In-water recompression (IWR) is a controversial but potentially life-saving procedure used when hyperbaric chamber access is not available within a reasonable timeframe. It should only be considered in specific circumstances and by trained personnel.
Disclaimer
In-water recompression is controversial and hazardous. It is not a substitute for emergency evaluation or hyperbaric physician guidance, and it should only be discussed in the context of remote operations with trained teams and no timely chamber access.
Equipment
Protocols described in the literature require reliable oxygen delivery, thermal protection, full-face mask or otherwise secure breathing interface, redundant gas planning, trained attendants, communications, and a controlled water environment.
Safety
Major risks include drowning, hypothermia, oxygen toxicity, worsening neurological symptoms, panic, separation, and inability to monitor the patient. Severe symptoms, altered mental status, poor conditions, or inadequate staffing should rule it out.
Documentation and Follow-up
Detailed documentation of symptoms, timeline, treatment protocol used, and response to treatment is essential. Even after successful IWR, the diver should be evacuated to a medical facility for evaluation and possible follow-up hyperbaric treatment.