This is a reproduction of a library book that was digitized

by Google as part of an ongoing effort to preserve the

information in books and make it universally accessible.

https://books.google.com
 º

| |G| | |] || UD E I | | G
BY DANIEL LENIHAN
AND KEN MORGAN

sººnbock MEMORA- ſº

-
\
“unmed STATES DEPARTMENT OF THE INTERIOR
AMATIONAL PARK SERVICE
º SOUTHWEST REGION
* SANTA FE, NEW MEXICO
- i ）; ， ， ， ， ） → → → → → → → → → → →
l/
/

HIGH ALTITUDE DIVING CONSIDERATIONS

-- - - - + -------

By

Daniel Lenihan and Ken Morgan

February 22, 1975

UNITED STATES DEPARTMENT OF THE INTERIOR

NATIONAL PARK SERVICE
SOUTHWEST REGION
SANTA FE, NEW MEXICO
， ， ， ， ， ， ， ， ） − k. i 1 l， ， ， ， ， ， !
 - - - -- - - - --------

This paper is intended as a compilation and discus

sion of existing "state-of-the art" techniques which have
been developed to deal with the problems and variables
which occur when diving activities are extended to a high
altitude environment. It is for the express use of Nation
al Park Service Diving Teams. Permission to reproduce the
various tables, charts, and text presented in this paper has
been secured from Skin Diver Magazine and NAUI News.

The authors would like to express appreciation to E. R.

Cross, C. L. Smith, Dr. Al Behnke, Sheck Exley, John Ratliff,
Larry Murphy, and Bill Cate for reviewing this paper and
making many helpful suggestions. The cover design was created
by Mary Beth Stokes and the editing of the draft manuscript
was done by Jane Harvey both of the Division of Planning and
Design, National Park Service. The typing of the manuscript
was done by Calverna Stokes and Priscilla Fields, Archeology
Division, National Park Service.
， ， ， ， ） – ） --Tl-T） ， ， ， ， ， ， ） №
 3.

- - -
--------~~~~~

HIGH ALTITUDE DIVING CONSIDERATIONS

， ， ， ， ， ， ， ， ， ， ， ， ，， ， ， ， ， ，
PARAGRAPH TITLE - PAGE N0.

INTRODUCTION - - - - - - - - - - - - - - - - - - - l

DECOMPRESSION REVIEW - - - - - - - - - - - - - - - 2
What Happens When the Diver Breathes Air
Under Pressure - - - - - - - - - - - - - - - - - 2
Gas Exchange and Nitrogen Absorption - - - - - - 2
Decompression and Denitrogenation - - - - - - - 3
Treatment- - - - - - - - - - - - - - - - - - - - 5
Prevention - - - - - - - - - - - - - - - - - - - 5 -- - - - * r * r *-

DECOMPRESSION PROBLEMS OF ALTITUDE DIVING - - - - 6

AS THEY RELATE TO SPECIAL SITUATIONAL WARIABLES
Situation 1: Dive Immediately After Arriving
at Altitude from Sea Level - - - - - - - - - - 7
Situation 2: Altitude Dive, No Extenuating
Circumstances - - - - - - - - - - - - - - - - 8
Situation 3: Altitude Dive Followed by Going to
Lowered Ambient Pressure - - - - - - - - - - - 13
Situation 4: Sea-Level Dive Followed by Going to
Lowered Ambient Pressure - - - - - - - - - - - 14
Situation 5: Altitude Dive Without Conversion
Tables - - - - - - - - - - - - - - - - - - - - 15
Situation 6: Altitude Dive to Sea-Level Dive - - 16
Situation 7: Sea-Level Dive to Altitude Dive - - 16
Situation 8: Recompression After Altitude Dive - 17

OTHER PROBLEM AREAS - - - - - - - - - - - - - - - 17

Boyle's Law Effects- - - - - - - - - - - - - - - 17
Equipment- - - - - - - - - - - - - - - - - - - - 17
Physiological Effects - - - - - - - - - - - - - 20

CONCLUSION - - - - - - - - - - - - - - - - - - - - 2]

BIBLIOGRAPHY (Informal) - - - - - - - - - - - - - 23
-， ， ， ， ， ， ， ， ， ， ， ， ， ， ， ， ， ， ,
 INTRODUCTION

The National Park Service has one of the most extensive and highly
developed diving programs in the Department of the Interior. Service
diving personnel are involved in search and recovery activities, biolog
ical studies, and maintenance in many park areas. Service underwater
archeologists are responsible for the research carried out in Federal
waters and on federally impacted submerged lands throughout the United
States.

Among the environmental variables encountered by Service divers in----------

their official scuba-diving activities is that of altitude. Several
park areas and many federally modified lands needing archeological work
in the western United States contain bodies of water that lie signifi
cantly above sea level. This fact can present very serious problems to
divers who have been trained to operate under the assumption that all
dives begin and end at one atmosphere absolute (sea level).

Diving at altitude, or going to altitude after a dive, changes an

important "given" relevant to the formulas and tables divers must learn
in order to cope with the physiological effects of pressure changes.
This "given" is the ambient pressure the diver is exposed to before and
after his dive. To the knowledge of the authors, none of the profes
sional diving concerns in the United States, including the Navy, have
dealt systematically with this problem; thus, individuals and groups
of divers who dive consistently at altitude have been forced to develop
their own specialized techniques. The following discussion of, and set
of procedures for, high-altitude diving have resulted from a synthesis
of information from articles derived from Skin Diver Maqazine, NAUI News,
the 1974 NAUI High Altitude Diving Conference at Lake Tahoe, and the ex
perience of the authors in their own high-altitude diving activities.

Because most of the problems associated with high-altitude diving

relate to decompression, we will begin with a brief general review of
the subject. The model used will be based primarily on the U.S. Navy
Diving Manual and popular U.S. diving publications. The general discus
sion of decompression will be followed by a systematic look at all the
parameters of the problem of high-altitude diving, particularly decom
pression variables.

