Appendix: Flow Charts and Treatment Tables

Appendix
Flow Charts and V

Treatment Tables
SECTION PAGE
GENERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 1
RECOMPRESSION TREATMENTS
WHEN CHAMBER IS AVAILABLE. . . . . . . . . . . . . . . . . . . . . . . . . . V- 1
FLOW CHART 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 5
FLOW CHART 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 6
FLOW CHART 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 7
FLOW CHART 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 8
AIR TREATMENT TABLE 1A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V- 9
AIR TREATMENT TABLE 2A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V-10
AIR TREATMENT TABLE 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V-11
TREATMENT TABLE 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V-12
TREATMENT TABLE 6A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V-15
Flow Charts and
Treatment Tables
V
GENERAL recompress the diver 10 feet in the water, but to remove the
This appendix contains the diving accident treatment diver from the water when decompression risks are
flow charts and a number of U.S. Navy Treatment Tables unacceptable and treat him in the chamber. When this is
used to recompress divers who have experienced done, the surface interval should be 5 minutes or less, with
decompression sickness or arterial gas embolism as a the diver always treated as having Type II symptoms.
result of their diving activities. The information in this
appendix reflects treatment procedures recommended by Treatment of Symptoms During Sur-D Surface Interval:
the NOAA Diving Program and taught in the NOAA If surface decompression procedures are used, symptoms
training program. All of the tables in this appendix have of decompression sickness may occur during the surface
been widely used in the field and have been shown to be interval. Because neurological symptoms cannot be ruled
safe and effective. out during this short period, the symptomatic diver is
treated as having Type II symptoms, even if the only
Diving Accident Treatment Flow Charts complaint is pain.
The flow charts shown are decision trees designed to aid
dive supervisors, diving physicians, Diving Medical Treating for Exceeded Sur-D Surface Interval: If the
Technicians, chamber operators, and other health care prescribed surface interval is exceeded but the diver
professionals who must decide how best to treat stricken remains asymptomatic, the diver is treated with Treatment
divers. Use of the decision tree requires only that the Table 5, or Treatment Table lA if no oxygen is available. If
diver’s condition be observed; a medical diagnosis is not the diver becomes symptomatic, the diver is treated as if
required for treatment to begin. Type II symptoms were present. Any symptoms occurring
during the chamber stops are treated as recurrences in
Recompression Treatment Tables accordance with Flow Chart 3.
The recompression treatment tables recommended by
NOAA are shown on the following pages. Instructions for Recompression Treatments When Oxygen Is Not
the use of these tables appear with each table and should be Available: If no oxygen is available, select the appropriate
followed precisely. Air Treatment Table in accordance with Table 1A, Table
2A, Table 3, and Table 4.
RECOMPRESSION TREATMENTS WHEN Use Table 1A if pain is relieved at a depth less than 66
CHAMBER IS AVAILABLE feet. If pain is relieved at a depth greater than 66 feet, use
Oxygen Treatment Tables are more effective and, Table 2A. Table 3 is used for treatment of serious
therefore, preferable over Air Treatment Tables. Treatment symptoms where oxygen cannot be used. Use Table 3 if
Table 4 can be used with or without oxygen but should symptoms are relieved within 30 minutes at 165 feet. If
always be used with oxygen if it is available. symptoms are not relieved in less than 30 minutes at 165
feet, use Table 4.
Symptoms During Decompression and Surface
Decompression: If symptoms of decompression sickness Descent/Ascent Rates for Air Treatment Tables: The Air
occur in the water during decompression, follow Flow Treatment Tables (lA, 2A, 3, and 4 using air) are used
Chart 1. After completing recompression treatment, when no oxygen is available. They are not as effective as
observe the diver for at least 6 hours. If any symptoms the Oxygen Treatment Tables. The descent rate is 20 feet
recur, treat as a recurrence of Type II symptoms. As an per minute; the ascent rate is not to exceed 1 foot per
option, the on-site Diving Supervisor may elect not to minute.
V-1
Recompression Treatments When Oxygen Is Complete Relief after 10 Minutes: If complete relief of
Available: Use Oxygen Treatment Tables 5, 6, 6A, 4, or Type I symptoms is not obtained within 10 minutes at 60
7, according to Flow Charts 2, 3, and 4. The descent rate feet, Table 6 is required.
is 20 feet per minute. Upon reaching treatment depth not
to exceed 60 fsw, place the patient on oxygen. For depth Musculoskeletal Pain Due to Orthopedic Injury:
deeper than 60 fsw, use treatment gas if available. Symptoms of musculoskeletal pain that have shown
Additional guidelines for each treatment table are given absolutely no change after the second oxygen breathing
below. period at 60 feet may be due to orthopedic injury rather
than decompression sickness. If, after reviewing the
Treatment Table 5: Treatment Table 5 may be used for the patient’s history, the Diving Medical Doctor feels that the
following: pain can be related to specific orthopedic trauma or injury,
Treatment Table 5 may be completed. If no Diving
• Type I (except for cutis-marmorata) symptoms when Medical Doctor is on site, Treatment Table 6 shall be used.
a complete neurological examination has revealed
no abnormality NOTE
• Asymptomatic omitted decompression of shallow Once recompression to 60 feet is done, Treatment
surfacing (20 fsw or less) Table 5 shall be used even if it was decided
• Asymptomatic omitted decompression of rapid symptoms were probably not decompression
ascent (from deeper than 20 fsw) if the missed sickness. Direct ascent to the surface is done only
decompression is less than 30 minutes in emergencies.
• Asymptomatic divers who have exceeded surface
interval limits following a Sur-D dive Treatment Table 6: Treatment Table 6 is used for the
• Treatment of resolved symptoms following in-water following:
recompression
• Follow-up treatments for residual symptoms • Type I symptoms where relief is not complete within
10 minutes at 60 feet or where a neurological exam
Performance of Neurological Exam at 60 fsw: After is not complete
arrival at 60 fsw a neurological exam shall be performed • Type II symptoms
(see Appendix II) to ensure that no overt neurological • Cutis marmorata
symptoms (e.g., weakness, numbness, incoordination) are • Arterial gas embolism
present. If any abnormalities are found, the stricken diver • Symptomatic uncontrolled ascent
should be treated using Treatment Table 6. • Asymptomatic divers with omitted decompression
greater than 30 minutes
Extending Oxygen Breathing Periods on Treatment • Treatment of unresolved symptoms following in-
Table 5: Treatment Table 5 may be extended by two water treatment
oxygen breathing periods at 30 fsw. Air breaks are not • Recurrence of symptoms shallower than 60 fsw
required prior to an extension, between extensions, or prior
to surfacing. In other words, the Diving Supervisor may Treating Arterial Gas Embolism: Arterial gas embolism is
have the diver breathe oxygen continuously for 60 minutes treated by initial compression to 60 fsw. If symptoms are
at 30 fsw and travel to the surface while breathing oxygen. improved within the first oxygen breathing period, then
If the Diving Supervisor elects to extend this treatment treatment is continued using Treatment Table 6. Treatment
table, the tender does not require additional oxygen Table 6 may be extended for two oxygen breathing periods
breathing than currently prescribed. at 60 fsw (20 minutes on oxygen, then 5 minutes on air, then
20 minutes on oxygen) and two oxygen breathing periods at
When Use of Treatment Table 6 is Mandatory: 30 fsw (15 minutes on air, then 60 minutes on oxygen, then
Treatment Table 6 is mandatory if: 15 minutes on air, then 60 minutes on oxygen). If there has
been more than one extension, the tenders’ oxygen
• Type I pain is severe and immediate recompression breathing period is extended 60 minutes at 30 feet.
must be instituted before a neurological examination
can be performed, or Treatment Table 6A: Arterial gas embolism or severe
• A complete neurological examination cannot be decompression symptoms are treated by initial
performed, or compression to 60 fsw. If symptoms improve, complete
• Any neurological symptom is present. Treatment Table 6. If symptoms are unchanged or worsen,
assess the patient upon descent and compress to depth of
These rules apply no matter how rapidly or completely relief (significant improvement), not to exceed 165 fsw.
the symptoms resolve once recompression begins. Once at the depth of relief, begin treatment gas (N202,
V-2 NOAA Diving Manual

