Incident Insights: Case Report Kadavu, Fiji

By DAN Asia-Pacific’s John Lippmann and Scott Jamieson.

Nigel is a healthy 47-year-old man who was diving with his wife in Kadavu, Fiji. He had completed a total of 120 lifetime dives and was fit and healthy.

The first and second days Nigel completed two dives, with a rest-day on the third. The incident occurred on the diver’s fourth day on Kadavu. Whilst completing the safety stop on this fifth and final dive, Nigel felt that everything was spinning around him. He surfaced and swam to the boat, at which point he lost all feeling in his body and had no arm or leg movement. The diver has full memory of these events but was unable to respond. The boat crew commenced oxygen first aid immediately. Nigel breathed O₂ via a non-rebreather mask with a flow rate of 10 Lpm and regained some feeling in his legs and arms.

Upon reaching shore a call was immediately placed to the DAN/DES (Diving Emergency Service) Hotline.

After hearing the dive programme, the diving doctor assessed the cause as possible CAGE (Cerebral Arterial Gas Embolism) needing further medical evaluation and recompression treatment. With no recompression chamber on Kadavu two options were considered by DAN TravelAssist.

  1. An air evacuation to Suva, where a recompression chamber is located.
  2. An air evacuation to Nadi, where the international airport is located, approximately a 50-minute flight from Kadavu, and then a further flight to Brisbane, Australia.

The preferred option was getting Nigel straight to Australia, but after learning that a permit would be required for a rescue plane which could take 6–18 hours, it was decided Suva was the best option given his condition. Despite the island of Kadavu having a landing strip, it doesn’t have lights, which meant that any plans to have a plane or helicopter land that evening were not viable. Consequently, he had to spend the night in Kadavu.

Whilst Nigel’s condition did improve, in that he was able to move all extremities and his speech was no longer slurred, he remained unable to urinate. The next morning, he was evacuated by helicopter to the Colonial Memorial Hospital in Suva for evaluation and treatment. He immediately received approximately two hours in the chamber, and the same the following day.

The DAN/DES doctors still recommended further treatment in Brisbane. While the air evacuation was co-ordinated, the diver underwent another treatment with limited improvement.

Upon reaching the Royal Brisbane Hospital he was diagnosed with spinal decompression illness and underwent a T62/T6 Treatment, approximately five hours in the chamber.

In total, Nigel received three short recompression treatments in Fiji before being transported to Australia. He then had fifteen further treatments.

Discussion

O₂ Availability

It was fortunate that the dive operator was well equipped with oxygen on-board, and the dive boat and staff trained in oxygen provision. It is likely that the outcome would have been very different without immediate and prolonged oxygen first aid.

Immediate Call to DAN/DES Hotline

Fast action in calling the DAN/DES Hotline meant that emergency evacuation procedures were investigated immediately. Instructions of DES doctors could be followed from the outset; a high-level concentration of oxygen was vital.

Coverage for Diving Incidents

In this case, the air evacuations alone cost in excess of US$110,000 – not including the cost of the chamber treatments! As a DAN Member, the evacuation costs were fully covered. And, in this highly stressful situation, it meant neither Nigel nor his wife had to worry.

Final Words from Nigel

“My ‘new normal’ at the moment is not too far removed from the old normal, to the outsider looking in; but my stamina remains shot. I have some ongoing sensation and function issues around my lower torso. My legs still do not feel like I expect them to feel, though they are improving. They tire out, they ache, the skin feels strange, and in the evenings I get small twitches.”

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