Perhaps this would be the best time to mention the great debt we
owe to E. R. Cross in regards to dealing with altitude diving problems.
His classic article in Skin Diver Magazine, which has since been reprinted
in NAUI News, has provided a valuable point of reference for all others
dealing with the problem, including the present authors. We also wish
to acknowledge the excellent work of C. L. Smith, Dr. Richard Bell, Dr.
Al Behnke, and Stan McNutt in this area. Bob Tolar also contributed
significantly to raising the consciousness of divers to high-altitude
diving variables by organizing the NAUI High Altitude Diving Workshop
at Lake Tahoe in August 1974. We wish to express our appreciation to
Skin Diver Magazine and NAUI News for giving us permission to reproduce
various tables, charts, and portions of text.
DECOMPRESSION REVIEW

When a number of different terms are found to refer to the same

thing among a group of people, it is a sure indication that thing is
important in the minds of those people. In the world of diving, "bends,"
"caisson disease," "compressed air illness," and a number of other terms
all refer to symptoms or aspects of what is known in official medical
language as "decompression sickness." -

Decompression sickness occurs when an excessive quantity of inert

gas (a gas not utilized by the body cells, such as nitrogen or helium)
is present in body tissues, accompanied by a lowering of ambient pres
sure. This situation arises almost exclusively in diving, underwater
construction projects (caisson work), and flying. The latter is an
important point for divers to remember. Altitude changes within 12
hours of diving, resulting from flying in an unpressurized aircraft
or an aircraft having standard (5,000 - 8,000 foot) pressurization, or
from arriving at a location considerably different in height from the
point of departure, can affect decompression rates. The altitude fac
tor can be even more important if the actual dive is to be made at high
altitudes, and decompression procedures must be modified to deal with
this problem.

WHAT HAPPENS WHEN THE DIVER BREATHES AIR UNDER PRESSURE

After descending 33 feet in sea water (or 34 feet in fresh water),

we say that the diver has "descended one atmosphere" –that is, that he
is subjected to a pressure increase of one (sea level) atmosphere over
the pressure existing at the surface. The air he demands through his
regulator from the compressed-air unit on his back will compensate for
this increase in outside pressure by creating an equal pressure within
his lungs. This means that even though the volume of the diver's lungs
and upper airways have not changed, there are now at least twice the
number of gas molecules actually in that volume. Thus far, the air;
although physically inside the body, has not yet been incorporated into
the circulatory system and body tissues. The actual absorption by the
body of the specific gases that constitute air takes place in a process
known as "gas exchange."

GAS EXCHANGE AND NITROGEN ABSORPTION

The last branching of the bronchioles (a network of progressively

smaller tubing in the lungs) ends in extremely small sacs, known as
"alveoli." It is in the alveoli that gas is actually absorbed and
eliminated by the pulmonary system. It is then returned to the heart,
from which it will be distributed throughout the entire vascular system.
It is important to understand at this point that gas exchange works under
the rules of partial pressure; that is, each component of air (nitrogen,
oxygen, traces, and so forth) independently effects a pressure balance
with the corresponding pressure of that particular gas in the vascular
system it is being exposed to. Thus, our diver at 33 feet is now having
nitrogen and oxygen absorbed by his bloodstream at twice the rate at
which it would be absorbed on the surface (at altitude, it would be more
than twice the rate). This means that the tissues are also being exposed
to nitrogen by the blood at twice the surface rate - but this does not
mean that they immediately absorb twice as much nitrogen as they had con
tained previously. . There is a time factor here, owing to the fact that.---...---
the blood vessels are serving a tissue mass far greater in volume than
the supply of blood, and also to the fact that tissues vary in their
capacities for nitrogen absorption. Fatty tissue, for instance, can
absorb five times more nitrogen than most other body tissues, which can
magnify problems for obese divers. This is a complicated factor, however,
and overweight divers actually have an advantage in certain situations.
The rate of absorption and release of gases from the body tissues is also
affected by temperature (especially extreme cold), by the physical condi
tion of the individual at the time of the dive, and even by the state-of
mind of the diver. Combinations of one or more of these factors could
actually throw the decompression tables off to a degree that significantly
affects a diver's decompression requirements.
DECOMPRESSION AND DENITROGENATION

When a diver ascends, he undergoes a reversal of the process of

nitrogen absorption called "denitrogenation." Denitrogenation involves
many variables that make it a complicated and crucial process. The most
important of these is time, for the length of time a diver breathes com
pressed air at depth determines the amount of nitrogen that his body tis
sues will absorb up to the point of saturation. When saturation is reached
for a particular depth, no more nitrogen is absorbed or released because
a state-of-balance has been achieved (and will remain until the diver
leaves his depth).
Now let us take the hypothetical case of a diver below 33 feet: He
has stayed long enough to significantly increase the tension of nitrogen
in his tissues - – not necessarily until he was saturated for that partic
ular depth, but still significantly in comparison to the normal tension
of nitrogen in his blood at the surface. As he starts to ascend, the
partial pressure of nitrogen in the alveoli lessens. The blood starts
to balance the situation by taking nitrogen from the tissues and releas
ing it back into the alveoli, where a reverse partial-pressure gradient
has now formed. But remember the time factor: The blood can only carry
a limited amount of nitrogen on each trip to the tissues, and it can only
carry a limited amount of nitrogen back to the lungs on each trip from
the tissues. Consider also that the ambient pressure exerted on the
diver's body tissues has also decreased. If the rate of ascent is not
gradual enough, and nitrogen is present in large enough quantities to
preclude its natural elimination by the body, it will come out of solu
tion in the tissues in response to the lowered ambient pressure, and
form bubbles. Bubble formation will occur when the partial pressure
of nitrogen within the cell becomes approximately twice that of the am
bient partial pressure. (There is actually a fairly wide range of vari ::
ance, but for the purposes of this schematic model, "twice" is close
enough.) The reason a dive from sea level to 33 feet can be conducted
for lengthy periods (although not indefinitely without stage decompres :
sion stops) is the fact that the pressure gradient stays below 2:1. If -- -

bubbles should form and reach a critical size, their release into vari
ous parts of the organism can cause decompression sickness.

