Tingling and Nausea in Malaysia

Among the variety of challenges that DAN faces when attempting to arrange an emergency evacuation for a diver: pirates!

pirate flag


In this recent case, a 43-year-old diver completed three days diving. On the final day she completed four dives:

  • Dive 1: 27m
  • Dive 2: 23m
  • Dive 3: 23m
  • Dive 4: Unknown depth.

The total dive time for each dive was approximately 50 minutes with a one-hour (approximately) surface interval between each dive.

The first two days were three-tank-dives at a shallower depth.

The last dive of the series ended at 3.30pm and it was 6.15pm when DAN received a call. The diver was complaining of tingling in all her extremities, which commenced one-hour after ending the dives and persisted, along with nausea. When the call was made to DAN she had been breathing oxygen for 20 minutes with no relief noted.

Upon receiving the above information the DAN Diving Doctor suspected possible neurological DCS  and recommended a medical evaluation. The diver said she would follow that advice if she had no improvement, however with night falling she was not able to travel to a medical facility due to the sunset to sunrise ‘pirate curfew’.

She was advised that if the situation were to become life-threatening, she could request special permission from the police to travel by boat during the curfew. Fortunately the operator had plenty of oxygen on hand, so oxygen first aid could continue.

It was decided that in the morning the operator would transport the diver to the medical facility, which was 30-minutes away by boat. If chamber treatment was required, it would be at the nearby Military Naval Base and a referral was required from the Diving Medical Officer at the local hospital.

In the morning, the dive operator advised DAN that the diver’s symptoms had cleared. Upon speaking to the diver she said she was mostly symptom-free with only a little tiredness in her muscles. She had finished diving for the trip and would be doing land-based activities prior to flying home the following day.

DAN suggested that she be evaluated in the local hospital , given she was going there anyway, and if DCI was indicated she was advised not to fly until she was asymptomatic for 72-hours minimum.

The diver was convinced that she was simply suffering heat exhaustion/dehydration as she reported improving more after taking hydrolytes than she did after a couple of hours of breathing oxygen.


Looking at the dive profiles and the relatively short surface intervals between them, it is unsurprising that the diver was symptomatic. Many divers get away with this most of the time, but, at DAN we often come across divers who don’t. There is a lot of individual variation in susceptibility between divers, and within divers on different occasions. Multiple factors can influence a diver’s susceptibility at different points in time. Maybe dehydration was one factor in this. Breathing oxygen is a very important part of the first aid and should be started as soon as possible and continued until advised by a diving doctor to be ceased. However, a change in symptoms can sometimes take some time and may depend on how effectively the oxygen is being provided. Many divers mistakenly believe that high concentrations of oxygen are being delivered when in reality the diver is only breathing a low concentration, as it is being diluted by large quantities of air. How to provide effective oxygen first aid is an important topic that will be addressed at another time.

If the possibility of an examination by a diving doctor is available, as it was the next day in this case, it is well worthwhile doing as the diver may not be aware of some of the more subtle indications of DCI, which may be important and require treatment.

In the cases we have shared over the past weeks we have looked at the variety of challenges that DAN faces when attempting to arrange an emergency evacuation for a diver, and in this case it was pirates! We are sure most divers have not contemplated the risk of pirates as a challenge that DAN faces. But it is just another factor to consider, and in an instance like this it reinforces just how important it is to dive with an operator that is able to provide an injured diver with a long duration of oxygen first aid.

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