Mahaki Decompression Hili e Lele, Barotrauma 'o e Telinga, mo e Fefononga'aki Fakafaito'o Fakamo'ui Lelei¶

Ko e lele ‘i ha vakapuna fakakomēsiale pe faka‘uli ‘i ha hala mo‘unga mā‘olunga hili pē ‘a e luelue ‘i he vaí ‘okú ne fakahaa‘i ai ho sinó ki ha fakasi‘isi‘i vave ‘o e ‘ea ‘i he ‘ātakaí. Neongo kuo ʻosi fakamālohiʻi ʻe he ngaahi vakapuna fakakomēsialé ʻa e ngaahi kāpiní, ʻoku fakaʻatā ʻe he ngaahi tuʻunga fakapuleʻanga fakafederal mo fakavahaʻapuleʻanga ʻo e vakapuna ʻa e kāpiní ʻi he māʻolunga ʻo e folau ʻeveʻevá ke holo hifo ki he mita ʻe 1,830 ki he 2,440 (fute ʻe 6,000 ki he 8,000) ʻi ʻolunga ʻi he fukahi tahí. Ko e holo ko 'eni 'o e 'ea 'oku tatau ia mo e 0.75 'atimosifia 'aupito, 'o hifo mei he 1.0 'atimosifia 'i he levolo 'o e tahi. Kapau 'oku ke kei 'ave 'a e toenga 'o e naitoloseni 'oku fakamovetevete 'i ho toto mo e ngaahi tisiula mei he luelue 'i he 'ea, pe kapau 'oku ke ma'u ha kato 'ea 'oku ma'u 'i loto 'i ha telinga lotoloto, sinus 'o e ava, feitu'u tafa kimuí ni mai, pe pneumothorax unvented, 'e lava ke fakatupu 'e he decompression fakafokifā ko 'eni 'a e mamahi faka'auha 'i he demboaf fatal e kasa tu'uloa 'i loto-e . ʻi he loto ʻeá.

Whether you are experiencing joint pain and numbness during a post-vacation flight, struggling with excruciating ear pressure that will not equalize on descent, or evaluating whether a family member is medically fit to board an international flight after hospitalization abroad, rapid recognition and strict physiological protocols prevent permanent injury. This guide covers emergency in-flight actions for suspected decompression sickness, Divers Alert Network (DAN) and Undersea and Hyperbaric Medical Society (UHMS) pre-flight surface intervals, safe maneuvers for severe otic and sinus barotrauma, and Aerospace Medical Association (AsMA) MEDIF fitness-to-fly rules.

Fai ʻeni he taimí ni .¶

1. Declare an immediate in-flight or roadside medical emergency if neurological or joint symptoms appear after diving. If you or a companion develop deep joint pain, skin mottling, numbness, tingling, dizziness, visual changes, or shortness of breath while flying or driving over a mountain pass after scuba diving, press the flight attendant call button immediately or pull over and call your local emergency number (911 ‘i he ‘Iunaite Seteté mo Kānatá, . 112 ‘i he kotoa ‘o e ‘Iunioni ‘Iulopé, . 999 ‘i he Pule‘anga Fakatahatahá) ‘o ngāue‘aki ‘etau . ngaahi fika fakavavevave tohi fakahinohino.
2. Request 100 percent high-flow medical oxygen immediately. Tell the cabin crew or paramedics: "I am a scuba diver who dived within the last 48 hours, and I am experiencing suspected decompression sickness. I need continuous high-flow 100 percent oxygen right now." Ask the crew to use a non-rebreather mask or demand valve if available in the aircraft's enhanced emergency medical kit, rather than a low-flow nasal cannula.
3. Contact the Divers Alert Network (DAN) 24-hour Emergency Hotline for hyperbaric physician guidance. As soon as you have satellite Wi-Fi, air-to-ground phone access, or ground cellular signal, call the DAN Emergency Hotline at +1-919-684-9111 (worldwide, collect calls accepted) or the DAN Europe hotline at +39-06-4211-8685 so a dive medicine specialist can coordinate with the airline's ground medical control (such as MedAire or Stat-MD) and locate the nearest operational multiplace hyperbaric chamber.
4. Lay the patient flat (supine) and hydrate with plain water if fully conscious. Keep the affected person lying horizontally. Do not elevate the legs or place the patient head-down (Trendelenburg position), as head-down tilt increases cerebral venous pressure and worsens brain edema. Give oral non-alcoholic, caffeine-free fluids if the person can swallow safely.
5. Stop forceful nose-blowing immediately if you feel sudden vertigo, tinnitus, or hearing loss during ear equalization. If an attempt to pop your ears causes a sudden spinning sensation, loud ringing, or muffled hearing, you may have ruptured the round or oval window membrane of your inner ear (inner ear barotrauma). Stop performing the Valsalva maneuver, sit upright, avoid straining or lifting heavy bags, and seek an urgent ear, nose, and throat (ENT) evaluation upon landing.
6. Never board a flight or drive above 610 meters (2,000 feet) before completing your mandatory post-dive surface interval. If your dive computer still displays a "No-Fly" icon or you have not met the minimum 12-hour to 24-hour surface interval guidelines established by DAN and UHMS, cancel or rebook your flight. Paying an airline change fee is minor compared to suffering spinal cord paralysis at 11,000 meters (36,000 feet) over an ocean.