HeO2) if available. Stay there for 30 minutes. A breathing Considerations: A Diving Medical Doctor shall be
period of 25 minutes on treatment gas, interrupted by 5 consulted before shifting to a Treatment Table 7 and
minutes of air, is recommended at depth to simplify time careful consideration shall be given to life support
keeping. The patient may remain on treatment gas during capability. In addition, it must be realized that the
ascent from treatment depth to 60 fsw since the P02 will recompression facility will be committed for 48 hours or
continually decrease during ascent. Decompress to 60 fsw more.
at a travel rate not to exceed 3 ft/min. Upon arrival at 60
fsw, complete Treatment Table 6. Consult with a Diving Indications: Treatment Table 7 is an extension at 60 feet
Medical Doctor at the earliest opportunity. The Diving of Treatment Tables 6, 6A, or 4 (or any other nonstandard
Medical Doctor may recommend a Treatment Table 4. treatment table). This means that considerable treatment
Treatment Table 6A may be extended for two oxygen has already been administered. Treatment Table 7 is not
breathing periods at 60 fsw and two oxygen breathing designed to treat all residual symptoms that do not
periods at 30 fsw. If deterioration is noted during ascent to improve at 60 feet and should never be used to treat
60 feet, treat as a recurrence of symptoms (Flow Chart 4). residual pain. Treatment Table 7 should be used only when
loss of life may result if the currently prescribed
Treatment Table 4: If a shift from Treatment Table 6A to decompression from 60 feet is undertaken.
Treatment Table 4 is contemplated, a Diving Medical
Doctor shall be consulted before the shift is made. Time at Depth: When using Treatment Table 7, a
Treatment Table 4 is used when it is determined that the minimum of 12 hours should be spent at 60 feet, including
patient would receive additional benefit at depth of time spent at 60 feet from Treatment Table 4, 6, or 6A.
significant relief, not to exceed 165 fsw. The time at depth Severe Type II decompression sickness and/or arterial gas
shall be between 30 to 120 minutes, based on the patient’s embolism cases may continue to deteriorate significantly
response. over the first several hours. This should not be cause for
premature changes in depth. Do not begin decompression
Recurrence of Symptoms: If deterioration is noted during from 60 feet for at least 12 hours. At completion of the 12-
ascent to 60 feet, treat as a recurrence of symptoms (Flow hour stay, the decision must be made whether to
Chart 4). decompress or spend additional time at 60 feet. If no
improvement was noted during the first 12 hours, benefit
Oxygen Breathing Periods: If oxygen is available, the from additional time at 60 feet is unlikely and
patient should begin oxygen breathing periods immediately decompression should be started. If the patient is improving
upon arrival at the 60-foot stop. Breathing periods of 25 but significant residual symptoms remain (e.g., limb
minutes on oxygen, interrupted by 5 minutes of air, are paralysis, abnormal or absent respiration), additional time at
recommended. This simplifies timekeeping. Immediately 60 feet may be warranted. While the actual time that can be
upon arrival at 60 feet, a minimum of four oxygen spent at 60 feet is unlimited, the actual additional amount of
breathing periods (for a total time of 2 hours) should be time beyond 12 hours that should be spent can only be
administered. After that, oxygen breathing should be determined by a Diving Medical Doctor (in consultation
administered to suit the patient’s individual needs and with on-site supervisory personnel), based on the patient’s
operational conditions. Both the patient and tender must response to therapy and operational factors. When the
breathe oxygen for at least 4 hours (eight 25-minute patient has progressed to the point of consciousness, can
oxygen, 5-minute air periods), beginning no later than 2 breathe independently, and can move all extremities,
hours before ascent from 30 feet is begun. These oxygen- decompression can be started and maintained as long as
breathing periods may be divided up as convenient, but at improvement continues. Solid evidence of continued benefit
least 2 hours’ worth of oxygen breathing periods should be should be established for stays longer than 18 hours at 60
completed at 30 feet. feet. Regardless of the duration at the recompression below
60 feet, at least 12 hours must be spent at 60 feet and then
Treatment Table 7: Treatment Table 7 is considered an Table 7 followed to the surface. Additional recompression
heroic measure for treating non-responding severe gas below 60 feet in these cases should not be undertaken unless
embolism or life-threatening decompression sickness. adequate life support capability is available.
Committing a patient to Treatment Table 7 involves
isolating the patient and having to minister to his medical Decompression: When using Treatment Table 7, tenders
needs in the recompression chamber for 48 hours or breathe chamber atmosphere. Chamber oxygen should be
longer. Experienced diving medical personnel must be kept above 19% and carbon dioxide below 1.5% surface
available before committing to Treatment Table 7. equivalent (sev) (11.4 mmHg). Decompression on
Flow Charts and Treatment Tables V-3

