Technical diving expeditions are taking participants into increasingly remote locations. Formulating a plan for management of decompression sickness (DCS) in such locations can be very challenging. In particular, evacuating a diver for recompression therapy can be a costly, difficult, and potentially hazardous undertaking. Almost paradoxically, the least serious DCS cases are often the most troublesome in respect of management decisions. For example, does a diver with pain in the elbow and patchy tingling in the forearm require evacuation from a remote site for recompression treatment? There has certainly been a long standing view that recompression is a standard of care for all divers diagnosed with DCS, but is this really necessary for minor symptoms? Ten years ago the Undersea and Hyperbaric Medical Society hosted a workshop at their Annual Scientific Meeting in Sydney to address this difficult issue. This two day event assembled a panel of the world’s most experienced diving physicians who generated a consensus on a definition of “mild DCS”. It was agreed that if a diver’s presentation met that definition, and if proper first aid treatment was instituted, then the diver would be unlikely to be disadvantaged if recompression therapy was subsequently omitted. For the first time, this consensus legitimised a decision not to evacuate a DCS case that met the definition of mild from a remote environment. The definition of mild DCS, how it is applied, and what constitutes “proper first aid treatment” will be described in this presentation. In contrast, there is never any debate over whether a diver with obvious spinal DCS needs recompression and in many respects this makes decision making easier for such cases. However, in remote locations the question then arises whether recompression should (initially at least) be provided in the water. This presentation will also briefly consider decision making around in water recompression, and discuss a protocol for its application.