DCS treatment on a plane??

[Dr Deco]

Hello readers:

ER Problems

In the years that I have edited this forum, the major difficulty that I have noted with ERs is that a misdiagnosis results and time is lost. As several responders noted, most physicians are not versed in the vagaries of DCS and problems result.

• Divers will be told that they do not have DCS because they were within the table limits.
• Divers will have their blood drawn, and DCS will be excluded as a diagnosis, because bubbles are not present in the blood sample.

What Divers Know -- Or Should Know.

Certainly you can get DCS if you are within the tables. If the dive was really trivial and the gas loads were negligible (let us say, at most 2/3 of the NDL), then one should have a high index of suspicion that we are more likely than not dealing with a sprain or over exertion.

Doppler monitoring has shown that few bubbles are detectable in the blood about one hour post dive. Doppler ultrasound is not used to diagnose DCS unless the pain has just appeared. [It is most successful in laboratory settings.] A blood draw will likewise almost never have bubbles present. It is common lore, however, that “the bends” are the result of gas bubbles in the blood of a diver.

That is a big mistake but not an uncommon one. :nonono:

Dr Deco :doctor:

 

[Tom Smedley]

I was not bashing paramedics - only stating that they are one level in the health care system. I was an original Paramedic. I am one of the ones who took all the heat from the MDs and Nurses and have been called a hose jockey and had everything I did taken off and redone by folks who thought I was a numbnuts or just refused to accept my qualifications out of spite. My paramedic certification came in 1973 while Roy and Johnny were just pups. I still have red lights in my blood and stop to watch everytime a vehicle with lights and siren comes by. I was also a hospital corpsman in Viet Nam. I was attempting to keep the discussion alive but guess I played on someone's nerves and was deemed arrogant. My DMT Certification came in 1988 the same year that I became a chamber operator taught by Dick Rutkowski himself.

I still contend that unless you have a prearranged protocol that you should take the person to the nearest medical facility where they can be stabilized and coordinated with DAN to get them to the nearest operational chamber. If you are at Vortex Spring and have a diving accident - you load the person into a vehicle of any sort (Washington County is not lucky enough to fund a Mobile Intensive Care Unit) and head for the nearest chamber at Bay County Medical Center in Panama City. You get there and find that the chamber is down for maintenance. You have wasted two hours getting that person to treatment. I believe (unless they have changed recently) DAN will tell you to take the victim to the nearest medical facility. If the NMF is a fully equipped Mobile Intensive Care Unit - Hoo Ah!

One of the original stigmas that we had to overcome was all those Hose Jockeys thinking that they know more than us syndrome. We proved them wrong and paved the way for you to enjoy a magnificent profession. Be proud of the job you do but be humble and don't be so defensive.

If you are a paramedic, you can't help getting a little stired when someone makes mention that they are sort of a paramedic. no, Bigjetdrivers statement didnt offend me, but I'm not a DMT, I don't know what DMT training consists of so I cant compare the two very accuratly. But I am a paramedic and what wildcard said is completely right. Tom your right you won't find any "ologist" in the back of an ambulance, but we are not ambulance drivers anymore it is an MICU and not in all cases but i'll bet you 100 to 1 that you can not get quicker life saving treamtent from an ER than you can in the back of an ambulance. now I said 100 to 1, there is too many variables to say that EMS is better than ER or vise versa, mainly due to call volume, experience. I took it that BIgjetdriver was saying that he can better understand a DCS situation than none diver pilots. this is suposed to be a message board for people post information to better help others, not to play a bashing game of someone's proffesion, so if you want to inlighten us on the abilities of the service you are accually familure than thats cool, but keep your mouth shut if you have never been in the back of an ambulance and I'm not talking about a staton tour, I'm talking about that 2am YOU make the life or death treatment decision for a patient and be willing to take responsability for any concequinces.

 

[BigJetDriver]

Bigjetdriver, thanks for the info and not bashing somemore. how can someone go about getting DMT training or maybe what do you need before you can achive DMT. The DMT sounds interesting, I'll be glad to here from ya.

One of the best places I can think of is Hyperbarics International, located in Key Largo, Florida. Founded by Mr. Dick Rutkowski, who is an acknowleged leader in the field, it is a great training facility.

See their website here:

http://www.hyperbaricsinternational.com/

I have known Dick Rutkowski for years. He is a great teacher, and his "war stories" are funny as heck. You can learn almost as much, if not more, from the after-hours sessions as you can in class.

Rob Davie

 

[BigJetDriver]

My DMT Certification came in 1988 the same year that I became a chamber operator taught by Dick Rutkowski himself.

I still contend that unless you have a prearranged protocol that you should take the person to the nearest medical facility where they can be stabilized and coordinated with DAN to get them to the nearest operational chamber. If you are at Vortex Spring and have a diving accident - you load the person into a vehicle of any sort (Washington County is not lucky enough to fund a Mobile Intensive Care Unit) and head for the nearest chamber at Bay County Medical Center in Panama City. You get there and find that the chamber is down for maintenance. You have wasted two hours getting that person to treatment. I believe (unless they have changed recently) DAN will tell you to take the victim to the nearest medical facility.