flowchart TD
    A["Traveler Developing Acute Symptoms on Flight or Mountain Pass"] --> B{"Did Traveler Scuba Dive or Freedive Within Past 72 Hours?"}
    B -->|"ʻIo"| C{"Symptoms: Joint Pain, Numbness, Vertigo, Rash, or Shortness of Breath?"}
    B -->|"ʻIkai"| D{"Faka'ilonga: Mamahi lahi 'i he Telinga/Sinus, Popping, pe Tuli Fakafokifā?"}
    C -->|"'Io - Mahalo'i 'oku DCS pe AGE"| E["Fakatokanga ki he Kau Ngāue ʻi he Kapiní ʻi he taimi pē ko iá pea Kole ʻa e ʻOkisiseni ʻoku Tafe Maʻolunga ʻi he 100%"]
    E --> F["Tuku 'a e Mahaki 'i he Flat (Supine) + 'Oange 'a e Vai Ngutu kapau 'oku ne 'ilo'i"]
    F --> G["Request Pilot Contact Ground Medical Control + Request Lower Cabin Altitude / Diversion"]
    G --> H["Call DAN Emergency Hotline (+1-919-684-9111) Upon Landing for Hyperbaric Chamber Transfer"]
    D -->|"Ear/Sinus Pain Only"| I["Use Oral Fluids, Swallowing, Toynbee, or Gentle Lowry Maneuver + Oxymetazoline Spray"]
    D -->|"Vertigo Fakafokifā, Nausea, pe Tuli Sensorineural"| J["Mahalo'i 'oku lavea 'a e telinga 'i loto / Perilymph Fistula: Ta'ofi kakato 'a e Valsalva"]
    J --> K["Tauhi e 'Ulu ke Ma'olunga, Faka'ehi'ehi mei he Fakamafasia pe Puhi 'a e Ihu, Kumi ha Sivi Fakavavevave 'o e ENT 'i he Ta'uta mai"]

Ko e hā ʻoku fakatupu ai ʻe he lele pe kolosi ʻi he ngaahi hala moʻunga māʻolungá hili ʻa e luelue ʻa e mahaki decompression .¶

When you breathe compressed air or enriched air nitrox underwater, the increased ambient water pressure forces inert nitrogen gas across your lung alveoli into your bloodstream and body tissues. Every 10 meters (33 feet) of seawater adds 1.0 atmosphere (101.3 kilopascals or 14.7 pounds per square inch) of pressure. As you ascend toward the surface at the end of a dive, the ambient pressure drops, creating a pressure gradient that causes dissolved nitrogen to diffuse out of your tissues and back into your lungs to be exhaled.

Even after you exit the water completely symptom-free, your slow-clearing tissues (such as bone marrow, cartilage, tendons, spinal cord myelin, and adipose fat) remain supersaturated with dissolved nitrogen for 12 to 48 hours. Decompression algorithms calculate safe ascent rates assuming you will remain at sea-level atmospheric pressure (1.0 ATA, or 760 mmHg) while off-gassing.

