DCS treatment on a plane??

[ArcticDiver]

Most of the posts to this thread have assumed the self-diagnosis/assessment of DCS is accurate. That is starting the thought process too far down the decision tree. There are other causes of discomfort that need to be ruled out. That can't be done very well in the field, let alone in an airplane.

Also, there have been a couple posts commenting that EMS/ER treatment has been less than satisfactory. Of course that happens. Just because you are in the hands of a medical professional doesn't guarantee perfect results. We all demonstrate our humanity by making errors. So, saying that you wouldn't go to the ER for suspected DCS is at best a foolish statement.

Like someone else posted when you have a suspected serious medical problem the absolute best thing to do under all circumstances is go to the nearest emergency room or department. If you can't transport yourself, or such transport isn't advisable given the circumstances, call EMS for ambulance transport. It would be too strong a statement to say never go directly to a decompression chamber. But the cases where that would be the best course of action would, I think, be extremely rare.

Once you are in the ER then don't be passive. By the same token don't be on obnoxious jerk either. Be assertive. If your condition won't allow you to be personally assertive then appoint someone else to do so on your behalf.

If it is DCS while you are waiting for the chamber to be made ready you can be supported with all the medical equipment and skill available. If it isn't DCS then you are where you need to be for proper diagnosis and treatment.

So, the wise person doesn't jump to a DCS diagnosis just because they have been diving and have some symptoms. The person also recognizes that they may need some heavy duty medical support before, during and after the episode whether DCS or not. That is why the wise person uses the EMS/ER system reinforced by assertive personal conduct.

 

[BigJetDriver]

(1) Most of the posts to this thread have assumed the self-diagnosis/assessment of DCS is accurate.

(2) Also, there have been a couple posts commenting that EMS/ER treatment has been less than satisfactory. Of course that happens. Just because you are in the hands of a medical professional doesn't guarantee perfect results. We all demonstrate our humanity by making errors. So, saying that you wouldn't go to the ER for suspected DCS is at best a foolish statement.

(3) Like someone else posted when you have a suspected serious medical problem the absolute best thing to do under all circumstances is go to the nearest emergency room or department. If you can't transport yourself, or such transport isn't advisable given the circumstances, call EMS for ambulance transport. It would be too strong a statement to say never go directly to a decompression chamber. But the cases where that would be the best course of action would, I think, be extremely rare.

(4) If it is DCS while you are waiting for the chamber to be made ready you can be supported with all the medical equipment and skill available. If it isn't DCS then you are where you need to be for proper diagnosis and treatment.

(5) So, the wise person doesn't jump (Ed. note: emphasis mine) to a DCS diagnosis just because they have been diving and have some symptoms. The person also recognizes that they may need some heavy duty medical support before, during and after the episode whether DCS or not. That is why the wise person uses the EMS/ER system reinforced by assertive personal conduct.

Artic Diver, et al,

(1) That is correct, because most of the posts here have been from medical professionals who are also divers and have at least basic knowledge of DCS.

(2) If you are a medical professional with knowledge of DCS signs, symptoms, and conditions, and you believe that you are experiencing DCS, it not only is NOT foolish to go directly to a Hyperbaric Medicine Center, the ultimate outcome, and sometimes your life may depend upon it!

(3) The cases are less rare than one might think. Again, I refer to my comment that it is not the fault of the people. It is the fault of the system, which pays little or no attention to this part of the medical field (for various reasons too detailed to go into here).

(4) A Hyperbaric Medicine Center will be able to support you medically. If they determine that your condition is NOT related to DCS, they will transfer you. If you have gone first to the ER, they may not figure it out, and they may not transfer you.

(5) So, the WISE person (See my reference in point number one above.) who knows that he or she IS suffering from DCS, does IN FACT go directly to the Hperbaric Medicine facility in order to receive proper treatment in a much more timely fashion.


Folks,

These statements of mine above are not hypothetical. They are based on case studies that are sad enough to make you damn near cry when you read them.

To paraphrase Mr. Natural: "Kids, get the proper training for the job. Don't try this at home! :doctor: "

Rob Davie

 

[Dr Deco]

Hello Avitar:

A quick answer to your question (2-1-05) concerning the Doppler instruments for vascular work and what is necessary for bubble detection.

Bubble detection for DCS is generally performed with more powerful Doppler devices with the insonation directed at the heart. These devices can detect bubbles at a depth of several inches but the signal of bubbles will have the background pulsations of the heart muscle. The signal is not very clear and requires real skill to hear the proper sounds.

Those devices for vascular work have smaller crystals and are focused for superficial vessels. If bubbles were present in a vein draining that tissue, the instrument would be able to detect it. These devices have not been used for DCS studies with humans,

Dr Deco :doctor:

 

[fins wake]

First case is a 50+ male dive instrcutor with joint pain following a series of deep(ish, 130 FSW) dives, on air and within the NDL. Reports to ED the next morning when pain has not resolved. Physician on duty take dive history, and proclaims that "you can't get bent on these profiles". Suggests that stress may be the root cause,and offers a well-known erectile dysfunction drug to help with stress relief at home.

