In Water Recompression

[rddvet]

Which is why a volunteer Dive Casualty Only Recompression Chamber based on the Catalina Model works @Akimbo : it doesn't rely on expensive annual UHMS accreditation requirements for Medicare reimbursement coverage of high volume treatment cases like Wound Care for example. Again, because of the low frequency of DCI cases, 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 full service weekday 9-to-5 Diabetic Wound Care Clinic.

Here's another and better solution for North Florida that they should be addressing at this TekDive USA conference in Orlando:

Shands/University of Florida Medical Center in Gainesville deserves establishment of a dedicated Hyperbaric Medicine Department -or at least a sub-specialty within Emergency Medicine or Anesthesiology- along with a large 6 ATA Multiplace Recompression Chamber with Auxiliary Lock Entrance to treat all routine inpatient/outpatient cases, as well as 24/7 emergency support of acute to critical DCI/near drowning dive accidents & casualties. There is a clear medical need, and perhaps DAN can be an ombudsman for the resident diving community to alert state dept of health and gov't officials of the problem (and maybe @Duke Dive Medicine can offer advice and opinion on this too), as well as helping to secure federal Dept of Health & Human Services Grant Funds to purchase and install a campus hospital based 6ATA capable Chamber.

This is the most viable solution you have right there in nearby Florida cave diving country, with a large pool of 24/7 available on-call Resident, Teaching Fellow, and Staff Attending Physicians specializing in Emergency Medicine and perhaps later with subsequent additional Hyperbaric training. It's the best permanent and sustainable model, because of the state's tax supported and publicly funded University of Florida Medical School, regional Level 1 Trauma Center designation, and better legal protection and immunity.

Do you just have a file on your computer of all of these things you copy and paste into forums. Thank god you stopped on cdf. Now it continues.....again.

Thank you for a Californian's perspective of what Floridians should do-----AGAIN.

I've got a friend that goes by Razorista. Look him up online. I think you two would be good friends.

 

[Kevrumbo]

Do you just have a file on your computer of all of these things you copy and paste into forums. Thank god you stopped on cdf. Now it continues.....again.

Thank you for a Californian's perspective of what Floridians should do-----AGAIN.

I've got a friend that goes by Razorista. Look him up online. I think you two would be good friends.

It's not about political rhetoric of California telling Florida what to do -but only what makes sense for the health and welfare of resident and visiting tourist divers (and in this instance, it ought not ever be IWR Therapy as a last resort treatment option here in the US). . . Do you understand @rddvet ?

You cannot conscionably justify @rddvet , the inexcusable fact that there's a designated regional Level 1 Trauma Center and state teaching hospital in Gainesville at Shands Medical Center/University of Florida Medical School, in the general vicinity of some of the most popular overhead technical divesites in North Florida Cave Country: and yet there is still no 6ATA capable, auxiliary lock, multiplace Recompression Chamber on campus, in daily inpatient/outpatient service and on emergency stand-by 24/7 for diving accidents as well. . .

You don't need a leading international hyperbaric scientist and experienced attending dive expedition physician like @Dr Simon Mitchell to tell you what is obviously an absurd and unacceptable lack-of-treatment resource condition such that you would have to resort to IWR -here First World in the United States. . .

 

[KevinNM]

What you propose is extraordinarily expensive. The reason it works in one place is that the institution wants it to for their own reasons. Likely because the med school faculty likes having it there.

We replaced a pair of recently upgraded cardiac cath suites with newly constructed and top of the line facilities with 3 rooms because the med school and hospital mgmt really wanted a particular interventional cardiologist and that was what he wanted. It was a LOT of money. It certainly doesn't hurt that it gets reimbursed pretty well and door to balloon time is a critical carefully monitored statistic by the feds.

But the point remains, what you need is a supportive hyperbaric medicine faculty at an institution to make it happen. Preferably one that want to build a well regarded residency program.

 

[Kevrumbo]

What you propose is extraordinarily expensive. The reason it works in one place is that the institution wants it to for their own reasons. Likely because the med school faculty likes having it there. . .

But the point remains, what you need is a supportive hyperbaric medicine faculty at an institution to make it happen. Preferably one that want to build a well regarded residency program.

Actually the point is the University of Florida Medical School at Gainesville doesn't even offer a Hyperbaric Medicine Fellowship. Other than a very small off-campus outpatient Wound Care Clinic (which chooses not to treat diving casualties), they don't have the required facilities and curricula to teach and practice a bonafide Hyperbaric Medicine Sub-specialty. And their Shands Medical Center in Gainesville is a designated Level 1 Trauma Center, but has to refer out emergency hyperbaric treatment for even simple type I pain only DCS Patients? Or what does that imply about more seriously acute AGE Patients and their prognosis for recovery??

