[A critical assessment of Trendelenburg's position in the acute phase after a diving accident]

For several years now, a controversy has developed on how to position a patient after a decompression accident with acute gas embolism. The usefulness of the so-called Trendelenburg position, based on experimental evidence gathered on dogs, has recently been challenged. The basis assumption was that cerebral embolism may be reduced by the hydrostatic effect of putting the head below the body's center of gravity. This position however required much technical resourcefulness and often delayed the first therapeutic intervention. Newer experimental research shows that, contrary to the old theory, positioning the head below feet level increases the intra-cranial pressure, injuring the blood-brain barrier, even when done under hyperbaric oxygen therapy. A wide consensus has now emerged, which should be communicated to first-aid personnel, so that no more time is being lost in trying to position the accidented diver by unduly complicated means. The current recommendations asks for laying the injured diver horizontally on its back, or sideways, if he is unconscious. It is by far more important to control its vital functions, give first-aid, administer oxygen in closed circuit, and shorten as much as possible transport time to the next center for hyperbaric therapy.