Treatment Table 7 is begun with an upward excursion at to the patient’s condition. Food may be taken at any time
time zero from 60 to 58 feet. Subsequent 2-foot upward and fluid intake should be maintained.
excursions are made at time intervals appropriate to the
rate of decompression: Ancillary Care: Patients on Treatment Table 7 requiring
intravenous and/or drug therapy should have these
Depth Rate Time Interval administered in accordance with a Diving Medical Doctor.
58-40 feet 3 ft/hr 40 min
40-20 feet 2 ft/hr 60 min Abort Procedures: In some cases, a Treatment Table 7
20-4 feet 1 ft/hr 120 min may have to be terminated early. If extenuating
circumstances dictate early decompression and less than 12
Preventing Inadvertent Early Surfacing: Upon arrival at 4 hours have elapsed since treatment was begun,
feet, decompression should be stopped for 4 hours. At the decompression may be accomplished using the appropriate
end of 4 hours at 4 feet, decompress to the surface at 1 foot 60 – foot Air Decompression Table as modified. The
per minute. This procedure prevents inadvertent early 60 – foot Air Decompression Tables may be used even if
surfacing. time was spent between 60 and 165 feet (e.g., on Table 4 or
6A), as long as at least 3 hours have elapsed since the last
Time Intervals: The travel time between subsequent stops excursion below 60 feet. If less than 3 hours have elapsed,
is considered as part of the time interval for the next or if any time was spent below 165 feet, use the Air
shallower stop. The time intervals shown above begin Decompression Table appropriate to the maximum depth
when ascent to the next shallower stop has begun. attained during treatment. All stops and times in the Air
Decompression Table should be followed, but oxygen-
Oxygen Breathing: On a Treatment Table 7, patients breathing periods should be started for all chamber
should begin oxygen breathing periods as soon as possible occupants as soon as a depth of 30 feet is reached. All
at 60 feet. Oxygen breathing periods of 25 minutes on 100% chamber occupants should continue oxygen-breathing
oxygen, followed by 5 minutes breathing chamber periods of 25 minutes on 100% oxygen, followed by 5
atmosphere, should be used. Normally, four oxygen minutes on air, until the total time breathing oxygen is
breathing periods are alternated with 2 hours of continuous one-half or more of the total decompression time.
air breathing. In conscious patients, this cycle should be If more than 12 hours have elapsed since treatment
continued until a minimum of eight oxygen breathing was begun, the decompression schedule of Treatment
periods have been administered (previous 100% oxygen Table 7 shall be used. In extreme emergencies, the abort
breathing periods may be counted against these eight recommendations may be used if more than 12 hours have
periods). Beyond that, oxygen breathing periods should be elapsed since beginning treatment.
continued as recommended by the Diving Medical Doctor,
as long as improvement is noted and the oxygen is tolerated Treatment Table 8: Treatment Table 8 is an adaptation of
by the patient. If oxygen breathing causes significant pain a Royal Navy Treatment Table 65 mainly for treating deep
on inspiration, it should be discontinued unless it is felt that uncontrolled ascents when more than 60 minutes of
significant benefit from oxygen breathing is being obtained. decompression have been missed. Compress symptomatic
In unconscious patients, oxygen breathing should be patient to depth of relief not to exceed 225 fsw. Initiate
stopped after a maximum of 24 oxygen breathing periods Treatment Table 8 from depth of relief. The Table 8
have been administered. The actual number and length of schedule from 60 feet is the same as Treatment Table 7.
oxygen breathing periods should be adjusted by the Diving
Medical Doctor to suit the individual patient’s clinical Treatment Table 9: Treatment Table 9 is a hyperbaric
condition and response to oxygen toxicity. oxygen treatment table using 90 minutes of oxygen at 45
feet. This table is recommended by the Diving Medical
Sleeping, Resting, and Eating: At least two tenders Doctor cognizant of the patient’s medical condition.
should be available when using Treatment Table 7, and Treatment Table 9 is used for the following:
three may be necessary for severely ill patients. Not all
tenders are required to be in the chamber, and they may be • Residual symptoms from AGE/DCS
locked in and out as required following appropriate
decompression tables. The patient may sleep anytime This table may also be recommended by the cognizant
except when breathing oxygen deeper than 30 feet. While Diving Medical Doctor when initially treating a severely
asleep, the patient’s pulse, respiration, and blood pressure injured patient whose medical condition precludes long
should be monitored and recorded at intervals appropriate absences from definitive medical care.