Decompression sickness manifests itself in such key areas as the

small fatty deposits associated with the cramped areas of circulation
around joints and the tiny fat deposits associated with the nervous
system (especially the spinal cord). Long, shallow dives tend to create
problems in the former, while short, deep exposures seem to affect the
latter more directly. Both conditions can lead to quite serious results.

There are also subclinical ways in which the bubbles can create
problems: Damage to brain cells and bone tissue (aseptic bone necrosis)
might not manifest itself symptomatically for long periods of time. Skin -

bends (itching and rash), or extreme fatigue, may also signify the forma
tion of bubbles of critical size.

The Navy Diving Manual reports that in 85 percent of their cases,

symptoms of decompression sickness occurred within one hour after expo
sures. In only 1 percent did they occur more than 6 hours later.

Muscle strains and joint sprains may easily be confused with the
localized pain that often accompanies decompression sickness, but such
conditions can occasionally be distinguished by the touch and motion test.
Muscle strains are usually quite sensitive to touch or movement, but there
is usually no discernible difference in severity of pain when this test
is applied to areas afflicted by decompression sickness only. Unfortun
ately, the touch and motion test suffers a drawback because decompression
sickness is most likely to occur in already-injured areas. The noticeable
increased pain resulting from the use of this test could therefore simply
indicate a muscular or joint injury associated with bends symptoms. Accord
ingly, if central-nervous-system symptoms are present, or there is Serious
doubt as to the nature of a localized pain after a dive, oxygen should be |
administered, and the diver must be moved to a recompression chamber as
soon as possible. (No analgesics should be taken; they can mask or par
tially remove the pain of decompression sickness, which can compound the
situation.)

~
 Statistical Distribution of Symptoms
(percentage of cases)

Localized pain - - - - - - - - - - - - - - - - - 89.0

Dizziness (staggers) - - - - - - - - - - - - - - - 5.3

Paralysis - - - - - - - - - - - - - - - - - - - - 2.3

Chokes - - - - - - - - - - - - - - - - - - - - - - 1.6

Extreme fatigue - - - - - - - - - - - - - - - - - l. 3 --------------

Collapse (with unconsciousness) - - - - - - - - - 0.5

(U.S. NAVY DIVING MANUAL, 1970)

TREATMENT

Due to the similarity of some symptoms of air embolism to those of

decompression sickness, and due to the fact that most divers are not com
petent to diagnose diving disorders, the presence of any of these suspi
cious symptoms — even if the individual has operated within the schedule
set by the tables – should be treated as if it were a sure indication that
the victim is suffering from a combination of decompression sickness, air
embolism, and shock. It should be kept in mind that the danger of air
embolism increases at altitude.

As soon as the symptoms become noticeable, place the individual in

a prone position, with feet raised, and body tilted slightly toward the
left. Administer oxygen if available, and rush the individual to a recom
pression chamber by helicopter if necessary. Do not try to recompress
the individual in the Water! !

Call ahead to make sure that the chamber is not in use, and that
trained personnel are available. (Fee will probably be levied.)
-
- *

PREVENTION

It should have become fairly obvious at this point that treatment

for decompression sickness is at best dangerous, unpleasant, time
consuming, and expensive. It is considerably wiser and easier to take
measures to avoid it in the first place. One easy way to avoid it is
to never dive below 33 feet during normal sea-level scuba exposures,
or a depth which produces twice the surface pressure when at altitude.
Other ways are to keep well within the "no-decompression" limits, and
if you do perform dives involving stage decompression, to follow the
tables strictly. Although these measures greatly diminish the chance
of affliction, it is still possible to be bent even after following
the tables; some people are just more prone to being bent than others,
and in addition, the tables can be thrown off by cold and excessive
exercise at decompression stops, and from the diver's assuming cramped
positions. Once the decompression requirements for a dive have been
determined, if there has been exposure to cold or heavy work on the dive,
you should then go to the next greatest time and depth specified in the......
tables.

Two important final points should be made: first, — you can be bent
on a single tank (especially during dives at altitude), so the Well
trained diver must be constantly aware of his exposure to depth and
time, no matter what the extenuating circumstances. Last - and perhaps
most important - do not forget that any dive you make within 12 hours
of your last dive will be affected by the residual nitrogen in your
system. If you make repetitive dives in the same 12-hour span, be sure
to consult the U.S. Navy Repetitive Dive Tables before so doing. Remem
ber too that so-called "no-decompression" dives, even those shallower
than 33 feet, result in a residual nitrogen factor, and they must there
fore be calculated into your repetitive dive schedule.

DECOMPRESSION PROBLEMS OF ALTITUDE DIVING

AS THEY RELATE TO SPECIAL SITUATIONAL WARIABLES

There are several specific situations in which altitude variables

can create problems for compressed-air or mixed-gas diving. In this paper,
we will concern ourselves with only the compressed-air problems, as fol
lows:

1. Arriving at altitude from sea level with the intention of diving

immediately.

2. Diving at altitude and remaining at that altitude or going to a

lower One within the next 12 hours. -

3. Diving at altitude and then going to a higher altitude within

12 hours (even if this means just driving over a high pass on the way
back to a lower altitude).

4. Diving at sea level and then either flying (note that even pres
surized cabins usually create an ambient pressure considerably less than
14.7 PSI) or driving to altitude.
 5. Diving at altitude with no conversion tables available.

6. Diving at altitude then going to sea level for a repetitive

7. Diving at sea level and going to altitude for a repetitive dive.

8. Being treated for decompression sickness at altitude.

SITUATION 1: DIVE IMMEDIATELY AFTER ARRIVING AT ALTITUDE FROM SEA LEVEL......

Before he even gets involved with the intricacies of decompression
that result from actually performing dives at altitude, the lowland
diver must first take into consideration the important fact that he has
been living at or near sea level, which has a significantly lower ambient
pressure than that of the dive site at altitude. This means that he is
literally decompressing from a saturation dive just by driving or flying
to the area in which he is going to dive. Consequently, if he wishes to
dive immediately, he finds that he already has a repetitive group letter
to deal with before he even gets in the water!

