Diver denied treatment at a Chamber in Panama City...

[The Chairman]

Just for the record, no outrage here. The hospital did the right thing. The problem, as I see it, is that there is a perception that the hospital treats divers.

This adds unnecessary delays in treatment.

I agree with lowviz on this. Why advertise that you will when you won't? That's not too much truth in advertising in my book.

 

[Wookie]

This also underscores the importance of knowing where the nearest chamber is in case of an injury. If the boat was offshore and the patient was evacuated by chopper, they would have been better off heading for Mobile. Maybe the coast guard just looked at the hospital's web site too?

A responsible dive operator ( ) will have a Diving Accident Management Plan, listing the closest chamber, the closest 24 hour chamber, the on-call physician's phone number, the secondary chamber (which will actually be tertiary, but you will no-$hit get treated there if the world is coming to an end), and addresses to all. They will have the number for the USCG flight surgeon in the district they are operating in (The flight surgeon makes the call to evacuate or not), the number for the CG helo dispatcher in the district they are in, maybe the cell number for the NOAA diving medical officer in case you can't get through to anyone else, the number to the dispatcher of the county medical evacuation chopper (they won't do a hoist to a boat, but might land in a national park if one were handy), the number for said national park EMT's because they sure as heck want to know that a chopper is about to land on their pad, and of course, the emergency number to DAN and the daytime number to DAN. A dive operator that may be in the Keys today and the Bahamas tomorrow and Puerto Rico the next day will have multiple copies of said plan to keep up to date. Their crew should be trained on the contents of the plan so that awkward situations (I assumed the chamber was accepting patients) don't pop up. It seems to me that the Panama City chamber stopped accepting DCS patients 5 or more years ago.

DAN will help generate this list of information FOR FREE!!!! They know every operational chamber in the world, they know who is down for maintenance and who will accept patients. This information is not a crapshoot, but you have to go out and gather it. Responsible divers would check with their operation to see if their Diving Accident Management Plan is up to date.

Or, you can just trust that the chamber is accepting patients that day, and if not, cry to the television station that you couldn't be treated in a perfectly good chamber.

 

[Akimbo]

I was hired to assist with a feasibility study to install a multifunction multiplace hyperbaric treatment facility at a hospital. Unfortunately I had to agree, treating divers is a marginal business model even in an area with a large diving population. The purchase cost, footprint, and manning requirements are just too high for the small number of cases.

The great majority of non-diving hyperbaric oxygen treatments can be scheduled during normal working hours with CO poisoning being one of the few exceptions. A two atmosphere mono-place (acrylic torpedo) chamber works fine for all of them. One operator can tend four or more patients on different protocols and with varying starting times. A six atmosphere plus multiplace and multi-lock chamber is required to treat divers and typically needs 2-3 people minimum. An emergency DCS treatment can walk in the door 24/7 and would hose up the schedule for normally-scheduled patients.

 

[Ana]

A responsible dive operator ( ) will have a Diving Accident Management Plan, listing the closest chamber, the closest 24 hour chamber, the on-call physician's phone number, the secondary chamber (which will actually be tertiary, but you will no-$hit get treated there if the world is coming to an end), and addresses to all. They will have the number for the USCG flight surgeon in the district they are operating in (The flight surgeon makes the call to evacuate or not), the number for the CG helo dispatcher in the district they are in, maybe the cell number for the NOAA diving medical officer in case you can't get through to anyone else, the number to the dispatcher of the county medical evacuation chopper (they won't do a hoist to a boat, but might land in a national park if one were handy), the number for said national park EMT's because they sure as heck want to know that a chopper is about to land on their pad, and of course, the emergency number to DAN and the daytime number to DAN. A dive operator that may be in the Keys today and the Bahamas tomorrow and Puerto Rico the next day will have multiple copies of said plan to keep up to date. Their crew should be trained on the contents of the plan so that awkward situations (I assumed the chamber was accepting patients) don't pop up. It seems to me that the Panama City chamber stopped accepting DCS patients 5 or more years ago.

DAN will help generate this list of information FOR FREE!!!! They know every operational chamber in the world, they know who is down for maintenance and who will accept patients. This information is not a crapshoot, but you have to go out and gather it. Responsible divers would check with their operation to see if their Diving Accident Management Plan is up to date.

Or, you can just trust that the chamber is accepting patients that day, and if not, cry to the television station that you couldn't be treated in a perfectly good chamber.

I've seen emergency plans like you described, written in a way that the person reading it can be at the edge of a nervous brake down but still can be effective because s/he doesn't have to think, just follow step by step.

 

[Wookie]

I've seen emergency plans like you described, written in a way that the person reading it can be at the edge of a nervous brake down but still can be effective because s/he doesn't have to think, just follow step by step.

Yes, even if more than one diver is injured and the Captain faints at the sight of blood, he can go to the sat phone and do something effective.

And I love your sig line. What a great way to say it.

