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

[DocVikingo]

Let me get my doctorly harangue out the way--it'll make me feel better:

I can't think of many things more foolhardy than being without health coverage. It can result in your being denied all but the most essential medical services, put you in debt for many years to come & lead to your getting jerked around by the system even more than is usual. Get on that college policy now. As for dive accident insurance, DAN's basic policy starts at just $54/yr.

Now, you asked about chamber fees--anywhere from $400 to over a $1,000 an hour depending on location & the services your DCI requires.

To give you a brief idea of the potential costs, here's a couple of paragraphs from my Sep '01 Undercurrent http://www.undercurrent.org/ article on dive insurance:

" ... recently saw a bill from a hyperbaric facility on Cozumel for the treatment of unexpected, uncomplicated DCS sustained in Oct 2000. La cuenta? Two Table 6, two Table 5 treatments plus related expenses=US$14,050.10. Had this hapless diver sustained injuries so severe that they couldn't be addressed on island and required air evacuation to Mercy Hospital in Miami, transportation alone would have cost from $10,000 to $20,000 depending on logistics.

Also in Oct 2000, after a week of diving on Provo a physician with over 200 dives suffered an unexpected case of the bends on her last day. She quickly underwent a Table 6 treatment, followed by 3 more over the next 3 days. Her return trip was on a private charter, pressurized Lear Jet to Ft. Lauderdale, a flight of about 600 miles. The damage? $7,200 for hyperbaric services & $4,600 for the ride.

An acquaintance of mine needed evacuation from a live-aboard off Panama to Miami following unexpected DCI sustained in August 2000. The air service secured a charge of $20,000 against his credit card before rolling the craft onto the tarmac.

Had any of these divers been stricken in remote Indonesia, the cost of air evacuation could easily have hit $35,000. Dan Nord, Director of DAN Medical Services, told “Undercurrent” of an $80,000 tab for an emergency evacuation from Southern Africa."

These numbers haven't gotten any smaller in the past couple of years.

Do the wise thing.

DocVikingo

 

[Genesis]

"Major medical", aka "catastrophe" insurance, is very wise to have.

However, for most people, the usual "HMO/PPO/etc" thing is another matter.

The US medical system has driven up pricing in this area, and wealth for doctors (and those who sue them) to the point of insanity.

Such "insurance" is not really insurance. You buy insurance against a catastrophe that you (1) cannot pay for yourself, but can justify the premium via pooling of risks, and (2) you do not expect to have to use.

Current "medical insurance" in the form of HMOs and PPOs, along with tradtional "indeminty" plans, are not insurance.

EVERYONE needs some amount of medical care, and as we age, the amount of care we will typically require dramatically increases. The most extreme part of the hyperbolic curve happens in the last year of your life - statistics are that 90% of all the health-care dollars you consume are burned during that last year. You and I are paying for that "last year" - that extra year of life expectancy - through the medical system one way or another. (You want to know how to fix the medical-cost problem? I just 'splained it - but its not politically correct!)

What you're buying is prepaid medical care, based on the statistical average of everyone, with a profit added, and with additional money added in for all those who profit from the "sidelines" (e.g. lawyers, lawsuits, $20 aspirins in hospitals, etc) Further, your ACTUAL risk is assessed regularly, and your premiums can and DO change (always upward, by the way) over time. That you're hidden from this by your employer, if you have one, doesn't change the facts. The amount kept from workers (and taken directly from those not employed) by this system is simply astonishing.

If you are "above the median" in your health you are far better off to buy only major medical coverage and pay out of pocket for everything else. Not only that, but you'd be surprised at how often providers will give you a better price for cash than they'd bill back to an insurance company!

I have it happen all the time!

As someone who KNOWS what it costs (most employed folks do not, as their company "hides" the true cost of this insurance from them - all they see is the payroll deduction) I can tell you with certainty that for most people this is a pure lose-lose proposition, and further, it makes the problem get worse as feeding an inefficiency only promotes more inefficiency.

Absent MAJOR changes, the system in this country WILL eventually collapse under its own weight, and when it does, it will be our (collective) fault.

Dive insurance is a different matter. There the cost/benefit analysis is an entirely different issue, and relatively easy to figure out. It also works to your advantage in essentially all cases.

Even so, to cite medevac costs from remote locations of the world is not relavent to a diver persuing this sport close to home, and makes for a highly misleading attempt at salesmanship.

If you get hit, it is resaonable to assume that the chamber ride(s) alone will run you in the thousands. Of course that's not all there is, as you have doctors and other services and such involved.

Given that you can buy very good insurance for under $100/year against these costs, its a good buy IF you dive frequently. While there are many who argue that its even more important if you don't (e.g. you do only five or 10 dives a year), since its statistically more likely for you to have a problem, the fact of the matter is that in that case the PER-DIVE cost starts to add up... which is probably why more people don't buy it.

 

[Arnaud]

Genesis, I was not aware of the O2 debate with DAN. Their initial position is surprising, but I'll leave that for another thread.

I have no medical background and well aware that, sometimes, common sense (which is what I'm left with) is not necessary the answer.

It seems to me that DAN is a respected organization. I have read a lot of their studies on their website and appreciate the services they provide to the diving community.

