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

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DocVikingo

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Surely every diver has heard this admonition repeatedly. But, seems that it hasn't sunk in with a goodly number.

I've been pouring over DAN's '03 "Report on Decompression Illness, Diving Fatalities and Project Dive Exploration" for the past couple of weeks and find it very informative, and at times distressing.

For example, the figures for delay to recompression by diagnosis are (in hours):

DCSI: Median=26; Mean=55; Range=1-277
DCSII: Median=17; Mean=40; Range=1-648
AGE: Median= 6; Mean=14; Range=1-52

Mean=arithmetic average

Median=the score at the middle of the sequence of values. Fifty percent of the values will fall below the median score and 50% above.

Given it is well documented that, on balance, the earlier recompression starts the better are going to be the results, these median values are disturbing. And, the fact that the means are so much larger than the medians indicates that some divers are waiting ludicrous periods before getting chamber treatment, e.g., nearly a month in one case of DCSII.

I'll grant that in the DCSI category there sometimes can be uncertainty about whether the diver has sustained a hit or not, although this really is not a good excuse for delay as when in any doubt one should get evaluated at a recompression facility.

I see no reason, however, for an median duration of 17 hours/average duration of 40 hours between the appearance of the first signs/symptoms of DCSII and eventual recompression. When you've sustained DCSII, you've got at least one neurological and/or cardiopulmonary sign/symptom. You know with near certainty that something is wrong. To me, this suggests a lot of denial.

DCI isn't an embarrassment--it's a medical condition warranting rapid attention. Do the right thing, please.

Best regards.

DocVikingo
 
DocVikingo, I think anyone will agree with your post. However, DAN recommends to transport the victim to the nearest ER, and not to the nearest chamber. While I understand the arguments to do so, I've always wondered about the delay this can cause in getting hyperbaric treatment, especially in a less than responsive or overcrowded ER. What's your opinion?
 
ER to chamber would be that long. I agree with the real Doctor on this... lots of denial going on. Most divers take pride in "pushing the limit" and not getting bent. Heck, I sure as shooting used to. Now I pride myself on how conservative I can be. Anal is good in this respect. But I had to buck the tide as it were, as most of my buds still seem hell bent on pushing the envelope. That is usually the cause of the so called undeserved hits. We need to do more on the entry level to lessen the stigma associated with a chamber ride.
 
IMHO, the average ER is not trained to diagnose or treat, and certainly is not equipped to treat, DCI.

And, depending on how prompt the attention of the ER (if they have accident victims, cardiac arrests, ruptured appendices, poisonings, births and the like going on you could sit for a good long while) and the distance from the ER to the nearest chamber, recompression could be substantially delayed by such a side trip.

Although I would want my care to be coordinated through the DAN dive emergency hot line, unless my DCI was imminently life threatening, or the only gateway to the chamber was through the ER, I'd prefer to be taken directly to the closest recompression facility, on 100% 02 from beginning to end, of course.

Thanks for raising this issue.

DocVikingo
 
I've read of and heard of several accounts where someone shows up at an ER, tells the people there they have been diving and think they're bent, and are given TYLENOL for the pain and "watched!"

Instead of getting them to/into a chamber pronto.

I think that quite frankly the best move is to get thy butt to a chamber immediately, and take the bottle of pure O2 you are breathing (and perhaps a spare!) with you. Screw the ordinary ER; they are neither trained to deal with this nor are the odds good of having the proper response administered.

There are magic words in an ER to get immediate and good attention. "Chest pain" is one of them; say that near or in an ER and you get IMMEDIATE attention.

"DCI" or "bent" is not in their lexicon.
 
Well, I'm happy to see that I'm not the only one questioning the need to go to the ER. Has anyone discussed this issue with a rep at DAN?

I have never been involved with a DCS accident and never had to call DAN (knock on wood). I am assuming that the ER thing is just a principle with many exceptions and, when calling DAN, they will most likely direct you to a chamber. Correct?
 
if it happens at sea, there is a protocol that is followed, as you heard at Chamber Evening. But what does happen if you figure this out at home later? I can just see this at Kaiser now...just make sure you have DAN's number on you.
 
DAN is full of, well, physicians.

This sounds like the kind of thing that I went through with them on the "O2 .vs. no O2" debate a few months back.

They finally backed down and said that they understood and agreed with my point of view (that is, if you think you "blew" a dive for some reason, go ahead and breathe the O2 if you have it - rather than "wait for symptoms to appear"), but it took getting past the "you're administering a drug" doc-speak before they got there.

What finally did it was pointing out that technical divers breathe pure O2 intentionally at 20' as their last "in-water" deco stop, and that we all know that the final deco stop is done on the surface. So, exactly what is the problem with accelerating N2 elimination on the surface, if its perfectly ok underwater? :)

This sounds like the same sort of situation.

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.
 
but delays can be experienced at the level of 911 and/or EMT. Grand Cayman is no exception. Even though ER physicians have seen many cases of DCI, not everyone in the chain of care is familiar with the variety of signs and symptoms that DCI can present.

Unfortunately, I have had to call the ambulance as a dive boat brought in a patient with suspected DCI. The signs were strongly suspect of a serious problem and I relayed the information to 911. The operator did not understand the seriousness of the situation and I actually had to provide a primer on DCI.

Once the EMT's arrived on scene, I again had to explain why the signs and symptoms should be treated as life threatening and why oxygen should be used.

Fortunately, once the patient actually arrived at the ER, the staff promptly attended to the situation and provided recompression treatment immediately. In Grand Cayman, the chamber is right at the ER so there is no problem with where you should first go.
 
with going to the wrong place initially is that you get "into the system" and it becomes damn near impossible to get out and back to the right place if you determine that you did the wrong thing - that is, if you're CAPABLE of doing so at that point!

This isn't too big of a deal for routine ER-style things. If you say "I feel pain in my chest" in an ER, they will very likely do the right thing, because all ERs have seen heart attacks, and most of them are reasonably equipped to at least get you stable before they have to move you, or can deal with whatever is going on right there.

But say "bent" or "DCS" in an ER, and you are likely to get a blank stare. The severity of the situation is almost certain to be misunderstood or completely ignored, especially if they are busy.

And once you're in there, then arranging transport and such is going to take even LONGER. With all the "protocol crap" they typically do you're talking about some real delays, even though the most expeditious thing to do, assuming the chamber is within an hour's driving distance or so, would be to stuff you in a car with a bottle of pure O2 and a demand valve and get your tailfeathers over there.

But that's not how it will go. They'll send you by ambulance, and they will likely not be set up to get you anything approaching 100% O2. Its simply not common protocol for most stuff, the usual "non-rebreather" masks don't deliver anything close to 100% unless the flow is cranked WAY up, and most EMTs and ER staffers won't because, once again, that simply isn't what they know. If the chamber is a good ways away they will have to arrange a low-level chopper, but it won't get "lifeflight" priority in nearly all cases, even though if its a Type II hit it damn well ought to.

I don't know that there is a real solution to this, other than trying to insure that you end up at the chamber facility in the first place if you suspect a problem. At least that way you are THERE.
 

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