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

[Wallowa]

I should make a comment on this specifically to the USN table 4 and 6 but before that I have worked with DAN on a number of hyperbaric chamber installations projects, chamber designs installations, fabrications and certification projects over the years. The senior vice President for safety for DAN is I think someone who can help you. I can give you his name and email contact if you like on private email within this forum if it helps. He should be able to help you better privately than we can with an open discussion on an open forum.

DAN safety signs off of each installation before "adopting" the chamber for DAN diver insurance treatments and my experience with them for each installation has been excellent and although each job has been very different ranging from for example a medical hospital multi place 12 man hyperbaric chamber for the DDRC Plymouth UK a 250MSW saturation system to the more diver oriented 100msw 4 man divers chamber within Larnica Hospital Cyprus to those typical 4 man 50 MSW small divers (deck decompression chambers) in Jamaica and Trinidad.
Further 120MSW Deck decompression chambers for the deep water HMS Dasher expedition and the HMS Exmouth. All the way down to on site on deck treatments. Then the inexpensive (small car cost) Portable or Transportable 55MSW rated two man chambers on site on deck or below deck for private vessel applications all the way back up to the private Yacht market. DAN have been excellent in my estimation however I deal purely with the engineering aspects and mechanical requirements

While I'm certainly not trying to sell you your own chamber but as a diver one interesting aspect of your required but unavailable 165 FSW treatment has been an increasing alternative treatment option of using a 50/50 heliox mix on the BIBS the COMEX 30 Table (modified with a negative bias tracking regulator for it to work at depth ) at a more manageable 30MSW depth and with a TTUP of around 7 hours it has proven to be most effective solution for these serous deterioration situations even after commencing a Table 6 provided you have a suitable rated pressure vessel and Heliox. The tender is on air and both go on oxygen at the shallow treatment depth during accent together with the standard 5 minute air breaks for tea and biscuits. It uses around a single 50L cylinder of 50/50 so 3 cylinders to cover. Now compare that 7 hour spell by contrast to the US Navy Table 4 a mind numbing experience of spending the next 36 hours in a chamber and running out of tea bags and a pot to pee in half way through. Take the glory any day over the pain.

Hi Iain,

Great down load of information! Alternatives to standard Navy treatment tables are becoming more and more effective...what you describe at what 4ATAs does the job but is attendant and equipment dependent as well finding a chamber that goes to 4 ATA.

Finally a cogent discussion of issues and alternatives and actionable information, thanks!

Do DM the contact information for the VP at DAN...appreciate that.

 

[iain/hsm]

Hi Iain,

Great down load of information! Alternatives to standard Navy treatment tables are becoming more and more effective...what you describe at what 4ATAs does the job but is attendant and equipment dependent as well finding a chamber that goes to 4 ATA.

Finally a cogent discussion of issues and alternatives and actionable information, thanks!

Do DM the contact information for the VP at DAN...appreciate that.

I guess we all have to be serious about stuff at some point and this subject is as serious as it gets in diving But I haven't finished yet so to be on the safe side don't hold your breathe I don't go off Brit style.
Ive enclosed a DHM Treatment chart of various treatment tables below in a pdf you may find interesting

 

[iain/hsm]

Problem is most diving destination outside the US will not have anyone to run a chamber full time.

Maybe I should offer a contentious option here regarding chamber operations in general.
But the difference between a medical hyperbaric treatment chamber and a divers decompression chamber is as good a starting point as any.

As divers there is nothing stopping any of us manning and running a chamber for divers recompression treatments.

1. A Chamber Operators Course is a one to two day course and about as easy as filling a cylinder just with more care a little slower and not quite as much pressure on the outside. While in the Inside like being inside a washing machine without the spin cycle.

2. Next would be a Diver Medics Course about a 10 day to two weeks course and again not difficult with possible exception of Intubation Extubation discussions and the inevitable panic caused among your fellow divers when discussing fitting a catheter inside the chamber and after looking at the length of the thing and the concept of its use slowly dawns on you. The panic starts when the instructor looks at you when asking for a volunteer.

Now you have a chamber operator on the outside and a diver medic who could be either be out or in depending on the chamber type (twin lock) and the treatment choice.

3. The other ideal set up would be a chamber attendant or tender inside the chamber and this could be the Diver Medic for any medical intervention or the tender depending on the set up and the seriousness of the divers condition. And an engineering Go-fa.

