Diving Accident or Suspected Decompression Sickness in the Philippines: Stop Diving, Get on Oxygen, Do Not Fly, Reach a Chamber

The first hour after surfacing: stop, lie down, oxygen, no flights

The moment decompression sickness is suspected, your diving day is over, however mild the symptom looks. The condition tends to start small and escalate: a sore shoulder at noon can become unsteady walking by late afternoon. In the first hour, do this in order:

1. Tell the dive guide or boat captain that you feel unwell. Do not hide it to avoid spoiling the trip. A properly run dive boat carries emergency oxygen; ask for it.
2. Lie flat and breathe high-concentration oxygen until you reach a doctor or the supply runs out. If you are alert and not nauseous, sip water.
3. Record your dive data: number of dives, maximum depth, bottom time, whether the ascent was fast and whether a safety stop was missed. Keep your dive computer with you and do not clear it; the physician will want to read it.
4. Do not go back into the water to “recompress”. Avoid hot showers, alcohol and exertion; each can make things worse.
5. Do not board an aircraft, and do not drive over high mountain roads. Lower ambient pressure aggravates symptoms.

If anyone on the boat is confused, struggling to breathe or losing strength in a limb, this is a full emergency. The boat should return immediately while the captain radios the coast guard or the nearest pier to arrange a pickup. Do not let the group vote on finishing the remaining dives first, and do not let anyone talk the affected diver into resting quietly in a cabin without oxygen. What happens once you reach shore is described in how emergency rooms work in the Philippines.

Recognising it: which symptoms cannot wait

There is no single signature symptom. The working rule is simple: any new symptom appearing within hours to a day after diving is blamed on the dive first. Presentations fall roughly into two groups.

Milder: a deep, dull ache in a joint or muscle (shoulder, elbow and knee are typical), itchy skin or a marbled rash, and a heavy fatigue you cannot explain. These are routinely mistaken for sore muscles from carrying tanks, or for sunburn.

More serious: tingling, numbness or weakness in hands or feet, unsteady walking, vertigo, blurred vision, ringing ears or hearing loss, chest pain, shortness of breath, coughing, confusion, or difficulty controlling bladder or bowel. Any one of these means you go now, not later.

A separate and faster emergency is lung over-expansion injury and gas embolism, caused by a rapid ascent or holding your breath while ascending. Signs appear within minutes of surfacing: chest pain, frothy or bloody sputum, loss of consciousness, or stroke-like weakness on one side. This needs oxygen and transport immediately.

Common misjudgements: symptoms come and go, and feeling better on oxygen does not mean it is over; having signed a waiver says nothing about your body; snorkelling does not normally cause decompression sickness, but scuba, freediving and introductory dives all can. Beginners most often overlook the follow-on activity: a sunrise hike up a mountain straight after an introductory dive, or an early flight the next morning. Tell the doctor about every such detail, including alcohol the night before and how much water you drank during the day.

Where treatment happens: chambers exist in only a few cities

Definitive treatment is recompression in a hyperbaric chamber, and in the Philippines these are found only in a handful of major cities and a few specialist or military medical facilities, not at every dive destination. On most islands, an accident therefore means a transfer rather than a visit to the local clinic.

The realistic route usually has three stages:

1. Stabilise on the island. A nearby clinic or provincial hospital can keep you on oxygen, give fluids, rule out other emergencies and help contact a higher-level hospital.
2. Call a dive emergency line. International dive-insurance organisations such as DAN run round-the-clock medical lines and can tell you which chamber is currently operating, whether it will accept you and how to get there. Chambers go down for maintenance and run on schedules, so confirm acceptance before you set off.
3. Arrange transport. Sea and road are preferred over air. Where air transport is unavoidable it needs a low-altitude or pressurised arrangement organised by the insurer’s assistance company; booking yourself on a regular commercial flight is the wrong move. The broader logic of inter-island and international transfers is in medical evacuation in the Philippines.

If the accident happens around Cebu or Bohol, our Cebu medical care guide explains how hospitals in the metro area are tiered. Wherever you are, chamber treatment often takes more than one session. Plan to stay in that city for several days and rebook the flight home only on the treating doctor’s written advice. While you wait for transport, stay on oxygen, stay lying down, keep warm but not hot, and have one companion write down the time each symptom started or changed, because that timeline is the first thing the chamber physician will ask for.

