dive buddy got bent

[diverrex]

This may not be correct, I'm sure a few posters here would know for sure, but I remember hearing once that in LA Country EMS has been instructed to take dive accidents straight to the Chamber, not the emergency room, exactly to avoid the experience of the OP and to get to someone sooner who knows about treating dive accidents.

 

[bamamedic]

I kind of hope that's not the case, unless they know, without a shadow of a doubt, that there is an appropriately trained MD immediately available, the chamber team is ready to go, there is no other patient in the chamber, etc, etc. Kind of a hard thing to know for sure during a 15 min transport...I'd probably be too busy with patient care to make the countless phone calls needed to coordinate that from the back of an ambulance.

For the vast majority of EMS responders, it's best to take the patient to the closest appropriate ED...then worry about transport to the chamber when they are stable.

 

[jimmy71]

I just wanted to post an update because this is not DAN's forum nor do i expect for them to defend themselves here. I presented one side of the story (mine) and i feel like it is only fair that i present any of their side as i know it. I know if i read this about someone else i would question my relationship with DAN and what services they will/will not provide. They contacted me and her for followup today.

some comments that DAN made that i felt were interesting. The hospital I transported to was the hospital that the shop had previously transport sick divers to for DCS. The dive shop had an emergency plan in place including preprinted directions, phone number and has dealt with the hospital before with such situations. The hospital was the first person we contacted once we realized she had a problem. Since we would be on the road for 30min+ without cellphone service, i asked the shop to contact DAN on our behalf and update them on the situation. DAN had contacted us while we were driving and did make changes and advice on how I was treating her which we followed.

DAN voice concern about this as they wanted/requested to contacted first. They said that the hospital you HAVE gone to is not always the hospital you SHOULD go to. They also said that they do/will triage over the phone and this allows them to contact the ER directly and that their lists are dynamic. They stated that they wanted to determine how and where a patient is transported to, even if this meant that transport is delayed. This surprised me. Obviously if the patient is not breathing exc call 911.

They also tried to contact (I assume after I requested) the HBO doc on call (and the ones DAN told us we needed to see) for the hospital we were at. The answering service refused to page them for DAN. They left it at that. They did not try to contact the ED.

I spoke to the DAN medical coordinator who was doing a routine follow up as he was unaware of the issues we had. He has since requested we contact the medical director of the HBO department (who was also the doc on call) and let her know our story. We have not decided if we will or will not.

We did get a call from a HBO doc in our hometown that we had contacted for follow up. He was unhappy with the story and also said that just from her initial symptoms that we should have been in the chamber upon arrival to the ED.

The director of DAN said that he is going to sit down and review this case as he now aware of it. He also said that the system failed but he does not necessarily know why/where or what can be done differently. He was genuinely interested/concerned on how to prevent this from happening in the future.

I am going to return my previous post so that people can make their own judgments. I do not want to bash DAN unfairly or taint peoples views of an organization that has done a lot for diving. What I do want people to know is that the back up plans and emergency procedures you have in place may not be what you think they are. We all know what you do if someone is bent to a life threatening degree (call 911). We also know what to do if you are not bent (drink beer with the crew). What is much harder and more likely to happen is to be a "little bent." I have to say from personal experience that this situation is much harder to deal with.

If you have any questions about my posts please PM me as I am not reading this thread, just posting any updates on outcomes to provide more information and to give DAN's side of the story as i understand it.

 

[jimmy71]

looks like i can not edit my orig post so here it is as it was (though i would like to add some paragraphs as a previous poster recommended)

It is sort of a long story and one that i feel bad about enough already. My long time dive buddy is also my long time girlfriend. She lets me handle all the technical aspects of the diving. I take care of the gear and is usually the person educating/reminding her about any risk and such. End result is that there was no uncontrolled assent or radical deviation from the planned dive. We could have been safer. If you want to exact details I am happy to supply them. Her computer acted screwy the night before and we decided to ignore it and have both of us "dive my computer." A mistake I know. I tried to increase our safety by tripling our safety stop and adding nitrox into the dive but not the N2 calculations. I also believe that dehydration and altitude play a big part in this. I am not bent. We dove the same dive.

My real question/discussion with what/how we were handled after we realized there was a problem. The dive shop i was with was stellar. I can not say enough good things about them. She had mild DCS that consisted as mod-mod severe shoulder pain, Nausea (without vomiting), and rash/itching on her chest. All the symptoms promptly resolved within 5 mins of 100% o2. We than placed her on 100% and transported her to the nearest hospital equipped and trained for DCS. This hospital is 1hr 45min away. We are both medical and trained in BLS/ACLS/PALS. I have advanced airway management training have no trouble giving O2. I do not question our decision on how we transported her. The dive shop contacted the hospital to notify them of the situation and of our ETA. They also contacted DAN to inform them as well as most of our trip is out of cell phone range. DAN contacted us via phone en route and gave us a couple names of MDs that were qualified in HBO treatment, advising us that often ER docs are not trained in such things. Wonderful info to have. The ER than contacted us and had me advise them of her condition. Perfect.

She was asymptomatic during the transport but was never off O2. When we arrived at the hospital were were triaged by the ER staff (RNs), because she was asymptomatic on O2 she was placed on the bottom of the list. I did request a NRB and an O2 tank as during all this time she was breathing through a reg. We sat in the ER for 2.5 HOURS and was still not seen my an MD. I contacted DAN at hr 1 and asked if they had contacted one of the MDs who's names they had given me. DAN informed me that they could/would not do that and it was the responsibility of the ER MD to do that after their assessment. I informed them that we had not currently been seen MD. They voiced that that troubled them but stated there was little they could do. I asked if they had spoken with the hospital we transported to on their recommendations and the answer was no.

