USN Dive Treatment Tables

USN Dive Treatment Tables

These tables and indications are compiled directly from the US Navy Dive Manual and are intended for use by USN Dive Medical Officers in the treatment of injured USN divers. Tables are arranged according to frequency of use and indications are immediately below each Treatment table, which makes it easier for reference and study than the actual USN Dive Manual.

Treatment Table 5

  • “Treatment Table 5 Indications:
    • Type I DCS (except for cutis marmorata) symptoms when a complete neurological examination has revealed no abnormality. After arrival at 60 fsw a neurological exam shall be performed to ensure that no overt neurological symptoms (e.g., weakness, numbness, loss of coordination) are present. If any abnormalities are found, the stricken diver should be treated using Treatment Table 6.
    • Asymptomatic omitted decompression
    • Treatment of resolved symptoms following in-water recompression
    • Follow-up treatments for residual symptoms
    • Carbon monoxide poisoning
    • Gas gangrene.”

Treatment Table 6

  • “Treatment Table 6 Indications:
    • Arterial Gas Embolism
    • Type II DCS Symptoms
    • Type I DCS symptoms where relief is not complete within 10 minutes at 60 feet or where pain is severe and immediate recompression must be instituted before a neurological examination can be performed
    • Cutis marmorata
    • Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation
    • Asymptomatic omitted decompression
    • Symptomatic uncontrolled ascent
    • Recurrence of symptoms shallower than 60 fsw.”

Treatment Table 6A

  • “Treatment Table 6A is used to treat arterial gas embolism or decompression symptoms when severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw. The patient is compressed to depth of relief (or significant improvement), not to exceed 165 fsw. Once at the depth of relief, begin treatment gas (N2O2, HeO2) if available. Consult with a Diving Medical Officer at the earliest opportunity. If the severity of the patient’s condition warrants, the Diving Medical Officer may recommend conversion to a Treatment Table 4.
  • If deterioration or recurrence of symptoms is noted during ascent to 60 feet, treat as a recurrence of symptoms.”

Treatment Table 4

  • “Treatment Table 4 is used when it is determined that the patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw. The time at depth shall be between 30 to 120 minutes, based on the patient’s response. If a shift from Treatment Table 6A to Treatment Table 4 is contemplated, a Diving Medical Officer should be consulted before the shift is made.
  • If oxygen is available, the patient should begin oxygen breathing periods immediately upon arrival at the 60-foot stop. Breathing periods of 25 minutes on oxygen, interrupted by 5 minutes of air, are recommended because each cycle lasts 30 minutes. This simplifies timekeeping. Immediately upon arrival at 60 feet, a minimum of four oxygen breathing periods (for a total time of 2 hours) should be administered. After that, oxygen breathing should be administered to suit the patient’s individual needs and operational conditions. Both the patient and tender must breathe oxygen for at least 4 hours (eight 25-minute oxygen, 5-minute air periods), beginning no later than 2 hours before ascent from 30 feet is begun. These oxygen-breathing periods may be divided up as convenient, but at least 2 hours’ worth of oxygen breathing periods should be completed at 30 feet.
  • If deterioration or recurrence of symptoms is noted during ascent to 60 feet, treat as recurrence of symptoms.“