On the HMS Exmouth dives they had one of our 120MSW chambers on deck more for gear testing and deep rebreather dry dives and testing small gear items at depth inside a bucket of water. The Exmouth sits around 60 to 70 MSW

On one of the dives after all the divers left surface I was sitting in the wheelhouse drinking tea
when out the window a divers head pops up complete unannounced and most defiantly unscheduled
Omitted decompression up from 70 MSW it can go pear shape very badly very quickly

By the time the deck crew had the chap on deck less than 3 minutes and I had the inner lock blown down to depth and the outer door open awaiting his arrival and he was down to depth and on oxygen BIBS before the tea had gone cold. Outcome nothing no residual problems. And in this case 50/50 heliox and 30MSW was not required but was available at the turn of a valve so it was a relatively simple event. Good

Now compare this to the alternative option of calling the Coast Guard waiting for a helicopter and a trip from Wick in the Moray Firth to the nearest chamber in Aberdeen. Not so Good.

HMS Exmouth (H02) - Wikipedia

en.wikipedia.org

The lesson I learned was many years before when I was a commercial offshore diver out in the North Sea on a pipeline inspection job from the West Sole platform to the North Sea Easington Gas Terminal
Two divers 30 MSW on scuba I was standby diver and my first witness of an omitted decompression incident for real. So by the book a US Navy Table 4 was called and 36 hours on a freezing deck teaches a strong message one you never forget to Never to do that junk again and find an alternative treatment table or stick to offshore sat system work .

The reason for all this junk above is an attempt to install a hard memory by which you will realise that you need to take full responsibility for the consequences of your own actions.
You need to be fully aware of the possible outcomes and the cost involved of not being able to resolve the situation. And to give this junk full consideration and attention as it gets worse as we go on.

 

[diverdoug1]

I wonder if you guys have really even tried to get the information you seek. For example, UHMS publishes 10 pages of names, addresses, and phone numbers of UHMS ACCREDITED HYPERBARIC MEDICINE FACILITIES.

I am a member of UHMS. Being a Google keyboard warrior just does not cut the mustard here. This list is not really very useful for international travel divers. There are relatively few UHMS accredited centers outside the United States. If you limit your diving to areas where initial treatment is quickly available in a chamber capable of providing a 6a treatment table, you will have very limited options for travel diving. If you are diving in an unfamiliar remote location and a diver ends up possibly needing HBOT, it sure would be nice to know what direction to steer the pointy end of the boat! Heading for nearest land or the closest aid station is NOT always the prudent course of action. Now while dealing with a ****** satellite phone connection, trying to contact Duke, despite appropriate pre-hospital first aid and supplemental oxygen the diver’s symptoms are not resolving You don’t have the contact info. for the chamber to find out there won’t be staff for 2 days So you finally get to the ‘aid station” you were directed to set course to and they tell you that you will have to be transferred to another island that you bypassed on the way to this one, The local nurse will not ‘discharge’ you for emergency transport until the local doc can be found and come take a wallet biopsy, Fast forward to next day for the air transport to the island that you bypassed and should have pointed your boat at originally, Then treatment is delayed because the “hospital” does not care for your credit card company and the “hospital ‘ accountant wants to haggle with your dive insurance company! Yeah, quite the run on sentence, that is what it seems like when an emergency is coming down around you! OR, you can be prepared with a plan! You have a list of closest HBOT facilities in the region of travel that have been providing treatment for DCI in the past year, maybe you have prepared a list of emergency care centers near these facilities which can evaluate DCI and get you quickly to HBOT if needed. Maybe even investigate what payment options might be required up front. If you are armed with a list of recently functioning centers providing HBOT for DCI (even lowly 3 ATA chambers), you have the option of being prepared as possible. Now you have a better idea which way the pointy end of the boat needs to be pointing! The Boy Scout and Cave Diver in me certainly knows which option sounds better. I’m a “learn to pack your own parachute” kind of guy. Regarding the argument that a list of chambers that have recently been providing HBOT for DCI should be privileged information because of fears that injured divers will be showing up prior to evaluation………..should we keep the location of surgery centers secret for fear that patients will be showing up at them for hip replacements prior to evaluation by an Orthopedic Surgeon? Should we hide the endoscopy centers so that we don’t have a line of patients at the door waiting for a colonoscopy without a bowel prep? Seems to me it would be better to share any available information on chamber operations and let divers traveling to BFE have the option of preparing as much as possible for DCI requiring HBOT. Keeping our heads in the sand and kissing it all up to God and the chance of reaching a technician in the moment, half way around the world in North Carolina, hopefully having the info you desperately need and have not had the chance to confirm yourself does not seem to be the best way to handle things

 

[Wallowa]

OK good news!