In the February 1975 issue of NAUI News, C. L. Smith has articulated

this problem well and offers a repetitive dive table to deal with it (see
Table: 1). This table indicates the depth of an equivalent saturation
dive and the lowest suggested repetitive group letter that should be used
for a particular altitude. Most dive sites in the United States lie at
6,000 feet or below (Lake Tahoe, one of the largest and most popular is
at 6,200 feet, but 6,000 feet tables are still used there successfully),
which means that in most cases a 6-hour wait will put the diver into
Group A, which little affects the dive.
 TABLE I

-w

Lowest Suggested
- - - Depth of Equivalent Repetitive Group
Altitude, ft. Saturation Dive, fi Letter at AIIival–
2,000 2.6 D
4,000 5.3 D
6,000 8.3 D
8,000 11.6 F
10,000 15.1 H
12,000 19.0 H
14,000 - 23.4 J

(C. L. Smith, NAUI News,

February 1975)

SITUATION 2: ALTITUDE DIVE, NO EXTENUATING CIRCUMSTANCES

What we are examining here is the classic situation entailing

an altitude dive with no extenuating circumstances, such as would
occur when a diver flies or drives to a reduced ambient pressure
afterwards. (We are also assuming that the diver has become suffi
ciently acclimatized to the altitude of the dive site.)

Given the present "state-of-the-art;" the best procedure is to

employ the conversion factors offered by E. R. Cross (see Tables A
and B). The following directions for the use of these tables are
in Cross's own words:

|
:

.
 •

Table “A” gives theoretical diving depths at altitudes to

* 10,000 feet for actual diving depths to 250 feet. To use this
table, enter the left column (actual diving depth) with the
actual, or next greater, depth of the dive. Across from this
depth, in the columns at the right, find the altitude of the
body of water in which the dive is being made. Use the next
higher altitude if altitude falls between those listed. The figure
given in the selected altitude column for the actual depth is -------> <-r:
the theoretical depth of the dive at that altitude.
As an example, assume a dive is to be made in a lake at
an altitude of 4,000 feet. Actual depth of the dive is to be 90
feet. Across from 90 feet in column 1 for an altitude of 4,000
feet will be found the theoretical depth of 104 feet. The rule
of using the next greater depth also applies in high altitude
diving, so the theoretical depth used for this dive would be
110 feet.
Further assume the first dive is to be for 35 minutes. At
what depths and for what times are the decompression stops?
Enter the standard air decompression tables for a depth of 110
feet for a dive of 35 minutes. Using the next greater time (40
minutes) it will be found that the decompression schedule calls
for decompression stops at 20 feet for 2 minutes and at 10
feet for 21 minutes. But actual depths of the decompression
stops must also be changed to theoretical decompression stop
depths. In Table “B” it will be found that at an altitude of
4,000 feet, the 20 foot stop must be taken at a depth of 17
feet and the 10 foot stop at a depth of 9 feet. Therefore,
theoretical decompression stops that are to be followed will be
2 minutes at 17 feet and 21 minutes at a depth of 9 feet.
Does this also work with the repetitive dive tables? Yes,
they must also be modified to obtain theoretical depth values.
First take the misnamed “no decompression” tables.
Again using the 4,000 foot altitude example, what is the
depth time limit at various depths? An inspection of Table
A” will show that a dive to an actual depth of 30 feet at
4,000 feet is equivalent to a dive to 35 feet at sea level. Now
enter the no decompression table for that depth and it will be
found the no decompression limit for that depth (35 feet) is
 --> * - - r

310 minutcs. This means that, at 4,000 fect above sca level, a
dive to an actual depth of 30 feet must be limited to 310
minutes instead of unlimited time as at sea level (if
decompression stops are to be avoided).
In the previous example of a dive to an actual depth of
90 feet at an altitude of 4,000 feet, the theoretical depth was
-found to be 110 feet. No decompression limit for this dive
would be 20 minutes. Note that the designator at the end of
the dive would be for the theoretical depth for altitude and
not for actual diving depth.
In the table for obtaining repetitive group designator at
the end of surface interval, no application of altitude diving
tables is required since depth is not a function of this table.
However, theoretical depth is a factor in the repetitive dive, or
dives, that may follow. Taking the original example of a 90
foot dive for 35 minutes at an altitude of 4,000 feet, assume a
repetitive dive to an actual depth of 60 feet after a surface
interval of 2 hours 19 minutes. What will be the no
decompression time limit?
It has already been determined that the theoretical diving
depth for a 90 foot dive at 4,000 feet is 110 feet. For a 35
minute (40 minutes must be used) dive at 110 feet the
repetitive group designator is “L”. After a 2 hour 19 minute
surface interval, an “L” diver becomes a "G" diver. The
repetitive dive was to an actual depth of 60 feet. In Table “A”
for 4,000 feet it will be found that an actual dive to 60 feet is
equivalent to a depth of 69 feet. Using 70 feet, again refer to
, the repetitive dive group designator and it will be found that as
a “G” diver going to 70 feet, an equivalent exposure of 37
minutes exists. For a dive to 70 feet the maximum no
decompression time limit is found to be 50 minutes. The diver
already has an equivalent exposure of 37 minutes for the new
depth which leaves an actual diving time of only 13 minutes
unless decompression stops can be programmed. |||
(E. R. Cross, 1970)

10
 FIGURE 2

TABLE A -

THEORETICAL DEPTH AT ALTITUDE FOR GIVEN ACTUAL

Actual
Diving DEPTH IN FRESH WATER -

Depth Theoretical Depth at Various Altitudes (in feet)

