Chambers And Insurance

[Kevrumbo]

. . .

Now, the biggest question I have isn't about individuals taking a recompression chamber, but about commercial diving outfits, with live-aboard boats, being so outfitted, or facilities at known diving destinations being so outfitted. That cost could be written off as a business expense, and be situated at the dive location.

SeaRat

For our 2013 Bikini Atoll Expedition, the liveaboard M/V Windward had an onboard multiplace Recompression Chamber (click link & scroll down in pdf):

http://www.petemesley.com/cms-assets/documents/172274-7207.bikini-main-info-2014.pdf

Otherwise, it's US Coast Guard or Air Force medevac flight from the airstrip on Bikini to Kwajalein, and then to Honolulu Kuakini Medical Center Hyperbaric Facility: roughly 2800 miles and maybe 5 to 7 hours flight just for this travel leg. (So you're looking at a potential total elapsed time of well over twelve hours getting a patient evacuated from Bikini Atoll).

 

[Kevrumbo]

You divers in North Florida should seriously consider organizing to get one of these, and specifically operated for the management of dive accident victims only 24/7 365:

Hyperbaric Clearinghouse Hyperbaric Chamber used

And this is your model how to run and fund it as a non-profit with corporate, state/county, University, diver donation and volunteer sponsorship:

How the Chamber is Funded > USC Catalina Hyperbaric Chamber > USC Dana and David Dornsife College of Letters, Arts and Sciences

 

[Jack Hammer]

In the 50s, a lot of deco schedules weren't well vetted. Ascent rates weren't as well understood. Mixed gases weren't used much. Scuba in general wasnt as common or accessible as it is now nor was the information about it. Modern technical divers have the benefit of decades of fine tuning of deco algorithms, access to information, training, and relatively reliable software to plan the types of dives people like JYC were pioneering. Chambers are still needed for divers, just not as frequently as they were decades ago.

 

[TONY CHANEY]

Every dive site has a chamber...it is call the water. Just joking so please turn the flame throwers off. You can really get deep into this subject matter rather fast. 1) technology has advanced to the point that it does not happen that often. Hospitals are closing them down because most are used just for wound care. 2) Expense of the chamber. 3) staffing the chamber with personnel certified...more money. 4) Lawsuits, lawsuits and more lawsuits! You can bet your bottom dollar that unless the diver is returned to perfect condition someone is getting sued. 5) will the insurance companies pay for the treatment? etc, etc.

When diving at a remote site, how many dive masters set up diver evacuation procedures in advance?

A very good suggestion was made concerning remote dive sites in cave country. Some of the sites have a sign posted with emergency info to include the GPS numbers that add in the emergency response team members locating you or the victim. i.e. Cow system. For first time divers we all point out the sign to them. Also, at the level technical diving, today almost every diver has passed their Rescue Diver course.

 

[Bob DBF]

Every dive site has a chamber...it is call the water. Just joking...

With the lack of chambers now, it may make a comeback.


Bob

 

[JohnnyC]

Every dive site has a chamber...it is call the water.

No need to kid. I know the case study linked below is old but that doesn't make it any less valid. It's definitely an option, and tables for Australian and Hawaiian and Navy methods can be found online. Easier with a rebreather, but a couple extra 80's full of O2 and a FFM isn't that much of a burden to keep around. Chances are if you're in cave country you've got a truck full of dive gear already, and on a boat it's not too much to ask for boat ops to keep a couple tanks of O2.

Pyle & Youngblood IWR Case Study

 

[Kevrumbo]

A sobering analysis from Duke Dive Medicine on the general "draconian" standard of care for dive accident victims: Recompression And Medical Ethics

A good analysis above, which explains the problem but doesn't offer any solutions at all (status quo --"It is what it is. . .")

Still though, even eighty-three-hundred miles away from you, Truk Lagoon has what can be considered a level 5 trauma facility and has a privately run multiplace Recompression Chamber on-call that can also readily treat emergent DCS cases. They have phone consultation with a Hyperbaric Physician (Dr. Glen Hawkins) -in Sydney Australia over 3200 miles away- when they run their HBOT Table 6. In addition to the paid Chamber Operator/Facility Director, there are now volunteer/relief chamber stand-by operator crews, trained personnel whose day jobs are at the major Dive Operations (Truk Lagoon Dive Center, Truk Odyssey Liveaboard etc), ensuring that the facility can still be up and running at a moment's notice even with the Director away off-island.

