DCS treatment on a plane??

[Tom Smedley]

If you are lucky enough to be in a place where there is a chamber that is great. If you are in a place where the chamber is staffed 24 X 7 that is wonderful. If you are in a place where the chamber has a hyperbaric nurse or physician that will anwer the radio that is stupendous.

Otherwise the nearest ER can stabalize - hydrate - oxygenate - monitor neuros - provide pain relief etc etc until a medivac chopper can be generated to move the patient to a hyperbaric facility who is in turn generating the on-call crew to give up their Sunday afternoon golf game to man the chamber.

If you are a paramedic in communication with an operational chamber that is also great but the general public should go the the ER. BTW even F.G. Hall and Jo Ellen Smith are not manned 24 X 7.

BTW standard protocal everywhere I worked as a medic for the last twenty years is straight to the nearest chamber if someone tells you they have DCS.

I was asked to assist with a lady who passed away on an aircraft once. The crew was sensitive to both the patient's and the family's needs. I have nothing but the highest praise for their actions. Those folks are highly trained and are absoutely cool headed and fantastic in an emergency.

 

[Wildcard]

People think they know what paramedics do but usualy have no idea. Modern day ambulances are literaly rolling ERs. Back home (alaska home) we have to check with the hospital to see if there is a Doc there so whe can give needed treatments prior to turning care over to the nurses since that can't give treatments on there own. Not true everywhere but it is in a lot of rural places...I was thinking, I have transported three people that I rember with DCS, all from planes since I haven't worked as a medic neear the ocean or big dive spots. All three were Docs.
And finaly, I just wanted to check to see that I was right.


"DMT Program
The Association of Diving Contractors (ADC) recommends that every commercial diving operation include at least one Diving Medical Technician per shift.

Many Public Safety, Fire Department, and Law Enforcement Dive Rescue / Recovery organizations require advanced emergency medical personnel on-site during operations.

Updated regulations from OSHA require medically trained personnel on-site during operations. In many states, the OSHA regulations have been adopted for "Public Safety" divers.

The Cornerstone DMT curriculum is based in diving and gas physics review, medical diagnosis and treatment of diving related injuries along with hyperbaric chamber operations. It is a 40-hour course of intensive study to prepare the student for the position of Diver Medical Technician or Hyperbaric Chamber Operator. It is also an excellent introduction to hyperbaric medicine and chamber operations for physicians.

Individuals who currently possess a DMT certification will receive recertification credit for this program. Additionally, the DMT-Basic status will be upgraded to DMT-Advanced status for students who elect to attend the Advanced Medical Skills portion of the DMT program."

And the Paramedic program:
Paramedic Schools
The Paramedic is the highest level of education obtainable for working in the pre-hospital environment. Most ambulances are staffed with at least one paramedic and there must be a paramedic on the ambulance for it to be classified as a Mobile Intensive Care Unit(MICU). In order to be accepted for Paramedic training you must first be a certified Emergency Medical Technician. Courses are generally based on the U.S. Department of Transportation (DOT) guidelines for Paramedic Course curriculum. All 50 States possess a certification procedure. Course duration depends on the level of training, but the basic courses last a year and include a mixture of classroom, clinical and in-field training. Paramedic training at paramedic schools consists of, on average, 1000 hours of classroom education and 700 hours of clinical experience. Clinical experience includes rotations in: Emergency Rooms, Surgery, Labor and Delivery, Psychiatric Services, Pediatrics, and an Intership on an ambulance supervised by Paramedic preceptors. EMT's and paramedics should be emotionally stable, have good dexterity, agility, and physical coordination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with accurate color vision. To maintain certification, EMT's and paramedics must reregister, usually every 2 years. Advancement beyond the EMT-Paramedic level usually means leaving fieldwork. An EMT-Paramedic can become a supervisor, operations manager, administrative director, or executive director of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants, while others move into sales or marketing of emergency medical equipment.


Sorry but I get real profesionaly defensive when people "think" they are Paramedics.
Does a DMT know more about hyperbarics that the average Paramedic, probably.

 

[Tom Smedley]

I usually don't get involved in agency or DIR bashing - even though sometimes I'd like to. I do know (and this does not have anything to do with the original post) - however - what paramedics do. They are ONE layer in the health care system. An important one I agree.

You sparked my interest with your "portable ER." Please let me know where you are a paramedic so I can move there. Your vehicle has a CT Scan, X-Ray Department - Laboratory - Food Service - Board Certified Cardiologist - Neurosurgeon - Chest Man - Gas Passer - General Surgeon - Board Certified ER Doc with 12 years of education - Licensed Pharmacist - Fully stocked pharmacy - Nuclear Cameras - Intensive Care Unit - Geez I'm sure I forgot something. Echo lab to spot them elusive bubbles - and a drug salesman or two to bring in lunch.

To keep it in perspective with the orginal post - airline crews are well trained and respond to stressors and pressure well.

I just want to see your vehicle - that sucker must be over a mile long. And like Forest Gump "That's all I have to say about that."

 

[Tom Smedley]

I just knew it wouldn't end with this - My friend just called and chewed me out because I forgot Respiratory Therapy - Ah yes - But I did mention gas passers. And my booger doc friend called and said there are no ENTs in your message. He has 15 years of education - jeez I knew I should have stayed out of this - Oh gosh my phone is ringing again and it's my friend who is a urologist and his friend a nephrologist - and - Oh I give up - your vehicle just inherited a trailer. A proctologist - the list just goes on and on...... I know lots of absoutely wonderful paramedics as I know lots of absoutely great SCUBA instructors. The really good ones know they're good and they know they're important and - they're humble about what they do. I'll hush!