Since you are a graduate and devotee of Dick (aka Hyper-Dick) Rutkowski's school, I am sure you will agree with me in my recommendation of his school as a good venue for Diver Medic Technician training.

I must, however, respectfully disagree with your statement about always going straight to the ER. A simple phone call will determine if the chamber is functioning, and prudence would dictate that one do so.

The condition of the patient will, of course, dictate the choices of transport depending upon severity of symptoms. I would be remiss if I attempted IV and airway support in the back of a POV, for instance.

Yet I maintain, and others will back me up here, (some from personal experience), that in the case of clear-cut DCS, I would go straight to the Hyperbaric Medicine facility.

Rob Davie

 

[Tom Smedley]

And I respectfully respect your opinion.

Dick is the best there is. I haven't seen him for a few years and don't know what his health status is. I went on a cruise on the Ocean Spirit with him and Bobby Lewis once. Hilarious!

Also the guys who actually do the knob twisting at F.G. Hall are witty and entertaining after hours. DAN occasionally asks for volunteers and you get to ride the mother of all chambers. I did the flying after diving study. Quite exciting.

 

[BEM]

Here is some information on this issue from the FAA (search for SCUBA and also look at page 43)

http://av-info.faa.gov/data/traininghandbook/faa-h-8083-25-4of4.pdf

 

[BigJetDriver]

Okay, folks, here's the drill, as we say in the trade.

(1) The Captain does not make the call on whether or not the aircraft diverts, initially. The crew calls Med-link. They advise the crew on treatment (limited), and recommend a return or divert.

The Captain then looks at the flight situation, and the fllight deck crew decides which is a better plan, i.e. divert, return, or press on. Trust me, folks, on this one. We will do everything in our power to get you to a place where a medical team can get you into the system.

(2) Melvin is, unfortunately, quite right about the second part. I AM a trained and certified Diver Medic Technician (sort of a paramedic plus some) and I can tell you that if you are bent, get yourself directly into the hands of the chamber folks, even if you have to go to fist city with the ambulance folks. If you wind up in the ER, 90% of the time, they won't know what to do with you, and they will probably misdiagnose you.

I don't mean to scare you, but it is the simple truth.

Rob Davie

Here's my reply to the original question. I am not sure how the above link to the Airman's Information Manual (Old Name) or Aeronautical Information Manual, could be considered relevant except in the most basic way. I do note, however, that they have included the relatively recent thinking on time-to-fly limits.

Thanks for the link!

Cheers!

Rob Davie

 

[TheAvatar]

Dr. Deco: Some of our ambulances carry doppler units with vascular probes to detect weak pulses in limbs when palpation fails. Are these usefull for listening for microbubbles?

(Not that we can legally base much from it if it can).

Or is the doppler device used for this considerably different?

-----

Big Jet Driver:

I've been very interested in a DMT course to augment my current training (W-NREMT-B/IV and PSD). Can you tell me more? I've always been apprehensive because of the extremely high cost of DMT courses and the locations they are offered seem to require considerable travel (from Colorado, which, strangely enough, has one of the highest dive cert per capita rates in the nation).

-----

If you are a paramedic, you can't help getting a little stired when someone makes mention that they are sort of a paramedic.

While I'm not a medic, it is amusing how frequently you come across such claims. I had a "sports injury specialist" tell me she could "do most of the things a paramedic can do"
"really? what drugs can you push?"
"uh none"
"can you intubate?"
"no"
"so you are more like an EMT?"
"i guess you could say that"
"can you put in an OPA?"
"a what?"
"so you are more like a first responder?"
"uhhhhh"

Of course scopes and protocols differ by area:

For example: IV and combitube are standing orders in our protocols for trained basics in our rural service.

But not *that much*

 

[firemedic296]

Hey Tom, thanks for the reply. I'm new to the board and just found out from a friend that some of you guys are familar with one another and ya'll try to "keep it alive", like you said. I should not have come of thinking that you didn't know what it is like for medics when I don't even know you. You are right i shouldn't be so defensive, I am proud to be a public servent, but humble enough to know there always room for growth. sorry if i ruined your post.

thanks bigjet for the link

 

[firemedic296]

While I'm not a medic, it is amusing how frequently you come across such claims. I had a "sports injury specialist" tell me she could "do most of the things a paramedic can do"
"really? what drugs can you push?"
"uh none"
"can you intubate?"
"no"
"so you are more like an EMT?"
"i guess you could say that"
"can you put in an OPA?"
"a what?"
"so you are more like a first responder?"
"uhhhhh"

Of course scopes and protocols differ by area:

For example: IV and combitube are standing orders in our protocols for trained basics in our rural service.

But not *that much* [/QUOTE]


Thats funny, try convincing a new nurse graduate, even if they say "uhhhh" or "a what" some of them still stay "so, I'm a registered nurse"....... Ha Ha HA, Thats bad I know, My wife wants to be a nurse.