If you think you may have sustained DCI, get evaluated immediately.+

[scuberd]

they told us that in California hyperbolic treatment was by prescription only. One must go to the ER or someone who is qualified to prescribe it. My instructor, a volunteer at the chamber on Catalina island, said that the chamber staff would turn you away without a prescription.

 

[The Chairman]

That my choice of an ER in this area has a chamber right there. Florida Hospital uses it for more than just diving accidents.

 

[Arnaud]

scuberd once bubbled...
they told us that in California hyperbolic treatment was by prescription only. One must go to the ER or someone who is qualified to prescribe it. My instructor, a volunteer at the chamber on Catalina island, said that the chamber staff would turn you away without a prescription.

That does not make any sense. There was a benefit for the Catalina Chamber this week (that's what KM was referring to) and we were told in details of the whole experience of a diver who got bent. The various participants (from the actual victim to the doc at the chamber) recounted the accident from their point of view. It was really interesting. In this instance, the victim was taken from the boat straight to the chamber (I think she had type II) with the assistance of the Coast Guards and Baywatch.

Meanwhile, from the DAN O2 Provider manual:

Remember to go to the nearest, most appropriate medical facility and not necessarily to the nearest hyperbaric chamber. There are a number of reasons why an injured diver should be transported to the nearest hospital emergency department and not to the nearest recompression chamber...

 

[Arnaud]

Genesis once bubbled...
Perhaps I'll have to call DAN next week and ask them what their recommendation is..... and no, I do not accept that "get to ANY medical care" is always superior, because it is often the case that a physician untrained in the particular malady you're suffering from will do either the wrong thing or nothing useful at all, but in both of those cases he WILL delay your access to effective treatment.

Please let us know if you do. A few months ago, my wife hurt her back on a Saturday and went to the ER at Cedars Sinai, considered one of the best facilities in the area. After waiting 5 hours, she was given a shot of such a high dose of painkiller that she became instantly high, and suffered severe hitching for the next 12 hours. Luckily, she just had twisted some back muscles and a few therapy sessions took care of the problem.

All this to say that I would hate to find myself at the ER with a serious case of DCI and be treated by a training attendant... I have always wondered about the effectiveness of DAN calling the ER facility. If the person at the other end of the receiver has no idea what DCI (or even DAN for that matter) is, how can you be properly diagnosed and receive appropriate treatment in due time?

 

[Genesis]

I've read that in the DAN O2 manual too, but that doesn't mean that they are making any sense.

This is exactly the same issue that I have with DAN in a number of other areas - trying to apply "doc-speak" and "doc-think", where one assumes that every doc is the same as THEIR docs.

This kind of "tunnel vision" is exactly what they garf about with divers and DCI (and they're right), but then they practice it themselves (which is wrong.) I went around with them on this with O2 being available on my boat (as a PRIVATE vessel, not a charter) and talking with them about my "little speech" that first-time divers on my boat get - the O2 is in this cabinet, and I encourage you to use it if you have any reason to think you might want to after a dive, even if you feel fine, if you think you might have screwed up somehow - the bottle is dirt-cheap to refill.

Well that triggered some discussion here a few months back, revolving around the "you're administering something" (no I'm not - the person who grabs the bottle is doing it themselves) culminating in my calling DAN and getting the actual doctor on the phone who wrote their "policy documents." He was at the time clearly thinking in "doc-speak", and while their parrots on the phone did indeed start with that position, when I got done talking with the actual doctor who wrote the material he conceded that (1) it would do no harm for someone to pull the bottle and breathe it, and far more importantly, (2) doing so might prevent a hit that someone would have otherwise taken.

Then you look at the DAN "incident report" with the guy who breathed a cylinder with less than 1% O2 in it. They list as "contributory factors" that the diver was overweight. That is, to steal a GI phrase, farm-animal stupid!

Back to the point at hand.....

