Unknown Woody From “Dive Talk” DCS and Medical Journey

[Six Feet Under]

How many of them are both capable and interested in treating divers? A lot of chambers have lots of patients booked for wound therapy or other purposes and don’t want to mess up their cash cow (and also don’t have anyone on-call). I’m also not at all confident that people fully qualified to administer wound therapy or other non-emergency treatment are qualified to treat DCS.

Probably none, but I'd bet none (or almost none) of them got calls from the hospital when my friend had a type II hit that took him almost 18 hours to resolve when we live within an hour's drive from at least seven different places with hyperbaric capabilities. Perhaps he could've gotten better treatment than 12 hours on O2 before they transported him to Orlando (90 minutes away) and ran him through the chamber at 2pm on a Wednesday...

Then again, early recognition (and acceptance) of symptoms would've helped in both his case and the D.T. case. I'm not recommending "making a list of chambers" to keep forever, I'm saying if you are planning something out of the ordinary, then it may behoove you to attempt to contact the nearest potential options and ensure they're open, accepting divers, if they have on-call staff, have treated DCS before, etc and include that in your EAP so that someone other than you can reference that potential chamber option to DAN or EMS providers in the event there's an incident...

"Prior to the trip, I reached out to ABC Hyperbarics and they said they take patients, here is their contact info if you don't have a known better option on the table" is a lot faster than having someone trying to take a list and make sure it's updated/accurate once the problem occurs.

 

[Nitrogenius]

So much to digest here But at least now finally we seem to get to something useful here out of the blatant ignorance of the persons triggering this thread, even though they will never admit their ignorance as it is integral to the concept of ignorance. And to be fair sometimes ignorance really is bliss, just not in the avenue of advanced diving and regular rec diving could also use a bit less ignorance however there it is built in the system as well (hey I have a buddy.. cool so let's rely with my life on such buddy that I barely know, but that is a totally different story)

The challenge is how do you do those things?

Perfectly answered by six feet under

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?

It was exactly that assumption that got them in trouble, wasn't it? Apart from not even being aware of card individual limits apparently. Calling them and letting them know you are headed to some more exotic place helps a lot. Even though that some cards still would not work as the human is being locked out from overriding the algorythm preemptively in some cases.

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

As noted.. Test Calling them helps. Especially from your destination and verify that it works and that you get through with the roaming provider

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.

Yes this is an issue. Interestingly as also aparent from this dicussion this is even a more problematic toppic right at home as in a lot of diving tourist location.
it should just be part of thge preparation for a dive trip involving adavanced dives (and does not hurt either with any rec diving)

I have been on a 2 month quest to try and identify hyperbaric treatment chambers for diving DCI.

Yes a huge issue in North America. Maybe running the health industry by for profit organisations is not the greatest idea after all?
Pretty much a non issue in countries with government run health systems.
Also way less of an issue (for tourists) in countries with a low GDP because there such treatment is usually very affordable to the rich tourist and their insurance so that running a chamber for those few instances it is needed is in facty profitable.

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.

Yes needs to be part of the plan. Not only knowing the options but also how to get there (safely or as best as possible)

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

Well however as the case at hand has shown just relying on Dan answering 24/7 isn't going to cut it

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

That sounds more like it

DAN did not and will not tell me where there are 6ata chambers....

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.

Yes! and this is showing that prepping your own plan is even molre important where you expect it the least. Back in your own stopming (diving) grounds), Unfortunately as rightfully poinnted out by six feet, you have to do your own research and do your own digging and after identifying potential chambers via the web actually call them and clarify whether or not and under whcih circumstances they will in fact take you (or not)

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.

Yes indeed. And while largely frowned upon I would never rule out the option of wet recompression in a pinch, while certainly not ideal it might still present the best option in some circumstances and certainly better than dying.

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

yes very very sad!

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."

Excactly!! There are many ways that lead to Rome. The main point is to actually realise and get started that this needs to be analysed and prepped before a trip and not in an actual emergency.
But sure Divetalk did nothing wrong here.. It is the lame credit card companies fault and Dans fault and American Express (pelase sign up here using this link) did the only great job, while also they probably have just done what they were supposed to and operated within their scope of service for a prime credit card, but again why should one be aware upfront what services a credit card entails and what limits they offer, when one can wait to an actual emergency to find out ?

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?

One would think there would be options for legal disclaimer language if there was really an interest to provide such inormation, but the reality is, there is no money in it to even bother doing that.

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.

Somewhat my point just raised, however one would think self care and risk management could effectively reduce the need of emergency assistance and cost mitigation!

 

[Nitrogenius]

I have to wonder if all this effort to obtain the perfect list of available chambers would not better be spent on avoiding DCS in the first place. That is, avoid the problem, rather than solve the problem.

