"Recompression in the water should be considered an option of last resort, to be used only when no recompression facility is on site and there is no prospect of reaching a recompression facility within 12 hours.... in divers with severe type II symptoms or symptoms of arterial gas embolism (e.g., unconsciousness, paralysis, vertigo, respiratory distress, shock, etc.), the risk of increased harm to the diver from in-water recompression probably outweighs any anticipated benefit. . ." (US Navy Dive Manual).
In addition to the presentation on IWR, perhaps there should be another discussion on how to set up a non-profit, local municipal government run Recompression Chamber EMS operation in the United States (i.e. North Florida) as well. . .
-----------------------
I was a member of a consulting group doing a feasibility study for a fairly large hospital investigating HBOT (HyperBaric Oxygen Treatment) facilities. Unfortunately, chambers that support unscheduled 24/7 emergency treatment is an awful business plan. Conventional mono or multiplace scheduled treatment centers that operate 8/5 (8 hours/day, 5 days/week) are hard enough to break even with -- even before the bizarre hospital billable markups are applied. Utilization of facilities and staff has to be pretty high and accepting an emergency patient screws up a fairly full schedule of patients. It really doesn't matter if the emergency is a diver with DCI or a CO poisoning case.
Multiplace HBOT facilities suitable for DCI treatments also require a relatively large footprint once you include support machinery (compressors and larger LOX storage) plus staff support. Hospitals make a lot more money on a diagnostic machine they can wheel up to a bedside on a per dollar invested basis; including the initial investment, trainings, certification, and maintenance.
Why Are Fewer Chambers Available for Emergencies? By Marty McCafferty, EMT-P, DMT
A misleading and inadequate assessment in the Alert Diver/DAN article, of the standard of care to treat the full range of morbidity in DCI Cases:
. . .Compounding the problem is that some injured divers are turned away because of a misconception that divers need a level of care beyond what a facility can provide. In fact, divers are generally healthier and more stable than the average wound-care patient.
Nor do injured divers need a chamber that can be pressurized to more than 2.8 ATA (60 feet of seawater), as is mistakenly believed by some health-care providers. The standard of care for the overwhelming majority of dive injuries is a U.S. Navy Treatment Table 6 (USN TT6). This treatment protocol does not exceed 2.8 ATA. Monoplace (single-occupant) chambers are capable of providing a USN TT6. . .
Alert Diver | Why Are Fewer Chambers Available for Emergencies?
This is what the DAN article above fails to consider:' A worst case emergent scenario of a dive casualty with AGE near drowning in full arrest, will need a 6 ATA capable Multiplace Chamber (multiple occupants including the patient, Chamber Patient Tender and an assisting Paramedic EMT) with an Auxiliary Lock to provide accessibility for an Emergency Medicine Physician with Hyperbaric sub-specialty to examine the patient at treatment pressure, as well as to return the Physician to surface atmospheric pressure in order to prescribe additional Advanced Cardiac Life Support (ACLS) treatment as needed.
There is a difference between a standard level of care mentioned in the article above, and a "Gold or Trauma Level Standard of Care":
. . .
Most chambers in the U.S. are used primarily for hyperbaric oxygen treatment for wounds or diabetes and secondarily if at all for diving accidents. They are smaller one or two person chambers meant to pressurize only to the equivalent of a 66-foot depth (3 ATA) in order to improve oxygen saturation to damaged tissues. The Catalina Hyperbaric Chamber has bunks to treat two divers and has been pressed into service to treat as many as four with attendant doctors, EMT’s, and tenders.
It can pressurize to 165 feet (6 ATA) in order to squeeze bubbles to their smallest diameter to treat embolisms. It is, therefore, ideally suited to treatment of [all] diving injuries. . .
USC Dornsife Scientific Diving: The Catalina Hyperbaric Chamber
-->
The best local resident divers in the world along with welcoming visitors to the best diving here in SoCal, deserve the best emergency support 365 24/7 --all provided by the only civilian joint private university-municipal government run, 6 ATA Recompression Chamber in the United States solely for the treatment of Diving Accidents, as an integral part of Los Angeles County EMS/Fire & Lifeguard/Paramedic and US Coast Guard offshore rescue operations.
Obviously
@Akimbo , you can't run a large multiplace 6ATA Recompression Chamber as an independent private business and medical clinic operation treating diving casualties only -there's no way it can financially sustain itself. And
@boulderjohn , the reason why you have private "UHMS accredited" hospital facilities refusing to take dive accident casualties is because of the high malpractice insurance for such a low volume of infrequent DCI cases, and also the expense to staff on-call personnel to cover after hours and weekends on 24hr stand-by for emergency DCI cases, plus they most likely do not have a Recompression Chamber rated to 6 ATA for worst case scenarios such as AGE. Unfortunately the bottom line for private facilities comes down to liability and profitability.
Again, the concept to apply in running a Dive Casualty Only Recompression Chamber is similar to running a
volunteer fire department -the call volume is not as great or frequent as a major metropolitan city or county, but the Emergency Service is still there on stand-by ready to respond.
One unique solution in operation since 1974 is the Catalina Hyperbaric Chamber Model: a strategic hybrid combination of tax-supported county/state dept of health, hospital & EMS services, volunteer chamber crew, and annual monetary donations & organized charity drives from the regional diving community, and major business corporate sponsorship for example to initially install a 6ATA Multiplace Recompression Chamber -in order to make this urgently needed service to work. (The legal protection comes from being administered as part of a municipal government EMS operation, under a statute of
Sovereign Immunity). Again, the cost of stand-by 24/7 operations for treating dive accidents only using volunteers and an on-call ER/hyperbaric physician is not as expensive as running a for-profit full service weekday 9-to-5 Diabetic Wound Care Hyperbaric Clinic facility.