What possible reason is there to go to somewhere other than a medical center with a chamber? If you're bent then you are! You can take the O2 with you (and you should); if you have enough to get TO the chamber location, why would you go to a "regular" ER instead? What possible assistance can they provide, other than the same order to get into the chamber that you will get from a doc at the chamber site?

If you're having a suspected coronary event or something similar, then sure, an ER is fine. I understand the concept of stabilizing the life-threatening things first. But DCI-II is not a trivial matter, the damage it does can be permanent, and the longer you wait the more likely it will be. Intentionally imposing a wait by going to the wrong medical facility is just plain silly, especially when the evidence shows that most doctors have absolutely no clue when it comes to DCI and many of them will do things that will actually harm you.

 

[MikeFerrara]

Genesis once bubbled...

What possible reason is there to go to somewhere other than a medical center with a chamber?

Going to the chamber and getting in is another story.

Callind DAN at the same time as activating EMS can help insure accurate diagnosis.

 

[FallenMatt]

The original post was about DAN numbers showing how long people wait before getting help with DCS.

With all that has been said before, i am wondering what the issue of paying for the treatment/visit to ER can play in the time taken waiting (hoping it will "go away" and the expense can be spared)

The only references to costs of recompression in chamber that i've seen were comments like "DAN insurance can save you tens of thousands of dollars of the costs of the DCS treatment".

I dont' have DAN insuarance, although i will probably get one if i continue diving as often as i do (after all it is less than $100 per year). I also don't have regual health insurance right now and the one i am going to get (one offered by my college) I seriously doubt it would cover any signifficant part of the cost.

So what is a cost of a chamber ride ?
Last time i went to ER few stupid stiches cost me about $250 (cut my knee with ... errr.. chainsaw)

 

[Genesis]

Going to the ER (which is where EMS will take you, 99% of the time, DAN or no DAN), if that ER is the wrong one, will only prolong your wait to get into that chamber.

In some cases, it may prolong it outrageously, as has been related by folks who have had it happen.

If you do not have insurance, a chamber ride will be EXPENSIVE (thousands or more.) If you're diving, you need some kind of insurance that will cover it, or a lot of free cash laying around.

"Activating" EMS is only the right choice if the EMS folks do the right thing. If you have assistance available you are OFTEN better off being privately transported than calling EMS and letting them take you in an ambulance. The real exception to this is where you need immediate ALS (e.g. coronary event, severe trauma where bleeding control or IV fluids are immediatley necessary or similar happening.)

This does not in any way describe the typical DCI case. For the typical DCS case the immediate need is to breathe the highest FO2 that I can manage to inspire and find medical assistance that is competent in evaluating a suspected DCI incident.

If I believe I am bent I will use my cell (or ask my buddy to use his cell!) to call DAN and find out where BOTH the nearest chamber AND the nearest medical facility TO THAT CHAMBER is if both are within a reasonable distance. If not, and it appears that I will need an airlift, then obviously we go in a different direction.

What I will not do if I believe I'm bent is walk into the local ER (or call EMS and have them transport me to the nearest ER) and expect them to be reasonably conversant in DCI - the evidence strongly suggests that they are, nearly to a single facility, NOT prepared to properly handle such a case.

 

[FallenMatt]

I agree

But you seem to be talking about an experienced diver who knows what's going on and getting entangled in the procedures of a local ER.

I was thinking about inexperienced/occasional divers who did something stupid/or not, got a hit, have no DAN insurance and just don't know what to do.

The ER trip can explain few hours of delay before getting to the chamber but I don't think it can explain 40+hours (to a month!!) waiting before getting treated.

I don't remember (maybe it was just my instructor) having any serious talk about what to do when you think you have DCS. There was bunch of talk about what to do to avoid it but not much about what to expect/do when you actually get into such situation.

I guess this is to keep the image of a "safe sport" of scuba diving. But that also means that if a fresh c-card holder gets into such situation he/she will be lost. Probably get tylenol, "sleep on it", and only after a longish while seek help.

 

[Genesis]

of course asking the agencies to actually talk about the real risks of the sport, and how this is a sports injury and needs immediate attention is, well..... unrealistic?