Lol! You might be onto something. Specifically the more remote the dive site gets and the more challanging the dive as such. Again and Dive Talk did such a great job with that by rushing to a dive site after some travel complications and then likely not drinking a lot in order not having to pee while doing a deep dive on air diluent navigating a major restriction. But hey certainly no responsibility here, ey?
Obvioulsy reducing risk factors as much as possible is your first line of defence!

Viking's comments should be re-read....they nail it! For all our august healthcare network here in USA....it boils down to fear of litigation and profit...so I see it.

Sad! Isn't it? Maybe government regulation isn't such a bad idea in certain areas after all!

How many of them are both capable and interested in treating divers? A lot of chambers have lots of patients booked for wound therapy or other purposes and don’t want to mess up their cash cow (and also don’t have anyone on-call). I’m also not at all confident that people fully qualified to administer wound therapy or other non-emergency treatment are qualified to treat DCS.

Part of the necessary preparation to find out who will be able to treat you!

You seem to be advocating for DIY rather than engaging the experienced and proven professionals. I am not that egotistical. I don't cut my own hair, either, much less take out my own gall bladder.

Ah so just leave it to chance and and up like DiveTalk?
Btw as a matter of fact I do cut my own hair!!! I'd hesitate a bit to take out my own gall bladder, but I certainly could theoretically construe circumstances where this becomes a plausible option

I don't understand the need for us (as divers) to have a comprehensive database of chambers. Lists are immediately outdated and even if updated, prior outdated lists will persist on the internet.

Ok well we have seen with DT how well that works to not do your own reasearch and rely on services without even understand what they do provide and what not. Ignorance is bliss, isn't it. Especially when you alomost die from it. Well at least it might make a great lawsuit to just follow the thought of always blaming others for ignoring own responsibilities. Funny that the highest percentage of folks that neglect any self resonpsibility in vast areas of life risks at the same time seem to advocate against a nanny state. Always blows my mind!

DAN has stated if you're traveling or diving outside the US, they will happily work with you on an EAP

Yes and one should hold them to their promise. Lets see how well that will work without wanting to share information oabout chambers and status.. But I might be wrong in this as Wallowa might say
Intgeresting to note that given the conversation the need for such EAP seems even more necessary within the US! But some of us already knew that before this discussion

Regardless, as also stated in the article, suspected DCS should first be confirmed by a physician, even if to also diagnose or rule out other medical conditions, then a chamber confirmed and transportation to the chamber arranged.

Highly questionable approach dealing with suspected DCS. That "policiy" is soley based on commercial considerations and not on maximising health care for the affected

If you're saying that you need to know chambers beforehand but you're first step is still to call DAN, then I don't understand the need for the list? DAN will take the same steps regardless of your list and will therefore not affect the outcome.

The difference being you force DAN to actually verify and confirm what is working in taht area and what isn't and by that gaining valuable time that otherwise could cost your life, but hey.. up to you.. Again ignorance is bliss!

I get the desire to have a list for EAP planning, but give me a use case where a list would alter the outcome of an accident that DAN would manage.

No offense kammel, but I suggest to read/inform yourself a little more about DCS and how it evolves, than the answer to this will become very apparent.
In simple language in a pinch it might be the difference between life and death (or otherwise serious not reversable damage taken). Minutes can make a difference depending the serevity of the underlying case or the speed the sickness develops/progresses.
Surely there might also be cases where in fact it does not make any difference. The problem being, you wouldn't know either way! So better to err on the safer side, wouldn't you think!

 

[Nitrogenius]

Then again, early recognition (and acceptance) of symptoms would've helped in both his case and the D.T. case. I'm not recommending "making a list of chambers" to keep forever, I'm saying if you are planning something out of the ordinary, then it may behoove you to attempt to contact the nearest potential options and ensure they're open, accepting divers, if they have on-call staff, have treated DCS before, etc and include that in your EAP so that someone other than you can reference that potential chamber option to DAN or EMS providers in the event there's an incident...

"Prior to the trip, I reached out to ABC Hyperbarics and they said they take patients, here is their contact info if you don't have a known better option on the table" is a lot faster than having someone trying to take a list and make sure it's updated/accurate once the problem occurs.

Thanks to show there is hope in the diving community but also in the application of what should otherwise being common sense, which unfortunately seems to get more and more lost!
Quite a concept common sense, Using your own brain and along with it accept responsibility for yourself and your life
By the way what I said includes the willingness to accept that using your brain might have been flawed and if you mess up due to that this is also your very own respnsibility and not someone elseses!!

 

[Wallowa]

Probably none, but I'd bet none (or almost none) of them got calls from the hospital when my friend had a type II hit that took him almost 18 hours to resolve when we live within an hour's drive from at least seven different places with hyperbaric capabilities. Perhaps he could've gotten better treatment than 12 hours on O2 before they transported him to Orlando (90 minutes away) and ran him through the chamber at 2pm on a Wednesday...

