Active hyperbaric chambers treating divers and staffing - travel divers need better information.

[diverdoug1]

In 2023 I experienced type II DCS which resulted in permanent neurologic deficits. DAN specialist on the phone assured me and the staff on the dive boat that there was a currently staffed chamber in Nassau. I was admitted to a hospital in Nassau, it took about 6 hours after admission to get transferred to a chamber. I was told this delay was due to staffing issues. I consider myself lucky because I have seen numerous reports of the "Chamber Shell Game" in Nassau. How many chambers? depending on where you look, somewhere between one and three. 24/7 hot line sure, but you might wait 4 or more hours to finally get someone to answer the phone. It seems to me it would be of great benefit to traveling SCUBA divers to have a RELIABLE resource to find operating hyperbaric chambers offering DCS treatment in different locations, as well as if they have staffing problems that are likely to delay treatment. This information is elusive for many locations, even if you are a long time DAN member.

 

[iain/hsm]

In 2023 I experienced type II DCS which resulted in permanent neurologic deficits. DAN specialist on the phone assured me and the staff on the dive boat that there was a currently staffed chamber in Nassau. I was admitted to a hospital in Nassau, it took about 6 hours after admission to get transferred to a chamber. I was told this delay was due to staffing issues. I consider myself lucky because I have seen numerous reports of the "Chamber Shell Game" in Nassau. How many chambers? depending on where you look, somewhere between one and three. 24/7 hot line sure, but you might wait 4 or more hours to finally get someone to answer the phone. It seems to me it would be of great benefit to traveling SCUBA divers to have a RELIABLE resource to find operating hyperbaric chambers offering DCS treatment in different locations, as well as if they have staffing problems that are likely to delay treatment. This information is elusive for many locations, even if you are a long time DAN member.

Hyperbaric services for general recreational scuba divers Type 1 and Type 2 bends treatments are by and large (and I generalise for our world wide service details and differences ) provided to you the end user as a private service.

The payment of said service is met by either the individual himself, a second party private insurer carrier or in the case of the UK by the NHS (National Health Service) provided free at point of use and paid for by Government taxes.

By contrast the reality of a private service providers business model is the need for a profit balanced by the overhead cost divided by the provision of serviceable agents over the number of users. While you the patient or "cash cow" for said service provide the mechanism for the operation while the second party insurance carrier provide the means.

The rest as they say is in knowing the detail.

 

[diverdoug1]

Hyperbaric services for general recreational scuba divers Type 1 and Type 2 bends treatments are by and large (and I generalise for our world wide service details and differences ) provided to you the end user as a private service.

The payment of said service is met by either the individual himself, a second party private insurer carrier or in the case of the UK by the NHS (National Health Service) provided free at point of use and paid for by Government taxes.

By contrast the reality of a private service providers business model is the need for a profit balanced by the overhead cost divided by the provision of serviceable agents over the number of users. While you the patient or "cash cow" for said service provide the mechanism for the operation while the second party insurance carrier provide the means.

The rest as they say is in knowing the detail.

The chamber where I have worked is in a teaching hospital setting. My point was that it would be very helpful for traveling divers to have a reliable and easily accessible list of operating hyperbaric chambers who will treat DCS, including location, contact info., operating times, type of chambers, and reviews from previous patients when available.

 

[tursiops]

My point was that it would be very helpful for traveling divers to have a reliable and easily accessible list of operating hyperbaric chambers, including location, contact info., operating times, type of chambers, and reviews from previous patients when available.

How would you propose to do this?
Does not DAN do a (say) 99% job, and you got caught in the 1%? (Sorry for you....condolences.)
The cost and effort to get from 99% to 99.5% is usually enormous.

 

[diverdoug1]

DAN does not publish this as a resource that I am aware of. It would be great if they did. Any time a family member is travel diving out of the country, I now call medical centers nearest to where they are diving and get info on the local chambers. Since I am a physician with hyperbaric subspecialty training, this is not too onerous a task to navigate. I don't think this would work logistically if large numbers of "civilian" divers were attempting to do this. Unfortunately, treatment of DCS injury (or even 24 hour on call staffing) is not available or practical at many chambers. Many hyperbaric facilities make the lion's share of their money from non-emergent wound care.

 

[Johnoly]

.. operating times,.....

This is the WILD CARD,because DCS chamber treatment requires Properly certified staff who may only be 1 or 2 people at that facility. Almost Every facility doesn't have the budget to keep them on call. Even here in southeast florida, just one doctor on vacation can shut down that chamber's availability. And vacations, re-assignment and previous days worked can change week by week. So you calling in advance doesn't mean that staff changes in the last 24 hours>> took that chamber off-line. If you think you might get bent, never dive Christmas or New Year's eve.

 

[tursiops]

DAN does not publish this as a resource that I am aware of. It would be great if they did.

They explain that the constant changes makes a static list not workable. They think it is better to get your call and then they only have to update the info for a small number of sites near you, instead of constantly trying to update everything everywhere.

Any time a family member is travel diving out of the country, I now call medical centers nearest to where they are diving and get info on the local chambers. Since I am a physician with hyperbaric subspecialty training, this is not too onerous a task to navigate.

Good on you.

I don't think this would work logistically if large numbers of "civilian" divers were attempting to do this. Unfortunately, treatment of DCS injury (or even 24 hour on call staffing) is not available or practical at many chambers. Many hyperbaric facilities make the lion's share of their money from non-emergent wound care.

Exactly.
So, even if we agree with you, how would something better than what DAN does work?

 

[Wallowa]

I am late to the party....but I have been beating the drum for a long time simply asking DAN or UHMS to publish a listing of known appropriate diver treatment hyperbaric chambers....specifically 6ATA chambers and not just 2ATA pulmonary/burn/sepsis chambers..

Give locations and contact information....without this with a serious AGE or DCS you are screwed....leave verification of status to the divers; unless DAN would create an online status site. Divers are the ones with skin in the game and not DAN, so I doubt if DAN will step up.

Are they operational? Yes, time is of the essence but no or inappropriate treatment is catastrophic.... Contact them periodically to determine there operational status and incorporate this verification into your emergency plan.

I get it, this about $$$ and effort and treating divers is a miniscule fraction of health corporate income.

Lots of rationalization why "you can't get there from here"..... may not matter unless it is you who needs the correct chamber treatment.

 

[tursiops]

Lots of rationalization why "you can't get there from here"..... may not matter unless it is you who needs the correct chamber treatment.

So do it yourself. Why rely on others?
How would you propose this be done in a sustainable and affordable way?

 

[diverdoug1]

So do it yourself. Why rely on others?
How would you propose this be done in a sustainable and affordable way?

I would start with asking DAN and other dive insurance to publish the chambers that were used for any of the cases they paid out on for DCS treatment each year and include all data known regarding each chamber, also each DAN case should send correspondence or links sent to each treated diver for participation in a DCS ‘chap book”, to add anecdotal info regarding their treatment. Payment issues (is a credit card with x$ available requested before treatment?, will they try to keep you for a neuro exam but the Neurologist won’t be on island for 2 weeks?). That kind of thing. Even as a hyperbaric specialist, I think I would have been much better prepared for my own DCS journey as a patient abroad if I had access to such a resource.