Oh, man, this is so complicated, I don't know where to start.
First off, it's been pointed out, and you acknowledge, that ER cases undergo a process called triage. We try desperately to identify the sickest patients and see them first. Clearly, by any criteria, your girlfriend met the "not sick" requirements -- she was awake and alert, with stable vital signs, no neurologic changes, and she was not getting worse. Therefore, she was likely to sit until she worked her way up the waiting list of stable patients.
Secondly, the physicians who work for DAN cannot see or examine your girlfriend. Their assistance is predicated on the valid information they get from medical professionals on the scene, who can evaluate the patient. DAN cannot call the ER and say, "Put this patient in a chamber," because they might well be wrong. DAN can help the ER doc figure out if the patient needs the chamber, and help expedite hyperbaric treatment when it is called for. But they depend upon the history and physical examination carried out by the doctors in place. And they have no role in interfering with the triage process, unless the symptoms reported by the patient suggest life-threatening DCS, which your girlfriend pretty clearly didn't have.
Finally, it is a fact of life that different communities and different hospitals have different resources at different times. The community where I work has whole weekends where we have no general surgeon and no orthopedist (this in an area of intense outdoor summer activities) and we never have a cardiologist, neurologist, neurosurgeon, or many other specialties. Some weekends we have folks on call, and other weekends we don't; we don't have the right to contact people who are not on call, even if we know they are in town. No doctor can be on call 24/7 -- that way lies madness. If the hyperbaric specialists DAN had listed were not on call, they could not respond to the ER. Among other problems, if they do so, they are committed for 24 hours to continue to be available for ER patients. Someone cannot make an exception for a patient who is interesting -- Federal law prohibits that.
I am very sorry about your experience. Like you, I would hope that if I presented to the ER with DCS symptoms, I would at least be admitted and put on hospital oxygen while awaiting evaluation. But I can tell you that, if you came to my ER on some nights, that even though I am a diver and a doctor, you would wait, and you would sometimes wait a long time. I don't have an answer for that -- it lies in policy way above my pay grade.
