[Mark Chase]

Originally Posted by Howard Payne

Clare's right to make the point.
Unless you get back down bloody quick - you'll just compress "grown" bubbles and allow them to pass across to the arterial side and up into your brain.
I reckon that if you're flustered and you've had a bad dive and shot to the surface - on a smaller dive - going back down could be a really bad idea.
21/6m under water is not a good place to find out your sick and you've made the wrong call.
I think in most instances with smaller dives - I'd opt for 02 + Nurofen / Chopper / Pot.

News just in! - apparently we have just bought some friends in cheaply from Eastern Europe. Just dressing them up in those annoying blue t shirts with the big white GUE logo on the back as we speak. Rest assured - their first word of English will be "Stroke"

Asperin not Nurofen.

Both are anti inflamatories but the tests found Asperin worked well and nurophen (Ibroprophen to be exact) didnt do as well.

Prehospital Care
Extricate the patient from water and immobilize if trauma is suspected. Generally, in-water recompression is not believed to be a safe option. Problems with air supply, hypothermia, potential oxygen toxicity, dehydration, and the uncontrolled environment make it less than ideal and increase the risks of drowning. However, in remote areas without reasonable-distance HBO chamber support, this may be the only option.

In Thailand, home to the diving Urak Lawoi fishermen, 72.1% exceed the no-decompression limits, yet medical treatment and HBO facilities are distant (10 h and 16 h, respectively). In this population, one third reported having experienced DCS, and in-water recompression has been shown to be an appropriate first-aid measure.

Much more research needs to be performed on the concept of in-water decompression, since over half (not just one third) were classified as experiencing recurring nondisabling DCS and about one quarter as having disabling DCS. A shorter in-water recompression protocol was also developed for use in the remote Northern Pacific Clipperton Atoll in an attempt to address the above concerns.

Administer 100% oxygen, intubate if necessary, and intravenously administer saline or lactated Ringer solution.

The use of first aid oxygen has proven so beneficial that the Divers Alert Network (DAN) has made a major effort to place oxygen at dive locations, in particular those that are remote with lengthy transport times to the nearest hyperbaric chambers and to ensure that people are trained in its use. A study of the use of first aid oxygen found that the median time to its use after surfacing was 4 hours and 2.2 hours after the onset of DCS symptoms. Forty-seven percent of victims received the oxygen. Complete relief of symptoms was found in 14% of victims. Even more striking was that 51% of victims showed improvement. This was with the oxygen before HBO treatment. Even after a single HBO treatment, those that had received oxygen before the HBO dive, even if many hours earlier, had better outcomes.

Consider aspirin for antiplatelet activity if the patient is not bleeding.

Perform cardiopulmonary resuscitation and advanced cardiac life support, if required, as well as needle decompression of the chest if tension pneumothorax is suspected.

Do not put the patient into the Trendelenburg position.
Transport to the nearest ED and hyperbaric facility, if feasible, and try to keep all diving gear with the diver. Diving gear may provide clues as to why the diver had trouble (eg, faulty air regulator, hose leak, carbon monoxide contamination of compressed air).