The physics of commercial aircraft cabin pressurization¶

Many travelers mistakenly believe that commercial airline cabins are pressurized to sea-level pressure. Pressurizing an aircraft fuselage to full sea-level pressure while cruising at 10,600 to 12,500 meters (35,000 to 41,000 feet) would place excessive fatigue on the airframe. Under United States Federal Aviation Administration (FAA) regulations (14 CFR § 25.841) and European Union Aviation Safety Agency (EASA) standards, commercial aircraft are designed to maintain a maximum cabin pressure altitude of 2,438 meters (8,000 feet) during normal cruise:

• Standard narrow-body and wide-body aircraft (such as Boeing 737, 767, 777, and Airbus A320/A330): Maintain a cabin altitude between 1,830 and 2,438 meters (6,000 to 8,000 feet), which corresponds to an ambient barometric pressure of 0.75 to 0.80 atmospheres (565 to 609 mmHg).
• Composite-fuselage aircraft (such as Boeing 787 and Airbus A350): Maintain a lower cabin altitude of 1,524 to 1,830 meters (5,000 to 6,000 feet), or roughly 0.80 to 0.83 atmospheres.
• Unpressurized island-hopper aircraft and helicopters: Small turboprop or piston commuter planes used between dive islands are frequently unpressurized and expose passengers directly to the ambient pressure of their actual flight altitude.

Going from sea level (1.0 ATA) into an airliner cabin at 2,438 meters (8,000 feet, or 0.75 ATA) is physiologically identical to ascending from 3.3 meters (11 feet) of seawater to the surface. That 25 percent drop in ambient pressure causes residual nitrogen microbubbles in your tissues to expand into symptomatic gas bubbles that block capillaries, stretch nerve sheaths, and trigger Decompression Sickness (DCS).

The hidden mountain pass trap on dive islands¶

You do not have to board an airplane to suffer altitude-provoked decompression sickness. On many volcanic dive destinations, coastal dive shops sit at sea level while the highway back to your resort or airport climbs over a high ridge:

• Hauai'i (Motu Lahi mo Maui): Ko e faka'uli 'i he Hala Saddle 'i he vaha'a 'o Kona mo Hilo 'oku kaka hake ia ki he mita 'e 2,021 (fute 'e 6,632), pea ko e faka'uli hake 'i Haleakala 'oku a'u ia ki he mita 'e 3,055 (fute 'e 10,023).
• Motu Kanali, Motu Reunion, Bali, Taiwan, mo Kosita Lika: Ko e ngaahi hala lalahi mei he matātahi ki he ʻuta ʻoku nau kolosi maʻu pē ʻi he ngaahi hala moʻunga ʻi he vahaʻa ʻo e mita ʻe 1,000 mo e 2,500 (fute ʻe 3,300 ki he 8,200) ʻi loto ʻi ha miniti ʻe 45 mei he matātahí.

Ko ha fakaʻuli pe ʻalu hake ʻi ha kā keipolo ʻi ʻolunga ʻi he mita ʻe 300 ki he 610 (fute ʻe 1,000 ki he 2,000) hili pē ʻa e luelue ʻi he vaí ʻokú ne ʻave ʻa e fakatuʻutāmaki tatau pē ʻo e fakalahi ʻo e pupulá ʻo hangē ko e lele ʻi ha vakapuna ʻoku ʻi ai hono mīsini.

Ngaahi fakahinohino faka'ofisiale 'o e vaha'a taimi 'o e funga 'o e funga 'o e puna (DAN mo e UHMS)¶

To prevent altitude-induced decompression sickness, the Divers Alert Network (DAN) and the Undersea and Hyperbaric Medical Society (UHMS) established consensus guidelines specifying the minimum time you must wait at sea level after exiting your final dive before ascending to altitude or flying in a commercial airliner.

Pre-flight surface interval decision table¶

Recognizing and managing in-flight decompression sickness (DCS)¶

Symptoms of altitude-provoked decompression sickness typically begin during the aircraft's initial climb to cruising altitude (within 20 to 60 minutes of takeoff) or within the first two to four hours of flight. Clinicians classify decompression sickness into Type I (Musculoskeletal, Cutaneous, and Lymphatic) and Type II (Neurological, Inner Ear, and Cardiopulmonary), though both require urgent 100 percent oxygen and hyperbaric medical evaluation because Type I frequently progresses to Type II while the aircraft remains at altitude.

