How should a patient with decompression sickness be transported to a recompression facility?

Transport of Decompression Sickness Patients

Patients with decompression sickness should be transported in a supine (flat on back) position, breathing 100% oxygen, with low-altitude transport (staying within 200 feet above ground level if using helicopter), and moved urgently to the nearest hyperbaric facility without delay. 1, 2, 3

Critical Transport Positioning

• Place the patient supine (flat on back) during transport to prevent worsening of symptoms and maintain cerebral perfusion 2
• Do not use head-down or Trendelenburg positioning, as this is no longer recommended 2
• If the patient shows evidence of shock and is responsive and breathing normally, maintain the supine position 1

Oxygen Administration

• Administer 100% normobaric oxygen immediately and continuously during transport, as this is the most critical first-aid intervention 1, 2, 4
• The American Heart Association specifically recommends that first aid providers with training in oxygen use provide supplementary oxygen for decompression sickness cases (Class IIa recommendation) 1
• High-fraction oxygen breathing serves as essential first aid while definitive hyperbaric treatment is arranged 5, 4

Altitude Restrictions for Air Transport

• If using helicopter transport, maintain flight altitude within 200 feet (61 meters) above ground level of the take-off point 3
• Symptoms of decompression sickness worsen significantly when this altitude threshold is exceeded 3
• Low-level helicopter flight has been proven both safe and effective for transporting decompression sickness patients when pressurized aircraft is unavailable 3
• Avoid any unnecessary altitude gain, as reduced ambient pressure will cause existing bubbles to expand and worsen the patient's condition 3

Fluid Management During Transport

• Administer intravenous crystalloids or dextrose saline to prevent and treat hypovolemia, which commonly accompanies decompression illness 2, 4
• Isotonic, glucose-free fluids are specifically recommended for prevention and treatment of the hypovolemia that occurs with decompression sickness 4
• Oral fluids may be given if intravenous access is not immediately available, though IV route is preferred 2

Transport Team and Equipment Requirements

• At least two trained personnel must accompany the patient, consistent with critical care transport standards 1, 6
• The transport team must carry full resuscitation equipment and medications 6
• Maintain continuous monitoring including pulse oximetry, electrocardiographic monitoring, and regular blood pressure measurements throughout transport 1, 6
• Ensure adequate oxygen supply for the entire transport duration plus a mandatory 30-minute reserve 7

Urgency of Transport

• Initiate transport immediately without unnecessary delays, as the latency between symptom onset and hyperbaric oxygen therapy is a critical prognostic indicator 2, 4
• Treatment should begin as soon as symptoms arise, as outcomes depend heavily on how quickly first aid and definitive treatment are provided 2, 8
• Call for emergency medical services immediately rather than attempting personal transport 1
• Nonessential testing and procedures that delay transfer should be avoided 1

Adjunctive Medications (Controversial)

• Consider aspirin and corticosteroids for patients with cerebral or spinal cord involvement, though evidence is limited 2
• These medications remain under discussion and should not delay transport to hyperbaric facilities 2

Common Pitfalls to Avoid

• Never transport at standard flight altitudes without pressurization, as this will cause bubble expansion and clinical deterioration 3
• Do not delay transport for complete stabilization, as definitive treatment (hyperbaric oxygen) can only occur at the receiving facility 6, 2
• Avoid transporting the patient in positions other than supine, particularly head-down positions 2
• Do not withhold oxygen or reduce oxygen concentration during transport 1, 2, 4