If they can train the necessary Basic Life Support personnel to make at least a level 5 trauma facility for acute DCS/AGE care & treatment, and make this system viable in a remote poor central pacific region like Chuuk Micronesia, why can’t y’all do the same in North Florida USA?

Again, it's up to you divers out there to generate grass roots support, along with some state & local corporate sponsorship (Dive Rite, Halcyon, Univ of Florida -etc) to set-up a non-profit emergency HBOT Diver's only facility out there in Cave Country. Or at least have some form of organized rotating 24/7 Recompression Chamber coverage amongst the private operators in the immediate region. Recruit and train volunteer Chamber Crews, rotate them in 24/7 stand-by with tacit cooperation & use of facilities from the local private chamber operators.

Work out the legalities and make this happen. . . !

 

[kensuf]

If they can train the necessary Basic Life Support personnel to make at least a level 5 trauma facility for acute DCS/AGE care & treatment, and make this system viable in a remote poor central pacific region like Chuuk Micronesia, why can’t y’all do the same in North Florida USA?

Again, it's up to you divers out there to generate grass roots support, along with some state & local corporate sponsorship (Dive Rite, Halcyon, Univ of Florida -etc) to set-up a non-profit emergency HBOT Diver's only facility out there in Cave Country. Or at least have some form of organized rotating 24/7 Recompression Chamber coverage amongst the private operators in the immediate region. Recruit and train volunteer Chamber Crews, rotate them in 24/7 stand-by with tacit cooperation & use of facilities from the local private chamber operators.

Work out the legalities and make this happen. . . !

My smarmy answer is "have you visited North Florida?"

But you have some good food for thought.

 

[Kevrumbo]

Depending on the type of chamber, an inside attendant may not be required. Monoplace chambers hold only one person, the patient, and are generally reserve for less acutely ill patients, though some facilities treat critically ill, intubated patients in them. Multiplace chambers like the one at Duke hold more than one person; patients are accompanied by at least one attendant (not necessarily a physician, often an RN, paramedic or EMT), who will place the oxygen apparatus on the patient and intervene in emergencies.

The standard of care for hyperbaric oxygen therapy in the U.S. is that a physician must be present or immediately available during the treatment, so remote supervision, telemedicine and automated chambers would not meet that.

Best regards,
DDM
----------------
www.dukedivemedicine.org
http://hyperbaric.mc.duke.edu/

Information provided is for educational purposes only, is not intended to replace the advice of your own health care practitioner, and should not be construed as a practitioner/patient relationship. Duke Dive Medicine does not condone the placement of "Skimwords" advertisements and does not endorse any of the products or services advertised.
Duke Dive Medicine, Today at 11:43 AM Report

DDM that's not quite correct. . . !

DAN Insurance confers for simple type I DCS, a table 6 HBOT can be initiated by a trained multiplace Chamber Crew with remote telephone consultation from a Hyperbaric Physician Specialist (again, at the Truk Lagoon Recompression Chamber above and in my case, direction & tacit approvals were given by Glen Hawkins MD in Australia by phone).

An Emergency Medicine Physician is physically in attendance at a multiplace chamber setting if the patient arrives acutely ill --unconscious or full arrest-- or goes into shock for example during HBOT treatment (in which the ER Doctor is pressurized in a separate lock chamber & then enters the patient's treatment chamber). The Hyperbaric Physician can still be in remote teleconference communication in this instance as well.

At the USC/Los Angeles County Recompression Chamber on Catalina Island, the chamber crew & Baywatch Lifeguard Paramedics typically start the HBOT on an acute patient as the Emergency Medicine Physician, who also is a Hyperbaric Medicine Specialist, is helicoptered in from the mainland.

 

[Kevrumbo]

My smarmy answer is "have you visited North Florida?"

But you have some good food for thought.

Put another way: If at least attempting to establish a barely adequate logistical network of Recompression Chambers can be done over 3.2 million square miles of Oceania, on some of the best diving spots but poorest nations on the planet, why can't you North Florida Cave Divers work to establish a more reliable network to treat dive casualties over a much smaller area?

DAN and Duke Dive Medicine are not going do this for you --you're going to have to organize & do it all yourselves. . .