DCS Fact Sheet for the Emergency Room

[uncfnp]

True. And it is a fine and delicate wire one is walking if they present to the ER expecting/requesting a specific treatment when in truth there is no 100% way to diagnose DCS. The risk to the ER is if they miss something, ie CVA by going straight to a chamber.

If simply alerting the staff to the risk doesn't work to at least get them to consider it in their differential, I honestly don't know what would. This might be where self/buddy advocacy needs to take a stronger roll. Did Mr F call DAN himself. Maybe carefully mention the liability issue if his requests are ignored?

 

[knotical]

dreamdive,

I took the liberty of editing your post to mimic your linked fact sheet wrt red lettering.

k

 

[Kevrumbo]

Here in Southern California, most divers & all Dive-Ops know who to call first in a Dive Accident Scenario (and it sure isn't DAN):

Hyperbaric Chamber For DCS/AGE: Always Go With LA County/USC Catalina. . .

USC Catalina Chamber vs Most Mainland Chambers

Mainland Chamber:
Most seen are Clinical Patients
Inland Hospital/Clinic
Most Cases Delayed
ER Stabilization before sent to Chamber
Retreatments
Paid Staff Physician onsite
Funded by Clinical Patient Treatments

Catalina Island Chamber:
Treat Divers only 24/7
Location is Where the Divers are
Fresh/Urgent Cases
Extension of LA County Medical Center ER
Few Retreatments
Volunteer Crew
Fly on-call Physician in
Funded by LA County Grants & Donations

Development of DCS Symptoms:
66% Within 30 Minutes
74% Within 2 Hours
95% Within 24 Hours
50% of divers Do Not Seek Treatment for >12 Hours after symptoms Develop (Serious Mistake!!!)

DCS Physiological Susceptibility Factors:
("An Alteration of Blood Flow")
Dehydration
Illness & Injury
Drugs & Alcohol
Cold Stress
Heavy Exertion
Obesity
Age
Anxiety
Patent Foramen Ovale
(above info from the USC Catalina Hyperbaric Chamber Mainland Based Volunteer Crew Program, class taken back on Oct 6-8 2006)

In my experience and in light of recent events here at the Opening of Lobster Season in off-shore LA County:

Simple straightforward triage as a First Responder (i.e. Boat Captain, Dive Master, Rescue Diver etc on the scene), based on initial reported symptoms and worst case scenario of a just surfaced conscious diver onboard in post-dive distress . . .Rule Out DCS and/or AGE.

Radio-in, rendezvous & evacuate patient by Baywatch Paramedic Boat or US Coast Guard Helicopter to Big Fisherman Cove West End Catalina while underway at sea. Evaluate and begin Oxygen Therapy at Catalina Hyperbaric Chamber as necessary with attending Emergency/Hyperbaric Physician on-call & enroute, and then post-treatment assessment & stabilize for transport. Helicopter patient back to mainland LA/USC County General Hospital for further diagnostic work-up/treatment as needed for secondary conditions or comorbid pathologies.

IMO, this is the preferred beginning of the standard chain of care for all dive accidents with suspected DCS/AGE --whether victim is conscious or unconscious; alert & oriented or in full cardiorespiratory arrest: the initial response and call for immediate aid should always be the same.

THIS ALSO IS STANDARD OPERATING PROCEDURE FOR ALL COMMERCIAL SPORTDIVE BOATS HERE IN OFFSHORE LOS ANGELES COUNTY FOR A DIVING ACCIDENT --TRANSPORT IMMEDIATELY TO THE CATALINA HYPERBARIC CHAMBER VIA BAYWATCH BOAT OR US COAST GUARD HELICOPTER ("WHEN IN DOUBT, CHOPPER 'EM OUT") . . . THIS IS THE BEST MOST PRUDENT COURSE OF ACTION TO TAKE AS EITHER A FIRST RESPONDER OR VICTIM!!!

USC Catalina Hyperbaric Chamber

 

[dreamdive]

Here in Southern California, most divers & all Dive-Ops know who to call first in a Dive Accident Scenario (and it sure isn't DAN):

Hyperbaric Chamber For DCS/AGE: Always Go With LA County/USC Catalina. . .

USC Catalina Chamber vs Most Mainland Chambers

Mainland Chamber:
Most seen are Clinical Patients
Inland Hospital/Clinic
Most Cases Delayed
ER Stabilization before sent to Chamber
Retreatments
Paid Staff Physician onsite
Funded by Clinical Patient Treatments

Catalina Island Chamber:
Treat Divers only 24/7
Location is Where the Divers are
Fresh/Urgent Cases
Extension of LA County Medical Center ER
Few Retreatments
Volunteer Crew
Fly on-call Physician in
Funded by LA County Grants & Donations

Development of DCS Symptoms:
66% Within 30 Minutes
74% Within 2 Hours
95% Within 24 Hours
50% of divers Do Not Seek Treatment for >12 Hours after symptoms Develop (Serious Mistake!!!)

DCS Physiological Susceptibility Factors:
("An Alteration of Blood Flow")
Dehydration
Illness & Injury
Drugs & Alcohol
Cold Stress
Heavy Exertion
Obesity
Age
Anxiety
Patent Foramen Ovale
(above info from the USC Catalina Hyperbaric Chamber Mainland Based Volunteer Crew Program, class taken back on Oct 6-8 2006)

In my experience and in light of recent events here at the Opening of Lobster Season in off-shore LA County:

Simple straightforward triage as a First Responder (i.e. Boat Captain, Dive Master, Rescue Diver etc on the scene), based on initial reported symptoms and worst case scenario of a just surfaced conscious diver onboard in post-dive distress . . .Rule Out DCS and/or AGE.

