For treatment of decompression sickness, Naval Base Guam is the place to go
By WYATT OLSON | STARS AND STRIPES Published: March 21, 2016
NAVAL BASE GUAM — Guam is a scuba diver’s paradise. Thousands flock here each year for a glimpse of the small Pacific island’s spectacular coral reefs, sea creatures and shipwrecks from both world wars.
But for those who dive too deeply or ascend too quickly, the fun can suddenly end with decompression sickness, and there’s only one place to go in the area for treatment: Naval Base Guam.
Commonly called “the bends,” the painful condition results from nitrogen suddenly converting into a gas and entering the blood stream when a diver surfaces too quickly. Left untreated, it can cause permanent tissue damage, paralysis and death.
For such emergencies, the base dive team operates a decompression chamber in which patients lie for hours at a time to receive relief. The Navy offers the treatment as a community service to the region, which is far from other chambers in Hawaii and Australia.
“It’s amazing the volume of tourists who come here to dive,” said Master Chief Diver Rodney Atherton, the base’s command master diver. “And the local companies give them a little course, and out to sea they go. Sometimes they don’t fare so well.”
The base’s dive team averages about one treatment a week — up from three a week before the advent of computerized dive monitors worn on the wrist that indicate depth and time underwater — but the flow can be sporadic. In February, the chamber was on a 45-day “dry spell,” Atherton said.
“But then it’ll come, and we’ll do one a day for three weeks straight,” he said. “You never know what’s going to hit. It’s kind of like a typhoon.”
The chamber looks like a short, stubby submarine, with one side shrouded by a wall of gauges and dials. Entry is through a large hatch at one end, and once it’s closed and pressurization begins, the patient remains locked inside with a medical corpsman for seven to eight hours.
The chamber has two small portholes, but the primary means of communication with five or six diver technicians outside is a two-way microphone and video camera.
Treating locals, tourists
Most patients are either tourists or local fisherman who dive for their catch. Once in a while, the team treats the spouse or children of servicemembers stationed on Guam.
The team rarely treats the base’s roughly 180 divers who are with the SEALS, Marine Special Forces, explosive ordnance disposal unit and the submarine tenders USS Emory S. Land and USS Frank Cable. Atherton credits that to rigid training and the fastidious use of the wrist dive monitors.
Despite general guidelines about depth and rate of ascent, individual physiology differs, Atherton said. The bodies of two divers submerging and ascending side by side might react differently.
For example, despite obeying a dive monitor, a servicemember’s 15-year-old daughter got decompression sickness so bad last year she couldn’t feel her legs, Atherton said. She was treated successfully in the chamber.
Tourists typically get in trouble by simply not recognizing the rigors of diving.
“I call 100-feet deep running a half a marathon,” Atherton said. “So you don’t come to the island, hung over from the night before, on jet lag and go run 13.1 miles. You just don’t do that, and of course you don’t want to run a full marathon.
“What happens is people come here and they’re running a full marathon at 130 to 190 feet, and they didn’t train for it.”
Decompression sickness underwent its first serious study in the mid-1800s after construction workers descending in caissons — watertight chambers open at the bottom — were affected. The condition earned the moniker “the bends” for the positions the workers took to relieve some of the pain.
The bends occurs during ascent, when a buildup of nitrogen is released as bubbles into a diver’s body with the change of pressure. The process is similar to carbonating a soft drink. Carbon dioxide is dissolved in a soft drink and remains so as long as the container is sealed and under pressure. When it’s opened, the pressure is released and the nitrogen converts to a gas that quickly escapes in the form of bubbles.
That action within a human body can tear blood vessels and nerves.
Local fishermen usually don’t use dive monitors. Last year, one miscalculated how deep he’d gone because the water was warmer than usual and fish went a bit deeper, perhaps 180 to 200 feet, Atherton said. By the time he got home, he wasn’t feeling well, drank a few beers and went to sleep.
“When he woke up, his legs weren’t working right and he basically crawled out of his house,” Atherton said. “The local pastor who lives right beside him saw this old fisherman trying to reach his truck.”
The pastor knew he was a diver and, after quickly surmising the problem, drove him to Naval Base Guam’s front gate.
Other patients are referred to the chamber by medical clinics or hospitals, where they might undergo concurrent care.
During the hourslong treatment, the chamber is usually pressurized to the equivalent of 60 feet below water, a pressure that “does magic” on the bends, Atherton said. The patient is given pure oxygen for 20 minutes, then taken off it for five minutes. The pressure is gradually lessened.
The team’s medical technician, Jessica Andrews, has spent many hours inside the chamber. It’s a stressful time for most patients, and a big part of her job is keeping them calm and comfortable while continually assessing their mental acuity and physical recovery.
“I try to treat a patient like any other family member, brother or sister, so that they know you’re invested in their care,” Andrews said.
Atherton described her job as keeping patients in a “happier place” and leading them to “where they need to go because the mind is a very big part of this.”
Treatment is best begun within 24 hours of the dive, Atherton said, and the pain of the bends usually drives divers to seek medical care quickly.
But the chamber can help even up to a week after symptoms begin.
“About the seventh day, if you have damage to your tissue and it’s been deadened by the bubbles, we probably can’t do much for you,” Atherton said.
Some patients require numerous treatments done over many days.
One of the toughest cases was a 68-year-old retired Navy diver who taught scuba skills to newbies.
In June 2014, Chuck Bressie developed severe decompression sickness after swimming up rapidly to stop one of his students from surfacing too quickly. Soon after the dive, his toes began to feel numb, Bressie said in an article published by the Navy.
“Then probably within two or three seconds it was up to my ankle, then I was numb up to my knees, then I got numbed up to my waist, and then I felt like I couldn’t move anything,” he said.
Bressie was quickly brought to the decompression chamber.
“The first three of four rides in the chamber, I don’t remember,” he said. “But as the rides got along, they got better.”
After three weeks, he was able to walk again, plagued only by hip pain. Bressie, advised not to dive again, sold all his gear.