Tag: Duke University

Don’t Dive Cold When You Don’t Have To

 

San Diego Center of Excellence in Diving

Clarke JR1, Moon RE2, Chimiak JM3, Stinton R4, Van Hoesen KB5, and Lang MA5,6.

1 US Navy Experimental Diving Unit, Panama City, Florida
2 Duke University, Durham, North Carolina
3 Divers Alert Network, Durham, North Carolina
4 Diving Unlimited International, Inc., San Diego, California
5 UC San Diego – Emergency Medicine, San Diego, California
6 OxyHeal Health Group, National City, California

 Introduction

The San Diego Center of Excellence in Diving at UC San Diego aims to help divers be effective consumers of scientific information through its “Healthy Divers in Healthy Oceans” mission. In this monograph we explore a research report from the Navy Experimental Diving Unit (NEDU) that is leading some divers to think they should be cold if they want to reduce decompression risk. That is a misinterpretation of the report, and may be causing divers to miss some of the joy of diving. There is no substitute for comfort and safety on a dive.

Background

In 2007 NEDU published their often-cited report “The Influence of Thermal Exposure on Diver Susceptibility to Decompression Sickness” (Gerth et al., 2007). The authors, Drs. Wayne Gerth, Victor Ruterbusch, and Ed Long were questioning the conventional wisdom that cold at depth increases the risk of decompression illness. After conducting a very carefully designed experiment, they were shocked to find that exactly the opposite was true. Some degree of cooling was beneficial, as long as the diver was warm during ascent.

Discussion and Implications

There are some important caveats for the non-Navy diver to consider. First of all, it was anticipated that a diver would have a system for carefully controlling their temperature during the separate phases of bottom time and decompression. Most non-Navy divers do not have that sort of surface support.

Secondly, the “cold” water in the NEDU study was 80 °F (27 °C). For most of us, 80 °F (27 °C) is an ideal swimming pool temperature, not exactly what you are going to find in non-tropical oceans and lakes. The warm water was 97 °F (36 °C), also a temperature not likely to be available to recreational and technical divers.

When testing the effect of anything on decompression results, the Navy uses their extensive mathematical expertise to select the one dive profile that is, in their estimation, the most likely to identify a difference in decompression risk, if that difference in risk exists. In this case the profile selected was a 120 fsw (37 msw) dive with 25 to 70 min bottom time, decompressed on a US Navy Standard Air table for 120 fsw (37 msw) and 70 min bottom time. That table prescribes 91 minutes of decompression divided thusly: 30 fsw/9 min (9msw/9 min), 20 fsw/23 min (6 msw/23 min), 10 fsw/55 min (3 msw/55 min).

A total of 400 carefully controlled dives were conducted yielding 21 diagnosed cases of decompression sickness. Overwhelmingly, the lowest risk of decompression was found when divers were kept warm during decompression. The effects of a 9 °C increase in water temperature during decompression was comparable to the effects of halving bottom time.

That is of course a remarkable result, apparently remarkable enough to cause civilian divers to alter their behavior when performing decompression dives. However, before you decide to chill yourself on the bottom or increase your risk of becoming hypothermic, consider these facts.

  1. Do you have a way of keeping yourself warm, for instance with a hot water suit, during decompression? If not, the study results do not apply to you.
  2. Of the many possible decompression schedules, the Navy tested only one schedule, the one considered to be the best for demonstrating a thermal influence on decompression risk. Although it seems reasonable that this result could be extrapolated to other dive profiles, such extrapolation is always risky. It may simply not hold for the particular dive you plan to make, especially if that dive is deeper and longer than tested.
  3. Most commercial decompression computers do not adhere to the U.S. Navy Air Tables; few recreational dives are square profiles. Furthermore, additional conservatism is usually added to commercial algorithms. NEDU is not able to test the effects of diver skin temperature on all proprietary decompression tables, nor should they. That is not their mission.
  4. The scientific method requires research to be replicated before test results can be proven or generalized. However, due to the labor and expense involved in the NEDU dive series, it seems unlikely that any experiments that would determine the relevance of these results to recreational or technical diving will ever be performed. As such, it may raise as many questions as it answers. For instance, the original question remains; if you become chilled on a dive, how does that affect your overall risk of decompression illness compared to remaining comfortably warm? Unfortunately, that question may never be answered fully.
  5. Thermoneutral temperatures for swim suited divers are reported to be 93 °F to 97 °F (34 to 36 °C) for divers at rest and 90 °F (32 °C) during light to moderate work (Sterba, 1993). So a skin temperature of 80 °F (27 °C) is indeed cold for long duration dives. If your skin temperature is less than 80 °F (27 °C), then you are venturing into the unknown; NEDU’s results may not apply.In summary, beer and some types of wine are best chilled. Arguably, divers are not.