Signs and symptoms of post-dive decompression sickness¶

• Type I DCS (Pain-Only and Skin):
  • Deep periarticular joint pain ("The Bends"): A dull, deep ache inside a large joint, most commonly the shoulder, elbow, knee, or hip. Unlike a sprain, DCS joint pain usually does not worsen with gentle movement, and inflating a blood pressure cuff around the joint may temporarily lessen the ache.
  • Cutaneous DCS (Cutis Marmorata / Skin Bends): Intense itching followed by a patchy, marbled, reddish-purple or bluish-white rash across the torso, shoulders, chest, or abdomen. Medical studies show that cutis marmorata is strongly associated with a right-to-left cardiac shunt (Patent Foramen Ovale, or PFO) and often precedes neurological spinal or cerebral DCS.
  • Lymphatic swelling: Localized pitting edema or tender lymph nodes in the chest wall, armpit, or groin.
• Type II DCS (Life-Threatening Neurological and Cardiopulmonary):
  • Spinal cord DCS: Numbness or pins-and-needles tingling (paresthesia) in the feet, legs, or hands; progressive leg weakness; difficulty walking down the aircraft aisle; a band-like constriction around the abdomen or pelvis; or sudden inability to urinate (neurogenic bladder retention) or loss of bowel control.
  • Cerebral DCS: Severe headache, visual disturbances (blind spots, tunnel vision, double vision), slurred speech, confusion, extreme fatigue, or one-sided weakness mimicking a stroke.
  • Inner ear DCS (Vestibular Bends / "The Staggers"): Sudden rotational vertigo, nausea and vomiting, involuntary eye jerking (nystagmus), and loss of balance.
  • Cardiopulmonary DCS ("The Chokes"): Substernal burning chest pain, a dry cough triggered by deep breaths, rapid shallow breathing, and cyanosis caused by venous gas emboli flooding the pulmonary filter. This can progress to circulatory collapse within minutes.

Step-by-step emergency protocol inside an aircraft cabin¶

If you or a dive buddy develop any of these symptoms while airborne:

