Missed Deco stops and DAN coverage for recompression

[BillP]

Short version: DAN insurance does cover recompression treatments for missed deco stops in asymptomatic divers.

Long version: In the discussion on Mia Tegner's tragic death after apparently surfacing and then descending to complete a missed decompression stop (see http://www.scubaboard.com/showthread.php?threadid=511&pagenumber=1 ), several people on the Rodale's board questioned whether it wouldn't be wiser to just skip the deco stop and go to a chamber for evaluation (and treatment if necessary) when you miss a mandatory deco stop. With PADI starting their DSAT Tec program and more and more divers doing decompression dives, I have a feeling that this issue will come up sooner or later.

Since the issue is bound to come up eventually, I wondered if DAN insurance covered "prophylactic" recompression treatments in asymptomatic divers for missed decompression stops- ie is a missed deco stop a "covered diving accident" even if the diver has no signs or symptoms of a decompression illness, and is the resultant evaluation and treatment a covered service under the insurance?

After contacting DAN by email 1/10/01 and being routed through several people, I finally got an answer from "Pam" in DAN's underwriter's provider relations department today. (Seems that the question has never come up before.) She tells me that prophylactic recompression treatments in asymptomatic divers for missed decompression stops is indeed a covered service under DAN insurance.

I'm sure that you still have to meet DAN's other requirements for coverage (eg.- if possible notifying DAN before seeking treatment for authorization and referral for treatment, not having descended below 130' with the Standard Plan, etc.) but it's good to know that the coverage is available if you decide to seek treatment.

If you have a dive accident insurance plan other than DAN's and you might be doing decompression diving, you might want to check it out with your insurer to be sure that you're covered.

HTH,

Bill

 

[DivingGal]

Thanks for the info. Yet another good reason for DAN.

 

[Mario S Caner]

Thanks for the info Doc, I've actually been in a situation before where a guy I was diving with depleted his air supply rapidly at depth and required too much of my air to get back to the surface safely. I made a decision and decided to stick with him, and in the process missed our final deco stop by a mear 7 minutes. (The total time required was 22) It was a very cold night so I couldn't feel my fingers at depth let alone once we got out onto the windy beach. So as a preventative measure I called DAN and took a drive down to the local chamber and chit-chated with a chamber technician under pressure. The doctors told me that it was unlikely that I had DCS, but it was better to be safe than sorry. So I took a 6hr ride in the chamber. At least I know what it's like now. But anyway, insurance took care of all but $50, of what would otherwise be rather costly.

Insurance is a must, especially for bonehead manuver's like the above

Though the above is in fact embarrasing, I chose to share it so that other's may benefit from my youthful mistakes.

 

[Kilo]

HELLO

I have not recived my training yet,but it is nice to know that there are companies out here that can get you covered for diving.How much does it cost to get covered?


Shane.AKA Kilo

 

[Mario S Caner]

Surprisingly little. Check out the DAN Website for rates.

 

[Kilo]

Thanks for the info......
Shane

 

[Dee]

Another good reason to be glad I keep my DAN insurance!

 

[DameDykker]

Hi Mario:mario:

I don't think that was embaressing. If your buddy was sucking up air that fast maybe he would have had other problems on the surface. You can always discuss where the breake point is with respect to missed decostops but I think you did the right thing. And this info from DAN really do support that behavior. I agree with you: The DAN membership is money well spent!

DSAO

 

[Dr Deco]

Dear Readers:

The question of missed deco stops and DCS is not unlike the question of DCS risk when deco stops are not required. There always exists the possibility that DCS could occur following a dive since there is not any way of knowing that the tissue perfusion (= blood flow) was favorable or not. The worst situation is high blood flow at depth to promote gas uptake (e.g., high musculoskeletal activity when fighting a current) and poor perfusion at the surface to reduce gas elimination (e.g., low heart rate while sleeping on the surface). While it might appear that these are handled in the decompression algorithm, these situations are indeed not. The algorithm handles many different “compartments” in an attempt to cover all of the bases, but the situation described above could yield a very bad result, since even “adaptive algorithms” do not adapt to all cases.

In addition to this, we have the “dark side” of decompression physiology, and that is the question of tissue micronuclei number (or more properly micronuclei “concentration”). These can vary from diver to diver and from day to day in any one person. Strenuous activity from climbing a ladder could result in micronuclei growth/formation.

Decompression sickness is a graded event in any one individual, going for a few bubbles forming to so many that clinical DCS presents. While the does exist a narrow range (in a very controlled setting) when DCS does or does not appear, in any group of individuals, this range is very broad. Nowhere is this more evident than in hypobaric (altitude) decompressions. In hypobaric (diving) situations, the picture is complicated by the variablities in both gas uptake (not present in altitude work since everyone is saturated at one atmosphere of nitrogen) and nitrogen gas elimination.

There is actually quite a spread in susceptibility to DCS, although the reason for this variation is the focus of much speculation among researchers. It is most likely connected to the biochemical makeup of the individual and the biophysical factors involved in micronuclei formation and lifetime.

If one knew that they were a “DCS susceptible,” then any missed decompression might be the cause for great concern. Most divers do not know where they stand with regard to DCS susceptibility, and therefore experts would always recommend that you consider yourself at risk in most situations, that is, consider yourself to be a “susceptible.” This will afford you a certain margin of safety with respect to acquiring decompression sickness if you always take this conservative approach. Since susceptibility could change daily, this conservatism would always be a good idea - - - while at the same time affording you the greatest chance of being alive to dive again. Nice thought. many have no doubt heard stories of Hawaiian black coral divers who perform unheard of feats of diving and decompression. These are no doubt the “resistants.” Regrettably, the “susceptibles” are paralyzed for life as they determined where they stood. Micronuclei, kismet ,or bad “karma”, the pathophysiology of spinal cord paralysis is the same for these people.

One bubble formation begins, the rules of gas exchange in the body move away from the Haldane concept that all gas is in solution and is transported in the blood. It is a whole new game and no a priori rule can cover all situations.


AUTHOR’S MESSAGE: One should always be cognizant of the risk of DCS and recognize that this risk will increase with gas loading. It is generally not all-or-nothing (bends/no bends) within a few minutes. Therefore, be vigilant in decompression, but do not be slavish to decompression such that one would speed in an auto to a chamber thus exposing themselves (and others) to a still greater risk.

I am pleased to hear that DAN will consider prophylactic recompression. Please consider that they are being very generous in being consistent with a policy of safe diving. I trust that we will not see abuses of this in the recreational diving community.

_______________
Dr. Deco

 

[BillP]

Thanks for the info Dr. Deco. I agree that DAN is being quite generous in offering the coverage. I didn't think that they would, so that's really why I asked. As PADI and other "mainstream" agencies start to offer decompression diving certification to the general recreational diving community I think it likely that an increasing number of divers will be presenting themselves to chambers for evaluation for missed deco stops. And I also think that an increasing number of chambers will be treating that increased number of divers "prophylactically" for missed deco stops. It remains to be seen at what level this increased use that I'm projecting becomes abuse.