Norwegian Diving- and Treatment Tables NDTT Ed 4 Rev C4 Empty page 2 2 NDTT Ed 4 Rev C4 Jan Risberg • Andreas Møllerløkken • Olav Eftedal Norwegian Diving- and Treatment Tables Tables and guidelines for surface orientated diving on air and nitrox. Tables and guidelines for treatment of decompression illness. This is an authorized translation of the fourth edition of ‘Norske dykke- og behandlingstabeller’ Third edition: English translation by: Hans Petter Roverud, Jan Risberg, Bob Gardiner Fourth edition: English translation by Jan Risberg www.dykketabeller.no [email protected] 3 NDTT Ed 4 Rev C4 ISBN XX-XXXXXX-X-X Printed in Norway by Molvik Grafisk AS Printed on three-layer extruded polypropylene film – PP ISO 9002 4 NDTT Ed 4 Rev C4 Preface This is the fourth edition of the Norwegian Diving- and Treatment Tables. This book contains tables for diving on air or nitrox, as well as therapeutic recompression procedures for decompression illness and other ailments requiring hyperbaric treatment. The present (fourth) edition has been significantly revised. The decompression tables for dives not considered exceptional (i.e. not identified with asterisks) are mainly unchanged from the third edition. However the exceptional dives and SurD-O2 dives have been revised with more conservative decompression obligations (shorter bottom times and/or extension of decompression times). The procedures for repeated dives are unchanged, but the schedules slightly adjusted. Additionally, we have introduced a procedure for multilevel diving. This publication aims to further the understanding of safe diving procedures. Hence, we emphasize the correct application of diving tables to limit the risk of decompression illness. We also focus on the correct procedures whenever an incident takes place. This publication targets all personnel involved in diving operations and a thorough knowledge of diving medicine and diving physiology is no prerequisite. With regard to diving medicine, there are divergent views on several issues. Most of the controversy stems from the lack of documented research and/or from inconclusive results. The reader should keep this in mind. This edition has been edited by two new authors: Olav Eftedal and Andreas Møllerløkken. Cdr SG (ret) Arne-Johan Arntzen has decided to withdraw from further editorial work due to age and workload. Previous head of submarine and diving medicine Svein Edsvik expired 2015 and did not get the opportunity to take part in the editorial revision. Arntzen and Eidsvik have been editors of the previous editions of these tables. Their contribution to standardized decompression and treatment procedures will forever be recognized. Bergen, ?.?. 2016 Jan Risberg Andreas Møllerløkken Olav Eftedal 5 NDTT Ed 4 Rev C4 ISBN XXX Printed in Norway by Molvik Grafisk AS Printed on three-layer extruded polypropylene film – PP ISO 9002 6 NDTT Ed 4 Rev C4 Contents Page Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Standard Air Decompression Table . . . . . . . . . . . . . . . . . . . . 13 Diving at Altitude above 250 m . . . . . . . . . . . . . . . . . . . . . . 18 Flying after Diving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Multilevel diving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Dive Computers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Diving related to oil and gas exploration. . . . . . . . . . . . . . . . . . . . 30 Oxygen Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Nitrox Diving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Surface Decompression Using Oxygen . . . . . . . . . . . . . . . . . 38 TABLES: Standard Air Decompression Table . . . . . . . . . . . . . . . . . . 41 Residual Nitrogen Timetable for Repetitive Air Dives . . . . . 60 Corrections for Dive Site Altitude . . . . . . . . . . . . . . . . . . . 61 EAD-Tables for Open-Circuit Nitrox . . . . . . . . . . . . . . . . . 62 Surface Decompression Tables Using Oxygen . . . . . . . . . . . 65 Prevention of Decompression Illness . . . . . . . . . . . . . . . . . . . 70 Deep Chamber Dives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Procedures in the event of an uncontrolled ascent. . . . . . . . . . . . . .78 Flow Chart – Uncontrolled Ascent . . . . . . . . . . . . . . . . . . . . 81 Decompression Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Barotrauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Treatment of Decompression Sickness and Air Embolism . . . . 88 Oxygen Treatment of Non-Diving Related Disorders . . . . . . . 93 Emergency action plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Diagnostics and examination check list . . . . . . . . . . . . . . . . . . 98 Selecting the Proper Treatment Table . . . . . . . . . . . . . . . . . .103 TABLES: Treatment Table 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 Treatment Table 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Treatment Table 5A . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 Treatment Table 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 Treatment Table 6A . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Treatment Table 6He . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 HBO table 14/60 and 14/90 . . . . . . . . . . . . . . . . . . . . . . .110 HBO table 20/60 and 20/90 . . . . . . . . . . . . . . . . . . . . . . .111 7 NDTT Ed 4 Rev C4 Empty page 8 8 NDTT Ed 4 Rev C4 Introduction 1. Any diving table will entail a compromise between maximizing bottom time versus decompression time on the one hand and minimizing the risk of decompression illness (DCI) on the other. During the latest years we have seen an increased focus on lowering the risk of contracting DCI. While these tables do not offer a novel approach to the problem they represent a modified approach being based on the best of well-tested tables and procedures. Any of these modifications have been based on real-life experience, namely a great number of various profiles that have been logged by Norwegian diving companies, using a variety of equipment. 