Decompression Sickness (DCS) Treatment in Patong, Phuket: First Aid, Oxygen, and Hyperbaric Referral 24/7
100% oxygen, IV fluids, neurological assessment, DAN liaison and fast transfer to the Vachira Phuket recompression chamber for divers with suspected decompression sickness or arterial gas embolism, in our Patong clinic or at your hotel, 24 hours a day. Clinically reviewed by the Doctor Patong Takecare Clinic medical team.
WhatsApp now, suspected DCS | Call +66 81 718 9080 | Find the clinic on Google Maps
Phuket sits at the centre of one of the world’s busiest dive scenes, with day boats and liveaboards running to the Similan and Surin Islands, Racha Yai, Phi Phi, Anemone Reef and the King Cruiser wreck. Most divers surface tired and happy, but every season we see DCS and the occasional AGE from rapid ascents, missed deco stops, repetitive deep profiles, dehydration or flying too soon. The right early move (oxygen, fluids, DAN call, transfer to Vachira) decides whether someone walks out of the chamber clean or carries a neurological deficit home.
What is happening in the body
Decompression sickness is what happens when nitrogen absorbed at depth comes out of solution faster than the lungs can offload it. The dissolved gas forms bubbles in joints, skin, spinal cord, brain and lungs, and the symptoms map to where the bubbles end up. Arterial gas embolism is a different mechanism: a breath-holding or rapid ascent overinflates the lungs, an alveolus ruptures, and gas enters the arterial circulation directly, where it travels straight to the brain or the coronary arteries. AGE can happen after a very shallow, very short dive, and the trademark feature is symptoms within seconds to minutes of surfacing, often loss of consciousness or stroke-like deficit. DCS tends to declare within an hour for serious neurological forms and within six hours for joint pain, but late presentations up to 24 hours do occur.
DCS Type I, Type II and AGE at a glance
| Pattern | Onset | Typical symptoms | Urgency and treatment |
|---|---|---|---|
| Type I DCS (mild) | Within 6 hours of surfacing | Deep ache in shoulder, elbow or knee, worse with movement (the “bends”), skin marbling (cutis marmorata), mild itch, fatigue out of proportion to the dive. | Same-day care. 100% oxygen, fluids, clinical assessment. Most still need hyperbaric oxygen at Vachira. |
| Type II DCS (serious) | Within 24 hours, often within 1 hour | Spinal: pins and needles, weakness, paralysis, bladder or bowel dysfunction, back pain. Cerebral: visual change, weakness on one side, ataxia, confusion, headache, dizziness. Chokes: chest pain, cough, breathlessness, shock. | Emergency. 100% oxygen at maximum flow, IV saline, urgent transfer to the recompression chamber. Outcome depends on minutes to hours. |
| Arterial gas embolism (AGE) | Seconds to minutes after surfacing | Sudden loss of consciousness, stroke-like focal deficit, seizure, cardiac arrest. Can follow breath-holding or rapid ascent, even from shallow depth. | Resuscitation. CPR if arrest, 100% oxygen, IV access, immediate transfer for recompression. |
First aid in the first ten minutes
Stop the dive day for everyone on the boat or buddy team, since one diver in trouble usually means a shared profile worth reviewing. Get the casualty out of the water safely, lay them supine (no longer head-down Trendelenburg, which raises intracranial pressure without helping), and put them in the recovery position if they are unconscious or vomiting. Start 100% oxygen by non-rebreather mask at 15 litres per minute or the highest flow your kit allows, because oxygen washes nitrogen out of tissues and is the single most important pre-chamber intervention. Give oral fluids (water or oral rehydration salts) if the diver is alert, or run IV saline (avoid glucose-containing fluids) if you have it. Call the Divers Alert Network Asia-Pacific hotline on +61-8-8212-9242 and call 1669 for the Thai ambulance, and call us so we can mobilise oxygen, IV, and transfer to Vachira Phuket Hospital. Do not attempt in-water recompression, an outdated practice that risks drowning, hypothermia and worsening symptoms.
Hyperbaric oxygen therapy at Vachira Phuket
Vachira Phuket Hospital in Phuket Town runs the only recompression chamber on the island, and it is the definitive destination for any suspected DCS or AGE from a Phuket dive. The standard protocol is a US Navy Treatment Table 6, which recompresses the diver to the equivalent of 60 feet (about 18 metres) on 100% oxygen for around 4 hours 45 minutes, with extensions if neurological signs are slow to clear. Some divers need a second or third session over the following days for residual symptoms. The earlier the recompression starts, the better the recovery, which is why we prioritise transfer over investigations that can wait. We liaise with DAN (Divers Alert Network), the chamber team and your dive operator’s insurance to keep the chain moving while you stay on oxygen.
Loss of consciousness on surfacing, even briefly. Stroke-like signs (one-sided weakness, slurred speech, facial droop, sudden visual loss). Seizure, cardiac arrest or collapse. Chest pain, severe cough, frothy sputum or breathlessness (the chokes, or pulmonary barotrauma). Numbness, pins and needles, weakness in the legs, bladder or bowel changes, severe back pain (spinal DCS). Confusion, severe headache, dizziness or unsteady gait (cerebral DCS). These pictures are AGE or Type II DCS, and the clock matters in minutes. Start oxygen, lay flat, call DAN, and move to the Vachira chamber.
You have joint pain, skin marbling, unusual fatigue, itch, mild numbness or tingling within 24 hours of any dive, even if the symptoms seem trivial. You have an unexplained DCS event after a conservative dive (we screen for patent foramen ovale). You are due to fly home soon and have any post-dive symptoms, since flying with bubbles still in circulation worsens DCS. You need a fitness-to-fly certificate after recompression. WhatsApp +66 95 073 5550 for a same-day clinic visit or hotel-room call out, and we can start oxygen on the way.
Prevention every diver in Phuket should follow
Dive within your computer and tables, ascend no faster than 10 metres per minute (slower in the last 9 metres), and do a 3 to 5 minute safety stop at 5 metres on every dive. Hydrate well before and after diving, and skip alcohol on dive days. Respect the no-fly interval: at least 12 hours after a single no-deco dive, and 18 to 24 hours after repetitive or multi-day diving (DAN recommendation), which matters here because most divers fly home soon after the last Similan trip. Be conservative on deep, repetitive, cold or decompression dives, particularly over the age of 40, and consider PFO (patent foramen ovale) screening if you have an unexplained DCS event. Do not dive with a cold, sinus congestion, poor sleep, hangover or any chest infection, and avoid hot tubs and saunas immediately after diving since heat accelerates bubble formation. Make sure your dive medical is up to date before any course, which we provide on our PADI Dive Medical page.
What we provide at the clinic and at your hotel
We assess any diver with possible DCS or AGE within minutes of the call, start 100% oxygen and IV saline on arrival or at your hotel, perform a focused neurological exam (cranial nerves, power, sensation, coordination, gait, bladder), and contact DAN and the Vachira chamber in parallel so the chamber team is briefed before you arrive. We arrange transport with oxygen on board, supply documentation for travel insurance and DAN claims, and follow up after recompression for residual symptoms. We also issue post-DCS fitness-to-fly certificates once you are clinically stable, since most airlines and insurers require written clearance before you board. See related pages on emergency care, accident and trauma care, the PADI dive medical, and the medical certificate service for fitness-to-fly clearance.
Summary
Decompression sickness and AGE are uncommon but real on every Phuket dive trip, and the first hour decides the outcome. Oxygen at 100% and high flow, flat positioning, IV or oral fluids, a call to DAN, and fast transfer to the only chamber on the island at Vachira Phuket Hospital are the steps that turn a frightening surface event into a clean recovery. We are open 24 hours, we travel to your hotel or the pier, and we stay with the case from boat to chamber to fitness-to-fly clearance.