1. Notify the Lead Flight Attendant (Purser) immediately and do not hide your symptoms. Divers sometimes stay silent on airplanes because they fear being blamed for violating fly-after-diving rules or causing a flight diversion. Delaying oxygen while nitrogen bubbles compress your spinal cord across an ocean can cause permanent paralysis.
2. State the exact medical phrase to trigger airline ground medical control: > "Ko au ko ha scuba diver 'oku ou a'usia 'a e acute Decompression Sickness 'oku fakatupu 'e he ma'olunga 'o e fale. Kataki 'o fetu'utaki ki he Kapiteni mo ho'o toketā fakafaito'o 'o e vakapuna kelekele (MedAire pe Stat-MD) 'i he taimi pe ko ia. 'Oku ou fie ma'u hokohoko 'a e 100 peseti 'o e 'osikena fakafaito'o 'i he tafe ma'olunga taha 'oku ma'u."
3. Optimize 'a e sisitemi 'o e tu'uaki 'o e 'osikena 'o e vakapuna:
   • 'Oku fa'a configured 'a e ngaahi hina 'osikena pasese to'oto'o angamaheni 'i he ngaahi vakapuna fakakomesiale 'aki ha regulator tafe ma'u pe 'oku fokotu'u 'i he 2 lita 'i he miniti (LPM) pe 4 LPM 'o fakafou 'i ha cannula ihu faingofua pe ko ha me'a fakapulipuli tefito.
   • Fakamatala'i faka'apa'apa ki he kau ngaue 'o e fale 'oku 'oatu 'a e 'osikena 'i he mahaki decompression ke fa'u ha zero-naitoloseni washout gradient ko ia 'oku vave 'a e naitoloseni diffuses mei he ngaahi pupula. Kole ki he kau ngaue ke nau vakai'i 'a e vakapuna Fakalahi 'a e Kit Fakafaito'o Fakavavevave (EEMK) ki ha Mask 'ikai-Rebreather mo e kato 'o e tanaki'anga pea fokotu'u 'a e regulator 'o e 'osikena 'o e silini ki hono tu'unga tafe ma'olunga taha (10 ki he 15 LPM), siofi 'a e silini remain taimi 'o e ma'u'anga tokoni a.
4. Ask the Captain to lower the cabin pressure altitude if operationally feasible:
   • Depending on the aircraft type, airspace traffic, and fuel reserves, the flight crew can manually set the cabin pressurization controller to maintain maximum differential pressure at a lower flight level, reducing the cabin altitude toward sea level (or 600 to 1,200 meters / 2,000 to 4,000 feet). Every fraction of an atmosphere of increased cabin pressure physically compresses nitrogen bubbles according to Boyle's Law (\(P_1 V_1 = P_2 V_2\)).
   • Kapau 'oku ma'u 'e he tokotaha luelue 'a e Fa'ahinga II 'o e ngaahi faka'ilonga 'o e neurological pe cardiopulmonary (vaivai 'a e va'e, palalisia, pukepuke 'o e bladder, puputu'u, pe "'a e chokes") 'i ha puna loloa, 'e fale'i angamaheni 'e he pule fakafaito'o 'o e kelekele 'a e Kapiteni ke fakahoko ha fakafetongi fakafaito'o vave ki he mala'e vakapuna hyperbilric medicpaine ofi taha mo e ofi taha.
5. Maintain horizontal positioning and oral hydration:
   • Fakatokoto kakato ʻa e seá pe fakatoka ʻa e tokotaha luelue ʻi he ngaahi sea laine ʻataʻatā ʻaki ha fakalahi ʻo e fusi nofoʻangá ʻoku fakamaʻu lolotonga ʻa e moveuveú.
   • ‘Ai ke inu ‘e he tokotaha luelue ‘a e mililita ‘e 500 ki he 1,000 (‘aunise vai ‘e 17 ki he 34) ‘o e vai pe ko e huhu‘a fakafoki ‘o e vai ‘i he ngutú ‘i he ‘uluaki houá kapau ‘okú ne tokanga kakato pea ‘ikai ke ne lua. Ko e 'ikai ha vai mei he 'ea 'o e fale 'oku momoko mo e diuresis 'i he fakauku 'oku ne fakatupu 'a e hemoconcentration, 'a ia 'oku ne fakakovi'i 'a e ischemia 'o e tisiuu 'o takatakai 'i he ngaahi pupula naitoloseni.
   • 'Oua 'e 'oange 'a e 'asipilini pe ibuprofen tukukehe kapau 'oku fakahinohino'i 'e ha toketā luelue, pea 'oua na'a teitei 'oange 'a e nitrous oxide anesthesia kapau 'e faito'o 'amui ange 'i ha falemahaki, he 'oku mafola 'a e nitrous oxide ki he ngaahi pupula naitoloseni pea fakalahi vave kinautolu.
6. Tauhi 'a e komipiuta luelue 'o ha'i ki he mahaki pe 'i he'enau kato 'ave:
   • 'E sivi'i 'e he toketā hyperbaric 'i he falemahaki talitali 'a e loloto-taimi 'o e komipiuta luelue ke fili 'i he vaha'a 'o ha Tepile Faito'o 'a e Tautahi 'a 'Amelika 6 (ko e tu'unga 4-houa 'e 45-miniti 'o e hyperbaric 'osikena recompression polokalama 'i he 2.8 ATA / 18 mita loloto tatau) pe ko ha tepile fakalahi.

Severe ear and sinus barotrauma during flights and mountain ascents¶

Even travelers who have never scuba dived regularly experience aerotitis media (otic barotrauma) and aerosinusitis (sinus barotrauma) during commercial flights, gondola rides, or steep mountain pass drives. Understanding Boyle's Law and the anatomy of the Eustachian tube allows you to distinguish between painful middle-ear squeeze and a surgical inner-ear emergency.

Why descent is far more dangerous to your ears than takeoff¶

According to Boyle's Law, the volume of a fixed mass of gas is inversely proportional to its absolute pressure at constant temperature. The greatest proportional change in gas volume occurs near sea level (between 0 and 2,440 meters / 8,000 feet):

