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

[Scared Silly]

I see both sides of this issue. However, it seems to me that a savvy hospital operator while not staffing 24/7 would at least have a call list for docs and techs that would willing to be called for such emergency situations. This list would be a voluntary list rather than an on call list which cost money. However, if they got called and came in they would get paid as the hospital would have a billable treatment.

As for the note on the website I would take it with a grain of salt as all they are noting is reasons for hyperbaric treatment - rather the the treatments provided. Still it does not look good.

Finally, props to the news station as the story was one of the most accurate descriptions of DSC given by a lay person - they are either a diver or did their homework.

 

[Wookie]

I wonder if we'd look at it differently if we knew that:

1: Skin Bends are typically treated with 100% O2 to resolution, the equivalent of getting a booboo and putting a bandaid on it. If symptoms don't resolve (or the cut gets infected), we go to see our doctor.

2: Pain only (type 1) bends will almost always resolve on 100% O2, like a deeper cut that may need a stitch. Use first aid (direct pressure on a wound, or 100% O2) if it is effective. If first aid is not effective, go to the Doc-In-A-Box or the Emergency Room.

3: Neurological DCS (Type 2) bends need a doctor's help, like getting hit by a bus. If you get hit by a bus, you will likely go to either an emergency room or a morgue. If it's the emergency room, the docs there will stabilize you, but you won't have reconstructive surgery that night. You may be in a wheelchair for 6 months before you walk again. You won't meet your surgery team in the OR, in fact, you might not meet them that week at all. The surgery team is not on hot standby waiting for a bus accident victim to get wheeled in. You might not even have surgery in the same facility your emergency room was located.

4: AGE or Pulmonary Barotrauma requires pressurization in a chamber as first aid. This is a serious condition and needs immediate attention.

As divers we tend to look at bends as an emergency condition that needs immediate care of a team of half a dozen folks. In reality, all of the cases of bends I've seen minus two, and that's probably 50 cases, resolved on O2. Two cases (my type 2 and another type 2) required pressurization in a chamber to resolve, and one (one of my divemasters) never did resolve to this day, even after 4 table 6s and 2 wound care treatments. When it gets down to needing a chamber to get well, it is either "tomorrow will be soon enough" (My treatment was delayed 4 days) or "it's already too late".

It just isn't worth it or necessary for a hospital to maintain that kind of staff on call, especially if a chamber is available in a reasonable amount of time, like in a couple of hours.

 

[chillyinCanada]

OK thanks Wookie, I feel better educated.

 

[NAM001]

I would think that if ou had a chamber, all that is needed is the protocol. That is only a phone call away. Isnt this like a meat wagon arriving and saying that they dont handle burn victoms. I would expect the hospital to arrange transfer to a staffed facility and provide first responding care.

 

[Wookie]

I would think that if ou had a chamber, all that is needed is the protocol. That is only a phone call away. Isnt this like a meat wagon arriving and saying that they dont handle burn victoms. I would expect the hospital to arrange transfer to a staffed facility and provide first responding care.

Board certified hyparbaric docs belong to an organization (ACHM) that says that a board certified hyperbaric doc must be on station whenever someone is in the pot. So, you have to have a doc there, not just on call....

 

[gopbroek]

RecentlyI went to an emergency room in Mexico, late in the evening on a weekend. I received prompt adequate care by a physician at a reasonable rate. As I was leaving the hospital I was struck by the lack of extra parasitic personnel I seem to see whenever I go to a US facility. The facilty in Cozumel had Physician, a nurse and a front desk admin guy. When I go to a medical or dental facility in the US it seems like the admin / billing staff out numbers the actual medical staff. The WHO ranks the US 38th in care and #1 in cost. It seems that the US system is based on $$ not actual care.

 

[JohnN]

RecentlyI went to an emergency room in Mexico, late in the evening on a weekend. I received prompt adequate care by a physician at a reasonable rate. As I was leaving the hospital I was struck by the lack of extra parasitic personnel I seem to see whenever I go to a US facility. The facilty in Cozumel had Physician, a nurse and a front desk admin guy. When I go to a medical or dental facility in the US it seems like the admin / billing staff out numbers the actual medical staff. The WHO ranks the US 38th in care and #1 in cost. It seems that the US system is based on $$ not actual care.

WAAAAYYYY off topic.

Be careful what you wish for. . . My wife is Dean/Director of a Physician Assistant program, 1-2 FMG (Foreign Medical Graduates) are accepted each year (for reference sake, it is extremely competitive to be admitted to a PA program. The admit ratio is almost 10:1). These FMG's are Doctors certified to practice in their native country. To the person, they perform in the bottom 10-15% of the class, a notable student (a surgeon from Ecuador) managed to fail Anatomy.

And don't get me started how a group of Doctors in Italy almost killed my wife through neglect after we had a very serious car accident. . .

 

[Mike]

It seems that the US system is based on $$ not actual care.

The US system is heavily influenced by insurance, drugs and attorneys. -- insurance is self explanatory, drugs - the insanely profitable drug industry, attorneys - the threat of lawsuits via malpractice. Those 3 things are why you see admin/billing staff out number medical staff. Mexico has very little of any of that, it's like a window into America during the 50's.

 

[JohnN]

The US system is heavily influenced by insurance, drugs and attorneys. -- insurance is self explanatory, drugs - the insanely profitable drug industry, attorneys - the threat of lawsuits via malpractice. Those 3 things are why you see admin/billing staff out number medical staff. Mexico has very little of any of that, it's like a window into America during the 50's.

You have numbers to back that up?

The best I can find puts the cost of malpractice insurance at ~2.4% Medical liability costs in U.S. pegged at 2.4 percent of annual health care spending | News | Harvard School of Public Health hardly a major factor

If you're looking for a smoking gun about the cost of medical care. . . answer this, why is medical insurance allowed as a "for profit" enterprise? Remember the bitching and moaning when insurance companies were forced to spend 80% of the premiums they collected on health-care? T

 

[ktomlinson]

Hopefully the take away people get from this is to either call ahead yourself, or call DAN and have them coordinate with a hospital that will treat you in a chamber.