A Diver's Story: Paralysed from the Waist Down
Written by recreational diver, Julian Rawles (pictured at DDRC)
Paralysed from the waist down, wearing an O2 mask and looking up at the air ambulance circling above me. This is not how I thought my Sunday recreational dive would end.
The dive was a beautiful one, water temperature 14 degrees, but wearing a dry suit so no problems, visibility a good 5m, depth 20m maximum. SS Galicia is an easy wreck with a range of sea life. We stayed down for 40 minutes, saw conger eels, plenty of crabs and lobsters and all manner of British fish, then made our way up.
I am a BSAC Sports diver with over 80 dives, mostly UK and a max depth experience of 40m. I had dived 4 times over the previous 4 weeks, 15 times over the year and have attended pool-training sessions every week over the previous 4 months. In short, this dive was well inside my comfort zone, however, for no explainable reason I felt ‘heavy’ on ascent and had to put in more air than usual to raise me off the seabed. I ascended steadily to 14m, but then moved faster than I wanted from 14m to 9m. My dive computer didn’t alarm but indicated to me to slow down my ascent, which I did comfortably with my dive buddy (a Sub-Aqua Diving Supervisor or SADS), stopping at 6m for our 3-minute safety stop. Again I had some minor buoyancy issues.
The computer of my buddy Paul, who was leading the dive, indicated 6m whereas mine indicated 6.5m. He had control of the DSMB (Delayed Surface Marker Buoy) and with a close eye on him I ascended another half meter to put my computer into the ‘count-down’ zone for my 3-minute stop. As I ascended next to Paul I struggled slightly with my buoyancy control, this is uncommon for me and I remember feeling a little embarrassed in front of him (knowing he would rib me later in the boat). I bounced between 4.2m and 6.5m 2 or 3 times before I steadied at 5m and my computer counted down 2 minutes, one minute and then indicated the safety stop was complete. Paul later told me, on the surface, that we had actually stopped for 4 minutes as my computer delayed the count down when it dropped below 6m.
All this seemed of no consequence, other than a few debrief points from Paul on the surface. Recovery to the RHIB (Rigid Hull Inflatable Boat) was easy and the safety guys in the RHIB helped us de-kit and we drank coffee whilst chatting about the dive. It was a cheerful boat, with banter flowing and enjoyable weather. Ten minutes later after recovering the second pair of divers, we were enjoying the transit back to Exmouth docks basking in the November sun and smooth seas.
But all was definitely not well
The pain in the area of my right kidney began quite softly at first and at the age of 43 and a former Royal Marines Commando I am familiar with aches and pains, so I duly ignored it and, not wanting to make a fuss I pretended to watch the other boats in the channel. The pain increased and spread to both sides of my back (Diving Doctors call it girdle pain; spinal bends are commonly a morphine level of pain). I found myself kneeling on the RHIB deck trying to lean over the side in the event of needing to vomit or blacking out. Typical of most divers I didn’t want to make a fuss and tried to work through it. My buddies were watching me and although I was oblivious, had started to take action. They contacted the on-call doctor at DDRC (the Diving Disease Research Centre) and explained my symptoms. On her recommendation they called 999 and arranged an ambulance to meet me at Exmouth docks. They also administered O2 from the boat and gave me fluids.
We entered Exmouth Docks within 25 minutes of surfacing from the dive and were preparing to leave the boat. It was at this stage that I realised I couldn’t stand, moreover, I couldn’t move or even feel my legs. I had lost all feeling from the waist down.
Time to Transfer for Treatment
My dive buddies lifted me from the boat and carefully laid me on the dockside where I could hear the sirens of the ambulance and saw the Devon Air Ambulance helicopter circling above us. I had obviously chosen my dive buddies well, as their quick actions and knowledge from the club training had worked well.
Picture by Neill Alexander for Devon Air Ambulance Trust
The paramedic team took me swiftly to the grounds of Exmouth Rugby Club where the local game was rudely interrupted - sorry lads - I hope you went on to win! The rugby ground provided a flat surface for the Air Ambulance to land. With a very slick and quick handover between the two crews, I was loaded into the helicopter and flown to DDRC, Plymouth.
At this point, it is important to mention the professional care of the Devon Air Ambulance crew; how they made me feel like a guest rather than a patient. Helen and Paul were superb, they talked to me, informed me where I was going and why, our ETA and other relevant and appropriate information. I was only in their ‘flying office/medical centre/helicopter’ for 15 minutes but the service provided really was remarkable. Thank you Helen and Paul.
At the DDRC I was greeted by the doctor, nurses and technicians who are not only experts in their field, but are also very experienced divers. Within 10 minutes of entering this ‘mini divers hospital’ I had been examined, tested, had lights shone in my eyes, ears (and other places!). I was swiftly put into the recompression chamber and underwent the ‘COMEX 30’. I had a technician in the chamber with me, watching my every move and administering different gases at different times.
I was treated to 7.5 hours of hyperbaric medicine. First we dived quickly to 30m in 3 minutes, this re-compressed all the gas bubbles in my tissues. I was breathing on heliox, which I remained on for 2.5 hours. Then I was transferred onto oxygen for 5 hours; 25 minutes at a time with 5 minute breaks to offset oxygen toxicity. By the end of the 7.5 hour treatment I had recovered sensation and movement in both legs and had almost normal functionality.
DDRC doctor, Sally Simmons, referred me to an overnight stay at Derriford hospital where I had another examination the next morning. By that time, I had experienced no relapses but my neurological functionality was still not quite where it should be (no cheap jokes about brain function and Royal Marines please!), so I was prescribed with daily 2.5 hour hyperbaric oxygen sessions at a depth of 20m, until my functionality stabilised. This took another 3 days.
I am pleased to say that one week later I was back at work with no adverse effects from my spinal bend. Unfortunately, I have been told I cannot dive for a minimum of 3 months and need a PFO test, which will hopefully provide answers to why I received the bend through no fault of any reckless diving.
What lessons have I learned?
Julian pool training with a buddy
My ascent profile and buoyancy could have been better but it was nowhere near severe enough to have caused a bend. Nonetheless a lesson in buoyancy at the safety stop is on my training agenda. The biggest lesson was the response from those around me. Every single one of the divers in the boat knew what to do, from seeking expert advice swiftly to having numbers on their phone and the slate, to acting on their training by giving me O2 and fluids early and calling the emergency services. I question whether I would have been so efficiently responsive? Would I have remembered how to administer the O2? Would I have had the number for DDRC in my phone?
I have also learned how valuable our emergency services are. Both the Devon Air Ambulance and the DDRC are charitable trusts, existing on charitable donations from generous members of the public.
I am sincerely grateful to my dive buddies; the Ambulance crew; the Devon Air Ambulance Crew; and the staff who treated me at DDRC. The care we have at our disposal as a UK diver is superb and my heartfelt thanks go to each and every one of them.
DDRC's Medical Director Dr Christine Cridge & Julian Rawles, at DDRC's Hyperbaric Medical Centre in Plymouth.
Comments from DDRC Medical Director, Dr Christine Cridge
Spinal cord decompression illness (DCI) thankfully is a rare disease but when it does occur it can cause significant long term disability. Spinal DCI is different to many diseases or injuries that affect the spinal cord as there is huge potential for recovery – if the diver receives appropriate first aid, prompt evacuation and timely recompression.
Through mechanisms such as bubble transfer across a PFO or ‘hole in the heart’, it can occur after seemingly innocuous dives. ‘Silent bubbles’ which occur in the venous side of the circulation, cross over into the arterial circulation through a PFO. Links have been made with skin and neurological bends. A skin bend alone will not cause long term damage, it does raise the concern that a diver has a PFO and we would recommend someone with experiencing a skin bend should seek immediate expert advice for review in case there are other neurological problems they have not realised.
Girdle pain is often the first sign that a diver is developing spinal cord DCI. The pain often starts in the back and spreads like a band around the body at whatever level is affected and can occur from the neck down but is commonly experienced around the lower chest or back. There are lots of different causes of back pain, which is in part why it is better to seek advice, but Jules describes very well what girdle pain feels like.
A common delay to prompt evacuation for recompression therapy we see time and again at DDRC is when a well-meaning person has told the diver “you can’t be bent after that dive”. We have a good working relationship with the Coastguard who can patch one of our diving doctors to a dive boat seeking advice.
At sea call Channel 16, on land call 999. Better to seek advice early, be treated quickly and make a full recovery in the way Jules has, than spend a long time afterwards living with the aftermath.
DDRC would like to thank Julian Rawles for taking the time to write his story and for allowing us to share it with others.