 

[Wildcard]

And are any of those present in an ER you arrogant @#$%. Nope, just in the rest of the hospital which all have to be called in which medics do by calling in and telling the ER what we have. BTW we DO have lab capabilities in some ambulances. Paramedics are the RT, MD, ENT, Pharm, lab, resp all rolled into one. Most anything you will get in the first ten to fifteen minutes, the life saving stuff is available in an MICU. Been to an ER lately? How long did it take to even see a medical professional? Like I said, MOST people don't have a clue.

 

[derwoodwithasherwood]

Bigjetdriver69's actual comment was "(sort of a paramedic plus some)". I didn't read it as a statement that he was more highly qualified than a paramedic, just a very rough analogy. Around here there's 3 levels of paramedic, the first having very basic qualifications in first aid, symptom relief, O2 therapy and SAED. At the other end of the scale, Level 3 medics and flight paramedics are highly trained and qualified -- I rather have one of them on scene at a bad accident than your average MD.

As for the ER analogy, I think it's a good one given the context it followed:

Otherwise the nearest ER can stabalize - hydrate - oxygenate - monitor neuros - provide pain relief etc etc until a medivac chopper can be generated to move the patient to a hyperbaric facility

I have to agree that a modern day ambulance can meet all those functions. Most don't have a CT scanner or a cafeteria, but then, neither do most Emergency Rooms. The scanner is often down the hall in the Diagnostic Imaging Department and the Cafeteria is in the basement.

BTW: The City of Toronto has a fleet of ambulance buses offering advanced pre-hospital care for mass casualty incidents. I'm sure other major cities have similar units: http://www.city.toronto.on.ca/ems/pdf_files/esu_5_1986_fact.pdf

 

[gkndivebum]

[...]BTW standard protocal everywhere I worked as a medic for the last twenty years is straight to the nearest chamber if someone tells you they have DCS.

You must have worked in a more enlightened place than where we live now.

Two stories about DCS and the Kona Community Hospital Emegerncy Department:

First case is a 50+ male dive instrcutor with joint pain following a series of deep(ish,
130 FSW) dives, on air and within the NDL. Reports to ED the next morning when
pain has not resolved. Physician on duty take dive history, and proclaims that
"you can't get bent on these profiles". Suggests that stress may be the root cause,
and offers a well-known erectile dysfunction drug to help with stress relief at home.
An argument ensued, a phone call was placed to DAN, and after some further
arguing over the telephone with DAN was sent to Honolulu for a table-6A ride.
No further symptoms.

Second case is a 30 male dive instructor with what turns out to be the worst case
of cutis marmorata that the Honolulu chamber has ever seen. Took TWO visits
to KCH ED before physician would even consult with DAN. This individual had an
undiagnosed PFO (since repaired, and he's back to instructing).


All of this said, things at the KCH ED are vaslty improved now. One of the new
physicians there holds a TDI Advanced Nitrox certification. She's a regular dive
buddy of mine, and the staff at the ED now knows to call her any time there's a
diving emergency. She moved to the island 6 months ago.

 

[firemedic296]

If you are a paramedic, you can't help getting a little stired when someone makes mention that they are sort of a paramedic. no, Bigjetdrivers statement didnt offend me, but I'm not a DMT, I don't know what DMT training consists of so I cant compare the two very accuratly. But I am a paramedic and what wildcard said is completely right. Tom your right you won't find any "ologist" in the back of an ambulance, but we are not ambulance drivers anymore it is an MICU and not in all cases but i'll bet you 100 to 1 that you can not get quicker life saving treamtent from an ER than you can in the back of an ambulance. now I said 100 to 1, there is too many variables to say that EMS is better than ER or vise versa, mainly due to call volume, experience. I took it that BIgjetdriver was saying that he can better understand a DCS situation than none diver pilots. this is suposed to be a message board for people post information to better help others, not to play a bashing game of someone's proffesion, so if you want to inlighten us on the abilities of the service you are accually familure than thats cool, but keep your mouth shut if you have never been in the back of an ambulance and I'm not talking about a staton tour, I'm talking about that 2am YOU make the life or death treatment decision for a patient and be willing to take responsability for any concequinces.

 

[BigJetDriver]

Folks,

I see that things have been going a bit wild since I've been gone. Perhaps I can present some explication.

(1) The DMT program set up at UTMB Galveston was aimed specifically at the "Oil Patch" medic group. The typical medic in that part of the profession has to be capable of everything from band-aid passing to minor surgery. He may have to either operate a chamber, or get in it to operate. In the field, he is the hands and eyes of a medical director who will be on the phone from an on-shore location.

I took the course, not because I want to work in the field, but because I tend to go off on re-breather expeditions to EBFE, and wanted to be able to take care of, and give life-suppport to an injured diver while we did l-o-o-o-n-g transports.

My hat is off to the Paramedics who do the work in the field. I would defer to them any day, unless they start talking nonsense when it comes to DCS.

(2) As others have noted here, most ER's have a problem with properly diagnosing and treating DCS cases, not because they are ignorant or uncaring. They are just simply not well-trained in the subject. This is a fault of the system, not the people. My heart-felt salute goes to the folks who give their best in our ER's. (My bod, however, goes straight to the chamber if I have a case of DCS. )

I hope this helps to explain my remarks. Sorry to have set off a furor, and then bailed out!!!!!

Cheers!

Rob Davie

 

[firemedic296]

Bigjetdriver, thanks for the info and not bashing somemore. how can someone go about getting DMT training or maybe what do you need before you can achive DMT. The DMT sounds interesting, I'll be glad to here from ya.