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
0 0 0 0 0 0 0 0 0 0 0
10 10 11 11 12 * .12 12 13 13 14 15
20 21 21 22 23 24 25 26 27 28 29
30 31 32 33 35 36 37 39 40 42 44
40 41 43 " 45 46 48 50 52 54 56 58
50 52 54 56 - - - 58 60 62 65 67 70 ------73.
60 62 64 67 69 72 75 78 81 84 87
70 72 75 78 81 84 87 91 94 98 102
80 83 86 89 92 _96 100 103 108 112 116
90 93 97 100 104 108 112 116 121 126 131
100 103 107 111 116 120 - 124 129 134 140 145
110 114 118 122 127 132 137 142 148 153 160
120 124 129 134 139 144 149 155 161 167 174
130 135 140 145 150 156 162 168 175 181 189
140 145 150 156 162 168 174 181 188 195 203
150 . 155 161 167 173 180 187 194 202 209 218
160 166 172 178 185 192 199 207 215 223 232
170 176 182 189 196 204 212 220 228 237 247
180 186 193 200 208" 216 224 233 242 251 261
190 197 204 212 220 228 237 246 255 265 276
200 207 215 223 231 240 249 259 269 279 290
210 217 225 234 243 252 261 272 282 293 305
220 228 236 245 254 264 274 . 284 296 307 319
230 238 247 256 266 276 286 297 309 321 334
240 248 258 267 277 288 299 310 323 335 348
250 259 268 278 289 300 311 323 336 349 363

TABLE B
| THEORETICAL DEPTH OF DECOMPRESSION STOP AT ALTITUDE

Prescribed
Depth - Theoretical Depth of Decompression Stop (in feet)
1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
- 0 0 0 0 0 0 0 0 0 0 0
10 10 9 9 9 8 8 8 7 7 7
20 19 19 18 17 17 16 15 15 14 14
30 29 28 27 26 25 24 23 22 22 21
40 39 37 36 35 33 32. 31 30 29 28

E. R. Cross, 1970)

ll
 Several factors relating to this procedure, which came to light
through the comments of Dr. Behnke and Dr. Bell at the 1974 high
altitude conference, must be noted.

First: Computerized analyses of critical tissue-pressure factors

have indicated that susceptibility to decompression sickness is some
what greater at altitude, even given the Cross conversions. This fact
should discourage individuals from doing anything like marginal or
"knife edge" diving. Playing close to the wire on decompression pro
cedures, even in relation to so-called "no-decompression" dives, be
comes even more foolish in altitude diving.

Second: The ascent rate must be adjusted when the Cross tables
are followed: The standard ascent rate of 60 feet per minute must be
slowed by 2 feet per minute for each 1,000 feet of altitude. Thus, a
dive at 5,000 feet would demand an ascent rate of 50 feet per minute,
rather than the standard 60 feet per minute.

Third: Behnke suggests that, while Cross's conversions for the

decompression stops should be followed on the whole, instead of going
to Cross's suggested point for the 10-foot stop (for example, at
5,000 feet it would be 8 feet), the given 10-foot stop as prescribed
in the United States Navy Standard Air Tables should be used instead.
These authors suggest also doing a short 8-foot stop as an added pre
caution (perhaps 1/3 the prescribed 10-foot stop).

In general, it should be noted that Cross's tables are almost

totally theoretical in nature, with little in the way of empirical
support, much as are the Navy Standard Air Exceptional Exposure Tables.
On the bright side, Dr. Bell of the University of California at Davis
has shown that for the 6,200-foot range, using the suggested modified
ascent rate, many hundreds of dives have been conducted with no appar
ent complications.

However, the authors of this paper strongly recommend building

an additional large safety factor into this procedure: the controlled
use of oxygen where decompression stops are required. As operational
ized by the Division of Archeology of the National Park Service's
Southwest Region, this involves tying off a cylinder containing pure
oxygen at the lowest anticipated stop above 30 feet. When the diver
reaches the decompression stop, he stabilizes for a moment or two,
still breathing from his compressed-air cylinder, and then switches
to pure oxygen. He does not immediately switch to the oxygen, because
|
during ascent he has just experienced a quick reduction of the oxygen
partial pressure in his circulatory system, and the sudden presence
of pure oxygen could conceivably cause an oxygen paradox effect which
*
could result in his blacking out. I.
12
m
 The diver should follow through with his standard air-decompression
schedule, as modified by Cross's tables and the above-mentioned factors,
but use oxygen in place of his air. This adjustment will serve to signif
icantly increase the nitrogen gradient in his lungs, and result in a very
comfortable safety margin.

Another technique that would help avoid confusion and mitigate to

a degree altitude decompression problems, is the use of the cave-bottom
time concept. This technique consists simply of coming up slower than
the prescribed ascent rate and figuring your period of ascent as part of
the bottom time. This results in a minor penalty in terms of decompres
sion time, but eliminates the considerable difficulties which arise when
people try to ascend at specific rates for each altitude they dive. The
cave-diving community in Florida developed this concept in response to a ‘’’
similar problem which presented itself when the configuration of differ
ent caves demanded varying ascent rates.

It is also recommended that the diver continue to consider himself

on a decompression schedule when he arrives at the surface. This means
that for a couple of hours afterward he should not exert himself, or do
anything that seriously involves circulatory-system stability (including
drinking alcoholic beverages soon after the dive). Divers should, how
ever, drink plenty of non-carbonated fluids before and after long deep
dives to help counteract a tendency towards dehydration.

Finally, it is imperative that Service personnel diving at higher

elevations beware of assuming that "minor" altitude variables aren't
really important enough to justify bothering with conversion tables and
special decompression techniques. E. R. Cross developed the altitude
conversions now widely used by the American diving community after he
was repeatedly bent doing working dives following Navy Standard Air
Tables at altitudes as low as 2,000 fee above sea level !

SITUATION 3: ALTITUDE DIVE FOLLOWED BY GOING TO LOWERED AMBIENT PRESSURE

We turn now to the specific situation in which the diver goes to

a lowered ambient pressure after the dive.

In general, the procedures outlined in the discussion of Situation l

should be observed here, with one added consideration. If the diver is
going to an increased altitude after the dive, which means a decreased
ambient pressure, he should figure his dive as though it took place at the
highest point reached. For example, if a diver is diving at an altitude
of 7,000 feet to an actual depth of 100 feet, Table A (Figure 2) indicates
that he must plan the dive as if he had been at 129 feet at sea level.
If the diver must drive home over an 8,000-foot pass, the new altitude
must be used instead of 7,000 feet, and his theoretical depth will be 134
feet. - This is a significant difference, because the diver must now decom
press on the 140-foot standard air-decompression schedule rather than the

13
130-foot table. This same principle must of course also apply if the
diver did a "no-decompression" dive; that is, he must plan his dive in
terms of the highest altitude he will encounter on his way home,

Now consider a situation in which the diver must fly after a dive,
be it from sea level or at altitude. In this case, if he can find out
what the cabin pressure of the airplane is from the airline, he can use
this figure in the same manner that he used the height of the highest
point on the drive home (as outlined above). The only problem here is
that a considerable act of faith is involved concerning the accuracy of
the airline's knowledge of the cabin pressures of their own airplanes
and their abilities to maintain them.

