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I was in Palau recently & the chambers appeared to be closed. Is this true? If so, why?
Thank you,
DocVikingo
Thank you,
DocVikingo
Palau Recompression chambers closed?
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Not true, the chamber is available.
I'm in Palau now and was invited to tour the chamber at their hospital Thursday. There was a potential DCS case earlier in the week and rumors were flying that the chamber was broken and/or that there was no staff to run it.
I had offered assistance when I heard the second rumor (I'm a supervisor at the USC Catalina hyperbaric chamber) and was invited there by the health ministry folks to see for myself. I was given full access to the chamber and everything there looks to be in good working order and all of their inspection records are up to date. About the only thing I didn't do was fire up their compressors.
They DO have staff available to run the chamber, just not as many as they would like. The dive industry and the government there are aggressively working to remedy that.
I'm in Palau now and was invited to tour the chamber at their hospital Thursday. There was a potential DCS case earlier in the week and rumors were flying that the chamber was broken and/or that there was no staff to run it.
I had offered assistance when I heard the second rumor (I'm a supervisor at the USC Catalina hyperbaric chamber) and was invited there by the health ministry folks to see for myself. I was given full access to the chamber and everything there looks to be in good working order and all of their inspection records are up to date. About the only thing I didn't do was fire up their compressors.
They DO have staff available to run the chamber, just not as many as they would like. The dive industry and the government there are aggressively working to remedy that.
Kevrumbo
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That's great to hear Tom . . .hope you're having a great time!
Wouldn't make sense NOT to have a functioning chamber on stand-by over there in Palau, when there's several each servicing the island hops of Chuuk, Guam and Kwajalein --all the way to Oahu/Kuakini Medical Center Honolulu (I was a patient at two of of those four chambers back in 2008).
OP
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Good to hear, Tom, although apparently it's slightly more complicated than that. Just because you got a tour doesn't mean all is hunky-dory.
Sources on the island told me the following.
Chamber was recently closed to divers for an extended period due to unavailability of sufficient tenders/operators. Because of this, it was being used only for existing patients and that suspected cases of DCI were given O2 & IV hydration and then flown to Guam. The chamber indeed is back in sketchy partial operation now for affected divers & a serious effort underway to get matters up to full speed & see that this doesn't happen again.
Best as I can determine, the pot is maintained at Belau National Hospital under an arrangement between the Palau Ministry of Health & a private company that specializes in hyperbaric services. Needless to say, PMH isn't the world's most effective bureaucracy & private chamber companies have been known to go slack at times, mostly due to $$ matters. I suspect that you may remember the fiasco some years back involving some MX chambers and the SSS Hyperbaric Services network. In any event, the chamber at BNH (fortunately?) treats only a very, very few cases of DCI in an average year. It's mostly used for other applications of HBOT and these aren't especially plentiful in the Koror region, either.
Regards,
DocVikingo
Sources on the island told me the following.
Chamber was recently closed to divers for an extended period due to unavailability of sufficient tenders/operators. Because of this, it was being used only for existing patients and that suspected cases of DCI were given O2 & IV hydration and then flown to Guam. The chamber indeed is back in sketchy partial operation now for affected divers & a serious effort underway to get matters up to full speed & see that this doesn't happen again.
Best as I can determine, the pot is maintained at Belau National Hospital under an arrangement between the Palau Ministry of Health & a private company that specializes in hyperbaric services. Needless to say, PMH isn't the world's most effective bureaucracy & private chamber companies have been known to go slack at times, mostly due to $$ matters. I suspect that you may remember the fiasco some years back involving some MX chambers and the SSS Hyperbaric Services network. In any event, the chamber at BNH (fortunately?) treats only a very, very few cases of DCI in an average year. It's mostly used for other applications of HBOT and these aren't especially plentiful in the Koror region, either.
Regards,
DocVikingo
Last edited:
OP
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Palaus Chamber is Working Again, But Not Full-Time
Courtesy of the June, 2012 issue of Undercurrent
What's the deal with Palau's hyperbaric chamber, reader Bob Kuhn (Palatine, IL) asked us. "I was at Palau recently and heard the chamber there has not worked in some time. Why? There are hundreds of divers coming here, but they have to go to Guam. I asked two divemasters at Sam's Tours and got two totally different answers. The first was that no one is trained, it's all private funding, and the dive shops don't communicate and work together well. The second was that there are actually two chambers, but one is broken and the doctor does not know how to operate the other one. My wife also sent an email to the hospital's information email address listed on Sam's website three days ago without a reply from the hospital. What's the real reason for a major dive destination not to have a working chamber?"
We contacted Sam's Tours and Fish n' Fins to find out what was happening. While Fish n' Fins never got back to us, Sam's Tours' managing director Dermot Keane did. He had just returned from a Memorial Day meeting arranged by the Palau Visitors Authority with medical staff at Belau National Hospital (BNH), where the three-year old chamber is located. Here's what he wrote:
"The hyperbaric chamber at BNH is and has been fully functional since installation. There are physicians and staff at BNH with training in hyperbaric medicine, chamber operations and chamber tending, though perhaps more staff are needed. The reason hyperbaric treatment was not available last week to treat a suspected decompression sickness case was the unavailability of a full team of qualified chamber tenders/operators to support the attending physician in administering hyperbaric treatment.