Treatment Table 7

  • “Treatment Table 7 is an extension at 60 feet of Treatment Table 6, 6A, or 4 (or any other nonstandard treatment table). This means that considerable treatment has already been administered. Treatment Table 7 is considered a heroic measure for treating non-responding severe gas embolism or life-threatening decompression sickness and is not designed to treat all residual symptoms that do not improve at 60 feet and should never be used to treat residual pain. Treatment Table 7 should be used only when loss of life may result if the currently prescribed decompression from 60 feet is undertaken. Committing a patient to a Treatment Table 7 involves isolating the patient and having to minister to his medical needs in the recompression chamber for 48 hours or longer. Experienced diving medical personnel shall be on scene.
  • A Diving Medical Officer should be consulted before shifting to a Treatment Table 7 and careful consideration shall be given to life support capability of the recompression facility. Because it is difficult to judge whether a particular patient’s condition warrants Treatment Table 7, additional consultation may be obtained from either NEDU or NDSTC.
  • When using Treatment Table 7, a minimum of 12 hours should be spent at 60 feet, including time spent at 60 feet from Treatment Table 4, 6, or 6A. Severe Type II decompression sickness and/or arterial gas embolism cases may continue to deteriorate significantly over the first several hours. This should not be cause for premature changes in depth. Do not begin decompression from 60 feet for at least 12 hours. At completion of the 12-hour stay, the decision must be made whether to decompress or spend additional time at 60 feet. If no improvement was noted during the first 12 hours, benefit from additional time at 60 feet is unlikely and decompression should be started. If the patient is improving but significant residual symptoms remain (e.g., limb paralysis, abnormal or absent respiration), additional time at 60 feet may be warranted. While the actual time that can be spent at 60 feet is unlimited, the actual additional amount of time beyond 12 hours that should be spent can only be determined by a Diving Medical Officer (in consultation with on-site supervisory personnel), based on the patient’s response to therapy and operational factors. When the patient has progressed to the point of consciousness, can breathe independently, and can move all extremities, decompression can be started and maintained as long as improvement continues. Solid evidence of continued benefit should be established for stays longer than 18 hours at 60 feet. Regardless of the duration at the recompression deeper than 60 feet, at least 12 hours must be spent at 60 feet and then Treatment Table 7 followed to the surface. Additional recompression below 60 feet in these cases should not be undertaken unless adequate life support capability is available.
  • Decompression. Decompression on Treatment Table 7 is begun with an upward excursion at time zero from 60 to 58 feet. Subsequent 2-foot upward excursions are made at time intervals listed as appropriate to the rate of decompression:
Decompression
  • The travel time between stops is considered as part of the time interval for the next shallower stop. The time intervals shown above begin when ascent to the next shallower stop has begun.
  • Tenders. When using Treatment Table 7, tenders breathe chamber atmosphere throughout treatment and decompression.
  • Preventing Inadvertent Early Surfacing. Upon arrival at 4 feet, decompression should be stopped for 4 hours. At the end of 4 hours, decompress to the surface at 1 foot per minute. This procedure prevents inadvertent early surfacing.
  • Oxygen Breathing. On a Treatment Table 7, patients should begin oxygen breathing periods as soon as possible at 60 feet. Oxygen breathing periods of 25 minutes on 100 percent oxygen, followed by 5 minutes breathing chamber atmosphere, should be used. Normally, four oxygen breathing periods are alternated with 2 hours of continuous air breathing. In conscious patients, this cycle should be continued until a minimum of eight oxygen breathing periods have been administered (previous 100 percent oxygen breathing periods may be counted against these eight periods). Beyond that, oxygen breathing periods should be continued as recommended by the Diving Medical Officer, as long as improvement is noted and the oxygen is tolerated by the patient. If oxygen breathing causes significant pain on inspiration, it should be discontinued unless it is felt that significant benefit from oxygen breathing is being obtained. In unconscious patients, oxygen breathing should be stopped after a maximum of 24 oxygen breathing periods have been administered. The actual number and length of oxygen breathing periods should be adjusted by the Diving Medical Officer to suit the individual patient’s clinical condition and development of pulmonary oxygen toxicity.
  • Sleeping, Resting, and Eating. At least two tenders should be available when using Treatment Table 7, and three may be necessary for severely ill patients. Not all tenders are required to be in the chamber, and they may be locked in and out as required following appropriate decompression tables. The patient may sleep anytime except when breathing oxygen deeper than 30 feet. While asleep, the patient’s pulse, respiration, and blood pressure should be monitored and recorded at intervals appropriate to the patient’s condition. Food may be taken at any time and fluid intake should be maintained.
  • Ancillary Care. Patients on Treatment Table 7 requiring intravenous fluid and/or drug therapy should have these administered in accordance with paragraph 17-12 and associated subparagraphs.
  • Life Support. Before committing to a Treatment Table 7, the life-support considerations in paragraph 17-7 must be addressed. Do not commit to a Treatment Table 7 if the internal chamber temperature cannot be maintained at 85°F (29°C) or less.”

Treatment Table 8

“Treatment Table 8 is an adaptation of Royal Navy Treatment Table 65 mainly for treating deep uncontrolled ascents (see Chapter 13) when more than 60 minutes of decompression have been missed. Compress symptomatic patient to depth of relief not to exceed 225 fsw. Initiate Treatment Table 8 from depth of relief. The schedule for Treatment Table 8 from 60 fsw is the same as Treatment Table 7. The guidelines for sleeping and eating are the same as Treatment Table 7.”

Treatment Table 9

  • “Treatment Table 9 is a hyperbaric oxygen treatment table providing 90 minutes of oxygen breathing at 45 feet. This table is used only on the recommendation of a Diving Medical Officer cognizant of the patient’s medical condition. Treatment Table 9 is used for the following:
    • Residual symptoms remaining after initial treatment of AGE/DCS
    • Selected cases of carbon monoxide or cyanide poisoning
    • Smoke inhalation
    • This table may also be recommended by the cognizant Diving Medical Officer when initially treating a severely injured patient whose medical condition precludes long absences from definitive medical care.”

USN Air Treatment Tables

These tables are compiled directly from the US Navy Dive Manual and are intended for use by USN Dive Medical Officers in the treatment of injured USN divers. “Air Treatment Tables 1A, 2A, and 3 are provided for use only as a last resort when oxygen is not available. Oxygen treatment tables are significantly more effective than air treatment tables and shall be used whenever possible.”

Air Treatment Table 1A

Intel

  • United States Navy Diving Manual, Revision 6 (Washington D.C.: US Government Press, 2008).

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