SITUATION 4: SEA-LEVEL DIVE FOLLOWED BY GOING TO LOWERED AMBIENT PRESSURE

Let us consider now a dive made at sea level followed by a drive

home over mountains or flight in an airplane.

In the January 1974 NAUI News, C. L. Smith outlined a procedure

for dealing with this situation that is simple to follow and reasonably
safe. He offers a reference table (see Figure 3) that allows the diver
to calculate when he can safely go to a reduced ambient pressure using
his repetitive group-letter as the indicator, rather than being forced
to wait 12 hours before returning home or flying.
|
FIGURE -3

Highest Permissible Repetitive Dive Group Letter -

to Ascend to Indicated Altitude

Altitude, Feet Above Sea Level
#ÉE

i # : s g

:
1
110
120
130
- -
140
150
- - -
- -

160
- - -
- -

170

l4
 Figure 3 indicates that if a diver reaches a maximum depth of 120
feet, he must undergo a surface interval time before flying or driving
to an altitude of 6,000 feet, which would be sufficient to take him to
Repetitive Dive Group D. For example, the standard air tables tell us
that 20 minutes at a hypothetical depth of 120 feet would put the diver
in Repetitive Dive Group H. He would have to wait l hour and 42 minutes
before he would be in Group D and ready to go to the reduced ambient
pressure presented by 6,000 feet of altitude.

It should be noted that Smith has not given group letters for ex
treme depths and time exposures, or for extreme combinations of depth
and altitude. The authors of this paper would like to express agree
ment with him on his implied point, which is that such exposures are ---------
getting into areas too marginal, safety-wise, for the application of
such a system. It is recommended that a 12-hour surface interval time
pass before a diver flies or drives to altitude after an exposure fall
ing within the exceptional range.

SITUATION 5: ALTITUDE DIVE WITHOUT CONVERSION TABLES

Let us look now at a situation in which a person decides to dive

at altitude but does not have conversion tables available.

In the November/December 1972 issue of NAUI News, Stan McNutt

suggested a simple rule-of-thumb that can be used when a diver does
not have his altitude conversion table handy and he is planning to do
a "no-decompression" dive at sport-diving depth (130 feet or shallower)
at an altitude less than 8,000 feet. This is a highly qualified situa
tion, but actually such conditions are probably those most common to
people who dive at altitude. That is, most divers are doing single dives
to sport depths within the no-decompression tables, and in this country
the altitude of the body of water will almost invariably fall below
8,000 feet. Park Service divers in working situations will probably
exceed one or more of these conditions, and they should therefore make
sure to have their conversion tables handy.

If the above-mentioned qualifying conditions are met, however,

McNutt's rule is to simply "add 4 percent of the actual depth for each
1,000 feet of altitude, then enter the standard no-decompression table
and follow standard procedure." This is a handy thing to know, but we
present it with some hesitation in this paper. In addition to remember
ing all of the qualifying factors, the diver must also keep in mind the
above-mentioned rule that if a drive home or cabin pressure in a plane
presents a lower ambient pressure than the dive area, he must use the
highest altitude encountered as the figure in his computations, and
not the actual altitude of the dive. Also, "decompression diving" does
not begin at 33 feet at altitude, but rather begins at depths corre
spondingly shallower as the altitude increases. Finally, if McNutt's

15
rule is followed, the assumption is that no exigencies will arise that
force a decompression stop. If the diver should have to stop, how is
he to know where and for how long, if he doesn't have his altitude con
versions available? It should also be noted that at altitude the diver
can get into decompression diving much more easily with a single tank
than he could at sea level.

SITUATION 6: ALTITUDE DIVE TO SEA-LEVEL DIVE

The next situation we will confront is that of diving at altitude

and then going to sea level for a repetitive dive. We refer to Cross's
Own Words:

"Now let's assume that a diver makes his first dive to

a depth of 90 feet (theoretical depth l OO feet) at an al
titude of 4,000 feet. After a surface interval of 2 hours,
19 minutes, during which time the diver drove to sea level,
he makes a repetitive dive to a depth of 60 feet in the
ocean. What happens to the tables?

For the first dive at altitude, use the theoretical

depth and theoretical decompression stop depths as in
the first example. After the surface interval and drive
to sea-level pressure, simply assume the original dive
was made to actual depth and actual decompression stop
depths at sea level. In other words, once sea level pres–
sure is reached the diver may assume the dive was made to
a depth of 90 feet for 35 minutes and that prescribed de
compression was taken for such a dive (7 minutes at ten
feet). Following this the diver is a "J" diver (at sea
level) and after 2 hours, 19 minutes surface interval he
is an "F" diver. Now entering repetitive dive tables, it
will be found the diver has an equivalent exposure (for
a 60-foot dive) of 36 minutes. Since the no-decompression
limit for a 60-foot dive is 60 minutes, the diver finds he
now has 24 minutes diving time before requiring decompression
stops."

(E. R. Cross, 1970)

SITUATION 7: SEA-LEVEL DIVE TO ALTITUDE DIVE

Now we examine what happens when the situation is reversed (and

again we defer to Mr. Cross):
in
. . (if you) make the first dive at sea level and then
go to altitude in . . . 2 hours and 19 minutes and make
(a) 60-foot dive at (an) altitude of 4,000 feet. What
happens?"