Acknowledgments

Support for the San Diego Center of Excellence in Diving is provided by founding partners UC San Diego Health Sciences, UC San Diego Scripps Institution of Oceanography, OxyHeal Health Group, Divers Alert Network, Diving Unlimited International, Inc. and Scubapro.

References

Gerth WA, Ruterbusch VL, Long ET. The Influence of Thermal Exposure on Diver Susceptibility to Decompression Sickness. NEDU Technical Report 06-07, November 2007.

Sterba JA. Thermal Problems: Prevention and Treatment, in P.B. Bennett and D.H. Elliot, eds., The Physiology and Medicine of Diving, 4th ed. (London: Saunders, 1993), pp. 301-341.

Why Deep Saturation Diving Is Like Going to the Moon, and Beyond

This week, as the Space Shuttle is making its last circuits around our planet, I lament what has happened to our space program. Yet, I am reminded of another exploration program that has, like the shuttle and the moon programs, reached incredible milestones only to retreat to a less exotic but still impressive status. That other program is experimental, deep saturation diving.

I have been privileged to conduct human physiological research on several deep saturation dives, one being a record-breaking U.S. Navy dive at the Navy Experimental Diving Unit (NEDU) in 1977 to a pressure equivalent to that found at 1500 feet sea water (fsw), or 460 msw*, and on a 450 msw (1470 fsw) dive at the GUSI diving facility at the GKSS Institute in Geesthacht, Germany in 1990. For perspective, the safe SCUBA diving depth is considered to be 130 fsw, although technical and cave divers often descend deeper, to 300 fsw or so.

NEDU, Panama City, FL

Dives in hyperbaric chambers like at GUSI and NEDU are simulated; the divers don’t actually go anywhere. But the effects of the high pressure on the divers’ bodies are just as they would be in the ocean. Of course, even in simulated dives, divers wear Underwater Breathing Apparatus, and descend into water contained within the hyperbaric complex.

In 1979, NEDU again set the U.S. Navy record for deep diving to 1800 fsw (551 msw). At Duke University in 1981, the U.S. record for pressure exposure was set by three saturation divers inside an eight-foot diameter sphere. The internal pressure was 2250 fsw (686 msw). One of those divers went on to become the senior medical officer at NEDU, none the worse for his high pressure exposure.

The French company Comex, of Marseille used an experimental gas mixture of hydrogen-helium-oxygen to reach 675 msw, before being forced back to 650 msw due to physical and physiological problems with the divers. However, like teams attempting the summit of Mount Everest, one diver from the dive team was pressed to a world record of 701 msw (2290 fsw), just squeaking past the U.S. record.

There is a poorly understood physiological barrier called the High Pressure Nervous Syndrome (HPNS) that limits our penetration to ever deeper depths. In spite of the use of increasingly exotic gas mixtures, helium-oxygen in the U.S. Navy, helium-nitrogen-oxygen at Duke University, and hydrogen-helium-oxygen at Comex, all attempts to dive deeper have, to date, been rebuffed.

Just as I had thought as a young man that trips to the moon would be common-place by now, I had also assumed diving to 3000 feet would be routine. But it is not.

In my early research days I was interested in the effects on organisms of very high pressure, 5000 psi, which is equivalent to a depth of over 11,000 feet (3430 meters). We now know those effects can be profound, altering the very structure of cell membranes. Reversing those effects while maintaining high pressure, at great depth, is a daunting scientific task. We don’t yet know how to do it.

What we do know is that reaching 1500 feet can be done without too much difficulty. In the 1980s it became almost routine to dive to 1000 feet at both the Naval Medical Research Institute (Bethesda) and NEDU. Deep saturation diving is a thriving business in the oil fields of the Gulf of Mexico and the North Sea.

Click for a larger image.

But as for the similarity between deep saturation diving and NASA’s moon missions, in the Apollo program it took slightly over three days to get to the moon, and almost an equal time to return. But as the above dive profile shows, it took sixteen days to reach the maximum depth of 1500 fsw, and seventeen days to safely return. Over that period of time astronauts would have whizzed past the moon and been well on their way to Mars. Unlike spacecraft and astronauts, divers must slow their descent to avoid HPNS, and must slow their return to the surface to avoid debilitating and painful decompression sickness. Diving without submarines or armored suits is very much a demanding, physical stress.

Politically, exceeding our current depth limits of approximately 2000 feet is akin to returning to the moon, and going beyond. We could do it, but at what cost? Should we? Will it ever be a national priority?

Maybe not for the United States, but I have a suspicion that other countries, perhaps not as heavily committed to space as we, will find the allure of beating current diving records irresistible. If there are medical or pharmacological interventions developed for getting divers safely and productively down to 3000 feet, then that would be a scientific achievement comparable to sending men to Mars.

*[The feet to meters conversion is slightly different from the feet of sea water to meters of sea water conversion. The latter represents pressure, not depth, and therefore includes a correction factor for the density of sea water.]