Radio-in, rendezvous & evacuate patient by Baywatch Paramedic Boat or US Coast Guard Helicopter to Big Fisherman Cove West End Catalina while underway at sea. Evaluate and begin Oxygen Therapy at Catalina Hyperbaric Chamber as necessary with attending Emergency/Hyperbaric Physician on-call & enroute, and then post-treatment assessment & stabilize for transport. Helicopter patient back to mainland LA/USC County General Hospital for further diagnostic work-up/treatment as needed for secondary conditions or comorbid pathologies.

IMO, this is the preferred beginning of the standard chain of care for all dive accidents with suspected DCS/AGE --whether victim is conscious or unconscious; alert & oriented or in full cardiorespiratory arrest: the initial response and call for immediate aid should always be the same.

THIS ALSO IS STANDARD OPERATING PROCEDURE FOR ALL COMMERCIAL SPORTDIVE BOATS HERE IN OFFSHORE LOS ANGELES COUNTY FOR A DIVING ACCIDENT --TRANSPORT IMMEDIATELY TO THE CATALINA HYPERBARIC CHAMBER VIA BAYWATCH BOAT OR US COAST GUARD HELICOPTER ("WHEN IN DOUBT, CHOPPER 'EM OUT") . . . THIS IS THE BEST MOST PRUDENT COURSE OF ACTION TO TAKE AS EITHER A FIRST RESPONDER OR VICTIM!!!

USC Catalina Hyperbaric Chamber

Wow, this is great! You guys certainly have it work out and I wish we could do that in Florida. I might try to set that up here in South Florida where we have a chamber op in Miami (which by rumor had been shut down but is back open) and the other is in St. Mary's (a single chamber and may not be operated 24/7). The key would be to convince EMS to transfer to the nearest Chamber rather than nearest ER (which is all they are required to do). That might be possible by prior arrangement with the chambers. Not sure on the SOP for call made to the Coast Guard.

By all means, divers and dive shops might want to establish with their nearest chamber and have a pre-established agreement set up that would facilitate the quickest transfers for a diver to be seen by a dive physician.

In the event that a diver contacts a chamber directly, do that ASAP because, as in another event involving North Florida, the chamber was not in operation! So look for contingency plans.

I believe in Murphy's Law: If you are prepared, you may never need it

Claudia

 

[Hickdive]

Mr F's scenario is not at all atypical.

I have been involved with or know of several DCS incidents of other divers where any involvement with the ER (or A&E as it is in the UK) invariable involves long delay before even oxygen is administered let alone recompression organised and started.

Simple rule of thumb is to avoid going anywhere near an ordinary hospital and to resist being sent there in the event of DCS or suspected DCS. However, if it cannot be avoided then I suggest that we all learn to recite the following or similar, to any and all medical personnel at the ER, in front of witnesses; "I am (or he or she is) a diver who has completed dives in the last 48 hours and unless and until determined otherwise I (they) should be treated as suffering from Decompression Illness. You must administer oxygen immediately and arrange recompression therapy now. If you fail to do so you will have the opportunity to watch your career sink without trace in court."

I have a nasty suspicion that, in these days of internet self-diagnosis, any printed sheet you might present to a non-diving medic is going to be disregarded as medicine by Google.

Don't forget to tell any emergency personnel that divers must not be given entonox.

 

[knotical]

... entonox.

I’ll bet I’m not the only one from the US who never heard of this, so to save others the search, entonox is a trademark for

A mix of nitrous oxide 50% and oxygen 50%

( from: Nitrous oxide and oxygen - Wikipedia, the free encyclopedia )

 

[Subcooled]

A very good idea indeed. The instructions should be made shorter though. Explain with one sentence that hyperbaric nitrogen (sometimes helium too) absorbed in the tissues during a dive, has come out of solution too fast causing ... embolism ... and other ... and that:

1a. the patient should be given 100% oxygen

1b. WARNING: other gasses may make the situation worse by enlarging the bubbles

2. contact a hyperbaric medicine / diving medicine specialist through Divers Alert Network, phone: ...

3. recompression chamber treatment

Short is better. It should be clear that DAN provides 24/7 a consulting expert... a doctor...

 

[knotical]

I do not understand why other gases, including nitrous oxide, would make the situation worse. If they are not the same "inert" gas as in the bubbles, where's the harm? (other than not delivering the maximum possible oxygen to any injury sites).

 

[Akimbo]

Here in Southern California, most divers & all Dive-Ops know who to call first in a Dive Accident Scenario (and it sure isn't DAN)…

The last I knew the only chamber taking divers in San Diego is UCSD (University of California San Diego) in Hillcrest, not Thornton in La Jolla. The chamber is a large multi-place and I’m not sure how well versed they are in the ER on diving related maladies.

In Monterey, where the greatest likelihood of a DCS incident would happen in Northern California, requires you to be diagnosed at CHOMP (Community Hospital of the Monterey Peninsula) before the chamber will take you at the Pacific Grove Fire Department. Just transportation after you land ashore can add nearly an hour before getting in the chamber.

 

[dreamdive]

True for Helium. Some decompression profiles actually include Helium.
As for Nitrous Oxide, would not know why that would be administered to somebody with DCS in the first place! It has been reported to increase pulmonary vascular resistance and may be contraindicated with people who have pulmonary hypertension among others.