participants will be able to:

Describe key DCS presentations using a simple, tiered symptom model and perform a brief targeted neurological assessment.
Apply initial surface management (100% oxygen, isotonic hydration, safe positioning, serial observations) while planning evacuation.
Evaluate when IWR may be considered in remote settings and list major contraindications (e.g., airway compromise, altered consciousness, haemodynamic instability, significant barotrauma, marked hypothermia).
Implement core IWR safety controls where appropriate (secure oxygen delivery, attachment to a down-line, adequate weighting, warmth, a standby/tended diver, reliable comms) and state abort criteria for CNS oxygen toxicity.
Plan team roles, equipment and comms, and draft a simple SOP/decision aid that includes documentation, telemedical advice, and mandatory hyperbaric follow-up.