4,000 mile rescue - Chuuk Atoll

[Wookie]

Hard to believe that even OSHA is that stupid… Oh wait, strike that.

I wouldn’t think any torpedo chamber would be acceptable by insurance companies or ACDI for any offshore commercial diving operations. Is this more for projects like filming or science?

You are correct, sir. ADCI cards are for commercial divers who actually inspect or construct things, showing an accredited education. There are lots of commercial divers out there who are filmers, researchers, mooring installation, (light moorings, like I might use), commercial spearfishermen, etc. who are giving lip service to OSHA or who need to meet a requirement in a procedure somewhere. There are a number of these chambers in Key West, one of them belonging to an underwater archeological organization who used to charter vessels of convenience. The government of whatever Adriatic sea country they were sailing from required a chamber onboard. Since they were hiring fishing vessels and the like, they choose to load a chamber that could be transported in 5 pelican cases.

Most DMT and medical chamber training tech organizations will not certify a chamber tech to operate these chambers. One of the primary rules of being a chamber tech (I know I'm not teaching you anything, but anyway) is to make sure the person in the chamber maintains an airway. It's pretty hard to do so in a monoplace chamber of any sort.

Again, these collapsable chambers are meant to tick a box, not actually do anything.

 

[finnks]

You are correct, sir. ADCI cards are for commercial divers who actually inspect or construct things, showing an accredited education. There are lots of commercial divers out there who are filmers, researchers, mooring installation, (light moorings, like I might use), commercial spearfishermen, etc. who are giving lip service to OSHA or who need to meet a requirement in a procedure somewhere. There are a number of these chambers in Key West, one of them belonging to an underwater archeological organization who used to charter vessels of convenience. The government of whatever Adriatic sea country they were sailing from required a chamber onboard. Since they were hiring fishing vessels and the like, they choose to load a chamber that could be transported in 5 pelican cases.

Most DMT and medical chamber training tech organizations will not certify a chamber tech to operate these chambers. One of the primary rules of being a chamber tech (I know I'm not teaching you anything, but anyway) is to make sure the person in the chamber maintains an airway. It's pretty hard to do so in a monoplace chamber of any sort.

Again, these collapsable chambers are meant to tick a box, not actually do anything.

You may not be teaching anything to Akimbo or to several of the other knowledgeable posters in this thread. However this curious vacation diver appreciates you taking time to share your knowledge. I had assumed these were a dry alternative to IWR. Now I'm getting the impression they are bureaucratically inspired high cost/low utility item.

Any thoughts on the REMO O2 rebreather units? Turned down offers to take operator classes as I don't see me ever being in a position to utilize such equipment. Seems to me that the O2 units on your typical dive boat or LDS are not properly maintained: insufficient pressure, malfunctioning regs, missing parts, dirty, etc. If people cannot maintain a simple tank, reg & face-mask delivery system - it is far too much to expect them to maintain a rebreather with functional scrubber material. Typical boat statement is not meant to apply to Wookie/Spree - my impression is that you run a tight ship.

 

[Wookie]

As a dry alternative to IWR, perhaps they have some value. IWR, (I am a firm believer in IWR if the circumstances warrant) has it's own problems, specifically the thermal problems as well as Oxygen toxicity issues.

I have no knowledge of the REMO system, aside from the fact that it exists. I prefer to carry multiple regulators and enough O2 to get 3 victims home on an 8 hour boat ride. There are few places I put divers in the water I can't get to real help in 8 hours. I assume no more than 3 victims. I have to assume something.

 

[Akimbo]

This is my take on IWR:

You are describing a situation where you must choose what sucks the least. What preparation and skills are available, how far is a chamber, and what are the symptoms?

Oxygen for decompression onboard, 500 miles from the nearest chamber or chopper to get you there, competent safety divers, and a mild joint pain? I'd be in the water sucking from the green bottle. Five miles offshore, CNS hit, inbound Coast Guard chopper, 20 miles from a hyperbaric hospital unit, onboard a typical sport diving half-day boat? I'd be lying down on deck patiently breathing Oxygen.

The problem is the huge variability between the two circumstances described above. DAN's recommendation is likely the least of the evils in most cases in the recreational setting. However, when you are the one at risk, I believe it is prudent to know more than memorizing a general recommendation rather than interpret it as a rule from God….

This is well worth reading:

Alert Diver | In-Water Recompression


Edit: Just to be clear, IWR is very limited compared to chamber treatment because of much lower partial pressures of O2, regardless of facilities and skills onboard.

