Police and commercial scuba divers are concerned for their safety following Toronto General Hospital's decision to stop treating stretcher patients in the city's only hospital-based hyperbaric chamber.
The life-saving machine is used to treat everything from carbon monoxide poisoning to decompression sickness.
The hospital's decision to stop treating patients who require a stretcher was triggered by concerns about back injury and decompression illness among medical staff working in the cramped machine, says Dr. Wilfred Cassar-DeMajo, who heads the hospital's hyperbaric unit.
"It is not safe for staff to be in the chamber with a stretcher," he says. "According to labour laws, we have no option but to safeguard the health of employees."
Toronto-area patients requiring stretchers, such as divers with the bends or fire victims with smoke inhalation, will now have to be transferred by air or ambulance to chambers in Hamilton, Ottawa or Buffalo.
And that delay could have tragic implications, says Bill Roman, president of the Canadian Council on Hyperbaric Medicine, a group that represents 110 hospital-based hyperbaric medical staff across the country.
"If there's a serious accident today involving a diver, you could either have a death or you could be crippled for the rest of your life," he says. "Ontario is now like a Third World country when it comes to hyperbaric care."
The prospect of sending injured divers to other cities for emergency treatment is a concern, says Sergeant Bill Kemp, head of the Toronto police underwater search and recovery team.
"I'd much rather have the guys go to Toronto than be shipped off, because that's delaying," says Kemp.
"Obviously, the closer the better.... I just want the best medical facilities available for guys in case of an accident."
Kemp's team of 14 divers scours the bottom of Toronto Harbour conducting security checks, and recovering evidence and human bodies.
Two of those officers were treated in Toronto General's hyperbaric chamber in the past two years following diving accidents, he says.
The decision to cut off hyperbaric care to critically sick patients on stretchers came after an occupational health and safety assessment found a potential risk to medical staff, Cassar-DeMajo says. Patients on stretchers represent an added burden because of the space they take up inside the already tight quarters of the submarine-shaped chamber.
But Cassar-DeMajo says the decision will not increase the risk to patients.
"The risk is really not significant," he says, adding that stretcher patients should be just as easily accommodated by hospitals in Hamilton, Ottawa or Buffalo.
But other hyperbaric experts question that assessment.
Dr. Eric Kindwall, an international expert in hyperbaric medicine and a former consultant for Toronto General, says the hospital's decision to eliminate critical hyperbaric care for stretcher patients could result in "increased mortality."
"If you want to let bureaucracy cost human lives, that's up to the citizens of Toronto," he said in a recent interview.
"If you have very critical smoke inhalations with monoxide poisoning, these people often require intensive care. And coming out of fires and so on, these people may not make it unless they can be fully managed in a chamber."
In 2002, Kindwall was hired by Toronto General to assess the hospital's hyperbaric program.
In his report, he concluded, "the present blurred direction of the (Toronto General) unit appears to be a major cause of its dysfunction."
Hyperbaric physicians at the hospital, who spoke to the Star on condition of anonymity for fear of professional reprisals, say that problem is the hospital's own making for buying an inappropriate chamber in the first place.
"Why did they buy a poorly designed chamber that had not been intended for such use?" said one hyperbaric doctor at Toronto General. "They ignored the recommendations of staff and bought a faulty chamber at a cost to the taxpayer. It is a reflection in my mind of incompetence on the part of the administration."
Cassar-DeMajo says staff were consulted before the current chamber was purchased.
Stopping hyperbaric treatments for stretcher patients will affect four to six patients a year, he says. But hyperbaric physicians at the hospital say a closer yearly estimate would be between 14 and 20 patients whose health could be threatened by lack of emergency care.
Dr. Brian Egier, medical director of the Firefighter's Hyperbaric Unit at Hamilton General Hospital, says his facility will make every effort to accommodate emergency hyperbaric patients from Toronto.
But depending on the injury and where it happens, the trip to Hamilton could affect the outcome, Egier says.
