Unknown Woody From “Dive Talk” DCS and Medical Journey

[dylanfromwinnipeg]

Own ERP would include
- knowing which credit cards work THERE up to which limit
- knowing who to call and verify that the call would be answered
- knowing which chambers are working and by which means they are accesible in what time

The challenge is how do you do those things?

For credit cards I assume my cards will work everywhere. But I know from experience that sometimes the visa/mastercard fraud detection algorithms kick in and block transactions unexpectedly. How can you KNOW it's going to work in advance?

How do you verify in advance that your calls will be answered in an emergency?

How do you know which chambers are working and how they are accessed? My understanding is that this information isn't widely available. And even if you know there's a chamber at some location, my understanding is a lot of them don't take divers.

 

[Wallowa]

The challenge is how do you do those things?

For credit cards I assume my cards will work everywhere. But I know from experience that sometimes the visa/mastercard fraud detection algorithms kick in and block transactions unexpectedly. How can you KNOW it's going to work in advance?

How do you verify in advance that your calls will be answered in an emergency?

How do you know which chambers are working and how they are accessed? My understanding is that this information isn't widely available. And even if you know there's a chamber at some location, my understanding is a lot of them don't take divers.

I have been on a 2 month quest to try and identify hyperbaric treatment chambers for diving DCI. Especially on the West Coast where I dive. No luck; just platitudes and told "we can't keep up to date information on what chambers are online" and when asked just for a listing of all chambers that would treat divers they just say "not available"....here is the kicker...tons of medical chambers to 2.8ata 100% oxygen chambers, many of those are mono-chambers [not for me, thank you]...the 2.8ata chambers serve a purpose [and make money for the health care community] but are not the best for severe DCI...why? Because type 2 DCS and embolisms may very well need a 6ata chamber such as with 6A table....good luck finding those! Also factor in the experience and training of what should be first line 'Diving Medicine Doctors' that evaluate and treat the injured divers. Just cursory training and little experience is insufficient in my view.

Second, and vital, is any transportation should never introduce hypobaric conditions on the injured diver with DCI....air ambulances need to be pressurized and land transport should not gain altitude with elevation gains such as mountain passes....nothing good happens with reducing atmospheric pressure on a DCI victim.

Love the promise that in our electronic dependent age we rely on communications for correct and timely treatment rather than expedited direct examinations and hands-on treatment. Old expression, but true, time is of the essence and delay works against resolution of crippling or possibly fatal DCI.

DSO

 

[tursiops]

For credit cards I assume my cards will work everywhere. But I know from experience that sometimes the visa/mastercard fraud detection algorithms kick in and block transactions unexpectedly. How can you KNOW it's going to work in advance?

Bad assumption. Usually you need to tell your CC company in advance that you will be using it from some unusual/strange/different/foreign location.

How do you verify in advance that your calls will be answered in an emergency?

Depends on who you call. DAN answers 24/7.

How do you know which chambers are working and how they are accessed? My understanding is that this information isn't widely available. And even if you know there's a chamber at some location, my understanding is a lot of them don't take divers.

You call DAN and they tell you where the nearest operating chamber is.

The point is, get DAN in the loop earlier rather than later.

 

[rvojr]

I have been on a 2 month quest to try and identify hyperbaric treatment chambers for diving DCI. Especially on the West Coast where I dive. No luck; just platitudes and told "we can't keep up to date information on what chambers are online" and when asked just for a listing of all chambers that would treat divers they just say "not available"....here is the kicker...tons of medical chambers to 2.8ata 100% oxygen chambers, many of those are mono-chambers [not for me, thank you]...the 2.8ata chambers serve a purpose [and make money for the health care community] but are not the best for severe DCI...why? Because type 2 DCS and embolisms may very well need a 6ata chamber such as with 6A table....good luck finding those! Also factor in the experience and training of what should be first line 'Diving Medicine Doctors' that evaluate and treat the injured divers. Just cursory training and little experience is insufficient in my view.

Second, and vital, is any transportation should never introduce hypobaric conditions on the injured diver with DCI....air ambulances need to be pressurized and land transport should not gain altitude with elevation gains such as mountain passes....nothing good happens with reducing atmospheric pressure on a DCI victim.

Love the promise that in our electronic dependent age we rely on communications for correct and timely treatment rather than expedited direct examinations and hands-on treatment. Old express, but true, time is of the essence and delay works against resolution of crippling or possibly fatal DCI.

DSO

I'm not that experienced and see that you are very experienced so this may be redundant and off topic. Have you called DAN for the local 6ATA chambers? Also local tech diving shops seem to know some of the chambers local to their charters. I had no idea this was an issue until I had my rescue class and went down this rabbit hole. It is eye opening!

 

[Wallowa]

I'm not that experienced and see that you are very experienced so this may be redundant and off topic. Have you called DAN for the local 6ATA chambers? Also local tech diving shops seem to know some of the chambers local to their charters. I had no idea this was an issue until I had my rescue class and went down this rabbit hole. It is eye opening!

