Question: Life Flight vs Diving Accident

[DivingLonghorn]

I was reading a recent thread in which a diver had to be life flighted to a hospital. I guess my question is who decides when flying a diver (post-dive) is appropriate? I know that there is a risk assessment between the divers health and chancing additional injuries by flying after diving. But are most EMS familiar with "diving" and the do's and don'ts of post dive activity (i.e. flying)? Does flying a diver who had a heart attack add to the complications, would administering emergency services and driving the diver be more beneficial? I hope I have posed the correct questions and they are clear.

Thanks.

 

[Drew Sailbum]

but sadly many EMS personnel do not have training in the handling of dive accident injuries. For land based transport, we have had to argue with paramedics in order to get them to keep the patient on oxygen during a 45 minute ride to the hospital.

As to flying... in some locales it is the only practical way to reach a chamber for treatment. I'm sure that the seriousness of the symptoms would help determine whether air transport is necessary.

 

[Dr Deco]

Dear DivingLonghorn:

LifeFlight

The physicians on the line will probably add their experience to this. Some Life Flights are by rotary wing aircraft and will not fly very high.

Those with fixed wing are best performed in a pressurized cabin (held at sea level pressure). This is a very costly arrangement with respect to fuel usage, I am told. The cost can be high and divers are warned that diving without medical insurance (that will include transportation costs) is not a wise procedure.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[vicky]

It is always a question of what are the alternatives- flying somebody for 30 minutes to nearest recomp. chamber/hospital, or taking the long route, say several hours by boat...
I've read somewhere of a diving accident where two divers had to abort a technical dive (DCS "guaranteed"). One of them preffered to get by plane to the nearest hospital, the second took his chances with "in water recompression"- took several deco tanks and went to recompress underwater for a long time. The one evacuated by plane (perhaps helicopter- I don't know) arrived dead, the IWR diver survived without any injuries... I don't know if they had the same conditions, risk factors etc. but the answer is not always so clear as to what is the best thing to do, other than trying to dive safer

 

[Dr Deco]

Hello Vicky:

Fight or Flight - - - Literally

This is a different question than a case of “the bends.” I might make the assumption that “guaranteed” meant that the decompression was shortened by at least one half hour. Since one of the divers actually died, I might hazard a guess that it was a good deal more. [ Actually, "they took several cylinders... to recompress for a long time."]

As in The Last Dive, these divers were in serious difficult.

Alternatives

If the decompression was truncated by approximately one half hour, there is a good possibility that one diver could experience serious consequences and the other is quite unaffected.

If it were longer than that, I believe that I would opt for the in-water recompression if such an alternative existed. Remember, this is not a normal (i.e., within the table) decompression with DCS developing. We are talking about a serious shortcoming.

Naturally, there is individual variability here plus a dose of speculation. Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Snowbear]

.... my training for DCI accidents was a paragraph in the book that said something about keeping the pt on their left side, 100% O2 and whatever "supportive care" (like IV's, intubation, whatever) is needed and burn some diesel (medic talk for drive their butt to the ER). Now that I am a diver and have a much better understanding of the physiology involved, if it was my call - I would send the patient by air.

Most of the diving here is several hours by surface transportation to a chamber. Driving from anywhere on the Kenai Peninsula to Anchorage involves 2-5 hours with at least 2 mountain passes at ~1500' elevation. By air is 30-60 minutes and can be done at an altitude of a few hundred feet or less (the aircraft can follow the river valley out to Cook Inlet and stay out of the passes).

 

[vicky]

Is this some sort of famous story, or something similar?

 

[Dr Deco]

The Last Dive was a book about two divers who needed to perform an emergency ascent and missed their decompression stops. One diver expired on the surface and the other was airlifted to a chamber where, after several hours, he too died.

 

[BigJetDriver]

DivingLonghorn once bubbled...
I was reading a recent thread in which a diver had to be life flighted to a hospital. I guess my question is who decides when flying a diver (post-dive) is appropriate? I know that there is a risk assessment between the divers health and chancing additional injuries by flying after diving. But are most EMS familiar with "diving" and the do's and don'ts of post dive activity (i.e. flying)? Does flying a diver who had a heart attack add to the complications, would administering emergency services and driving the diver be more beneficial? I hope I have posed the correct questions and they are clear.

Thanks.

The questions are quite clear, unfortunately, the answers are anything but!

As someone who is a mixed-gas CCR diver, a DMT, and a professional pilot, these questions are of extreme interest to me. Having asked a lot of people in these professions, here are the answers as I know them:

First, the hyperbaric center where I received my training was fully familiar with decompression medicine due to the fact that it was the center for treating Gulf of Mexico oil-patch divers. In one notorious case, a diver in full blown DCS was brought to the ER after normal hours for the chamber. The doc on duty diagnosed the case as a cardiac problem and sent him, after initial treatment, to the cardiac ICU. It took intercession by the Director of Operations, and finally, the doctor in charge of the Hyperbaric Medicine Division to get him into the chamber.

Second, any decision about a developing DCS case requires field evaluation of the patient by knowlegeable personnel, if possible, and balancing of a lot of kinds of risks.

For instance, if the case is serious and getting worse, even with administration of pure O2, a helicopter evacuation becomes a good choice, IF you are in range, and IF the weather is suitable.

As Doc. Deco has pointed out, the Life Flight helicopter does not normally fly at high altitudes. If the range is not excessive, they will generally be anywhere from 500 to 1500 feet, at least in flat coastal areas. (Remember that if it is a pick-up directly from the boat, the Coast Guard will fly the mission.) If time is critical, and you declare an emergency, they WILL come if at all possible.

Finally, if you are REALLY a long way out of range, and you have the equipment and training to do so, in-water recompression becomes a serious option. Please note the caveats. You must have some specialized gear, personnel who know how to do this, and environmental conditions that will allow it.

I hope that this is some of the information you were looking for. Please remember that this does not constitute medical or procedural advice...please insert standardized warning here...! Over to you, Doc.