• Lolotonga 'a e mavahe mo e kaka (Ascent): 'I he holo hifo 'a e 'ea 'i he loto fale mei he 1.0 ATA ki he 0.75 ATA, 'oku fakalahi 'a e 'ea 'oku ma'u 'i loto 'i ho'o telinga lotoloto 'aki 'a e peseti 'e 33 nai**. Ko e taimi pe 'oku mahulu hake ai 'a e 'omi 'i loto 'i ho telinga lotoloto 'i he 'omi 'o e fale 'aki 'a e 15 ki he 20 mmHg nai, 'oku teke 'e he 'ea fakalahi 'a e Eustachian tube 'oku fakaava passively hange ha valve flapper 'o e founga 'e taha, venting bubbles ki he tu'a 'o ho ihu. Ko e mamahi 'o e 'alu hake 'oku fa'a hoko pe ia 'i ha ava 'o e sinus 'oku poloka pe lolotonga 'a e alternobaric vertigo, 'a ia 'oku fakafokifā 'a e 'ea 'a e telinga 'e taha lolotonga ia 'oku nofo 'a e telinga 'e taha 'i he 'ea.
• During landing approach (Descent): As the aircraft descends back to sea level over 20 to 30 minutes, cabin pressure rises from 0.75 ATA back to 1.0 ATA. The air pocket inside your middle ear shrinks in volume by 25 percent, creating a relative vacuum inside the middle ear space. Because the lower two-thirds of the Eustachian tube is a soft collapsible tube, you must actively contract the muscles of your soft palate and pharynx (by swallowing, yawning, or equalizing) to pull the tube open and let air flow into the middle ear.
• The Locking Phenomenon (At roughly 90 to 120 mmHg differential): If you sleep through the beginning of the aircraft's descent or have mucosal swelling from a cold or allergies, the rising cabin pressure outside your eardrum squeezes the soft walls of your Eustachian tube flat shut. Once the pressure differential across the tube exceeds 90 to 120 mmHg (roughly equivalent to a descent of 900 to 1,200 meters / 3,000 to 4,000 feet without equalizing), the negative vacuum locks the Eustachian tube with a force that exceeds the muscular strength of your soft palate. Swallowing and yawning can no longer open the tube, the eardrum stretches inward, blood vessels in the middle ear lining rupture (hemotympanum), and the eardrum can perforate.

Safe vs. dangerous ear equalization techniques¶

Distinguishing Middle Ear Barotrauma from Inner Ear Barotrauma (Perilymph Fistula)¶

If you feel a sudden sharp pain or pop in your ear during a flight or after a dive, distinguish between two different injuries:

• Middle Ear Barotrauma (Tympanic Membrane Rupture / Hemotympanum):
  • Symptoms: Increasing sharp pressure pain during descent that may lessen after a sharp pop, followed by muffled conductive hearing loss, a feeling of fullness or fluid behind the eardrum, and sometimes a small trickle of blood or clear fluid in the ear canal.
  • First aid: Keep the ear completely dry. Never put ear drops, water, oil, hydrogen peroxide, or cotton swabs into an ear with a suspected perforated eardrum. Most traumatic eardrum perforations heal spontaneously within 2 to 6 weeks, though a physician should inspect the ear.
• Inner Ear Barotrauma (Round or Oval Window Rupture / Perilymph Fistula):
  • Symptoms: Happens immediately after a forceful Valsalva maneuver when trying to force a blocked ear to pop. You experience instantaneous rotational vertigo (the cabin spins), nausea and vomiting, loud roaring or ringing tinnitus, and profound sensorineural hearing loss (nerve deafness in that ear).
  • Emergency action: This means the delicate membrane separating your middle ear from your fluid-filled inner ear cochlea has torn, leaking inner-ear perilymph fluid. Stop all nose-blowing and equalization immediately. Sit with your head elevated at 30 to 45 degrees, avoid straining or lifting heavy bags, and go straight from the airport to an emergency department with an Otolaryngologist (ENT surgeon) on call. Prompt corticosteroids, bed rest, or surgical patching of the fistula is required to salvage permanent hearing.

Flying with other medical conditions: Aerospace Medical Association (AsMA) fitness rules¶

Scuba diving is not the only condition where cabin depressurization creates a medical emergency. Under Boyle's Law, any trapped pocket of air inside the human body expands by 30 to 35 percent at a cabin altitude of 2,438 meters (8,000 feet). Even in healthy travelers, arterial blood oxygen partial pressure (\(PaO_2\)) drops from roughly 95 to 100 mmHg at sea level down to 55 to 60 mmHg at an 8,000-foot cabin altitude (a pulse oximeter \(SpO_2\) around 88 to 91 percent).

If you suffer an injury, surgery, or illness abroad, airlines enforce the Aerospace Medical Association (AsMA) and International Air Transport Association (IATA) Medical Manual clearance intervals before allowing you to board a commercial flight home.

