Portable Hyperbaric Chambers

[Dr Deco]

Hello readers:

From the recent posting, the discussions concern facilities that can actuallu purchase and use the Hyperlite. I was of the impression that the original question concerned something simple on a live aboard boat. There would not be any trained folks around in most cases.

If you are speaking about the US Navy and Coast Guard, certainly we could expect a much higher level of expertise than that on a recreational dive boat.:cool2:

Dr Deco :doctor:

 

[Thalassamania]

I agree. I was thinking that products like the SOS Hyperlite would be useful for helicopter evac, military missions, commercial diving ops and possibly marine science expeditions. ...

The marine science community, is a series of workshops, roundly rejected the idea of ever carrying such equipment into the field.

 

[Bubbletrubble]

The marine science community, is a series of workshops, roundly rejected the idea of ever carrying such equipment into the field.

Why? If a properly-trained physician were on-board, the staff was trained to use it, and the unit was kept properly maintained, I see no disadvantage. Am I missing something here? Is it possible that, since these workshops occurred, advances in technology have significantly lowered the cost of such devices? I can see how this could dramatically change the cost-benefit analysis. I believe that the SOS Hyperlite costs less than $40,000 USD.

When were these workshops held?

 

[tc]

To address a few points in here- (I was involved in the testing at Catalina)

The price of the unit was more like 100K. (Pure hearsay- I have not verified)

Our protocols are to go to 165' for an AGE treatment- 60' for DCS.

If your chamber is big enough you can take the whole unit inside, and then pressurize the chamber around it and take the patient out once you reach 60'. This part is not theoretical- we did it.

I know the USCG's intent is to use them when diving in remote areas, get the diver under pressure and on O2 till you can transfer to a medical facility.

If you have the protocols worked out ahead of time you can begin a hyperbaric treatment without having a doctor present- we often begin treatments after a phone approval from a doc at USC while the doc that will be supervising the treatment is enroute. Of course you do have to have personnel on scene with sufficient training to relay the patients condition accurately and supervise the operation of the chamber.

Because of the cost and the training required this type of solution is more likely to find application in commercial, military, scientific or Public Safety diving done in remote areas rather than sport diving.

 

[Thalassamania]

Why? If a properly-trained physician were on-board, the staff was trained to use it, and the unit was kept properly maintained, I see no disadvantage. Am I missing something here? Is it possible that, since these workshops occurred, advances in technology have significantly lowered the cost of such devices? I can see how this could dramatically change the cost-benefit analysis. I believe that the SOS Hyperlite costs less than $40,000 USD.

When were these workshops held?

Cost is not the issue, $40K is nothing when it comes to ship operation budgets or facilitates grants. The issue is personnel, personnel qualification requirements, shipboard space used both by the facility and any dedicated personnel weighed against a lack of demonstrable need.

Here is the chamber part of the workshop's findings:

Recompression Chambers

Findings

• A review of the history of academic research diving does not justify requirement of on-board recompression chambers.
• Chambers may be desirable for diving techniques/equipment that are outside the current practices of the scientific divingcommunity .
• Of the chambers available, a double lock multi-place unit is the superior choice

Recommendations

• Normal at-sea scientific diving from UNOLS vessels does not require provision or use of an on-board recompression chamber.
• Diving beyond the experienced norm, especially in a remote site, should reviewed on a case-by-case basis as part of the dive planning process to determine if chamber is warranted
• The general level of emergency medical preparedness should be enhanced encouraging the training of crew members (and even interested research divers Emergency Medical Technicians) .
• In-water, oxygen decompression or the use of NITROX should be evaluated as techniques capable of providing greater safety margins.

The entire report may be found here:

University-National Oceanographic Laboratory System

Final Report of The Workshop on Scientific Shipboard Diving Safety

 

[Bubbletrubble]

Cost is not the issue, $40K is nothing when it comes to ship operation budgets or facilitates grants. The issue is personnel, personnel qualification requirements, shipboard space used both by the facility and any dedicated personnel weighed against a lack of demonstrable need.

Thal, if I'm not mistaken, that workshop occurred in 1990. 20 years later, I wonder if their recommendations would change considering the importance of timely recompression in instances of AGE and Type II DCS, the small size/weight of the portable hyperbaric chamber units, and their relatively affordable cost. I would think that the training of the personnel would be a minor obstacle. With advances in video conferencing and telemedicine, it may even be possible for a qualified physician in another location (somewhere on terra firma) to weigh in on patient assessment and recommended treatment protocols.

 

[Thalassamania]

We have not (knock on wood) had a problem in the science community with either AGE or Type II DCS, either before 1990 or after, so I doubt that the recommendations would be significantly different. Cost is not the issue, and has never been the issue, as I stated ... it's primarily a lack of any demonstrable need.

 

[Bubbletrubble]

Our protocols are to go to 165' for an AGE treatment- 60' for DCS.

@TC: Thanks for all of the great info.

I was under the impression that standard treatment protocol for AGE was to pressurize to 60 fsw first and see if symptoms abate. If they go away, then TT6 should be followed. If symptoms persisted, then the depth would be gradually increased until the patient experienced "significant improvement," but not to exceed 165 fsw. Once at the depth of relief, treatment gas (N2O2, HeO2) should be started if available. Stay there for 30 minutes (25 min on treatment gas, then 5 min air break). Decompress to 60 fsw at a travel rate not to exceed 3 ft./min. Upon arrival at 60 fsw, complete Treatment Table 6. At that point, a hyperbaric physician could weigh in on whether it's necessary to go to TT4 and/or TT7. I believe that the US Navy Diving Manual describes a treatment algorithm such as this.

Is this approach no longer used? Your statement implies that a TT6A is first line intervention.

 

[Bubbletrubble]

We have not (knock on wood) had a problem in the science community with either AGE or Type II DCS, either before 1990 or after, so I doubt that the recommendations would be significantly different. Cost is not the issue, and has never been the issue, as I stated ... it's primarily a lack of any demonstrable need.

@Thalassamania: That's a very good track record.

IIRC, you stated previously that any DCS hit whatsoever would be the end of a marine scientist's diving career. I wonder if this caused any under-reporting bias or if it may have weeded out those divers who had a higher DCS probability (PFO?).

 

[muddiver]

If there is a hyperbarric doctor in charge the procedure of the facility may be much different than the U.S.N. treatment process. The Catalina chamber and the USC program have done extensive testing and research on micro bubbles using the doppler method and a number of other studies on treatments. The Navy has been doing the same thing for the last three or four decades because it works for them.

The problem with any chamber, portable or stationary is that you have to have personnel that are fully trained to operate a chamber, and if it is for treatment of a symptomatic diver you need, at a minimum, a Dive Medical Technician to provide care to the casulty. If it is so remote that you need to do a treatment table 6, you need enough operators and DMTs to run around the clock.