Flow Chart 1 .
Treatment of Decompression Sickness Occurring
While at a Decompression Stop in the Water
NOTES:
1. If 100% oxygen is available for divers with

a helmet or full face mask, shift to this gas
at depths of 30 fsw or less.
2. As an option, the Diving Supervisor may
elect not to recompress the diver 10 feet in
the water, but to remove the diver from the
water when decompression risks are
acceptable and treat the diver in the
chamber.
3. If recompression goes deeper than the
depth of the first stop in the
Decompression Table use a stop time
equal to 1 1/2 times the first stop in the
Decompression Table for the one stop
deeper than the first stop. Always take a
stop every 10 feet.
4. No oxygen available.
Decompress by
multiplying all
stop times in table
by 1 1/2
(Note 3)
Compress to 60 fsw
Symptoms in chamber on
present at Table 5 or Table 1A
surface? (Note 4)
Compress to 60 fsw
in chamber on
Table 6 or Table 3

Flow Chart 2
Treatment of Type I
Decompression Sickness
Diagnosis:
Decompression Treatment from Diving or Altitude Exposures
Sickness Type 1
(Note 1)
NOTES:
1. If a complete neurological
Complete two more exam was not completed
Complete relief oxygen breathing before recompression, treat
during first 10 min.
periods on Table 6 as a Type II symptom.
at 60 feet?
(Note 3) (Note 2) 2. Treatment Table 6 may be
extended up to four
additional oxygen-breathing
periods, two at 30 feet
and/or two at 60 feet.
3. Diving Supervisor may elect
to treat on Treatment Table
Complete 6.
treatment on 4. Treatment Table 5 may be
Table 5 extended two oxygen-
(Note 4) breathing periods at 30 fsw.