Mandatory medical wait times before commercial air travel (IATA / AsMA guidelines)¶

Founga ke ma'u ai 'a e Fakangofua Fakafaito'o 'a e Kautaha Vakapuna (IATA MEDIF Form) mo e intervention malu'i fefononga'aki¶

If you are recovering from dive decompression therapy, a broken bone, pneumonia, or surgery abroad and need to fly home on a commercial airline:

1. Kole 'a e foomu Tokoni Makehe / Tesi Fakafaito'o (MEDIF) 'a e kautaha vakapuna 'o 'ikai toe si'i hifo he houa 'e 48 ki he 72 kimu'a pea ke mavahe:
   • Ko e meimei ngaahi kautaha vakapuna fakavaha'apule'anga kotoa pe 'oku nau ngaue'aki 'a e standardized konga ua Foomu Fakamatala Fakafaito'o 'a e IATA (MEDIF).
   • Part 1 is completed by the passenger or travel agent (listing flight numbers, wheelchair needs, stretcher requests, or in-flight oxygen flow rate).
   • Part 2 is completed and signed by your attending physician at the local hospital (listing exact diagnosis, hemoglobin level, room-air oxygen saturation \(SpO_2\), date of last dive or surgery, whether any surgical chest tubes or casts are split, and whether a medical escort is needed).
2. Coordinate with your Travel Insurance / Assistance Medical Director before booking your ticket home:
   • If you suffered decompression sickness or another acute medical emergency overseas, read our guide on medical emergencies and evacuation abroad and call your travel insurance 24-hour emergency assistance center immediately.
   • Following serious Type II decompression sickness, a commercial flight at an 8,000-foot cabin altitude, even 72 hours after hyperbaric treatment, can sometimes cause a relapse of neurological symptoms. In severe cases, your dive insurance or travel medical policy will arrange a sea-level pressurized air ambulance evacuation (where a dedicated medical aircraft flies with its cabin pressurized to 1.0 ATA sea-level pressure) so you experience zero decompression stress on the journey home.

Ngaahi fehu'i 'oku toutou 'eke .¶

Can I fly safely right after snorkelling or swimming at the surface?¶

If you only swam at the surface of the water breathing through a snorkel without diving underwater, you have accumulated zero excess nitrogen and can fly immediately. However, if you performed repetitive deep breath-hold freediving (repeatedly diving down to 10 to 30 meters / 33 to 100 feet for several hours), especially if you also scuba dived earlier in the week, nitrogen can accumulate enough to cause freediving decompression sickness. After intense repetitive deep freediving, wait at least 12 to 24 hours before flying.

What happens if I develop mild joint pain or skin mottling after I have already landed from my flight home?¶

ʻOua naʻá ke teitei fakakaukau ʻe mole atu pē ʻa e ngaahi fakaʻilonga hili ʻa e puná ʻiate kinautolu pē he taimí ni ʻi hoʻo toe ʻi he kelekelé. Ko e ngaahi pupula naitoloseni ‘oku fakatupunga lolotonga ha lele ‘oku nau fakatupu ‘a e maumau ‘o e endothelial, fakatahataha‘i ‘o e ngaahi peletilet, mo e fula ‘i loto ‘i ho ngaahi tisiú ‘a ia ‘oku hokohoko atu na‘a mo e hili ‘a e foki ki he mālohi ‘o e levolo ‘o e tahí. Ta mai ki he Laine Fakavavevave ʻo e Netiueka Fakatokanga ʻa e Kau Luí (+1-919-684-9111) ʻi he taimi pē ko iá pea ʻalu ki ha potungāue fakavavevave ʻoku fehokotaki ki ha senitā faitoʻo ʻo e hyperbaric. ‘Oku kei ola lelei pē ‘a e faito‘o ‘osikena hyperbaric na‘a mo e taimi ‘oku kamata ai ‘i he houa ‘e 24 ki he 72 hili ‘a e kamata ‘a e faka‘ilongá.

‘Oku ta‘ofi mo‘oni ‘e he ngaahi me‘a faka‘ai‘ai telinga ‘oku fakamālohi‘í ‘a e barotrauma ‘o e telingá ‘i he ngaahi vakapuná?¶

'Oku 'i he ngaahi telinga 'oku fakatonutonu 'e he 'ea 'o e ceramic-filtered ha filter porous 'oku ne fakatuai'i 'a e tu'unga 'oku liliu ai 'a e 'ea 'o e fale 'oku ne taa'i ho eardrum lolotonga 'a e kaka mo e hifo. Lolotonga 'oku 'ikai ke nau lava 'o fakaava ha poloka 'o e Eustachian tiupi 'iate kinautolu pe, 'oku 'omi 'e he fakatuai'i 'o e liliu 'o e 'omi ha taimi lahi ange 'o e tiupi sluggish ke fakatatau kimu'a pea toki loka'i 'a e tapuni. Fakahū kinautolu kimuʻa pea mavahé, toʻo kinautolu ʻi he māʻolunga ʻo e folau vakapuná, pea toe fakahū kinautolu ʻi ha miniti ʻe 45 kimuʻa pea nau tūʻuta lolotonga hoʻo folo mo inu ʻa e vaí.