I made a call to DAN after approx every hr of wait time in the ER. I also tried to contact the MDs DAN had told us about and was shut down by there answering service. One of them was on call but they do not page them for patients. It has to be at the request of someone higher up the food chain than us. I asked DAN to call them on my behalf but they stated they could not. If those doctors were aware of our presence in the ER i will never know. At the 4 hr mark of 02 administration, we personally made the decision to d/c it. Our thought process was that we were going to soon be leaving this ER and we needed to know her condition. It was at this time that I also indicated to the ER staff that we would be leaving shortly. They told me that there was an ER doc who was a diver who wanted to see her but would they had no beds available. I asked when that might be and there were unable to answer so we continued our plan. 15 min later we saw a doc in the waiting room who listen to her lungs (no neuro) and our dive profiles. She informed us that the real problem with DCS is AGE and that my buddy was probably fine. She said she wanted to find out who were the HBO docs at the hospital talk to them. I told her their names and gave them the phone number to their answering service. I even let her know which one was on-call that night.

At about 30 min off O2 my buddy had an ache return to her shoulders but no other symptoms. When we placed he back on O2 the symptoms did not resolve. They ache never escalated like it had before. At an hour after the MD had seen and never seeing anyone again, us we decided to leave to hospital. I do not know if she was ever able to speak with anyone. Guess I never will.

We went home off O2. We had plenty with us to make it through the night if any problems returned with any altitude changes on the drive home. The next morning she had no shoulder pain or residual signs. We looked in our yellow pages and made an appointment with a HBO doc whos website says he deals with divers The earliest his secretary could get us an appointment is this Thursday (7/29/10). We also called DAN and asked them who they recommended she see. They only had 1 MD listed in our area and it was not the person we spoke with. We left a message on his voice mail and have still not heard from them. She was bent on 7/25/10.

I thought I had DAN insurance for 2 reasons. One was to pay for accidents. The more important thing was to help us navigate the system. They have done nothing to help us in the system which makes me very sad. When I get into a wreck and contact "OnStar," they do not tell me the phone numbers of the ambulance and police and tell me good luck. This is what DAN did. I have no weight, leverage, or ability to enter that hospital as anyone other than man next to us who "felt dehydrated." I thought that is what DAN can do. What does a call to DAN do? It did nothing to change or help our treatment. I hope I am able to find a better insurance because this is not what I wanted. I guess it is somewhat fortunate but unfortunate that I will probably how have a phone number for a MD that will be able to help me in an emergency. His job can be nothing more than to let people know I need help. No one was able to do that for me when I needed it.

Sorry for the long email. I just wanted to be thorough.

 

[Couv]

OK, in light of post #93 I guess I owe DAN an apology. As I understood (or misunderstood) that DAN had taken almost no action, when in fact they attempted to contact the cognizant HBO doctor.

I stand corrected; DAN did not drop the ball, and fair dues to them for looking into the issue.

Jimmy, I hope your GF fully recovers; please update us on her condition.

Couv

 

[bsee65]

Maybe DAN didn't "drop the ball", but they acknowledge that the system failed. At some level, at least, it sounds like DAN agreed that the expectations of the OP were not unreasonable in terms of the outcome he was expecting.

Looking at the whole of the incident, it would seem the hospital was the biggest impediment to a positive outcome. As such, I can't understand why someone who was willing to come discuss it here isn't willing to contact the senior person at the hospital where the problem occurred.

 

[pwr2al4]

Jimmy, sorry to hear about your situation, happy to hear that your girl is doing better.

My question may sound a little strange but its only because I am in the same boat so to speak and wonder if what happened to you (Traige in the ER, the unacceptable wait etc.) could be handled some other way to be avoided in the future.

I noticed you said you have BLS/ACLS/PALS, Im assuming Medic/Rn or better? I have the same as well and am an instructor among other things. I mean no disrespect whatsoever, With your scope of training as a healthcare provider, not to mention the fact that you were literally on scene and involved, how the heck did get stuck with a ridiculous ER wait in a situation like this? If this was a simple airway obstruction or partial drowning w/o LOC, bad case of the flu, simple fracture etc. I can understand sitting in the ER and checking vitals and a NRB w/ O2. BUT POSSIBLE DCS? I would of been raising holy ****ing hell. Did you identify yourself to the nurse in any way at all? They must of understood what DCS is right, how the hell did they not get her a bed and start doing their thing. plus no neuro consult?

If an ER/ ER doctor is acting as your med director on the trip in, and her current treatment is whithin your scope of practice than as far as im concerned its your show up to and including the handoff which would be directly to the doc. If the doc isnt around then so be it but shes arriving as a priority .. If anyone started giving me any static about any of that up until that point then I would voice my concerns over the fact that legally she was under your care until handed off properly just like any other patient, (at which point I would again make it clear about where I'd like her to end up) and also that if you were essentially in contact with med. direction on the trip in, updating her condition and advising them or seeking permission for treatment, then the doc and ED also has a responsibility to continue care otherwise there would be abandonment issues unless handed off to another ER staffer
(WHETHER OR NOT I ACTUALLY THOUGHT THIS WAS ALL TRUE WHICH OF COURSE IT ISNT), Surely it seems like they could of made a hell of a lot more effort based simply on your word alone along with intial signs and symptoms regardless if she was currently asymptomatic or not.