The first aid is in the cases of suspicion of symptoms of decompression illness.

Emergency Procedures:

A.first aid in suspected cases of decompression illness:
II- OXYGEN(O2)100% oxygen breathing should be started as soon in any suspected case of DCS.Oxygen provides the following benefits to the diver:
1.Adds no more inert gas.
2.Washes out dissolved inert gas by increasing nitrogen tension between tissues and blood and minimizing its partial pressure in the lungs.
3.Washes the inert gas out of bubbles by maintaining a tension gradient in the tissues reducing the bubble size.
4.Improves blood and tissue oxygenation leading to decrease of areas of Ischemia.
5.Helps reduce respiratory distress.
6.May reduce shock and cerebral edema.
So, Oxygen breathing might improve existing symptoms and prevent other symptoms from occurring.

Oxygen delivery systems commonly used in diving first aid in Egypt

A) Demand System
The easiest and most effective way to achieve near 100% O2 in case of a spontaneously breathing victim is the demand valve delivery system; it also reduces the waste of O2 especially in the newly introduced O2 Rebreathing Delivery System.

B) Constant flow systems
I) Simple face maskIt is the most commonly used O2 mask, though having the following disadvantages:
1.Often seals poorly.
2.Large ventilation holes allow O2 to be further diluted with ambient air. So this simple mask delivers O2 at concentrations as low as 35-50%.

II) Partial rebreather mask. Fitted with a reservoir bag, which helps to elevate O2 concentrations up to 55- 65%.
* Forget about air breaks every 20 minutes in case of using continuous flowing systems as the O2 delivery in far below 100%.
*Periods of O2 breathing should be recorded and the diver's response to O2 should be observed and relayed to the treating Hyperbaric physician.
*Industrial oxygen must not be used as a substitute to medical oxygen.

III- POSITIONINGIf  DCS is suspected, the injured diver should be positioned horizontally without the head or legs elevated.
-If the diver feels faint, has a thready pulse or low blood pressure, elevation of the legs may improve the case. However, if the diver's condition appears to deteriorate as a result, the legs should be lowered.
- Unconscious or nauseated divers should be placed on one side with the neck extended (recovery position).
-Any diver requiring resuscitation should be placed supine.
-Some injured divers, such as those suffering from heart problems, may find it easier to breathe while sitting or semi-reclined.

Trendlenberg position (victim lying on left side with his feet raised up 30 degrees) was thought to reduce the incidence of bubbles transportation to the brain and heart against gravity.But recent studies proved this to be incorrect and that position is no longer currently recommended as it might be harmful in some cases.

IV- FLUIDSIn any suspected case of DCS, fluid administration is extremely important as dehydration is one of the major contributing factors.
Encourage the conscious victim to drink +300 ml of water per hour.
If the tender has medical training background, an intravenous line of saline or Ringers is recommended especially for an unconscious diver.

V-Treat and guard against ASSOCIATED PROBLEMS e.g.Shock, Hypothermia, near drowning, Injuries etc.

VI- Monitor for deterioration and record observations.
*The first and most significant aid is to plan for safe dives including accident management and plans for evacuation to the nearest recompression facility.
*Dive leaders should co-operate with chamber personnel by doing what is asked of them, being honest in all of their answers to questions.

B.Five minute neurotically exam:
A simple method to help assess if a diver is suffering from DCI, the observations of this test should be recorded and passed to the treating doctor or facility: