[Decompression sickness accident management in remote areas. Use of immediate in-water recompression therapy. Review and elaboration of a new protocol targeted for a mission at Clipperton atoll]. / Gestion d'un accident de plongée en situation d'isolement. Intérêt de la recompression thérapeutique par immersion. Revue et proposition d'un nouveau protocole à l'occasion d'une mission sur l'atoll de Clipperton.

In-Water Recompression (IWR) is defined as a treatment of decompression sickness by immediate underwater recompression after the onset of symptoms in remote areas where hyperbaric chambers are not available. At least three methods of IWR have been published. They used pure oxygen breathing for prolonged periods of time at a depth of 9 m. IWR effectiveness in comparison with standard recompression techniques has not been assessed. IWR should be used in remote localities as an immediate measure to stop the evolution of decompression illness before evacuating the victim for subsequent treatment to the nearest hyperbaric facility. Resulting from environmental conditions, the risks of drowning and hypothermia are the most often quoted, pure oxygen breathing at 9 m can also expose to acute oxygen toxicity. The objectives of this work are: first, to examine existing published methods of IWR; second, to propose a new method of IWR. All published methods of IWR involve victim returning underwater for a long period of time. But dehydration due to a long period of immersion can worsen symptoms of decompression illness and acute oxygen toxicity is also related to the duration of the exposition. In response to these considerations we developed a shorter method of conducting IWR specifically targeted for a diving mission at Clipperton atoll in the Northern Pacific Ocean.

Thermal changes observed before and after J.-L. Etienne's journey to the North Pole. Is central nervous system temperature preserved in hypothermia?

The thermoregulatory responses of a French doctor, Jean-Louis Etienne, were examined in a standard cold test before and after his journey to the North Pole, to investigate whether general and/or local cold adaptation had occurred. The two tests were carried out in a climatic chamber for 2 h at rest (dry bulb temperature, 1 degree C; relative humidity, 40%; wind speed, 0.8 m.s-1). After his journey, Etienne showed a general hypothermic-hypometabolic adaptation, i.e. a decrease in rectal temperature (Tre) and metabolic heat production (M), and an increased local skin temperature of the extremities. Between the two tests, a change occurred in the relationship between tympanic temperature (Tty) and M. During the post-journey cold test, Tty [as representative of the central nervous system (CNS) temperature] increased while the decrease in Tre was accelerated, probably due to a redistribution of blood volume towards the CNS. Such a mechanism would protect the central core with special reference to the CNS.