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>Everything came together smoothly at the start of our exploratory wreck expedition in the Gulf of Thailand. Our boat, MV Trident, even left two hours ahead of schedule for our 16-hour ride to a promising set of coordinates the captain had obtained from local fishermen in exchange for beer and cigarettes. Typhoons and wars have littered the gulf with an astonishing array of wrecks, from Chinese junks, submarines and aircraft to Japanese merchant vessels, and we hoped to find a virgin shipwreck to explore.
>The boat continued through the night as our dive team slept, the engines slowing to a crawl as we approached the coordinates. Within minutes the captain saw a shape rise up on the scope; there was indeed a large wreck below, sitting on the bottom at 270 ft (82 m). Over breakfast I reviewed some of the problems that virgin wreck exploration holds: floating nets, silt-filled interiors, collapsing structure and no option for air-rescue in case of a problem. If a diver had a minor "niggle" or pain-only "hit," we would choose in-water recompression. (Note: In-water recompression has its own dangers and should not be attempted without the necessary training and equipment. DAN does not recommend the practice. — Ed.) Given our remote location 200 miles (321.2 km) offshore, diligence and conservative planning were the orders of the day. Everyone analyzed their gases, checked backup systems and filled in run times. Once the surface-supplied oxygen was dropped on a deco bar beneath the boat, we began to descend to whatever awaited below.
>Conditions were perfect, with water temperatures a comfortable 87°F (31°C) and visibility of 100 ft (30 m). We had located a large freighter, upright and intact, with a cargo of lumber stacked neatly in the holds. We looked in the bridge windows; all the navigational equipment stood in place. A huge grouper lurked in the stairway between decks, unsure what to make of us. Ascending, I found that the forward mast of the wreck was obscured by huge shoals of fish.
>It was an awesome dive! Bill (not his real name) surfaced shortly after I did and climbed aboard, totally ecstatic. Settling on the bench, he happily recounted his amazement at the intact wreck, but as he continued, his expression changed; he became quiet and introspective. He said his calves were achy and that he had a sharp pain behind his right knee. I asked if he had done all his deco and cleared both of his computers; he answered, "Yes."
>I suggested he immediately begin in-water recompression and directed a crew member to assist and monitor his progress. Swimming toward the deco station, Bill stopped. "My hands aren't working, and I can't hold on the line," he said. In fewer than five minutes, Bill's condition had gone from happy and symptom-free, to slight niggling pain and now to a severe central nervous system problem. I had no choice but to scrub the in-water recompression and bring him back aboard.
>As Bill lay down on a cushioned bench, the pain worsened and he became dizzy. We started him on 100 percent oxygen from a demand regulator and removed his wetsuit. He had large, ugly red splotches on his chest, stomach and thighs. Within 10 minutes after surfacing, he experienced extreme vertigo and vomited. There was no doubt that Bill was suffering a serious case of decompression sickness (DCS).
>While another diver monitored Bill, I accounted for the rest of the expedition. Everyone else on Bill's dive team was fine, but I still had divers under the boat who couldn't surface for two hours. I powered up one of the two satellite phones on board and called DAN.
>On the opposite side of the world, it was 3 a.m. To my relief, the operator picked up on the second ring. I explained I had a diving emergency and was immediately transferred to a DAN medic, who calmly asked for information. I could almost feel the pause when I told him the closest chamber was 180 miles (290 km) away. He read back the details, and then he said the chamber supervisor in Koh Samui would call me directly.
>An hour had passed since Bill surfaced, and the angry red splotches had spread; his vertigo and retching were intense, and he couldn't keep any water down. One dive team member, a paramedic, began monitoring Bill's pulse and breathing rate and switched him over from the demand regulator to an oronasal mask. Despite the oxygen and our best care, Bill was clearly suffering and needed help fast.
>As we took Bill's pulse, the ring of the satellite phone startled me; it was Mike Fife, the chamber supervisor from Koh Samui. He requested an update on Bill's condition. He said he would try to arrange a helicopter evacuation, but we should head for land as soon as possible. When all my divers were on board, we cut anchor, and, with a rumble, the diesels churned the water at maximum revolutions. Even at top speed, our best time to Koh Samui was still 18 hours away.
>As the day began to fade into night, Bill grew steadily worse. When he tried to sit up, he passed out. His vital signs wavered back and forth, but the pain in his legs was as constant as the throb of our engines. The red welts irritated him terribly in the heat. We took turns wiping him down with a cool damp cloth to try and ease his discomfort.