As of May 29, 2012, there is a physician and a full staff of qualified chamber operators/tenders on hand to provide hyperbaric chamber treatment, if needed, to a hospital patient under evaluation for DCS. The solution now in place is a short-term measure to restore availability of chamber treatment on an emergency-call basis only, as opposed to 24/7 standby. In the meantime, multilateral efforts involving dive centers, hospital administration, Palau Visitors Authority and Belau Tourism Association are underway to promptly produce solutions for a return to the previous full-service levels."
Keane says that there are only two suspected, but not official, DCS cases this year, and no cases last year. (The most recent annual high was four DCS patients in 2009.) Still, we hope the full-service level returns quickly. As you'll read in our story "Those Deadly Downcurrents," Palau has some tricky dive sites that can put divers in risky situations where they may need chamber access immediately, rather than the once-a-day, two-hour flight to Guam.
Regards,
DocVikingo
Courtesy of the June, 2012 issue of Undercurrent
What's the deal with Palau's hyperbaric chamber, reader Bob Kuhn (Palatine, IL) asked us. "I was at Palau recently and heard the chamber there has not worked in some time. Why? There are hundreds of divers coming here, but they have to go to Guam. I asked two divemasters at Sam's Tours and got two totally different answers. The first was that no one is trained, it's all private funding, and the dive shops don't communicate and work together well. The second was that there are actually two chambers, but one is broken and the doctor does not know how to operate the other one. My wife also sent an email to the hospital's information email address listed on Sam's website three days ago without a reply from the hospital. What's the real reason for a major dive destination not to have a working chamber?"
We contacted Sam's Tours and Fish n' Fins to find out what was happening. While Fish n' Fins never got back to us, Sam's Tours' managing director Dermot Keane did. He had just returned from a Memorial Day meeting arranged by the Palau Visitors Authority with medical staff at Belau National Hospital (BNH), where the three-year old chamber is located. Here's what he wrote:
"The hyperbaric chamber at BNH is and has been fully functional since installation. There are physicians and staff at BNH with training in hyperbaric medicine, chamber operations and chamber tending, though perhaps more staff are needed. The reason hyperbaric treatment was not available last week to treat a suspected decompression sickness case was the unavailability of a full team of qualified chamber tenders/operators to support the attending physician in administering hyperbaric treatment.
As of May 29, 2012, there is a physician and a full staff of qualified chamber operators/tenders on hand to provide hyperbaric chamber treatment, if needed, to a hospital patient under evaluation for DCS. The solution now in place is a short-term measure to restore availability of chamber treatment on an emergency-call basis only, as opposed to 24/7 standby. In the meantime, multilateral efforts involving dive centers, hospital administration, Palau Visitors Authority and Belau Tourism Association are underway to promptly produce solutions for a return to the previous full-service levels."
Keane says that there are only two suspected, but not official, DCS cases this year, and no cases last year. (The most recent annual high was four DCS patients in 2009.) Still, we hope the full-service level returns quickly. As you'll read in our story "Those Deadly Downcurrents," Palau has some tricky dive sites that can put divers in risky situations where they may need chamber access immediately, rather than the once-a-day, two-hour flight to Guam.
Regards,
DocVikingo
dgrauman
Registered
I just returned from Palau. My wife and I are both physicians, and spend a few days diving with a member of the USAF military medical team on the island. According to her, there are two chambers, but currently no one trained to operate them. It seems that several different governments have given a lot of medical equipment to the island in recent years and set it up, then left without personnel support. There may well be one or more persons on the island who have some familiarity with the equipment, but as with any medical procedure it is important to have recurrent training and experience. An emergency is not the time to be trying to remember "now, what valve do I turn first?" Clearly, the situation is hit or miss at best.
I would love to get a definitive answer to this question. While I hold Dermot in the highest regard and believe him to be eminently credible, his response is from a person in the Palau tourism industry, reporting what he was told by the Palau tourism industry.
dgrauman
Registered
I think there is unlikely to be a definitive answer to this for any remote area. Personnel come and go, budgets and priorities shift. Also, I think there is a tendency for divers to note that there is a chamber available, and therefore all is OK. An emergency that may require decompression is just one kind of diving emergency. I think if you read the account of an accident in the reef hook sticky thread in this forum, it will give a sense of what a real emergency is like in a rural area. I have served in rural hospitals, and the description of a disaster is quite accurate.
My belief is that a diver should hold this concept firmly in mind when diving. Experienced divers can be lulled into a false sense of security by the presence of a chamber, and may take risks that would be reasonable if one were within reach of a more major facility. It might be advisable to set a higher safety margin in remote areas, rather than relying on experience and skills.
My belief is that a diver should hold this concept firmly in mind when diving. Experienced divers can be lulled into a false sense of security by the presence of a chamber, and may take risks that would be reasonable if one were within reach of a more major facility. It might be advisable to set a higher safety margin in remote areas, rather than relying on experience and skills.
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