In contact with Virginia Mason hyperbaric chamber folks and yes they can treat to 6 ATA...here is what he sent and I have requested other follow-up information. Will let folks know what their protocols for accepting injured divers and treatment are as I learn them.

"Yes, our chamber at Virginia Mason Center for Hyperbaric Medicine does have a maximum depth of 165'. We are equipped with 50/50 Nitrox for use during a US Navy Treatment Table 6A."

 

[rjack321]

Perhaps the best chamber to treat injured divers on west coast is missing....USC Catalina... USC Catalina Hyperbaric Chamber - USC Catalina Hyperbaric Chamber they are top tier treatment of all DCI levels of injury....the list is incomplete and missing what we need the most, identified and correct diver treatment chambers.

Instead of angrily claiming the list is incomplete, you could instead recognize that the USC facility isn't actually UHMS accredited.

OK good news!

In contact with Virginia Mason hyperbaric chamber folks and yes they can treat to 6 ATA...here is what he sent and I have requested other follow-up information. Will let folks know what their protocols for accepting injured divers and treatment are as I learn them.

"Yes, our chamber at Virginia Mason Center for Hyperbaric Medicine does have a maximum depth of 165'. We are equipped with 50/50 Nitrox for use during a US Navy Treatment Table 6A."

If you actually dove or trained anywhere around here, you'd know this already. It's discussed in every rescue course in Washington. And if you are on a boat in Neah Bay (or anywhere on Vancouver Island) with a complex case you're still completely effed.

 

[Wallowa]

Instead of angrily claiming the list is incomplete, you could instead recognize that the USC facility isn't actually UHMS accredited.

If you actually dove or trained anywhere around here, you'd know this already. It's discussed in every rescue course in Washington. And if you are on a boat in Neah Bay (or anywhere on Vancouver Island) with a complex case you're still completely effed.

Jack,

Where do you get that I am angry that the UHMS list presented as potential diver treatment facilities omitted the most active treatment chamber on the west coast? Not angry just pointing out that the UHMS list is geared almost exclusively toward "wound" hyperbaric treatments and not diver treatments. It is not there to serve divers. As for lacking UHMS accreditation? Why would that matter? Or are you implying that the Catalina chamber is below UHMS standards of care since they lack their accreditation? Good grief.

I think you wanted to ask me if I have every dived in the Sound or on Vancouver Island....yup lots of dives on Gulf, San Juans, Bainbridge Islands, along the East coast of Vancouver Island up to and including Port Hardy, Desolation Sound, Lund and various Puget Sound sites....but what is the point?

"completely effed"? Why? Transportation? Do not know what transportation is available in Canada to the chamber but assume USCG in US waters will get there quickly and either boat you or helicopter you to the chamber. Canada does not have the equivalent of our USCG? No knowledge of what they have.

Not wanting to keep reiterating that all I am asking for is a listing of diver treatment chambers.

Not burn, or sepsis or COPD/pulmonary treatments but actual chambers capable of treating divers with what you phrased as "complex" cases. Not a hard concept to understand.

 

[diverdoug1]

Canada does not have the equivalent of our USCG? No knowledge of what they have.

If they are still using the CH-124 Sea Kings they had 2 years ago, I would take my chances in waiting for the boat to return! No, no, no, nothing even close to our USCG!

 

[Wallowa]

If they are still using the CH-124 Sea Kings they had 2 years ago, I would take my chances in waiting for the boat to return! No, no, no, nothing even close to our USCG!

Doug,

Is that due to maintenance or crew skill? Across all of Canada? As I recall there were used by USCG in '80s... we ran quick response rescue drills with the USCG and cool thing was they could set down on the water where we could slide the Miller board with attached 'victim' directly into the copter. Heard post flight maintenance after landing on water was very long....

Sikorsky CH-124 Sea King - Wikipedia

en.wikipedia.org

Correction this was we had and the Canadian CH-124 was patterned after...

Sikorsky SH-3 Sea King - Wikipedia

en.wikipedia.org

 

[diverdoug1]

News reports all mentioned air frame age and maintenance. I have no info on crew skill other than my cousin who was one of the RCAF Snowbirds. He might be a little biased!