DAN did not and will not tell me where there are 6ata chambers....when asked for the 'nearest' chamber they directed me to a hospital 4+ hours away by vehicle[too many passes to get there] with a medical 2.8ata chamber....seriously, DAN says they will not publish or provide a listing of chambers...not just chambers that could treat serious DCI cases but the chambers that will accept divers. Even if chambers are not 24/7 at least it gives you options.

I am disgusted with the "can't get there from here" attitude, but unfortunately in today's society of not taking responsibility for anything that could result in legal actions for any involvement or anything that could hurt the corporate bottom line...I get it. Medical community is big business and DAN has evolved [devolved?] into that model....at least that is how I see it. Contrary to the current paradigm I do believe that a nationwide emergency response plan by regions can be drafted that would include a listing of closest chambers for treating Type 1 & 2 DCS or AGEs that includes the vanishing number of 6ata chambers. And emergency transportation options with pressurized planes.

You can get there from here and to plagiarize a current popular mantra of tech divers: DIR. It just takes someone or organization with the stones and integrity to "do it right". In the mean time folks, get down to the details and have a verified emergency plan for your dives that could save your butt in the worst case "what if". Even if that means only a 2.8ata chamber that may or may not be the best option.

Hey I could be wrong about all this!

DSO

 

[kammel78]

DAN did not and will not tell me where there are 6ata chambers....when asked for the 'nearest' chamber they directed me to a hospital 4+ hours away by vehicle[too many passes to get there] with a medical 2.8ata chamber....seriously, DAN says they will not publish or provide a listing of chambers...not just chambers that could treat serious DCI cases but the chambers that will accept divers. Even if chambers are not 24/7 at least it gives you options.

I am disgusted with the "can't get there from here" attitude, but unfortunately in today's society of not taking responsibility for anything that could result in legal actions for any involvement or anything that could hurt the corporate bottom line...I get it. Medical community is big business and DAN has evolved [devolved?] into that model....at least that is how I see it. Contrary to the current paradigm I do believe that a nationwide emergency response plan by regions can be drafted that would include a listing of closest chambers for treating Type 1 & 2 DCS or AGEs that includes the vanishing number of 6ata chambers. And emergency transportation options with pressurized planes.

There's no need to speculate, they (DAN) have addressed this exact concern and provided their reasoning which is certainly open to debate.

https://dan.org/health-medicine/health-resources/diseases-conditions/why-does-dan-not-share-chamber-availability/

"DAN maintains a database of hyperbaric facilities willing to and capable of treating divers. It is challenging to ensure this database is current, as most chambers do not routinely report their status to DAN."

Playing devil's advocate, I can certainly see the struggle with this. If DAN were to publish a list, that list then becomes static and outdated the second it's posted. Then someone copies the list, emails it out to divers and people keep referencing the outdated list even if it's updated on their website.

I particularly like this statement from the above article..."DAN is not the only resource for chamber information for travel abroad. Your dive operator should be able to give you this information before arrival."

 

[Wallowa]

There's no need to speculate, they (DAN) have addressed this exact concern and provided their reasoning which is certainly open to debate.

https://dan.org/health-medicine/health-resources/diseases-conditions/why-does-dan-not-share-chamber-availability/

"DAN maintains a database of hyperbaric facilities willing to and capable of treating divers. It is challenging to ensure this database is current, as most chambers do not routinely report their status to DAN."

Playing devil's advocate, I can certainly see the struggle with this. If DAN were to publish a list, that list then becomes static and outdated the second it's posted. Then someone copies the list, emails it out to divers and people keep referencing the outdated list even if it's updated on their website.

I particularly like this statement from the above article..."DAN is not the only resource for chamber information for travel abroad. Your dive operator should be able to give you this information before arrival."

Definitely one perspective..."challenging" , "struggle", "outdated".....but we should be asking what is the alternative? If DAN can't have a contact listing of diver treatment chambers that are on-line and if those chambers can't or will not routinely and periodically update their status with DAN....again what is the alternative?

Is it not better to have a listing of chambers available for divers so that individual divers can utilize the list to verify the chamber status during the development and immediate emergency planning for a dive? Always comes back to individual responsibility of each diver, not operators or DAN, to ensure that before they dive they have an updated emergency plan in place and with them on the dive.

Even a phone number for these treatment chambers with a message line stating their current status would work; if we had the location, type and phone number of the diver treatment chambers. Nada now. Without that you abrogate your well being to a third or fourth party rather than assuming that responsibility yourself. Nobody has more skin-in-the-game than the injured diver.

DAN serves a function but they are limited by business decisions, resources and the proclivity of many divers to "let them" provide for our safety. A listing of chambers and pressurized air ambulances by zones or regions in USA, regardless of current status, is in my estimation a minimum. Then each diver needs to step up and own our responsibility for our specific emergency plans tailored to meet the needs for each dive. To accomplish that we need the listing of needed resources to correctly and timely implement our specific emergency plan. Hope for the best but prepare for the worst. Or just hope for the best and see how that works out.