16
 "On the completion of (a) 90-foot dive for 35 minutes
at sea level, if the diver has immediately gone to an al
titude of 4,000 feet, the sea level dive must be treated
as though it were made at an altitude of 4,000 feet. The
repetitive dive would also be treated as in the previous
example for a repetitive dive at 4,000 feet."
SITUATION 8: RECOMPRESSION AFTER ALTITUDE DIVE

We now come to the last situational variable that we are going

to discuss: the problem of recompression treatment after an altitude
dive. It should be noted that if the diver who has been "hit" is re
compressed at a sea-level facility, no conversions need be applied.
If, however, he is recompressed at altitude (and there are recompres
sion facilities at altitude - Albuquerque, New Mexico, for example),
special steps should be taken. The authors are not prepared to offer
guidelines for meeting such recompression situations, but simply point
out the logical problem that would be presented. We are not convinced
that simply applying Cross's decompression-stop conversions would be
acceptable. For one thing, it seems that ascent-rate in the chamber
should be different. Hopefully, these factors have been taken into
consideration by those individuals who have devised treatment sched
ules for use in chambers at high altitude locations.

OTHER PROBLEM AREAS

Boyle's Law Effects - Due to the fact that the ambient surface pressure
of a dive site is reduced at altitude, the actual mechanical effects of
Boyle's Law will be intensified. On ascent, therefore, all air spaces
in, or attached to, the diver's body will be subjected to an accelerated
rate of gas expansion in direct proportion to the increased altitude.

This can affect the diver in two important ways. First, he is in

greater danger of developing an air embolism should he go into an uncon
trolled ascent. Second, the diver is more likely to go into an uncon
trolled ascent since he has to compensate for an accelerated rate of ex
pansion of his suit and buoyancy compensator on his way to the surface.
This problem will be mitigated to a degree by the diver adopting a slower
ascent rate which he is obliged to do anyway because of decompression
considerations (See Page 12). Where the situation presents the most
serious hazards is in the context of training neophyte divers. "Free
ascent" training should be attended by extreme caution.
EQUIPMENT
The primary equipment problem when diving at altitude is that Of
skewed depth-gauge readings. Oil-filled gauges that have not been ad
justed for altitude will give readings that have little connection with

17
reality. Nor can the diver rely upon the gauge's reading a consistent
percentage less than the actual depth, for the readings vary from time
to time with the gauge. (One gauge we tested read correctly at just
about any altitude, including sea level, which was surprising - - and,
in fact, logically unsupportable.)

To adjust an oil-filled gauge for altitude, remove the screw from

the center hole of the gauge. At the lower ambient pressure, there
will be room for more oil, once the screw is removed. Fill up this
space with a light machine oil and replace the screw.

Aside from actually altering the gauge, one may choose to use an
unmodified gauge, and employ the following conversion factors for Bour
don and Bellows gauges offered by C. L. Smith.

TABLE:
Corrections for Bourdon and Bclows Gauges

Correction to Add
Altitude, to Gauge Reading,
—ſº- —“——
0 -

1,000 1.3
2,000 2.5 -

- 3,000 3.6
4.000 4.7 NOTE: The correction is about
5,000 5.8 one foot per 1,000 feet
6,000 - 6.8 of altitude.

'7,000 7.8 -

8,000 8.8
9,000 9.8
10,000 10.7
11,000 11.6
12,000 12.4

---

The authors of this paper do not recommend this procedure because

we feel from our experience that deviations from these gauges are not
predictable enough.

Capillary gauges, on the other hand, will actually do the diver's

altitude computations for him. Because they are based on Boyle's law,

18
and essentially comprise an open system, they tend to show the diver's
actual depth would be in relation to sea level; that is, the higher
the altitude, correspondingly the greater the reading. Some divers
simply enter the standard air decompression tables with the depth re
corded on their capillary gauge, with results similar to those obtained
from conversions based upon the actual depth reading. But this method
is acceptable only in a limited sense. Its major short-comings are
similar to those associated with the use of a capillary gauge at sea
level. Accuracy becomes compromised after the first 30 feet to 40 feet
simply because the calibration-marks run so close together. Fouling
and clogging are also problems associated with most commercial capillary
gauges. - - - - -- - - - - - - - - ---

If the capillary method in altitude diving is chosen, it is highly

recommended that a homemade gauge be manufactured, using a foot-long
piece of wide plastic tubing. This could be attached to a board and
then calibrated at diving altitude by using a marked line in a controlled
dive. The gauge would be clumsy to carry around (it cannot be inverted
if it has a wide orifice), but it does present a reasonably accurate
depth gauging technique for altitude-diving.

Turning now to decompression meters, we have some simple, capsu

lized advice: Don't use them. In the opinion of the authors, no auto
matic decompression computer or meter on the commercial sports market is
dependable enough to be used at sea level - - let alone at altitude.

Having looked at all the problems associated with depth-gauging

devices, the obvious question now is which is best? The authors feel
that, wherever possible, a marked line should be used to tell actual
depth when diving at altitude. The diver should then refer to a set
of submersible altitude conversions that should accompany his regular,
standard air-submersible tables. This is by far the safest procedure,
but in many cases it is not feasible. For instance, divers conducting
a search operation in an area with low visibility and variable bottom
depths cannot assume that their marked line just happens to be at the
deepest point of the search area. Cave divers also are unable to take
advantage of the accuracy and simplicity of using a marked line.

In cases where the marked line cannot be used, it is recommended

that oil-filled gauges that have been corrected and checked against marked
lines at the same altitude be employed. It would also not be a bad idea
to take along a capillary gauge and take the time to see if the conver
sion depth taken from using the oil-filled gauge in coordination with
the altitude tables is the same as the reading on the capillary gauge.
Whichever reading is more conservative (deeper) in terms of decompression
should be the one chosen.

While still on the subject of equipment, it should be noted that

some wet-suits, primarily those in which injected nitrogen bubbles are

19
the insulating agent, will fit tighter at altitude. We feel this results
from the expansion of the sealed bubbles at altitude and the resultant
reduction of the inside volume of the suit. This at least seems to be
|
the case, based upon the subjective experience of the authors and one of
their wives. Three, however, is not exactly a strong statistical sample,
and so if our logic concerning the mechanism causing this phenomenon is
faulty, we would like to be told, and would welcome correction. It should
be noted that some individuals we have queried state that they do not no
tice any wet-suit "swelling" at altitudes.
PHYSIOLOGICAL EFFECTS

There are some physiological problems of a rather subtle nature . . . . . . . -

associated with altitude diving that should be discussed at this time.