(Yeah right, IWR Therapy! )

 

[KevinNM]

If the med school/hospital has no interest in hyperbaric medicine then you are screwed.

So the focus should be on changing that. Which is probably not at all easy.

 

[Kevrumbo]

If the med school/hospital has no interest in hyperbaric medicine then you are screwed.

So the focus should be on changing that. Which is probably not at all easy.

It's because the local taxpayer constituency (i.e. the North Florida resident dive community) in support of a publicly funded state university school of medicine and Level 1 Trauma Center doesn't know how to organize, ask for and lobby their University of Florida Board of Trustees to augment the School of Medicine with the refurbishment of the large 6ATA Chamber facility on hospital campus (with local dive manufacturers' tax deductible sponsorships from Dive Rite, Halcyon etc for example to cover part of the initial building and re-installation outlay costs) in order to properly teach & practice the entire scope of Hyperbaric Medicine as a sub-specialty of Emergency Medicine or Anesthesiology.

Facetiously speaking and "just sayin": It's apparently easier for the local taxpayer constituency (i.e. the North Florida resident dive community) to hold tech & cave diving conferences about IWR, and then individually go out and buy FFM's and gas switch blocks and extra Oxygen bottles in support of an IWR Therapy operation for themselves, rather than establish a proper emergency medical "best practice" protocol for all divers -tourist visitors and locals alike- at a nearby regionally designated Level 1 Trauma Center.

 

[kensuf]

Actually the point is the University of Florida Medical School at Gainesville doesn't even offer a Hyperbaric Medicine Fellowship. Other than a very small off-campus outpatient Wound Care Clinic (which chooses not to treat diving casualties), they don't have the required facilities and curricula to teach and practice a bonafide Hyperbaric Medicine Sub-specialty. And their Shands Medical Center in Gainesville is a designated Level 1 Trauma Center, but has to refer out emergency hyperbaric treatment for even simple type I pain only DCS Patients? Or what does that imply about more seriously acute AGE Patients and their prognosis for recovery??

(Yeah right, IWR Therapy! )

UF Health/Shands used to have a beautiful chamber. It was on perma-loan by NASA. It has been shut down since 2011, all due to budget cuts. Hooray!

 

[Schwob]

Loved the thread for the short little while while it actually was on topic, you know, IWR, the one thing one could do and could have control over when ... being remote or when the one reachable chambet is in use or undergoing service ... or when governments / health care providers / rescue organisations fail or do not care to come up with affordable ways to provide a functional available recompression chamber...
All the things one could do to change that surely are vastly interesting and surely deserving of their own topic / thread... and maybe they must indeed appear in this and likely other IWR threads... But I for one appreciate this thread as "IWR" thread... am trying to anyway...

 

[Schwob]

Some maybe stupid "curiosity" kind of thoughts ((also not necessarily on the IWR topic):

Is the cost in hyperbaric chambers mostly in the installation (which if designed to be efficient could maybe fit in the foot print of a 1 car garage) or in the personell required to cover one's legal butt or...?

Recompbooth:
Is a use your self, pay per use chamber thinkable? Sort of like (half?) shipping container sized or smaller, can be trucked / shipped anywhere, if you have the right the magig DAN (substitute your organisation) card that certifies you are qualified and current to use / supervise the recompbooth, you stick it the card reader and go about running the chamber for the emergency at hand ... on your own and the pationt's own risk... all agreed to by accepting the magic card...
Thinkable at all?
Not at all?
Anywhere maybe, but not the US ... for legal reasons?

Water pressure is cheap...
Is an IWR suit for two people (snug so as to kerp buoancy reasonable and anchori g manageable) thinkable that gets anchored & suspended at the desired depth (empty or flooded). open zipper, patient and companion enter. close zipper, inflate to just above ambient (a few drysuit valves should do)... breathe ambient gas if oversupplied and exhausted or breathe whatever from tank........
Why bother - no real idea (no business case), just wondering if it might adress a few issues of IWR, like water around "the air intake" and if it might make for a safer, yet very affordable way to do recomp. anywhere on the cheap ... pending on the cost in anchoring maybe cheaper than a bag on the surface that has to hold the pressure...

 

[Graveyarddiver]

I think the topic needs to be brought up more, and recognized as always being an option. Not necessarily the best, but always available. I have always questioned the risk of waiting for rescue of a person bent, it could take hours to get them to a chamber, while educated individuals on the boat, or dive site, could quickly put that person back in the water and reduce the risk of long term injury or death. While the time and gas commitment necessary to do this is great, labor intensive, and not without risk, it certainly under the right conditions could mitigate other risks drastically.