Use AED on surface.
Can patient be
transported to higher
medical care within a
reasonable
timeframe?
Diving Casualty Decision Tree
Is the diver
conscious?
Does the patient have a pulse?
Yes
Joint pain,
swollen/painful
lymphnodes, or skin
irritation occurring
after leaving bottom
Headache, foul taste
in mouth, burning
eyes,
unconsciousness,
multiple divers
affected
Cutis
Marmorata
CO Poisoning
DCS Type I
No
No
Neurological deficits,
numbness occurring
less than 10 minutes
after reaching
surface
DCS Type I
Arterial Gas Embolism
Neurological deficits,
numbness, burning
pain/distress/cough/shortness
of breath in center of chest
(Cardiopulmonary), dull or
lancing pain in girdle-like
presentation (Spinal), or
vertigo/nausea occurring
after 10 minutes from
reaching surface
After long exposure to
high partial pressure of
oxygen: muscle
twitching/irritability/
convulsions/nausea/
dizziness (CNS), burning
pain in chest/
coughing/shortness of
breath (Pulmonary)
Dull ache or tightness
under the breastbone,
pain radiating to
shoulder/back, voice
change, neck swelling
Loss of muscle control,
drowsiness, weakness,
agitation,
unconsciousness
Hypoxia
Mediastinal and
Subcutaneous
Emphysema
O2 Toxicity
Remove patient
from O2
No
Yes
Complete neuro, press
to 60 FSW, put patient
on 100% O2, and
complete another
neuro within 10 min of
reaching bottom. Were
the patient’s symptoms
completely relieved
within 10 min?
Complete TT-2A
Yes
Complete TT-1A
No
Yes
Complete TT-5
Did the patient
surface from 50
FSW or shallower?
Yes
Omitted Decompression: does
the patient have symptoms?
No
No
Go to green box
How deep was
the deepest stop
omitted?
Deeper than
30 FSW
Yes
No
Press to depth of
relief not to exceed
165 FSW. Were
symptoms relieved
with in 30 min?
Yes
Get to higher medical
care, shallow
recompression with
UMO consultation
Press patient to 60 FSW and put on 100%
O2. Were the patient’s symptoms
unchanged or worse after 20 min on O2 at
60 FSW?
Is O2 available in
the chamber?
Yes
No
Complete TT-3
Compress to
depth of relief
not to exceed
225 FSW.
Complete TT-8.
Use surface
decompression
procedure
Less than 1 min
20 or 30 FSW
1 to 7 min
Greater than 7 min
How much
decompression
was missed?
How many
SurDO2 periods
were missed?
2 or fewer
More than 2
Put patient
on 100% O2
Get patient to higher
medical care, needle
decompression if
necessary
Press to depth of
relief not to exceed
165 FSW. Would the
patient benefit from
additional time at
depth?
Complete TT-6
Could loss of life result
if decompression is
undertaken from 60
FSW?
No
Yes
Complete Air TT-4
Complete present table
Return to depth of
stop. Increase stop
time by 1 min and
resume original
schedule
Hypercapnia
Yes
No
Deep uncontrolled ascent.
Deeper than 50 FSW and
greater than 60 min of
decompression missed.
Headache, increased
sweating, increased
breathing rate,
unconsciousness,
convulsions
Pneumothorax
Is O2 available in
the chamber?
No
Sudden sharp pain in
chest followed by
shortness of breath,
and weak pulse
(Simple),
progressively more
intense over time
(Tension)
Put patient on
100% O2
DCS Type II
Press to depth of relief
not to exceed 165 FSW.
Was relief found at
shallower than 66 FSW?
Transport to higher medical care
No
Yes
What are the patient’s symptoms?
Yes
Complete TT-7
Complete TT-4
No
Complete TT-6A
Yes
What is the temperature?
Greater than 104F
95F to 104F
85F to 94.5F
Less than 85F
No TTs
TTS 5 and 9
TTS 5, 6, 6A, 1A,
and 9
All TTs
How long was the loss of O2?
Less than 15 min
15 min to 2 hrs
Resume
treatment at
point of
interruption
What is the current
depth?
What TT was being
conducted?
TTs 5, 6, or 6A
Complete
treatment with
maximum
extensions
What type O2 toxicity
symptom occurred?
TTs 4, 7, or 8
60 FSW or shallower
No compensation
is required
Switch to comparable air
table at current depth
Deeper than 60 FSW or
symptoms worsen
Complete TT-4
Remove from O2 until
all symptoms have
subsided. Resume O2
breathing 15 min after
all symptoms have
subsided
CNS first sign
(non-convulsion)
CNS convulsion or
repeat symptoms
Pulmanory
Greater than 2 hours
What is the present
TT?
TTs 5, 6, or 6A
Yes
TTs 4, 7, or 8
Is the patient
responding to
treatment well?
No
Continue O2 breathing as
long as it is considered
beneficial or until pain
limits inspiration.
Remove
patient from
O2 and
consult with
UMO.
Remove patient from O2.
After all symptoms have
subsided, decompress
10 FSW at 1 FPM.
Resume O2 breathing
Remove patient
from O2. Consult
with UMO before
continuing O2
treatment.