These consist primarily of Subjective observations made by the authors,
along with some theorizing by diving physiologists and some general points
of interest that might warrant further research.
The first has to do with the effects of ascent from depth during an
altitude dive, as opposed to the effects of a dive conducted at sea level.
It should be noted that since the diver is ascending to a point at the
surface that has a significantly lower ambient pressure than he would be
encountering at sea level, he is consequently changing the partial pres
sures of all the gasses in his breathing medium at a greater rate. Earlier
.
in this paper we demonstrated how this can affect decompression considera
tions, and we indicated that a slower rate of ascent was mandatory (see
Page 12). There are, however, other problems which may present themselves
which relate more to the nature of specific gas effects. -

The first of these deals with oxygen and carbon-dioxide tensions in

human tissues. A diver who is not a native to high-altitude living on
ascent from a dive is leaving an oxygen-rich environment which has been
artificially presented to his system by descending in water while using
compressed air. At depth, he could cease hyperventilating, which is one
of the natural immediate responses of the body to acclimatize it to alti
tude. The diver adopts his more natural breathing rate, and as he returns
to the surface and its rarified atmosphere, he is suddenly presented with
an ambient partial pressure of oxygen that may be considerably less than
the .2ATA he is accustomed to at sea level. This situation could conceiv
ably cause an oxygen syncope. One of the authors (Lenihan) and his wife,
who had never lived at altitude before, occasionally encountered unusual
dizziness symptoms immediately after ascent at 5,000 feet and 6,000 feet,
while natives to the area never seemed to be bothered with the problem.
Our layman's diagnosis is that this is due to the physiological mechanisms
described above. Such dizziness is a mild annoyance, but if in an aggra
wated case (e.g., heavy exertion on the dive) this should progress to
actual fainting while still in the water, it could then pose a serious
problem.

20 ſ
 It should also be mentioned in passing that an unacclimatized
diver is leaving a nitrogen-rich environment upon ascent to enter
another environment that has an unnaturally low partial pressure of
nitrogen. Stanley Miles has mused over what effects a "nitrogen
blanket" may have on the psycho-physiological makeup of peoples liv
ing at different altitudes. He mentions that "there is some flimsy
evidence to suggest that a lowering of tissue nitrogen levels may
enhance nervous activity." This nitrogen factor has also been suggested
as having long-range effects on behavorial patterns of mountain dwellers.
These ideas have met with a lot of skepticism, but nothing that we see
as being a conclusive denial of their validity, especially because the -----

answers to these questions probably lie as much in the realm of physical

anthropology as physiology, and the anthropologists have not yet con
fronted the issue in any meaningful way.

Finally, in our "what if," or raw speculation, section we would

like to pose a question for physiologists that we have not yet had satis
factorily answered. It has occurred to us that if a human being spends
a considerable amount of time living and working at altitude, he is then
taking a somewhat altered physiological makeup with him when he returns
to sea level. Hyperventilation, which is one of the first reactions of
the body to exposure to altitude, is followed by the development by the
blood of an increased ability to utilize and transport oxygen, along
with other changes in the chemical properties of muscle tissues, etc.
We can see how hyperventilation can correct itself rather quickly, but
what we are concerned with are other, long-range, changes. The question
that nags us is, "Will a diver who is acclimatized to altitude be more
susceptible to oxygen poisoning if he goes to sea level and takes part
in deep-diving activities?" We recommended that Park Service personnel
act under the assumption that this is the case until we can be assured
by competent physiologists that it is not.
CONCLUSION

In this paper we have presented under one cover a compilation of

data from disparate sources that describe what we feel is the "state
of-the-art" in altitude diving. We have commented on, and expressed
our opinions concerning, the efficacy of certain techniques, and have
added some of our own observations and theories as well.

Two points have been mentioned that we would like to re-emphasize:

First, altitude diving is still in a primitive stage of development,
and the only thing we can be sure of is that all the variables have not
yet been fully considered, and that we are engaging in an area of diving
that is only marginally safe. Second, in dealing with altitude decom
pression problems, it is highly recommended that the tables be followed
strictly and that, whenever possible, oxygen be used on decompression
stops instead of air. This means decompressing with oxygen according

2]
to Navy Standard Air Decompression tables, using altitude conversions
as indicated by the various tables offered in this paper.

This technique provides a tremendous safety factor, and will all

but eliminate decompression problems in altitude diving. It does, how
ever, involve taking some strict precautions to avoid specific hazards
that attend using this gas for in-water decompression. The 02 decom
pression bottle and regulator must be specially cleaned for oxygen use
(if converted air bottles are used). The oxygen equipment should be
well-labled and used only for shallow decompression stops. No chopstick
or petroleum products (such as Waseline) should be used by the diver
on his lips or in the area covered by the face mask.

Whichever technique is utilized, be it the use of air, with strict

ultra-conservative use of the tables, or the use of oxygen, which offers
some logistic problems in turn for the safety factor it supplies, alti
tude diving should be approached by Park Service Divers with fore thought
and caution.

22
||
 The following is an informal bibliography of sources used
for this paper.

Buck, Michael NAUI News.' .. October/November 1973

Cross, E. R. Skin Diver Magazine November 1970 - --- - - - --

McNutt, Stan NAUI News November/December 1972 - * * *

Smith, C. L. NAUI News September/October 1972

NAUI News January 1974

NAUI News February 1975

Ratliff, John NAUI News January 1975

Miles, Stanley Underwater Medicine 1969

C. N. C. The New Science of 1974

Skin and Scuba Diving

U. S. Navy U. S. Navy Diving 1970

Manual

Mount, Tom Safe Cave Diving 1973

(NACD,Editor)
Bennett and Elliott The Physiology and 1969
Medicine of Diving

23
 0.5D L 32DD LA 5D

b890 & 32004.50 a

 _z & 2.
Z»e 2. 2.

442/.
a 2&A, cº

º
Jul 13 tº
BRDu BEDD+5D

b6904,32004.50 a