"The lack of access to hospital-based chambers in Ontario is a frustration. This certainly makes the situation worse."
The life-saving machine is used to treat everything from carbon monoxide poisoning to decompression sickness.
The hospital's decision to stop treating patients who require a stretcher was triggered by concerns about back injury and decompression illness among medical staff working in the cramped machine, says Dr. Wilfred Cassar-DeMajo, who heads the hospital's hyperbaric unit.
"It is not safe for staff to be in the chamber with a stretcher," he says. "According to labour laws, we have no option but to safeguard the health of employees."
Toronto-area patients requiring stretchers, such as divers with the bends or fire victims with smoke inhalation, will now have to be transferred by air or ambulance to chambers in Hamilton, Ottawa or Buffalo.
And that delay could have tragic implications, says Bill Roman, president of the Canadian Council on Hyperbaric Medicine, a group that represents 110 hospital-based hyperbaric medical staff across the country.
"If there's a serious accident today involving a diver, you could either have a death or you could be crippled for the rest of your life," he says. "Ontario is now like a Third World country when it comes to hyperbaric care."
The prospect of sending injured divers to other cities for emergency treatment is a concern, says Sergeant Bill Kemp, head of the Toronto police underwater search and recovery team.
"I'd much rather have the guys go to Toronto than be shipped off, because that's delaying," says Kemp.
"Obviously, the closer the better.... I just want the best medical facilities available for guys in case of an accident."
Kemp's team of 14 divers scours the bottom of Toronto Harbour conducting security checks, and recovering evidence and human bodies.
Two of those officers were treated in Toronto General's hyperbaric chamber in the past two years following diving accidents, he says.
The decision to cut off hyperbaric care to critically sick patients on stretchers came after an occupational health and safety assessment found a potential risk to medical staff, Cassar-DeMajo says. Patients on stretchers represent an added burden because of the space they take up inside the already tight quarters of the submarine-shaped chamber.
But Cassar-DeMajo says the decision will not increase the risk to patients.
"The risk is really not significant," he says, adding that stretcher patients should be just as easily accommodated by hospitals in Hamilton, Ottawa or Buffalo.
But other hyperbaric experts question that assessment.
Dr. Eric Kindwall, an international expert in hyperbaric medicine and a former consultant for Toronto General, says the hospital's decision to eliminate critical hyperbaric care for stretcher patients could result in "increased mortality."
"If you want to let bureaucracy cost human lives, that's up to the citizens of Toronto," he said in a recent interview.
"If you have very critical smoke inhalations with monoxide poisoning, these people often require intensive care. And coming out of fires and so on, these people may not make it unless they can be fully managed in a chamber."
In 2002, Kindwall was hired by Toronto General to assess the hospital's hyperbaric program.
In his report, he concluded, "the present blurred direction of the (Toronto General) unit appears to be a major cause of its dysfunction."
Hyperbaric physicians at the hospital, who spoke to the Star on condition of anonymity for fear of professional reprisals, say that problem is the hospital's own making for buying an inappropriate chamber in the first place.
"Why did they buy a poorly designed chamber that had not been intended for such use?" said one hyperbaric doctor at Toronto General. "They ignored the recommendations of staff and bought a faulty chamber at a cost to the taxpayer. It is a reflection in my mind of incompetence on the part of the administration."
Cassar-DeMajo says staff were consulted before the current chamber was purchased.
Stopping hyperbaric treatments for stretcher patients will affect four to six patients a year, he says. But hyperbaric physicians at the hospital say a closer yearly estimate would be between 14 and 20 patients whose health could be threatened by lack of emergency care.
Dr. Brian Egier, medical director of the Firefighter's Hyperbaric Unit at Hamilton General Hospital, says his facility will make every effort to accommodate emergency hyperbaric patients from Toronto.
But depending on the injury and where it happens, the trip to Hamilton could affect the outcome, Egier says.
"The lack of access to hospital-based chambers in Ontario is a frustration. This certainly makes the situation worse."