Again, I could be wrong.....

DSO

 

[kammel78]

Definitely one perspective..."challenging" , "struggle", "outdated".....but we should be asking what is the alternative? If DAN can't have a contact listing of diver treatment chambers that are on-line and if those chambers can't or will not routinely and periodically update their status with DAN....again what is the alternative?

Is it not better to have a listing of chambers available for divers so that individual divers can utilize the list to verify the chamber status during the development and immediate emergency planning for a dive? Always comes back to individual responsibility of each diver, not operators or DAN, to ensure that before they dive they have an updated emergency plan in place and with them on the dive.

Even a phone number for these treatment chambers with a message line stating their current status would work; if we had the location, type and phone number of the diver treatment chambers. Nada now. Without that you abrogate your well being to a third or fourth party rather than assuming that responsibility yourself. Nobody has more skin-in-the-game than the injured diver.

DAN serves a function but they are limited by business decisions, resources and the proclivity of many divers to "let them" provide for our safety. A listing of chambers and pressurized air ambulances by zones or regions in USA, regardless of current status, is in my estimation a minimum. Then each diver needs to step up and own our responsibility for our specific emergency plans tailored to meet the needs for each dive. To accomplish that we need the listing of needed resources to correctly and timely implement our specific emergency plan. Hope for the best but prepare for the worst. Or just hope for the best and see how that works out.

Again, I could be wrong.....

DSO

I get it but I don't see where that's DAN's responsibility to provide and maintain. DAN's efficacy is not in providing resources for self-care or even in risk management, it's in emergency assistance and cost mitigation.

The reality is that we're in a very small minority of use cases from a business operations perspective and have to deal with those limitations. It certainly doesn't help when one of the few organizations devoted entirely to divers gets bashed to death for views and internet clout.

 

[Wallowa]

I get it but I don't see where that's DAN's responsibility to provide and maintain. DAN's efficacy is not in providing resources for self-care or even in risk management, it's in emergency assistance and cost mitigation.

The reality is that we're in a very small minority of use cases from a business operations perspective and have to deal with those limitations. It certainly doesn't help when one of the few organizations devoted entirely to divers gets bashed to death for views and internet clout.

True that, good observations...but DAN has been and is more than "emergency assistance and cost mitigation" [insurance]...they have been a fount of medical and diving safety augmentations and information for decades. Yes, we are a tiny slice of the business operations at large, but we are 100% of DANs....without we divers they serve no function. We need DAN and DAN needs us.

Bashing and constructive criticism are distinctly different....when viable options are proposed it is constructive; denigrating just to get licks in is useless and counterproductive...bashing...and I agree as stated DAN serves a function in the diving community, a valuable function that I have seen erode over the years...why? Who can say...business is business but I believe divers are quicker now to pass the buck for emergency preparedness rather than step up and take responsibility for their own safety. Hey, only my opinion and experience.

Seriously, is it not feasible and appropriate for a listing of diver treatment chambers to be made available to the diving community? Current status should be up to the person drafting their own emergency plan before each dive. A phone call either to the nearest appropriate chamber or DAN [if they periodically update chamber status] to confirm they are on-line is an essential element in an emergency plan. If chambers can't afford a hot-line stating current status then perhaps a posting of status on their website at a minimum. Proactive rather than reactive; wait until a diver with DCI needs an expedited [always] treatment in a chamber and you are seriously behind the curve.

Wish I had a magic wand to provide all of us rapid appropriate transportation, a chamber director/physician's evaluation and then appropriate hyperbaric treatment schedules. Ain't feasible, especially with the current mind set of the diving community of "call DAN" and they will provide. Diving is a privilege that we earn by assumption for our own safety. Each dive is a solo dive, each ascent is a decompression ascent and to remain intact and safe is up to each diver. At least in my world.....

DSO

 

[Six Feet Under]

The challenge is how do you do those things?

For credit cards I assume my cards will work everywhere. But I know from experience that sometimes the visa/mastercard fraud detection algorithms kick in and block transactions unexpectedly. How can you KNOW it's going to work in advance?

How do you verify in advance that your calls will be answered in an emergency?

How do you know which chambers are working and how they are accessed? My understanding is that this information isn't widely available. And even if you know there's a chamber at some location, my understanding is a lot of them don't take divers.

1. Call your creditors or banking institution and tell them you'll be in X country on Y date range, and conducting activities of this nature. Have them leave a note on your account or ensure those algorithms are turned off for that time frame (I've had this happen just going from Florida to Nevada and trying to buy gas two times in a row at a gas station because the first attempt timed out and I tried it again).

2. Call those numbers and verify whatever pertinent information you need to know, ahead of the departure date of your trip. DAN should answer 24/7, but it doesn't mean the local facilities will.

3. I'd call the chambers individually that are closest and ask if they are open, have any dates/times of closure, if they're staffed full-time, if they accept divers, if they're part of DAN's network (something I'd ask DAN too - verifying both ends would give me peace of mind), and how they conduct treatment if not.