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Proceedings Decompression And PROCEEDINGS DECOMPRESSION AND THE DEEP STOP Salt Palace Convention Center Salt Lake City, Utah, USA JUNE 24-25, 2008 SPONSORED BY: Undersea and Hyperbaric Medical Society US ONR Divers Alert Network National Association Underwater Instructors Professional Association of Diving Instructors Editors: Peter B. Bennett, Ph.D, D.Sc. Bruce Wienke, Ph.D, Simon Mitchell, MB, Ch.B., Ph.D Bennett PB, Wienke B, Mitchell S, editors of the Decompression and the Deep Stop Workshop. Proceedings of the Undersea and Hyperbaric Medical Society’s 2008 June 24-25 Pre-Course to the UHMS Annual Scientific Meeting, Salt Lake City, Utah. Copyright©2008 by Undersea and Hyperbaric Medical Society 21 West Colony Place, Suite 280 Durham, NC 27705 USA All rights reserved. No part of this book may be reproduced in any form without written permission from the publisher. This workshop was jointly sponsored by, Undersea and Hyperbaric Medical Society (UHMS), US Office of Naval Research (ONR), Divers Alert Network(DAN), International Association of Nitrox & Technical Divers (IANTD), National Association of Underwater Instructors (NAUI) and Professional Association of Diving Instructors (PADI) Opinions and data presented at this workshop and in these proceedings are those of the contributors, and do not necessarily reflect those of the Undersea and Hyperbaric Medical Society. ACKNOWLEDGEMENTS: We would like to extend our thanks for the financial support for this workshop from UHMS, ONR, DAN, NAUI Worldwide, IANTD, and PADI and for cosponsoring the meeting in Salt Lake City, June 2008. Additional thanks to Lisa Tidd, Stacy Rupert, and Cindi Easterling for their logistics support. Grateful appreciation is extended to Kim Farkas for so efficiently transcribing all the presentations and discussion. Thanks to Stacy Rupert for the extensive work in the production of these proceedings. Cover photo: Tim O’Leary, NAUI ___________________________ DISCLOSURES: Planners: The following planners had no financial relationships with commercial interests to disclose: Peter Bennett, Bruce Wienke, Simon Mitchell, Lisa Tidd and Paul Sheffield (CME Rep) Faculty: The following faculty had no financial relationships with commercial interests to disclose: Peter Bennett, Joseph Dituri, Neal Pollock, Bruce Wienke, Richard Vann, Alessandro Marroni, Tom Mount, Tim O’Leary, Alf Brubakk, Christian Gutvik, Ed Betts, Wayne Gerth, Drew Richardson, Tom Neuman, Jean Blatteau, Simon Mitchell, Joseph Dituri The following faculty has disclosed a financial relationship: Jarrod Jablonski, Halcyan Manufacturing, CEO & Global Underwater Explorers, President/Non-profit The following have provided commercial support to this activity: NAUI, DAN, IANTD and PADI ISBN: 0-930406-24-9 DECOMPRESSION AND THE DEEP STOP WORKSHOP PROCEEDINGS Table of Contents Decompression and the Deep Stop Overview ................................................................................................... 1 Introduction to the Program............................................................................................................................... 3 Early Observations on the Effect of “Deep” Decompression Upon Doppler Ultrasonic Bubble Signals Following 210/50 and 170/30 Dives ...................................................................................... 5 LANL Deep Stop Data Bank and Dual Phase Bubble Model for Profile Analysis and Risk ............................ 15 Discussion: Early Observation / LANL Deep Stop ........................................................................................... 55 TECHNICAL DIVING USE OF DEEP STOP • Technical Diving Overview ................................................................................................................ 63 • A Decade of Deep Stop Training with the Reduced Gradient Bubble Model..................................... 85 • A Practical Look at Decompression Survival on Dives Deeper than 100 Meter and Use of Intuitive Decompressions ................................................................................................................... 103 • World Record Cave Dive, Deep Stops Within the Woodville Karst Plain Project ............................. 111 • The Application of “Deep Stops” in ANDI’s Technical Diver Training and Expeditions................. 113 • Deep Stops: Awareness and Current Practice in the Technical Diving Community........................... 119 • Discussion: Technical Diving ............................................................................................................. 139 NAVAL USE OF THE DEEP STOP • Could the U.S. Navy Benefit from Technical Diving Techniques? .................................................... 143 • Empirical Evaluation of the Efficacy of Deep Stops in Air Decompression Dives............................. 165 o Discussion: US Navy Benefit / Empirical Evaluation........................................................... 187 • Deep Stops During Decompression from 50 to 100 msw Didn’t Reduce Bubble Formation in Man ................................................................................................................................................. 195 • Discussion: ........................................................................................................................... 207 Bubble Detection and DCS Relevance .............................................................................................................. 215 • Discussion ........................................................................................................................................... 227 The Optimal Path............................................................................................................................................... 235 • Discussion: .......................................................................................................................................... 249 The Effect of Deeper Stops on Bubble Formation is Dependant on Length of Bottom Time ........................... 255 • Discussion: .......................................................................................................................................... 265 IDAN Deep Stop Research for Recreational Divers.......................................................................................... 271 • Discussion: .......................................................................................................................................... 281 The Use of Deep Stop in Recreational Diving................................................................................................... 287 • Discussion: ......................................................................................................................................... 393 General Discussion/Future Research................................................................................................................. 395 Consensus Statements........................................................................................................................................ 323 Appendices A. Workshop Faculty ........................................................................................................................ 325 B. Workshop Participants ................................................................................................................. 327 C. Workshop Agenda........................................................................................................................ 331 Decompression and the Deep Stop Workshop Proceedings DECOMPRESSION AND THE DEEP STOP WORKSHOP OVERVIEW Theoretical and practical solutions as to how to ascend or decompress after diving have been considered since Haldane some 100 years ago, yet decompression sickness (DCS) still occurs. The traditional “Haldanian” approach to planning decompression has been to limit supersaturation (the difference between tissue inert gas tension and ambient pressure) according to empirically derived rules that purportedly maximize gradients for inert gas washout and therefore provide a low risk of DCS. The use of Doppler to monitor the central venous circulation, however, shows this approach still frequently results in bubble formation. Other more recent decompression theories have relied on so called “bubble models” which focus on prevention of such bubble formation. To do this, the algorithms limit supersaturation more aggressively and typically result in the imposition of deeper decompression stops. These have been used quite successfully for many years by technical divers for deep diving. In recent years, the utilization of a deep stop by recreational scuba divers at depths less than 130 fsw (41 m) also has been proposed. This is now appearing in dive computers using “bubble models” such as Varying Permeability or the Reduced Gradient Bubble Model or the Half the Depth Model. Some training agencies have also incorporated deep stops into their training regimens. However, there is debate as to when to stop, for how long and how often in regard to whether such a deep stop does limit bubble growth or ameliorate the risk of DCS. This workshop has brought together the most active international individuals with practical human data, animal research and theoretical concepts to help clarify the role of “deep stops” in contemporary recreational scuba and technical diving, and to point out what we know as well as indicate future research needs. Copyright©2008 Undersea and Hyperbaric
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