I took the DAN O2 course, not to get another card, but because everyone agrees that providing O2 is the most important thing to do in a diving accident. I enjoyed the reading material as much as practicing the drills.

I find it odd that the one advice they give that did not seem to make sense came up on page 77 (out of the 78 pages of the manual). All the good reasons listed in favor of going first to the ER do not seem IMHO to outweight the position you and DocVinkingo are advocating. Why would such a respected organization give such an advice???

What I would like to find out is if someone was ever sent by DAN to a general ER to be diagnosed by a physician with no diving medicine knowledge and had an hyperbaric treatment delayed as a result of it. In short, does DAN actually enforce the principle they're advocating?

DocVikingo, I hope we're not hijacking your thread. This seems an important issue in light of the importance of getting treatment quickly.

 

[Arnaud]

FallenMatt once bubbled...
I agree

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.

Actually, all the basics are in the OW manual (PADI, at least), but are usually not seriously taught until the Rescue program which is optional...

 

[DocVikingo]

LOL--not hijacking my post at all. I find this a very interesting digression.

BTW, DAN does not "enforce" an "ER first" position. As long as you act responsibly & participate in good faith in your care, you're covered. DAN will pay for necessary covered dive accident-related medical services once your primary health carrier has fulfilled its obligations, if any, and DAN receives an Explanation of Benefits (EOB).

Best regards.

DocVikingo

 

[scubasean]

DCI results from Nitrogen bubbling out into the tissues and the joints, right?

Is going to O2 because you reduce the amount of nitrogen going into your system through your lungs?

Or is there a bigger reason going to O2 is a good thing?

--Sean

 

[DocVikingo]

100% 02 is a good thing for several reasons:

1. It maximizes inert gas elimination by creating an optimal diffusion gradient & reduces the size of the inert gas bubbles.

2. It assists in oxygenating tissues that are 02 deprived due to obstruction of blood vessels by DCI-related gas bubbles.

Best regards.

DocVikingo

 

[kelpmermaid]

Doc, I , too, may be guilty of hijacking your thread, but I have to comment on what Scuberd said:

"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's not exactly the case. I have been out there at Wrigley when an injured diver was brought in off of a small boat from a nearby dive site. The diver was evaluated, and the doctors at USC determined what treatment (if any) was required.

Check the Chamber website for emergency contact numbers...

http://wrigley.usc.edu/hyperbaric/TOP.HTM

 

[FallenMatt]

Arnaud once bubbled...

Actually, all the basics are in the OW manual (PADI, at least), but are usually not seriously taught until the Rescue program which is optional...

... err... so this is somethign along the lines of :"this stuff may cost you your life or permament injury, pay us some more $$$ and we will tell you what to do in emergency" ?

ok, that's kind of harsh.

I would think something as simple as detailed description of a "typical" (if something like that exists ) DCS hit from water to getting out of hospital would get a long way into enlightening people what to do in such situation. Or at least what to expect. It is one thing to know to "call DAN or go to ER when you see DCS symptoms" and one to see in example that even a uneasiness about some symptoms is not stupid reason to look for help.

I am not sure if i am clear about my point here During a scuba course a new diver gets through all different kinds of drills and situations to make sure he/she knows what to do in various situations, it gets repeated until a diver can get the stuff right (air sharing, emrgency ascent etc)

and yet in a situation like DCS it is just mentioned that he/she should get medical help asap. (i don't have PADI manual lying around so i am not sure how much space is devoted there for "what to do after".

Having a description of a case to go through during training would help put a person's mind at ease about the validity of looking for help (stuff like joint pain or skin rash doesnt' really "feel" as important as.. let's say, cutting one's knee with a chainsow). Also dealing with situation where one doesn't really know what will happen next is very stressfull so i understand why a person would like to avoid it by trying to play down the symptoms (and no, description like "you need to be recompressed in a decompression chamber" is not clear enough what actually is going to happen.

I guess this is all from past personal experience: as a kid i was "Accident prone" (too wild, i guess).. so i know pretty well what to expect/do when i happen to cut my knee with a chainsaw. This is prety much automatic:
cut+bunch of blood = ER

Now DCS symptoms just doesn't seem "important enough" compared to that (even though it may be much more dangerous to one's life), no matter how many times i would hear "if you have those symptoms you need to seek medical help". Now, give me a "nice" description of an actual DCS case with treatment etc. and i assure you i will be much eager to seek help asap. (not a very very bad case because if i am in fetal position screeming in pain .. err.. that screams "er" in itself, no education needed to come to that conclusion)

(that's actually what happened with me, fresh with my c-card vs. few months later after i've read some accident reports... it finally sink in)


now i realize i've made the same point 3 times in the above post rambling all the way though it :/ ... sorry for that. I have my c-card for only 8 months now, with 32 dives loged.. confused new diver.. i guess

ps. the reason why i dont' have health insurance right now is because after moving from NJ i've got shocked realizing that the same minimal coverage as i used to have costs here 7 times as much money, it takes a while after that initial shock to go ahead and pay for it (yes, i am going to get it, there is not much choice)...

 

[Genesis]

you just had the other 6/7ths of it hidden from you where you were.

This is precisely what I was talking about.