The dive shop’s responsibility and how insurance fits in

In the moment, the priority is the patient. On liability, do one thing only: preserve the evidence. Later the shop’s logbook may have been tidied up and the crew may have changed.

Keep the following on the day:

• raw data from your dive computer, photographed or exported, plus your buddy’s;
• the shop’s name, the guide’s name and certification number, the boat’s name, your booking messages and receipt;
• photos of the liability waiver and medical questionnaire you signed;
• short written notes from others on the boat about whether oxygen was available, how quickly it was given and who decided to continue with the next dive, with their contact details;
• every medical record, diagnosis, transfer document and hospital bill.

Typical points of operator responsibility include taking you beyond the limits of your certification, an unmanageable guide-to-diver ratio, ignoring discomfort you reported, and running a boat with no emergency oxygen. A waiver does not excuse gross negligence, but whether a claim succeeds, and how far, depends on the evidence and the specific case.

On insurance, separate three policies. Dedicated dive insurance normally covers chamber treatment and emergency transport. General travel insurance often excludes scuba or caps the depth, so read the wording. Credit-card cover rarely helps. Notify quickly and let the insurer’s assistance company arrange the transfer; paying yourself and claiming later is noticeably harder. How to read these clauses is covered in whether to buy domestic travel insurance in the Philippines. If you have no cover at all, tell the hospital so at the start and ask for a written estimate before each stage of treatment, so that family at home can arrange funds in time rather than being surprised at discharge.

The following days: flying, diving again and an expiring visa

After decompression sickness, the date you may fly is set by the treating physician, not by your return ticket. Even after uneventful diving a substantial surface interval before flying is standard; after symptoms it is longer, and airlines and insurers may both ask for written fitness-to-fly advice.

Practical issues that come up in those days:

• Interrupted itinerary. Obtain the diagnosis and a written statement that you should not fly, then use it to rebook flights and to claim trip interruption under your policy.
• Visa or visa-free stay about to expire. A medical delay must be handled by extending at the Bureau of Immigration before the stay expires, with the medical certificate in hand; explaining after the fact is far weaker. If you are stuck on an outlying island with the same problem, see what to do when your visa is expiring on a remote island.
• Diving again. Not on this trip. Whether you return to diving afterwards should be assessed by a doctor familiar with dive medicine, and some cases need further tests.
• Your companions. One person staying with you is enough. The others can continue, leaving reliable contact details and a copy of your passport page.

Where the outcome was serious or the operator clearly broke basic rules, you can record the incident with the local tourism office and the police. Whether to pursue compensation is a legal question; for an individual case consult a licensed attorney. This article is not legal advice and does not replace a physician’s diagnosis. Keep your own written timeline of the day while memories are fresh, because every later conversation with a doctor, an insurer or an operator will start from it.

What Yixing can and cannot do here

Yixing is not a medical provider. We do not diagnose and we do not decide whether you are fit to fly. What we can take over is the part where you are far from home, the language is a barrier and the itinerary has fallen apart.

That includes arranging a Chinese-speaking escort and medical interpretation so your symptoms and dive profile are explained accurately to the doctor; helping to line up vehicles and boats for the stretch between an island clinic and a city hospital; putting together the list of documents an insurer will ask for; and, when treatment keeps you in the country longer than planned, assisting with a stay extension and re-arranging onward travel and accommodation. For this kind of on-the-ground help, contact us through Yixing settling-in and emergency assistance.

What we cannot do and will not promise: we cannot choose your treatment, cannot guarantee that an insurer will pay, cannot pursue a dive shop on your behalf, and will never suggest boarding early to save an itinerary.

Yixing International Travel is a privately owned consultancy and travel-services company registered in the Philippines (SEC Registration No. CS202009551). It holds Bureau of Immigration accreditation (BI Accreditation No. CA-202624381-1, valid to 2027-06-30), DOLE accreditation and PRA accreditation, and has no affiliation with any government office, hospital or insurer.

The order once more: stop diving, oxygen, no flights, dive emergency line, a hospital with a chamber. If you are taking children out on the water, read our outdoor safety checklist for children beforehand. For other illness or injury on an island far from a hospital, the sequence is in sick or injured on an island with no hospital nearby. Save this page offline before a dive trip; boats and remote beaches are exactly where a signal is least reliable, and the person reading it may be your buddy rather than you.