Flow Chart 3
Diagnosis:
Arterial Gas
Treatment of Arterial Gas Embolism
Embolism or or Decompression Sickness
Decompression
Sickness ACLS
capabilities Consider use of
available ACLS and Table 6
within 20 min.
(Note 4)
(Note 3)
Pulse
present?
NOTES:
1. A diving medical doctor shall be

Compress to 60 consulted before committing to a
feet. Commence
Treatment Table 4 or 7.
oxygen breathing
at 60 feet.
2. Treatment Table 6A may be
extended if necessary at 60
and/or under 30 feet.
3. Cardiac arrest requires
Unchanged Complete treatment Advanced Cardiac Life Support
or worsening
symptoms?
on Table 6
(ACLS). For the greatest chance
(Note 5)
of resuscitation, consultation with
a Diving Medical Doctor is
required as soon as possible.
Compress on air Complete 30 min.
4. Recompression chamber must
to depth of relief period breathing be surfaced to perform
or significant air or treatment gas defibrillation.
improvement, not on Table 6A 5. Assessment of patient must be
made within 20 minutes. If the
to exceed 165 fsw (Note 7)
stricken diver remains pulseless

after 20 minutes, termination of
Remain at
treatment depth, More time
resuscitation may be considered.
not to exceed
needed at depth 6. Additional time may be required.
of relief?
90 min. total (Note 1) 7. Enter Treatment Table 6A at
depth of relief or significant
improvement.
Decompress
on Table 4
Decompress to 60
to 60 feet
feet, not to exceed
3 ft/min. Complete
Treatment Table 6A
(Note 2)
Complete
Life threatening
symptoms and Table 4
more time needed
(Note 1)
at 60 feet?
(Note 1)
Decompress
Remain at 60 feet
on Table 7
at least 12 hours
(Note 1)
(Note 6)

Flow Chart 4
Treatment of
Recurrence During Treatment Symptom Recurrence Recurrence Following Treatment
Diagnosis: Diagnosis:
Recurrence Recurrence
During Following
Treatment Treatment
Symptom Diver on oxygen

Treat according
onset 60 feet compress to
to Flow Chart 3
or deeper? 60 feet
Complete three
20-min. oxygen
Deeper breathing periods
recompression at 60 feet
needed?
(Note 1)
Continue
and/or extend Decompress
Symptoms
current table on Table 6
relieved?
Compress to
depth of relief
Deeper
(165 feet maximum)
recompression
with patient
NOTES: needed?
off O2
1. A diving medical doctor shall

be consulted before
committing to a Treatment
Table 4 or 7. Life
threatening Decompress
Remain at depth 2. Treatment Table 6 may be symptoms or on Table 6
:30 min. on air or extended up to two additional more time needed
at 60 feet? Extended
treatment gas oxygen breathing periods at (Note 2)
if available 30 and/or 60 feet.

3. Additional time may be
required.
Remain at 60 feet
Decompress
Enter Treatment at least 12 hours
on Table 7
Table 6A at (Note 1 and Note 3)
More time needed
(Note 1)
at treatment depth? treatment depth
(Note 1) and decompress
accordingly
Symptoms
still present
Complete
Decompress and more time needed
at 60 feet? Table 4
to 60 feet (Note 1) (Note 1)
on Table 4

Air Treatment Table 1A
1. Descent rate Ñ 20 ft / min. 3. Time at 100 feet includes time from the
2. Ascent rate Ñ 1 ft / min. surface.
Depth/Time Profile
Depth
(fsw)
20 ft /min
Ascent Rate 1 ft/min
Time at Depth (minutes) Total Elapsed Time:

472 Minutes
(7 hours 52 minutes)
Stop Ascent Total

Depth Time Time Breathing Elapsed Time
(feet) (minutes) (minutes) Media (hrs:min.)
100 30 Air 0:30
80 12 20 Air 1:02
60 30 20 Air 1:52
50 30 10 Air 2:32
40 30 10 Air 3:12
30 60 10 Air 4:22
20 60 10 Air 5:32
10 120 10 Air 7:42
0 10 Air 7:52

Air Treatment Table 2A
1. Descent rate — 20 ft / min. 3. Time at 165 feet includes time from the
2. Ascent rate — 1 ft / min. surface.
Depth/Time Profile
Depth
(fsw)
20 ft/min

813 Minutes
Stop Ascent Total

(feet) (minutes) (minutes) Media (hrs:min.)
165 30 Air 0:30
140 12 25 Air 1:07
120 12 20 Air 1:39
100 12 20 Air 2:11
80 12 20 Air 2:43
60 30 20 Air 3:33
50 30 10 Air 4:13
40 30 10 Air 4:53
30 120 10 Air 7:03
20 120 10 Air 9:13
10 240 10 Air 13:23
0 10 Air 13:33

Air Treatment Table 3
1. Descent rate Ñ 20 ft / min. 3. Time at 100 feet includes time from the
2. Ascent rate Ñ 1 ft / min. surface.
Depth/Time Profile
Depth
(fsw)
Descent Rate
20 ft /min

1293 Minutes
Stop Ascent Total

(feet) (minutes) (minutes) Media (hr:min.)
165 30 Air 0:30
140 12 25 Air 1:07
120 12 20 Air 1:39
100 12 20 Air 2:11
80 12 20 Air 2:43
60 30 20 Air 3:33
50 30 10 Air 4:13
40 30 10 Air 4:53
30 720 10 Air 17:03
20 120 10 Air 19:13
10 120 10 Air 21:23
0 10 Air 21:33