Oxygen Toxicity Limits & Symptoms

 

[Wookie]

This is my take on IWR:



This is well worth reading:

Alert Diver | In-Water Recompression

We just sponsored a symposium in San Diego on IWR. We will get the procedings in about 6 months. I'll post them when they are available.

 

[Johnoly]

This is my take on IWR:

This is well worth reading:

Alert Diver | In-Water Recompression

Keep in mind that Alert Diver is a medical magazine dedicated to 100% unequivocal safety and they will never fully endorse IWR nor diving with great whites without a cage. It's up to the individual diver to read the research fully and make up their own mind even before they step one foot onboard a remote boat. I have 3 dive friends who have some form of paralysis from being bent (all undeserved right?).

Before I go on a remote trip, I have the IWR tables/procedures printed and in my dry bag with me. When help is far away, the diver needs to know how to save themselves (from any emergency). Divers carry lights, radios, SMB's, whistles, horns, mirrors, pony bottles, snorkels and chem sticks as tools for safety. IWR tables/procedures is just another tool for safety and like the others, know how to use it in advance even if you never have to.

 

[Akimbo]

Sounds like we are on the same page. The Alert Diver article I linked to did a realistic job of describing the challenges and what it takes to overcome some of them. Like I wrote, under the right circumstances “I'd be in the water sucking from the green bottle.”

I probably would not have dove Truk earlier this year if the chamber on the island were not operational.

 

[Kevrumbo]

For simple type I DCS, pain only in one limb or joint-space, IWR works. Caveats include having a dive tender at depth with you to monitor & assist if necessary for an Ox-tox event; and must have favorable sea/water state (manageable swell, waves & temperature) and weather. It all worked for me at remote Bikini Atoll last year, and I even resumed tech wreck diving later at Chuuk Lagoon for two more weeks with no further problems after a four-day recuperative break.

IWR as prescribed by UTD has optional 30, 60 or 90 min total treatment times at 9m breathing 100% O2, with 10 min on and 5 min air break. Slow 1m per 10min ascent with 5min air breaks every 10min, so ascent time from 9m would take around over 2hrs. Easy profile to remember.

As for the OP, note that Chuuk FSM has a Compact of Free Association with the US (with the use of Truk Lagoon as a potential future quick staging and back-up base for our inevitable war with China/N. Korea), so all the logistical/administrative infrastructure is there to handle such an operation -"Island hopping" from Oahu to Kwajalein; to Chuuk/Weno to pickup the patient, and finally arriving in Guam.

So there weren't any closer Air Force Transports at Andersen AFB in Guam available to perform the emergency Medevac?

 

[Strongdiver]

Diver is at Guam hospital but will be medivaced to Australia since the Navy Chamber staff do not feel they can treat him due to his meds. He was diving with a rEvo CCR and Shearwater computer, it was the 3rd day of his dive tour, and he had just dived 2 relatively "shallow" wrecks, the Heian and Kansho Maru. I have been asked to remove my Facebook post and I did, but it generated excellent discussions about US DAN insurance, versus insurance available to Guam residents, CNMI, Virgin Islands, Puerto Rico, etc . Our prayers go to him and his family.

---------- Post added May 23rd, 2014 at 11:11 PM ----------

Yes, the Care Jet brought a different patient who had been on a liveaboard. This was about 2 years ago. He recovered fully and went back to diving. He posted on my Facebook page to thank certain people and report that he was back to diving.

---------- Post added May 23rd, 2014 at 11:15 PM ----------

Thanks, DandyDon. I am starting to catch on.

 

[Cavediver.rob]

A couple points to clear up some misunderstandings, In the 4 1/2 years I have been working in Chuuuk (Truk Lagoon) the chamber has not been closed for refitting or any other reason. The times that patients have been Midivac'd out were due to them not being medically stable enough to the enter the chamber or involved other issues the made it more practical to move the patient to a medical center that offered more resources than Truk. This last incident is the same, a chamber operator was available and moved to the same hotel that the attending doctor was at to ensure the he could operate the chamber if needed. IWR is also not an option for unstable/unconscious patients. The chamber here in Truk is not manned 24/7 and does require some work to get people into position to operate it. There are no hyperbaric doctors in Truk, this is the main reason that serious cases need to be moved to Guam or Hawaii for proper treatment. There has been talk about moving the chamber to the hospital, unfortunately there is no way the physically move the chamber at the moment.