 

[luscioman]

It very sad that happened. As Wookie said DAN does provide excellent information for everyone. The unfortunate thing is there are still many people that do not know about them. I can tell you in the Miami area there are over 5 chambers available. The local hospitals usually have a wait list with them and use them a lot for wound care. Mercy Hospital in Miami has had a chamber for years but then let it close for lack of use. Since they were bought by HCA they decided to refurbish the chamber and it has been up and running for the past 2 years. I guess we are lucky down here by having so many chambers available. One of the best places is in the keys Hyperbarics International :: Home . They do most of the training for chamber operators in the US.

 

[doctormike]

This raises an interesting question - if treating DCS is a money-losing business model for most facilities that don't have frequent customers, then who picks up the slack at the places where chambers are available for emergency recompression but not used enough to pay for themselves?

I guess a big hospital like Jacobi covered the difference between what my insurance paid and what it costs to staff their chamber 24/7 the same way they cover other necessary but unreimbursed but necessary services (like some ER fees). They spread that cost out to other budgets so that the departments that make money help fund the ones that don't.

Does the diving community (i.e. local shops and operators) in places with deeper wrecks ever pool their resources to support recompression? Especially at a place that is not near other chambers? For example, who pays for staffing and maintaining the chamber at Truk Lagoon?

 

[WB2GLP]

Seeing that they have a multiplace chamber, one would believe that they would, could, and should treat emergent cases like DCS, but that's not always the case today. Most hyperbaric centers do not treat emergent cases (such as the first 6 on their website list) or remain open 24x7x365 because of staffing requirements. Their multiplace chamber would require a minimum of 3 people to treat her condition. Not knowing the specifics of this situation, If they didn't have the staffing to treat her, they should refer her to somewhere that can. That seems to be what they did. It's not as though they told her to go home and sleep it off, did they?

Thankfully she was diving within close proximity to other chambers capable of treating her and not off diving in some far corner of the world requiring planes, trains, and four legged friends to get here there.

 

[Mike]

I agree with lowviz on this. Why advertise that you will when you won't? That's not too much truth in advertising in my book.

The only advertising I see is one line on a web page. Will probably disappear with the next update. Are they doing TV commercials or radio ads or something?

---------- Post added September 23rd, 2014 at 01:03 PM ----------

Well this is just par for the course in this forsaken place. Talk about biting the hand that feeds you.

They claim to have Florida's most beautiful beaches because the top layer of sand is white and makes for a pretty photo. advertise in all the square states directly north of us, but they don't bother to have lifeguards, nah instead they have a convoluted system of flags that makes the homeland color warning system a logical set up. So the land locked tourist that are used to fresh water in ponds or whatever, are faced with rip currents present every mile or 2 most of the days. Meanwhile they just play with colored flags so the city (or the county or whoever) is not liable for the few tourists that drown every season.

I saw it in a preview for the news a couple of days ago, your typical "watch later why our hospital doesn't treat divers anymore" My husband commented we'll have to watch (which we never do) and we talked about it, why bother watching, whatever the reason they will broadcast is sure to be a stupid reason. This place fills their mouth claiming they have amazing wrecks, and every so often come up with costly campaigns to brag about the handful of metal chunks and construction debris they call dive sites. Well how about making sure things get done properly?

And now Bay Medical, supposedly a "world class BS" finally faced with a situation admits they haven't treated a diver in years. @#&ckers !!!! I bet most of the dive shops around had Bay Medical as the place to go in case of emergency.
Then again, fits this place so well, wonder how many dive shops here actually update their emergency plan once a year or so, like any normal outfit should.
People I know that dive for a living, are forced by their regulations not only to confirm availability of emergency service but to describe the process to be admitted so that their emergency folder includes phone numbers, POC's, even where to park in order to make it as efficient as possible.

Dang:shocked2:

---------- Post added September 23rd, 2014 at 01:05 PM ----------

This raises an interesting question - if treating DCS is a money-losing business model for most facilities that don't have frequent customers, then who picks up the slack at the places where chambers are available for emergency recompression but not used enough to pay for themselves?

Well is some place that is medically saturated like the United States, I think you see what you are seeing in this thread -- a number of them stop doing it and their is less 'slack' for the remaining and they remain profitable.

This problem seems far worse in smaller, poorer countries. Didn't Truk lose it's chamber recently and now it's an emergency evacuation plane ride to the nearest one?

 

[doctormike]

Well is some place that is medically saturated like the United States, I think you see what you are seeing in this thread -- a number of them stop doing it and their is less 'slack' for the remaining and they remain profitable.

This problem seems far worse in smaller, poorer countries. Didn't Truk lose it's chamber recently and now it's an emergency evacuation plane ride to the nearest one?

That's what I was thinking... if diving brings a lot of money into the area, but the local medical establishment can't support an emergency chamber financially, at what point would it be worthwhile for the dive ops to jointly subsidize one? Is that done anywhere?