Treatment Table 4
1. Descent rate Ñ 20 ft/ min. 6. If oxygen breathing is interrupted, no
2. Ascent rate Ñ 1 ft/ min. compensatory lengthening of the table is
3. Time at 165 feet includes time from the surface. required.
4. If only air is available, decompress on air. If 7. If switching from Treatment Table 6A or 3 at
oxygen is available, patient begins oxygen 165 feet, stay a maximum of two hours at 165
breathing upon arrival at 60 feet with feet before decompressing.
appropriate air breaks. Both tender and 8. If the chamber is equipped with a high-O 2
patient breathe oxygen beginning two hours treatment gas, it may be administered at 165
before leaving 30 feet. fsw, not to exceed 2.8 ata O2. Treatment gas
5. Ensure life support considerations can be met is administered for 25 minutes interrupted by 5
before committing to Table 4. Internal minutes of air.
chamber temperature should be below 85o F.
Depth/Time Profile
Depth
(fsw)
ft.
ft.
Descent Rate
20 ft /min
HRS HRS HRS HRS HRS HRS HRS


39 Hours 6 Minutes
(30 minutes at 165 fsw)
to 40 hours 36 minutes
(2 hours at 165 fsw)

Treatment Table 5
1. Descent rate Ñ 20 ft/min. 5. Treatment Table may be extended two oxygen-
2. Ascent rate Ñ Not to exceed 1 ft/min. Do not breathing periods at the 30-foot stop. No air
compensate for slower ascent rates. break required between oxygen-breathing
Compensate for faster rates by halting the periods or prior to ascent.
ascent. 6. Tender breathes 100% O2 during ascent from
3. Time on oxygen begins on arrival at 60 feet. the 30-foot stop to the surface. If the tender had
4. If oxygen breathing must be interrupted because a previous hyperbaric exposure in the previous
of CNS Oxygen Toxicity, allow 15 minutes after 12 hours, an additional 20 minutes of oxygen
the reaction has entirely subsided and resume breathing is required prior to ascent.
schedule at point of interruption. *
Depth/Time Profile
Depth
(fsw) Ascent Rate
1 ft/min
Descent Rate Ascent Rate

20 ft/min 1 ft/min
Time at Depth (minutes)

Total Elapsed Time:
135 Minutes
Breathing Media (Not Including
Descent Time)
= Oxygen = Air
* Procedures In the Event of Oxygen Toxicity. At the first sign of CNS oxygen toxicity, the patient should be
removed from oxygen and allowed to breathe chamber air. Oxygen breathing may be restarted 15 minutes after all
symptoms have subsided. If symptoms of CNS oxygen toxicity develop again, interrupt oxygen breathing for another
15 minutes. If CNS oxygen toxicity develops a third time, contact a Diving Medical Doctor as soon as possible to
modify oxygen breathing periods to meet requirements.

Treatment Table 6
1. Descent rate Ñ 20 ft / min. up to two additional 75 Ðminute periods at 30
2. Ascent rate Ñ Not to exceed 1 ft/min. Do not feet (15 minutes on air and 60 minutes on
compensate for slower ascent rates. oxygen), or both.
Compensate for faster rates by halting the 6. Tender breathes 100% O2 during the last 30
ascent. minutes at 30 fsw and during ascent to the
3. Time on oxygen begins on arrival at 60 feet. surface for an unmodified table or where there
4. If oxygen breathing must be interrupted has been only a single extension at 30 or 60
because of CNS Oxygen Toxicity, allow 15 feet. If there has been more than one
minutes after the reaction has entirely extension, the O 2 breathing at 30 feet is
subsided and resume schedule at point of increased to 60 minutes. If the tender has had
interruption. * a hyperbaric exposure within the past 12
5. Table 6 can be lengthened up to two hours, an additional 60 Ðminute O2 period is
additional 25 Ðminute periods at 60 feet (20 taken at 30 feet.
minutes on oxygen and five minutes on air), or
Depth/Time Profile
Depth
(fsw) Ascent Rate
1 ft/min
Descent Rate Ascent Rate

20 ft/min 1 ft/min
Time at Depth (minutes)

Total Elapsed Time:
285 Minutes
Breathing Media (Not Including
Descent Time)
= Oxygen = Air

