Hyperbaric Oxygen Therapy (HBOT) for Decompression Sickness: Addressing the Gaps

Hyperbaric Oxygen Therapy (HBOT) for Decompression Sickness: Addressing the Gaps

Decompression sickness, often referred to as “the bends,” is a potentially life-threatening condition that can occur when a diver surfaces too quickly or violates safe no-decompression limits. This can lead to nitrogen bubbles forming in the bloodstream and tissues, causing severe joint pain, dizziness, paralysis, and even death. Hyperbaric oxygen therapy (HBOT) has long been the gold standard for treating decompression sickness, yet its availability remains a critical issue in the United States.

  • The gas phase of decompression sickness is relatively quick. The gas that comes out of solution in a decompression event has a very high surface tension which wreaks havoc on tissue and sets in motion a cascade of inflammatory responses. Hyperbaric oxygen helps regulate the downstream damage and promotes healing.  

The Origin of Decompression Sickness and HBOT

The concept of decompression sickness dates back to the early days of diving and caisson work. The condition became widely recognized in the 19th century during construction projects like the Brooklyn Bridge, where workers in pressurized environments frequently experienced mysterious and debilitating symptoms after surfacing. Over time, researchers discovered that these symptoms were caused by nitrogen bubbles forming after decompression.

During the 20th century oxygen was used to enhance the treatment of decompression sickness resulting in much better outcomes and safer treatment tables. By placing patients in a pressurized chamber and administering pure oxygen, the therapy hyper-oxygenates affected tissues, facilitating recovery and mitigating long-term damage.

  • Interesting note; initially decompression sickness was not treated with oxygen, but rather staged decompression while breathing air. It wasn’t until later in 1937 that the utility of using 100% oxygen for the treatment of decompression sickness was realized. To put that into prospective the first reported case of decompression sickness in two miners was 1841. The Brooklyn Bridge was built between 1869 and1883. 

Limited Access to Emergency HBOT

While HBOT is a proven and essential treatment for decompression sickness, its availability in emergency settings is deeply uneven. In areas with high diving activity, some hospitals are equipped with hyperbaric chambers, providing a lifeline for affected divers. However, vast regions across the country remain without access to this critical resource. The consequences are dire: without timely treatment—ideally within hours of symptom onset—divers face permanent injury or even death. The critical window for treatment underscores the urgency of having hyperbaric oxygen therapy readily available in emergency settings, especially in areas around our coastlines. This stark disparity highlights an urgent need for action to ensure life-saving care reaches all who need it, no matter their location.

The Call for Expanded HBOT Services

Decompression sickness doesn’t just affect professional divers—it can impact recreational divers, underwater workers, and even aviators. Increasing access to HBOT chambers in underserved regions is vital to ensuring safety for individuals who rely on this therapy. Advocacy efforts and public awareness campaigns are essential to bridging these gaps.

Even pop culture has taken note of HBOT’s significance. Netflix’s Outer Banks features a storyline where a character battles “the bends,” spotlighting hyperbaric oxygen therapy as a key solution. While dramatized for entertainment, this reference underscores HBOT’s historical relevance—used for decompression sickness since 1937—and its growing visibility in modern narratives. Despite this, accessibility gaps persist nationwide, leaving many divers without life-saving treatment when it’s needed most.

Moving Forward

As more people take up diving as a hobby or profession, the demand for accessible HBOT services will continue to grow. By addressing these shortages and investing in emergency hyperbaric care, we can ensure that no diver is left without the treatment they need. The bends may be an ancient problem, but modern medicine has the tools to solve it—if we make them accessible to all.

We urge readers to spread awareness about the life-saving potential of HBOT and encourage healthcare providers to consider bringing this vital service to their facilities. Together, we can bridge the gap and ensure that every diver has access to timely care. 

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