>The satellite phone rang again. It was Mike from the Koh Samui chamber with bad news: There would be no air evacuation, but he had arranged for a speedboat to meet us at first light, roughly 50 miles (80 km) from Koh Samui, in order to shave three hours off Bill's time to the chamber. The captain proposed a latitude and longitude that would work for both vessels, and I promised to call the chamber if Bill's condition changed during the night.
>The next 10 hours seemed like an eternity. Dinner was a somber event; Bill lay next to us, softly moaning. We gave him tiny pieces of watermelon to suck on, but everything came right back up. As our bow carved a phosphorescent "V" through the darkened seas, I drew up a watch list to make sure someone would check on Bill and take his vital signs every 30 minutes. I took first shift, and then, before heading to my bunk, I hastily packed essentials for both Bill and me, including all of Bill's medical and emergency information.
>Only sheer exhaustion allowed me to sleep a few hours. Unfortunately, Bill couldn't sleep; his mind raced, and the pain throbbed. Every 30 minutes or so the watch-stander asked how he felt and checked his pulse and respiratory rates. Before sunrise I came back up to the salon, relieved to find Bill holding on.
>As the sun rose, we closed on the coordinates. With the slowing of the engines, all on board lined the rails, their eyes straining for the fast rescue boat. Minutes dragged by before the rescue boat appeared as a white moustache on the horizon. We anchored our vessel and readied Bill for transfer. As soon as we secured the 40-ft (12-m) speedboat alongside, a lone figure jumped aboard; it was Mike from the Koh Samui chamber. After a brief update and introduction to Bill, Mike arranged a litter carry. Thankfully, the seas cooperated, and the transfer went smoothly. Clutching all the notes taken about Bill's situation, I jumped aboard the speedboat, and we raced for the island.
>As we neared shore, I could see the ambulance at water's edge; when the speedboat backed up to the beach, the emergency personnel waded out to meet us. Eager hands grabbed the litter, and within minutes of our arrival, Bill was under a doctor's care. Things seemed to move very fast. Before I knew it, attendants carried Bill into the multiplace chamber, and, with a loud clank, they shut the large hatch. Mike sat me down and reviewed the details of Bill's dive and condition after the dive.
>As I answered his questions, I watched the chamber operator spin the valves and heard the roar of air as the chamber was pressurized down to 60 ft (18 m). Almost as soon as the chamber reached bottom pressure, Bill's vertigo lessened, but surprisingly, his leg pain intensified. While he breathed pure oxygen with scheduled air breaks, the pain eventually lessened. Soon he drank water for the first time in 24 hours. This chamber treatment, a U.S. Navy Treatment Table 6, lasted about five hours.
>Bill had to be carried into the chamber, but he walked out — shakily, but he was walking. He looked and felt much better, and even the welts had reduced to a slight redness. Bill received four more chamber treatments over the next few days, and with each treatment he began to feel better and stronger. After his release from the hospital, Bill said he felt better than he had before the incident. Bill and I had a few days left on vacation, so we relaxed by the water's edge and reflected on the trip.
>Thanks to good planning, we were able to contact DAN immediately for the support needed to set a successful rescue in motion. Within 24 hours, Bill was in a chamber and on the road to recovery. DAN was there for us, arranging the fast rescue boat, the ambulance at the water's edge, the chamber and the hospital. The idea of not being able to contact DAN, or worse, not having someone like DAN to help in a dive emergency like Bill's, is unthinkable.
>As soon as the operator told me the caller's name, I knew the location would probably be remote and the dive would most likely have been deep. It was 3 a.m. in North Carolina, but I became very awake very quickly!
>The Medic's Perspective
>Richie Kohler's report was a textbook example of what DAN medics like to hear; the information was well-organized and thorough. In addition to the patient's dive profiles and medical history, I was able to get a complete set of vital signs from the paramedic who was caring for him. Though they were far from definitive medical care, I knew their preparedness would give this diver the best possible chance of a good outcome.
>After I left the line with Richie, I contacted our referral facility on Koh Samui, where Mike Fife confirmed they were willing and able to receive the injured diver. He also began to investigate possibilities for a rescue to get the diver to Koh Samui even sooner. I made a few inquiries of my own with DAN Asia-Pacific and even the Royal Thai Air Force. When we put our heads back together, the speedboat Mike had available to him seemed to be the best option on the table, and indeed, it ultimately shaved several critical hours off transport time.
>— Brian Harper, EMT, DMT
DAN Medical Information Specialist
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>© Alert Diver — Fall 2009