Ko e hā naʻe talamai ai ʻe ha toketā tauhi fakavavevave ko hoku lavea ʻi he telinga ʻi he luelue ko ha mahaki telinga ʻi he taimi naʻe kamata ai lolotonga ha luelue pe lele?¶

Ko e kau toketā ‘oku ‘ikai ke nau taukei ‘i he faito‘o ‘o e luelue pe ‘ea ‘oku nau sio ‘i he taimi ‘e ni‘ihi ki ha fo‘i telinga kulokula, ‘oku tafe toto ‘oku ‘i ai ‘a e vai ‘i hono tu‘á hili ha lele pe luelue pea ‘oku nau faka‘ilonga‘i hala ‘a e barotrauma ‘o e telinga lotoloto ko e acute bacterial otitis media. Tala maʻu pē ki he toketā siví ʻa e hisitōlia pau ʻo e barometric: pe naʻe kamata ʻa e mamahí lolotonga ʻa e hifo, pe naʻá ke fakahoko ha founga fakamālohi ʻo e Valsalva, pea pe ʻoku ʻi ai haʻo vertigo pe tinnitus ʻoku māʻolunga.

Kuo vakaiʻi ʻa e ngaahi maʻuʻanga fakamatalá¶

• Divers Alert Network (DAN) & Sosaieti Fakafaito'o 'i Lalo tahi mo e Hyperbaric (UHMS): Ngaahi Fakahinohino 'o e Fakataha'anga Lue Fakafiefia ki he Lele Hili mo e Ngaahi Fakahinohino Fakatahataha (Fakavaha'apule'anga / 'Iunaiteti Siteiti).
• Tautahi 'a 'Amelika: U.S. Tohi Fakahinohino ki he Lue 'a e Tautahi, Fakatonutonu 7, Voliume 2, Vahe 9 (Ngaahi Founga 'o e 'Alu hake mo e Lele Hili 'a e Lue) & Voliume 5, Vahe 20 (Fakatotolo'i mo e Faito'o 'o e Mahaki Decompression mo e Arterial Gas Embolism) ('Iunaiteti Siteiti).
• Kautaha Fakafaito'o 'o e Vakapuna (AsMA): Ngaahi Fakahinohino Fakafaito'o ki he Folau Vakapuna, Pulusinga hono 2 / Ngaahi Fakahinohino Fakafaito'o 'a e Komiti Fefononga'aki Faka'ea ki he Mo'ui Lelei (Fakavaha'apule'anga).
• Kautaha Fefononga'aki 'Ea Fakavaha'apule'anga (IATA): Tohi Fakahinohino Fakafaito'o 'a e IATA, Pulusinga hono 12: Tokanga'i 'o e Pasese, Ngaahi Taimi 'o e Faka'ata 'o e MEDIF, mo e Fisiolosia 'o e Ma'olunga 'o e Kapini (Fakavaha'apule'anga).
• Sosaieti Fakafaito'o 'o Pilitania (BTS): Malanga Fakafaito'o ki he Ngaahi Fokotu'u ki he Folau 'Ea ki he Kau Pasese 'oku nau ma'u 'a e Mahaki 'o e Manava mo e Taimi Tatali Hili 'a e Pneumothorax (Pule'anga Fakatahataha).

Ngaahi fakahinohino fekau'aki¶

• Ngaahi me'a fakatu'utamaki fakafaito'o mo e fetukutuku ki muli .
• Tokoni 'a e 'Amipasitoa mo e konisula .
• Mo'ua 'i muli pe kaniseli 'a e vakapuna .
• Ngaahi meʻa fakatuʻupakē ʻi he vaka folau ʻeveʻevá, liʻaki ʻa e vaká, mo e tangata ʻi he vaká
• Tohi fakahinohino fika fakavavevave