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Flying and Diving

During the last 10-15 years, the practice of diving as a sport during holidays has expanded enormously. While in Germany, only about 100 000 divers are organized in clubs and train more or less regularly, we reckon on the tenfold number of recreation divers concerned with under-water "sightseeing" exclusively during the holidays.This group is especially prone to diving accidents, as they often lack conscious prevention due to lack of training and experience. Additionally, these divers tend to visit holiday areas with almost no infrastructure for a treatment of diving accidents. The time span between the last dive and the return flight is usually too short, as well.

The reason for many severe diving incidents is the nitrogen dissolved in surplus and reversibly under increased pressure (decompression sickness, DCS) or the breathing gas penetrating the vascular system in the pulmmary barotrauma of the lung (arterial gas emboly, AGE). In both cases, these are processes that are caused by the ascent (decrease in pressure) and often occur only at the end of the dive and at the surface - frequently with a free interval of minutes to hours. Both clinical pictures are nowadays summarized under the term "decompression illness" (DCI), as they can often hardly be distinguished from one another and are therapied in similar ways.
Possible symptoms are pains of the joints (»bends«) or itching skin (»diver's fleas«) as well as pulmonary function disorders. Cerebral effects may cover the whole range of the apoplectic insult (stroke).Frequently, there are spinal manifestations up to a complete paraplegia.

Therapy

The availability of pressure chambers for the therapy constitutes a major problem.

Because of this, administering O2 under normal pressure as a first step has been established as a compromise for an instant treatment. Similarly to increased pressure, oxygen produces an accelerated dissolving of the gas bubbles by nitrogen wash-out. The improved supply of O2 under pressure and the initial mechanical reduction of the gas bubbles are not achieved, however. While this has already been suggested several decades ago and was theoretically and practically proved, only the massive involvement of the Divers Alert Network (DAN) has achieved a more or less complete global blanket coverage. Thanks to this initial treatment, the risk of permanent damage has substantially decreased - and the instant treatment leads to complete restitution in some cases.
In spite of this, the transport to the pressure chamber after the introduction of the normo-bar O2 therapy remains obligatory, as it is necessary for a definite treatment of major breakdowns and as a final prognosis of seemingly harmless initial symptoms will in many cases need days or weeks.

Flying after Diving

The specific combination of diving depth and ground time is crucial for the necessary period for the de-gassing of the body fabric. Diving several times a day over a period of several days in succession leads to a disadvantageous accumulation of nitrogen in the body, which may effect problems in case of a subsequent flight.

In modern aircraft, there is a minimum cabin pressure of 0.75 bar, which corresponds to a height of about 2500m above NN. This additional decrease in pressure may now lead to decompression complaints.

To exclude any risk, 24 hours should pass between the last dive and the flight. With dives requiring decompression or with multiple exposures, several days up to 48 hours should pass.