I just knew we'd get some use of that proctologist hidden away in Tom's portable ER truck ... :11ztongue

Okay, seriously, the reason I'm joining the fray at this late stage is to support Rob (BigJetDriver) and gkndivebum as regards getting oneself directly to the hyperbaric chamber if one actually suspects DCI, and not the ER. I'm not a DMT (at least, not yet), but I do have some, uh, personal experience of hyperbaric chambers and emergency rooms. And yes, one would ideally phone DAN or the local chamber first. Ideally.

BigJet has made all the points so well in his summarization above that I feel there is little further to add, particularly given gkndivebum's examples and Dr Deco's comments. Except that ...

... it is possible that the MD/operator on call at the hyperbaric chamber actually might make the same bad call as the ER guys in the example above and decide against DCI and hyperbaric treatment. But the odds are lower on a bad call, particularly if one has DAN insurance and can defer to them for advice.

 

[Wildcard]

I would like to clarify something here. If people expect to just drive up to a chamber and go for a ride, you will be quickly corrected. If you suspect DCS, make this known and you WILL be transported to the nearest approprate medical facility. You will be evaluated, then and only then will you be sent for a ride. Just like you can't just drive up to a MRI and tell them you think you have a brain tumor and expect to get in.

Ive been in a lot of ERs in my life and I find it hard to believe that someone who comes in for DCS would be blown off by the staff. Im sure it has happened but not often.

 

[BigJetDriver]

If people expect to just drive up to a chamber and go for a ride, you will be quickly corrected. If you suspect DCS, make this known and you WILL be transported to the nearest approprate medical facility. You will be evaluated, then and only then will you be sent for a ride. Just like you can't just drive up to a MRI and tell them you think you have a brain tumor and expect to get in.

Ive been in a lot of ERs in my life and I find it hard to believe that someone who comes in for DCS would be blown off by the staff. Im sure it has happened but not often.

Wildcard,

If you are referring to my remarks, you are definitely misunderstanding something.

The Hyperbaric Medicine facility IS the medical facility. The staff will include a Doc as well as the CHT's. In the case of the facility I trained in, they would only take you next door to the ER if DCS was ruled out.

As for the ER staff, I doubt as well that they would casually dismiss or "blow off" the patient, as you put it. But as I, and others on this Board (such as Doc Deco) know full well, they might well misdiagnose the patient, for the reasons stated above.

Rob

 

[Wildcard]

I wasen't refering to you in particular but people need to know that you go to the ER first. After making sure it's not some other problems and making arrangements, then and only then will you be sent back down....I will make a call tomorow if I rember, but I quite sure you can't just go to a chamber and ask to be treated.

 

[BigJetDriver]

People need to know that you go to the ER first. After making sure it's not some other problems and making arrangements, then and only then will you be sent back down....I will make a call tomorow if I rember, but I quite sure you can't just go to a chamber and ask to be treated.

No, the real answer is this. People need to know that if they have enough medical and diving knowledge to have a reasonable belief that they are, in fact, suffering from DCS, they need to go DIRECTLY to the HYPERBARIC MEDICINE FACILITY. The doc there will evaluate them, and refer them to the ER if he or she believes it is not a DCS case.

If the chamber you are referring to, Wildcard, does not have a Hyperbaric Medicine Specialist available, then you do need to go direct to the ER.

And...good bloody luck to you, mate!!! :11:

Rob Davie :doctor:

 

[ArcticDiver]

No, the real answer is this. People need to know that if they have enough medical and diving knowledge to have a reasonable belief that they are, in fact, suffering from DCS, they need to go DIRECTLY to the HYPERBARIC MEDICINE FACILITY. The doc there will evaluate them, and refer them to the ER if he or she believes it is not a DCS case.

If the chamber you are referring to, Wildcard, does not have a Hyperbaric Medicine Specialist available, then you do need to go direct to the ER.

And...good bloody luck to you, mate!!! :11:

Rob Davie :doctor:

You say that a medical professional who KNOWS they have DCS should short circuit the system and go directly to a chamber. I submit that a medical professional, of all people, ought to know that is exactly the wrong thing to do under, as I said, most circumstances. Why?

Have they made an accurate assessment of themself? Unlikely but possible. Likely symptoms are not unique to DCS. Wouldn't it be the pits to self-assess DCS only to find it was a different life-threatening condition? Then you find yourself at a chamber when you need to be in a hospital.

Is the chamber operational, staffed and available? Who knows? Now, If it is available and the staff says "come on over" then by all means do so if the patient can get there safely. That is going to be rare, but possible.

Do they have the tools and people with them to provide life support if things go sour? How about the tools and skill to assess the current signs and symptoms? An EMS crew has all those things. The ER/ED has more and the hospital is even better equipped.