2. The “Norwegian” decompression tables have remained essentially unchanged since they were issued for the first time in 1980 (NUI-report 30-80). The tables were printed as an independent publication in 1986 and later revised in 1991 and 2004. Some minor errors were corrected in the last edition published as “Third edition – Revision May 2008” (in Norwegian language only). The air decompression table (staged in-water decompression with air as a breathing gas) was initially based on Royal Navy’s Table 11, though modified with a slower ascent rate and a different procedure for repetitive dives. Bottom times contracting decompression time exceeding approximately 35 min was identified with asterisk (dives not recommend to be planned for). 3. The surface decompression table using oxygen (SUR-D O ) was a revised 2 version of US Navy's SUR-D O from 1951. The revisions was based on 2 operational experience by Norwegian diving contractors. The revised procedure was more conservative than the original and demonstrated safer than the original procedure. The SUR-D O table was previously much used in offshore diving and 2 is still being used in lager inshore diving projects. 4. The use of oxygen-enriched air (nitrox), including its optional use with surface decompression, is fairly uncommon in Norwegian commercial diving. Used properly, nitrox may improve safety as well as cost effectiveness. 5. The responsibility of the dive supervisor. Care should be taken when reading the decompression tables. Tables may appear to provide the correct decompression for any exposure, solely based on depth and bottom time. Other factors such as work load and diver and diver’s age affect decompression obligation. We try to bring these and other matters to the attention of the reader. 6. Decompression illness and long-term health effects. Recent research confirms that neurological DCI is more common than previously thought. Additionally, the incidence and extent of long-term health effects of DCI seems more extensive than previously believed. It is thus important to use diving procedures that minimize the risk of DCI. 9 NDTT Ed 4 Rev C4 7. Table safety. A given dive table’s safety is commonly presented as expected DCI incidence. To ascertain the true incidence of DCI, a large number of properly logged dives are required. In spite of this, the end results may be equivocal. Several tables have been subject to testing (among these US Navy (USN), French and Norwegian tables), but there is presently no substantial advice to support superior safety performance of one table compared to the others. Measurement of venous gas embolism (“silent bubbles”) are frequently accepted as an outcome measure when testing new tables. Decompression tables may be compared on the basis of extent of venous gas embolism, but extent of intravascular bubbles is not a sensitive measure for health effects. Diving may cause long term health effects on e.g. lungs, the skeleton and nervous system, but these health effects develop so slowly that they are difficult to associate the use of a certain decompression table. It is extensively documented that DCI is a risk factor for later development of long term health effects on the nervous system. In the absence of better outcome measure, the incidence of DCI is commonly accepted as a performance indicator of a decompression table. 8. The ‘Norwegian tables’ have been used by Norwegian Society of Underwater Contractors. Diving contractors have logged diving activity (hours of diving) and DCI incidence since 1994. Through the decade of 1993–2003 ~ 220,000 hours were logged and the DCI incidence reached ~ 0.05 ‰ per hour; i.e. one case of DCI per 20,000 hours. The Norwegian Oil Directorate published a report in 1994 on standard decompression tables for surface oriented diving. Six institutions were questioned concerning their experience using the Norwegian standard tables. The diving on the Kalstø project had a particular high incidence (9259 dives, DCI incidence 0.18%). The other dives (52353) had a DCI incidence of 0.04%. Studies have reported that some divers experience symptoms after decompression not being reported to physicians (“unreported DCI”). Treatment of DCI using the company’s recompression chamber will add to this. Still, we assume the number of unreported cases to be small. 9. Shields and coworkers published 1989 a report analysing the incidence of DCS after surface oriented dives on the UK continental shelf. It is worth mentioning that the report analyse approximately 130 000 dives with other decompression procedures than those recommended by the Norwegian tables. The incidence of DCS was 0.26%, but the most important result in the report was the description of risk associated with dives with high inert gas load. Dives with high inert gas load (as indicated by their “PRT” –i.e. the product of pressure and square root of time) had significantly higher risk of DCS than dives with less inert gas load. Shields and co-workers recommended a PRT=25 to border the high- and low risk dives. UK authorities (HSE) has established PRT 30 as a threshold for surface oriented dives without the use of TUP (Transfer Under Pressure, pressurized diving bells). The UK bottom time limitations are referred in the section of “Prevention of decompression illness” in this publication. 10