Editing In-water recompression (section)

== In-water recompression tables ==
Six IWR treatment tables have been published in the [[scientific literature]].{{clarify|Which are thse?|date=September 2022}} Each of these methods have several commonalities including the use of a full face mask, a tender to supervise the diver during treatment, a weighted recompression line and a means of communication. The history of the three older methods for providing oxygen at 9 [[metres sea water|msw]] (30 [[feet sea water|fsw]]) was described in great detail by Pyle and Youngblood.<ref name=Pyle/> The fourth method for providing oxygen at 7.5 msw (25 fsw) was described by [[Richard Pyle]] at the 48th Annual UHMS Workshop on In-water Recompression in 1999.<ref name=uhms/> The Clipperton method involves recompression to 9 msw (30 fsw) while the Clipperton(a) [[rebreather]] method involves initial recompression to 30 msw (98 fsw).<ref name=Blatteau />

The treatment tables recommended for use in chambers are not suitable for in-water recompression as the oxygen partial pressures and the associated risk of oxygen toxicity are too high.<ref name="Walker and Murphy-Lavoie" />
{{expand section|Clarify which are the three older methods and which method uses 7.5 msw|date=September 2022}}

=== Australian in-water recompression table ===
[[Image:Australian IWR.jpg|thumb|Australian In-water Recompression Table]]
The Australian IWR Tables were developed by the [[Royal Australian Navy]] in the 1960s in response to their need for treatment in remote locations far away from recompression chambers. It was the shallow portion of the table developed for recompression chamber use.<ref name=edmonds1979/><ref name=edmonds1995/>

Initial recompression is to 30 fsw (9 msw). Oxygen is breathed during the entire treatment without any air breaks and is followed by alternating periods (12 hours) of oxygen and air breathing on the surface. Surfacing is at 4 minutes per fsw.

=== Clipperton in-water recompression tables ===
[[Image:Clipperton IWR.jpg|left|thumb|Clipperton In-water Recompression Table]]
[[Image:Clipperton a IWR.jpg|thumb|Clipperton(a) In-water Recompression Table]]
The Clipperton and Clipperton(a) methods were developed for use on a [[Scientific diving|scientific]] expedition to the [[Clipperton Island|atoll of Clipperton]], 1,300 km from the Mexican coast.<ref name=Blatteau/> The two versions are based on the equipment available for treatment with the Clipperton(a) table being designed for use with rebreathers.

Both methods begin with 10 minutes of surface oxygen. Recompression is to 30 fsw (9 msw) for the Clipperton IWR table, oxygen is then breathed for 60 minutes and while surfacing at 1 metre per minute without any air breaks. For the Clipperton(a) IWR table, descent is made to the initial treatment depth of 30 msw, maintaining a [[partial pressure]] of 1.4 ATA. and breathed at that depth for 10 minutes followed by ascent to 9 msw at 1 metre per minute. As near as possible to 100% oxygen is breathed at 9 msw for 30 minutes, followed by ascent to the surface at 1 metre per minute. Oxygen breathing on the surface for 6 hours post treatment and [[Intravenous therapy|intravenous]] hydration fluids are also administered following both treatment tables.

=== Hawaiian in-water recompression table ===
[[Image:Hawaiian IWR.jpg|right|thumb|Hawaiian In-water Recompression Table]]
The Hawaiian IWR table was first described by Farm et al. while studying the diving habits of Hawaii's diving [[fishermen]].<ref name=farm/>

The initial portion of the treatment involves descent on air to the depth of relief plus 30 fsw or a maximum of 165 fsw for ten minutes. Ascent from initial treatment depth to 30 fsw occurs over 10 minutes. The diver then completes the treatment breathing oxygen and is followed by oxygen breathing on the surface for 30 minutes post treatment.

The Hawaiian IWR Table with Pyle modifications can be found in the proceedings of the DAN 2008 Technical Diving Conference. <!-- or through download from DAN [http://www.diversalertnetwork.org/FastAccess/2008TechnicalDiving.aspx here]. dead link-->

=== Pyle in-water recompression table ===
[[Image:Pyle IWR.jpg|left|thumb|Pyle In-water Recompression Table]]
The Pyle IWR table was developed by [[Dr. Richard Pyle]] as a method for treating DCS in the field following scientific dives.<ref name=Pyle/>

This method begins with a 10-minute surface oxygen evaluation period. Compression to 25 fsw on oxygen for another 10-minute evaluation period. The table is best described by the treatment [[algorithm]]. This table does include alternating air breathing periods or "air breaks".

=== US Navy in-water recompression tables ===
[[Image:USN Type1Sx IWR.jpg|thumb|US Navy Type I Symptoms In-water Recompression Table]]
[[Image:USN Type2Sx IWR.jpg|thumb|US Navy Type II Symptoms In-water Recompression Table]]
The [[US Navy]] developed two IWR treatment tables.<ref name=usn/> The table used depends on the symptoms diagnosed by the medical officer.

Oxygen is breathed the entire treatment without any air breaks and is followed by 3 hours of oxygen breathing on the surface.

=== IANTD in water recompression protocol ===
The [[International Association of Nitrox and Technical Divers]] (IANTD) has developed a specialized training program for technical divers to perform in-water therapeutic recompression. This procedure is designed for use in remote locations where hyperbaric chambers are not available. The program prepares divers to assess when conditions and equipment are appropriate, and when the diver's condition warrants such emergency treatment.<ref name="IANTD IWR" /> The protocol primarily involves breathing oxygen at a depth of 25 feet of seawater (7.5 meters),<ref name="Doolette and Mitchell 2018" /> with scheduled air breaks to reduce the risk of oxygen toxicity. This approach is intended to manage decompression sickness in extreme situations where conventional treatments are not accessible.