Treatment Table 6A
1. Descent rate Ñ 20 ft/min. entirely subsided and resume schedule at
2. Ascent rate Ñ 165 fsw to 60 fsw, not to point of interruption. *
exceed 3 ft/min, 60 fsw and shallower, not to 7. Table 6A can be lengthened up to two
exceed 1 ft/min. Do not compensate for additional 25-minute periods at 60 feet (20
slower ascent rates. Compensate for faster minutes on oxygen and five minutes on air), or
rates by halting the ascent. up to two additional 75-minute periods at 30
3. Time at treatment depth does not include feet (60 minutes on oxygen and 15 minutes on
compression time. air), or both.
4. Table begins with initial compression to depth 8. Tender breathes 100% oxygen during the last
of 60 fsw. If initial treatment was at 60 feet, up 60 minutes at 30 fsw and during ascent to the
to 20 minutes may be spent at 60 feet before surface for an unmodified table or where there
compression to 165 fsw. Contact a Diving has been only a single extension at 30 or 60
Medical Doctor. fsw. If there has been more than one
5. If a chamber is equipped with a high-O 2 extension, the O 2 breathing at 30 fsw is
treatment gas, it may be administered at 165 increased to 90 minutes. If the tender had a
fsw and shallower, not to exceed 2.8 ata O2. hyperbaric exposure within the past 12 hours,
Treatment gas is administered for 25 minutes an additional 60 minute O2 breathing period is
interrupted by five minutes of air. Treatment taken at 30 fsw.
gas is breathed during ascent from the 9. If significant improvement is not obtained
treatment depth to 60 fsw. within 30 minutes at 165 feet, consult with a
6. Deeper than 60 feet, if treatment gas must be Diving Medical Doctor before switching to
interrupted because of CNS oxygen toxicity, Treatment Table 4.
allow 15 minutes after the reaction has
Depth/Time Profile
Depth
ft/min
(fsw)
ft/min
Descent Rate
20 ft/min
ft/min
Breathing Media Time at Depth (minutes) Total Elapsed Time:

350 Minutes
= Oxygen = Air
(Not Including
Descent Time)

Treatment Table 7
1. Table begins upon arrival at 60 feet. Arrival at Maximum CO 2 concentration is 1.5% SEV
60 feet is accomplished by initial treatment on (11.4 mmHg). Maximum chamber internal
Table 6, 6A, or 4. If initial treatment has temperature is 85o F.
progressed to a depth shallower than 60 feet, 5. Decompression starts with a 2-foot upward
compress to 60 feet at 20 ft/min to begin Table excursion from 60 to 58 feet. Decompress with
7. stops every two feet for times shown in profile
2. Maximum duration at 60 feet is unlimited. below. Ascent time between stops is
Remain at 60 feet a minimum of 12 hours approximately 30 seconds. Stop time begins
unless overriding circumstances dictate earlier with ascent from deeper to next shallower
decompression. step. Stop at four feet for four hours and then
3. Patient begins oxygen breathing periods at 60 ascend to the surface at 1 ft/min.
feet. Tender should breathe only chamber 6. Ensure chamber life-support requirements can
atmosphere throughout. If oxygen breathing is be met before committing to Treatment Table
interrupted, no lengthening of the table is 7.
required. 7. A Diving Medical Doctor shall be consulted
4. Minimum chamber O2 concentration is 19%. before committing to this treatment table.
Depth/Time Profile
Ascent Rate
1 ft/min
0
4
20
Ascent Rate = 1 ft /hr
Descent Rate (2 ft every 120 min)
20 ft/min
40 Ascent Rate = 2 ft /hr

Depth (2 ft every 60 min)
(fsw) Ascent Rate = 3 ft /hr

(2 ft every 40 min)
60 12 hrs minimum 6 hrs 10 hrs 16 hrs 4 hrs

No maximum limit 6 16 32 36
Time at Depth (hours)

Treatment Table 8
1. Enter the table at the depth which is exactly 5. While deeper than 165 fsw, a helium-oxygen
equal to or next greater than the deepest depth mixture with 16 Ð21% oxygen may be breathed
attained in the recompression. The descent rate by mask to reduce narcosis. At 165 fsw and
is as fast as tolerable. shallower, a heliox mix with a PO2 not to exceed
2. The maximum time that can be spent at the 2.8 ata may be given to the diver as a treatment
deepest depth is shown in the second column. gas. At 60 fsw and shallower, pure oxygen may
The maximum time for 225 fsw is 30 minutes; for be given to the diver as a treatment gas. For all
165 fsw, 3 hours. For an asymptomatic diver, the treatment gases (HeO 2 , N 2 O 2 , and O 2 ), a
maximum time at depth is 30 minutes for depths schedule of 25 minutes on gas and 5 minutes on
exceeding 165 fsw and 2 hours for depths equal chamber air should be followed for a total of four
to or shallower than 165 fsw. cycles. Additional oxygen may be given at 60
3. Decompression is begun with a 2-fsw reduction fsw after a 2-hour interval of chamber air. See
in pressure if the depth is an even number. Treatment Table 7 for guidance.
Decompression is begun with a 3-fsw reduction 6. A high-O 2 treatment mix can be used at
in pressure if the depth is an odd number. treatment depth and during decompression. If
Subsequent stops are carried out every two fsw. high O2 breathing is interrupted, no lengthening
Stop times are given in column three. The stop of the table is required.
time begins when leaving the previous depth. 7. To avoid loss of the chamber seal, ascent may
Ascend to the next stop in approximately 30 be halted at four fsw and the total remaining stop
seconds. time of 240 minutes taken at this depth. Ascend
4. Stop times apply to all stops within the band up directly to the surface upon completion of the
to the next quoted depth. For example, for required time.
ascent from 165 fsw, stops for 12 minutes are 8. Total ascent time from 225 fsw is 56 hours, 29
made at 162 fsw, and at every two-foot interval minutes. For a 165-fsw recompression, total
to 140 fsw. At 140 fsw, the stop time becomes ascent time is 53 hours, 52 minutes, and for a
15 minutes. When traveling from 225 fsw, the 60-fsw recompression, 36 hours, 0 minutes.
166 foot stop is 5 minutes; the 164 Ðfoot stop is
12 minutes. Once begun, decompression is
continuous. For example, when decompressing
from 225 feet, ascent is not halted at 165 fsw for
3 hours. However, ascent maybe halted at 60
fsw and shallower for any desired period of time.
Depth Max Time at Initial 2-fsw Stop Times