If you are traveling do you even know where the chamber is and how to get there?

If you and I are diving and I get symptoms that may be DCS, or if I'm on your airplane and get such symptoms, please, oh please, get me to the nearest ER as soon as possible. Then while I'm being tested and diagnosed; while I'm being supported by IV, Oxygen, maybe even breathing assistance, and getting appropriate drugs make the calls. If it is DCS then after you make sure the chamber is available take me there in an ambulance with a competent crew. I'll thank you for it.

Oh yes, since I may be in discomfort and pain from whatever is wrong with me, don't pay too much attention to my self-diagnosis. Pay lots of attention to my description of signs and symptoms. But ask the guy whose brain is clear to make the assessment.

 

[BigJetDriver]

(1) You say that a medical professional who KNOWS they have DCS should short circuit the system and go directly to a chamber. I submit that a medical professional, of all people, ought to know that is exactly the wrong thing to do under, as I said, most circumstances. Why?

(2) Have they made an accurate assessment of themself? Unlikely but possible. Likely symptoms are not unique to DCS. Wouldn't it be the pits to self-assess DCS only to find it was a different life-threatening condition? Then you find yourself at a chamber when you need to be in a hospital.

(3) Is the chamber operational, staffed and available? Who knows? Now, If it is available and the staff says "come on over" then by all means do so if the patient can get there safely. That is going to be rare, but possible.

(4) Do they have the tools and people with them to provide life support if things go sour? How about the tools and skill to assess the current signs and symptoms? An EMS crew has all those things. The ER/ED has more and the hospital is even better equipped.

(5) If you are traveling do you even know where the chamber is and how to get there?

(6) If you and I are diving and I get symptoms that may be DCS, or if I'm on your airplane and get such symptoms, please, oh please, get me to the nearest ER as soon as possible. Then while I'm being tested and diagnosed; while I'm being supported by IV, Oxygen, maybe even breathing assistance, and getting appropriate drugs make the calls. If it is DCS then after you make sure the chamber is available take me there in an ambulance with a competent crew. I'll thank you for it.

(7) Oh yes, since I may be in discomfort and pain from whatever is wrong with me, don't pay too much attention to my self-diagnosis. Pay lots of attention to my description of signs and symptoms. But ask the guy whose brain is clear to make the assessment.

Folks,

There are a lot of assumptions being made here and assigned to me as part of scenarios that I did not specify, or, as Uncle Pug would say: "You're dragging out that straw man again!"

(1) I submit that a medical professional, as opposed to a lay person, would know EXACTLY how to speed the process up.

(2) See #1 above (ref. medical professional). Straw Man: chamber versus hospital--around here most, if not all of our chambers are IN the hospital.

(3) As I said in a previous post, (which obviously wasn't read), and I say again: "PRUDENCE WOULD DICTATE THAT YOU CALL AHEAD TO CHECK THE STATUS OF THE CHAMBER!" (Excuse the emphasis, but perhaps it will be noticed this time.

(4) I really don't know where you folks up there hide your chambers. They're out in the woods, one must suppose, by the way you keep disparaging them, but I keep using the phrase "Hyperbaric Medicine Center", hoping that you will perhaps realize that it connotes doctors, nurses, life-support equipment, radiology, pharmacy, consulting specialists, and all of the other things we have come to expect in LARGE hospitals (such as the one I trained in), as well as the chamber and it's associated techs.

(And yes, before you start in, I do know, (having seen them), that there are some places that basically only have a large pressure vessel, a depth gauge, stop watch, and first aid kit. It seems to be your assumption that I was talking about them when I refer to going to the chamber. Perhaps that is the only kind of chamber set-up you have up there. If that is all you have out in EBFE, well, you play the cards you were dealt, and may God save your soul.)

(5) Another Straw Man. Reference #3 above.

(6) If you and I are diving, presumably we will have covered such things in the briefing. If it is your wish to be transported via EMS directly to the ER, then that is exactly what will happen.

If you are on my aircraft, we will give you O2 at 15 lpm, and if the doc at the end of Med-Link advises it, we will divert when and where possible, and turn you over to the EMT's of the Fire-Rescue Service at our divert base, wherever that may be. After that, you're in their hands, and God's. (That is the way the system works, full stop.)

(7) If you are in distress and have given me previous permission to do so, I will do a field assessment of your condition. Subject to your previous request, you will be transported by the most expedient means in the situation to an ER.

If you are unconscious, I will use the equipment I have at my disposal to support you, until we can turn you over to either a helicopter crew, or an EMS unit at the dock.

Folks,

For the lay person (i.e. average citizen), the anwer is simple. Call 911, and turn the victim over to the EMT's when you can.

As for me, if I know I have DCS and I have some way of doing it---I am going straight to the HYPERBARIC MEDICINE CENTER.

Cheers!

Rob Davie :doctor: