Editing In-water recompression (section)

===Indications===
Indications are based on symptoms and signs of [[decompression illness]] where expected benefits are likely to outweigh risk. There is a tension between conditions serious enough to justify the risks and clinical states which indicate excessive risk. Risk may not be considered justified for cases where the symptoms suggest a spontaneous recovery is likely without recompression, although the actual risk in these cases is likely to be relatively low. As of 2018 there is no widely accepted method for objectively selecting divers suitable for in-water recompression, and although remote consultation with a diving medical practitioner is advised by the Doolette and Mitchell 2018 protocol, it is likely that remote advice will vary significantly depending on who is contacted and how willing they are to accept responsibility for giving advice on a procedure with which they may have little personal experience and for which there is no clear decision tree.<ref name="Doolette and Mitchell 2018" />

An attempt has been made to provide some structure to the decision process which can be useful to divers without medical training, by the technical diving certification organisation [[International Association of Nitrox and Technical Divers]] (IANTD), which in consultation with diving medical experts, produced a decision map for field use. The system relies entirely on gross observation, omitting a detailed neurological examination. It categorises symptoms into three "tiers", which correspond roughly with perceived severity of DCI, and appropriateness of IWR in suitable conditions.<ref name="Doolette and Mitchell 2018" />

Tier 1 symptoms would not be severe enough to justify IWR, but would be monitored and discussed with a remote consultant. These are generally non-specific symptoms which may or may not be of DCI, and are not an immediate or significant threat, such as headache, lethargy, or nausea.<ref name="Doolette and Mitchell 2018" />

Tier 2 symptoms are severe enough to suggest IWR if they present soon after surfacing, or are progressive, but not necessarily if there is a delay of some hours and the symptoms are not progressive. IWR would be justified for tier 2 when it may prevent the development of more severe symptoms. These symptoms are likely to be of DCI, but are not likely to result in permanent injury or death if not treated. They include musculoskeletal pain, excepting symmetrical ''girdle pains'', lymphatic obstruction with subcutaneous swelling, skin rashes and [[Paresthesia|paraesthesias]] such as tingling.<ref name="Doolette and Mitchell 2018" />

Tier 3: symptoms are severe enough to justify IWR if there are no contraindications and the logistical requirements are in place. These symptoms and signs are likely to be of DCI and indicate a risk of permanent injury or death. Some of them are also contraindications to IWR. They include changes in state of consciousness, or obvious confusion, difficulty with speech, visual changes,{{clarify|date=September 2022}} disturbances in balance, obvious sensory loss (numbness), obvious weakness or paralysis, bladder dysfunction, (usually inability to urinate), bowel dysfunction, loss of limb coordination, shortness of breath, and bilaterally symmetrical girdle pains.<ref name="Doolette and Mitchell 2018" />