Decompression Sickness Symptoms for Tunnel Workers

Q: Decompression Sickness Symptoms for Tunnel Workers

Hello Mr. <br>Chang： <br>Decompression sickness (DCS), commonly known as "the bends," occurs when individuals work in high-pressure environments (greater than one atmosphere). <br>Prolonged exposure to high-pressure air causes the body tissues to dissolve significant amounts of n

Symptoms of decompression sickness?

Doctor Lin, could you please clarify whether working in an underground tunnel for a year could lead to the onset of decompression sickness (also known as "the bends") after that year? If decompression sickness has a latent period, could it manifest a year later? Additionally, what are the differences in symptoms of decompression sickness experienced by someone working in a tunnel compared to those experienced by a typical diver? Thank you for your assistance!

Zhang, 40~49 year old female. Ask Date: 2001/06/21

Dr. Lin Zhengyan reply Diving Medicine

Hello Mr.
Chang:
Decompression sickness (DCS), commonly known as "the bends," occurs when individuals work in high-pressure environments (greater than one atmosphere).
Prolonged exposure to high-pressure air causes the body tissues to dissolve significant amounts of nitrogen.
If the personnel ascend without following the proper decompression procedures, the nitrogen dissolved in the body tissues can form bubbles, filling various tissues and organs, leading to clinical symptoms, which is referred to as decompression sickness.

The clinical symptoms of decompression sickness can be classified into two types based on severity: Type I (mild) and Type II (severe).
Symptoms from both types can occur singly or in combination.
Symptoms of Type I can evolve into those of Type II, and Type II symptoms often include Type I symptoms such as skin rashes.

1.
Symptoms of Type I decompression sickness are most commonly fatigue, itching, skin rashes, localized subcutaneous emphysema, and joint and muscle pain.

2.
Symptoms of Type II decompression sickness include:
(1) Central nervous system: headache, dizziness, nausea, vomiting, facial droop, slurred speech, altered consciousness, personality changes, semi-consciousness, complete unconsciousness, seizures, and death.

- Vision: blurred vision, double vision, hemianopia, blindness, and dilated pupils.

- Auditory and balance: tinnitus, hearing loss, vertigo, vomiting, and nystagmus.

- Sensory nerves: numbness or tingling in the limbs, facial nerve paralysis.

- Motor nerves: weakness in the limbs, unsteady gait, hemiparesis, and coordination difficulties.

- Spinal nerves: back pain, abdominal pain, diarrhea, lower limb paralysis, and incontinence.

- Other neurological symptoms.

(2) Respiratory system: dry cough, shortness of breath, chest pain, rapid heartbeat, and hyperventilation.

(3) Cardiovascular system: chest tightness, chest pain, and shock due to myocardial hypoxia.

(4) Severe muscle and joint pain during ascent.

Any of the above symptoms occurring within forty-eight hours of working in a high-pressure environment or after leaving it should be considered as decompression sickness.

Regarding your question about whether decompression sickness could manifest a year after working in an underground tunnel, the answer is:
1.
If the underground tunnel is a high-pressure environment (using air compressors that create pressure greater than one atmosphere), it could potentially cause decompression sickness.
If the tunnel is not a high-pressure environment (unless explosives are used), and is only at one atmosphere, it would not cause decompression sickness.

2.
As previously mentioned, symptoms occurring during work in a high-pressure environment or within forty-eight hours after leaving should be considered decompression sickness.
Therefore, if decompression sickness occurs while working in an underground tunnel, it would not manifest a year later but rather within forty-eight hours.

3.
If working in a high-pressure environment leads to joint and muscle pain or other symptoms, one might not realize that decompression sickness has already occurred.
People often attribute these symptoms to fatigue from work and may overlook them, only to discover a year later that joint damage or necrosis (avascular necrosis) has developed, or that there are neurological sequelae.
This situation indicates that decompression sickness was already present but ignored and untreated, leading to joint damage and necrosis due to prolonged nitrogen bubble obstruction, which is chronic decompression sickness, not a delayed manifestation of decompression sickness after one year.

Decompression sickness occurs within forty-eight hours of working in a high-pressure environment or after leaving it; it does not manifest a year later.
Symptoms that appear a year later are indicative of chronic decompression sickness, resulting from prolonged nitrogen bubble obstruction due to exposure to high-pressure environments.
The symptoms of decompression sickness from working in a tunnel are the same as those of typical decompression sickness.

If you need further clarification, please call: (08) 8881238, Department of Diving Medicine, Hengchun Branch, Pingtung Hospital, Ministry of Health and Welfare.

Reply Date: 2001/06/21

More Info

Decompression sickness (DCS), often referred to as "the bends," is a condition that can occur when a diver ascends too quickly after spending time at depths where the pressure is significantly higher than at sea level. This condition is primarily associated with underwater diving, but it can also affect workers in high-pressure environments, such as tunnel workers who may be exposed to similar pressure changes.

To address your question, it is indeed possible for symptoms of decompression sickness to manifest after a delay, although this is not the most common scenario. Typically, DCS symptoms appear within minutes to hours after a rapid ascent or decompression. However, there are cases where symptoms can be delayed, sometimes referred to as "chronic DCS," which can occur days or even weeks after the exposure. This delayed onset is less common and may be influenced by various factors, including the individual’s health, the duration and depth of exposure, and the specific conditions of the work environment.

In the context of tunnel workers, the risk of developing decompression sickness can arise from working in pressurized environments, particularly if they are subjected to rapid changes in pressure. The symptoms of DCS can include joint pain, dizziness, fatigue, difficulty breathing, and neurological symptoms such as confusion or paralysis. These symptoms can be similar to those experienced by divers, but the specific presentation may vary based on the individual and the circumstances of their exposure.

For tunnel workers, the symptoms may also be influenced by the nature of their work environment. For instance, if a worker is in a confined space with limited ventilation, they may experience additional symptoms related to carbon dioxide buildup or oxygen deprivation, which can complicate the clinical picture. Moreover, the physical demands of tunnel work, combined with the psychological stress of working in such environments, can exacerbate symptoms and lead to a higher risk of injury or illness.

It is crucial for tunnel workers to be aware of the signs and symptoms of decompression sickness and to receive proper training on how to manage pressure changes. Regular monitoring of health and safety protocols, including gradual decompression procedures when exiting high-pressure environments, can help mitigate the risks associated with DCS.

If a worker suspects they are experiencing symptoms of decompression sickness, it is essential to seek medical attention immediately. Treatment typically involves hyperbaric oxygen therapy, which helps to reduce the size of nitrogen bubbles in the bloodstream and tissues, alleviating symptoms and promoting recovery.

In summary, while decompression sickness is primarily associated with diving, tunnel workers can also be at risk if they are exposed to significant pressure changes. Symptoms may appear immediately or, in rare cases, after a delay. Understanding the risks and symptoms associated with DCS is vital for ensuring the health and safety of workers in high-pressure environments. Regular training, monitoring, and adherence to safety protocols can significantly reduce the risk of developing this condition.

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