(fsw) Treatment Depth (minutes)
(hours)
225 0.5 5
165 3 12
140 5 15
120 8 20
100 11 25
80 15 30
60 Unlimited 40
40 Unlimited 60
20 Unlimited 120

Treatment Table 9
1. Descent rate Ñ 20 ft/min. 5. Tender breathes 100% O2 during last 15
2. Ascent rate Ñ 20 ft/min. Rate may be slowed minutes at 45 feet and during ascent to the
to 1 ft/min depending upon the patientÕs surface regardless of ascent rate used.
medical condition. 6. If patient cannot tolerate oxygen at 45 feet,
3. Time at 45 feet begins on arrival at 45 feet. this table can be modified to allow a treatment
4. If oxygen breathing must be interrupted depth of 30 feet. The oxygen breathing time
because of CNS Oxygen Toxicity, oxygen can be extended to a maximum of three to
breathing may be restarted 15 minutes after four hours.
all symptoms have subsided. Resume
schedule at point of interruption. *
Depth/Time Profile
0
15
Depth
(fsw)
30
Descent Rate Ascent rate

20 ft/min 20 ft/min
45
2: :15 30 5 30 5 30 2: :15
Total Elapsed Time:

Time at Depth (minutes) 102 Minutes 15 Seconds
(Not Including
Breathing Media Descent Time)
= Oxygen = Air
* Procedures in the Event of Oxygen Toxicity. At the first sign of CNS oxygen toxicity, the patient should be

The NOAA Diving Manual was prepared jointly by the National Oceanic and
Atmospheric Administration (NOAA), U.S. Department of Commerce and Best
Publishing Company.
This CD-ROM product is produced and distributed by the National Technical Information
Service (NTIS), U.S. Department of Commerce.
Visit our Web site at www.ntis.gov.

Appendix: Flow Charts and Treatment Tables

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Appendix: Flow Charts and Treatment Tables

Uploaded by

Copyright:

Available Formats

Appendix

Flow Charts and V

V-2 NOAA Diving Manual

Flow Charts and Treatment Tables V-3

V-4 NOAA Diving Manual

1. If 100% oxygen is available for divers with

Flow Charts and Treatment Tables V-5

V-6 NOAA Diving Manual

1. A diving medical doctor shall be

stricken diver remains pulseless

Flow Charts and Treatment Tables V-7

Symptom Diver on oxygen

1. A diving medical doctor shall

if available 30 and/or 60 feet.

V-8 NOAA Diving Manual

Ascent Rate 1 ft/min

Time at Depth (minutes) Total Elapsed Time:

Stop Ascent Total

Flow Charts and Treatment Tables V-9

Ascent Rate 1 ft/min

Time at Depth (minutes) Total Elapsed Time:

Stop Ascent Total

V-10 NOAA Diving Manual

Ascent Rate 1 ft/min

Time at Depth (minutes) Total Elapsed Time:

Stop Ascent Total

Flow Charts and Treatment Tables V-11

HRS HRS HRS HRS HRS HRS HRS

Time at Depth (minutes) Total Elapsed Time:

V-12 NOAA Diving Manual

Descent Rate Ascent Rate

Time at Depth (minutes)

Flow Charts and Treatment Tables V-13

Descent Rate Ascent Rate

Time at Depth (minutes)

V-14 NOAA Diving Manual

Breathing Media Time at Depth (minutes) Total Elapsed Time:

Flow Charts and Treatment Tables V-15

40 Ascent Rate = 2 ft /hr

(fsw) Ascent Rate = 3 ft /hr

60 12 hrs minimum 6 hrs 10 hrs 16 hrs 4 hrs

Time at Depth (hours)

V-16 NOAA Diving Manual

Depth Max Time at Initial 2-fsw Stop Times

Flow Charts and Treatment Tables V-17

Descent Rate Ascent rate

Total Elapsed Time:

V-18 NOAA Diving Manual

You might also like