“If a diver does not feel right after surfacing, do not wait for the symptoms to declare themselves on the drive back to the hotel. Start oxygen at the highest flow you have, lay them flat, call DAN and call us. Recompression at Vachira works best when it starts in the first few hours, and the difference between a full recovery and a residual deficit is almost always how fast the first oxygen mask went on.”
Doctor Patong Takecare Clinic medical team
Frequently asked questions
How much oxygen does a diver with suspected DCS actually need?
As close to 100% oxygen as you can deliver, by non-rebreather mask, at the highest flow rate the cylinder allows (typically 15 litres per minute), and you keep it running continuously until handover at the recompression chamber. Oxygen creates a steep nitrogen gradient between tissues and the lungs, which accelerates bubble shrinkage and dissolution. Dive boats in Phuket carry emergency oxygen kits for exactly this reason. Do not ration it: even if symptoms appear to improve, keep the mask on, because bubbles can reform when oxygen stops.
When should I suspect DCS rather than just a sore shoulder or tired legs?
Any joint pain, numbness, weakness, skin marbling, unusual fatigue, headache, confusion, breathlessness or visual change within 24 hours of a dive should be treated as DCS until ruled out, especially if the symptoms started within an hour of surfacing or after a deep, repetitive or rapid-ascent profile. Pain that improves when you push on the joint, or pain that is hot, red and clearly traumatic, is more likely musculoskeletal, but the diving doctor makes that call, not the diver. If in doubt, oxygen on, call us.
Where exactly is the Phuket recompression chamber, and how do we get there?
The only recompression chamber on the island is at Vachira Phuket Hospital in Phuket Town, roughly 45 minutes by road from Patong depending on traffic, and a similar distance from most dive piers. We arrange transport with oxygen running for the whole drive, brief the chamber team and DAN by phone en route, and send your dive profile and any boat oxygen records ahead. The hospital handles the recompression treatment (typically a US Navy Table 6) and admits for monitoring as needed, and we coordinate follow-up and the fitness-to-fly certificate once you are out.
Is DAN membership worth it for a one-week dive trip?
Yes, for almost every visiting diver. DAN (Divers Alert Network) membership is inexpensive, the dive accident insurance bolt-on covers recompression, hospital admission, evacuation and repatriation, and most ordinary travel insurance policies specifically exclude diving accidents or cap them well below the cost of a chamber run. The DAN Asia-Pacific 24-hour emergency hotline (+61-8-8212-9242) is the single number every Phuket diver should save in their phone before the first dive, alongside 1669 for Thai ambulance and our WhatsApp.
When can I fly home after DCS treatment?
Most divers wait at least 72 hours after a clean recompression run before flying, and longer if any neurological symptoms were present or if more than one chamber session was needed. The decision is individual and depends on residual signs, the type of DCS, your dive profile and the flight length, so we examine you, check your symptoms have resolved, and issue a written fitness-to-fly clearance through our medical certificate service. Flying too soon can re-precipitate bubbles and undo the recompression, which is why insurers and airlines look for the certificate.
Should I be screened for a patent foramen ovale (PFO) after an unexplained DCS hit?
If you had DCS after a conservative dive profile, or a second DCS event, PFO screening is reasonable. A patent foramen ovale is a small opening between the right and left atria of the heart that around one in four adults silently carry, and it lets venous bubbles short-circuit the lungs and reach the arterial side, which raises the risk of neurological DCS. The test is a bubble-contrast echocardiogram, usually done back home. The result changes dive planning (more conservative profiles, longer surface intervals, sometimes consideration of closure), and we can give you a referral letter and a copy of your records for the cardiologist.
Sources
Divers Alert Network (DAN). Decompression illness: signs, symptoms and first aid. dan.org.
Undersea and Hyperbaric Medical Society (UHMS). Indications for hyperbaric oxygen therapy: decompression sickness and arterial gas embolism. uhms.org.
US Navy Diving Manual, Revision 7. Treatment Table 6 protocol.
National Health Service (NHS). Decompression sickness. nhs.uk.
Get help now
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