Then again, early recognition (and acceptance) of symptoms would've helped in both his case and the D.T. case. I'm not recommending "making a list of chambers" to keep forever, I'm saying if you are planning something out of the ordinary, then it may behoove you to attempt to contact the nearest potential options and ensure they're open, accepting divers, if they have on-call staff, have treated DCS before, etc and include that in your EAP so that someone other than you can reference that potential chamber option to DAN or EMS providers in the event there's an incident...

"Prior to the trip, I reached out to ABC Hyperbarics and they said they take patients, here is their contact info if you don't have a known better option on the table" is a lot faster than having someone trying to take a list and make sure it's updated/accurate once the problem occurs.

Good example of when an emergency plan has a listing of diver treatment chambers near the dive site would have hastened treatment....reaching out requires knowledge of chamber locations and contact points.

I am backing down on this topic, since the solutions or at least contributory information to facilitate timely and correct treatment of DCI seems to rile folks up and shuts down dialogue....same old same old, "can't get there from here" mentality...do the homework folks and try [damn near impossible] to include in your emergency plan where you need to be taken [correct chamber needed to treat Type 1 or 2 and embolisms]...and correct transportation options.

Website and phone recordings for chamber status can be easily updated, but you first need to know where the closest chamber might be on-line to check on their status. Ditto for transport to the chamber; out west we have a lot of mountains necessitating a pressurized fixed wing air ambulance, perhaps on east coast a helo could fly you to a chamber below the suggested max 800 ft absl....any gain in altitude only makes DCI worse.

Like stated, I will let you folks duke it out about assuming responsibility for your emergency plan or simply differing to the DAN or other entities for their emergency plans.

Stay safe and enjoy your dives.

DSO

PS....If a listing of 6ata chamber in USA comes to light or even exists, please PM me how to source it; thanks...un-watching this thread.

 

[tursiops]

Ah so just leave it to chance

Are you really implying that the only alternative to a fully curated and up-tp-date list of chambers is leaving one's treatment to chance? Thar is a totally false statement and unworthy of you.

 

[Nitrogenius]

Are you really implying that the only alternative to a fully curated and up-tp-date list of chambers is leaving one's treatment to chance? Thar is a totally false statement and unworthy of you.

Well as you imply with "unworthy to me" that is in fact not what I am implying.
I am just trying to provoke thought about this matter! The more folk dig into this the more apparent the in some occasions shockingly sparse availability of chambers that are willing to treat divers will become. The more pressure it will create on folks that are actually in the position to do something about it nad hence improve the situation.
And provocation seems what is needed here, as with Wallowa (one of the few actually trying to do what appears to be necessary preparation) exiting this discussion just shows the level of lack of interest in this.

I am not surprised at all btw, so no one would be able to scare me away with their reaction but I do emphasize with Wallowa's reaction.

And btw a little secret. Even in Northern Germany the availability of chambers that will treat divers is an issue and noty only recently. But also there it is an effect of for profit orghanisations running the hosiptals and they just think if they have a chamber at all it makes much more money to use it for other treatments. Luckily if you know the trigger points because of the law you can still strangarm them into treatment (at least during their operation hours) but you will have to strongarm them in such emergency, so better have a plan and know which chambers are operational at which hours, because without it you might be sent somehwere where crucial time is lost.
If this is something you are willing to accept.. Up to you, I am better safe than sorry, but along with what has been written I might also be one of those that due to that has lower chances ever needing a chamber as surely I try to adress it by the root cause already trying to rduce risk factors for DCS as much as I can.
Having said that I already did have a hit, that wasn't treated with a chamber at all though (another long story)

 

[Cert1967]

There's multiple problems with the current state of affairs in American healthcare and the chamber problem is a microchasm of that problem.

Let's say I want to make a deco dive in any other country than the USA. DAN will tell me, upfront where the nearest chamber is. . .

In the USA, they say they want you to call 911 (I agree) and let the EMS system work. I'm not knocking the EMS system in the USA (it's awesome) but if I have a 4-6 hour wait to get to a chamber where I'm diving (I do) I may elect to make a different decision about dialing 911 than I'd make in a place where the nearest chamber is 30 minutes away.

I'd make the same risk assessment in a foreign country, and I'd be prepared for it, but in the US, we have to make an educated guess about what's best because of DAN's paternal attitude.

That said, they could provide information that is something to the effect of: "These are the chambers and their capabilities as far as we know. Things change. Don't depend on this list without verifying the information herein... etc., etc."

Your ability to make a reasoned risk assessment is diminished by DAN's unwillingness to provide this information. That might be good for the average rescue diver, but it's terrible for someone trying to make an accurate assessment of risk (or more to the point, for someone trying to make a plan to mitigate risk).

</soapbox>

Maybe buy insurance from someone other than what DAN reps?

 

[tursiops]

Well as you imply with "unworthy to me" that is in fact not what I am implying.
I am just trying to provoke thought about this matter! The more folk dig into this the more apparent the in some occasions shockingly sparse availability of chambers that are willing to treat divers will become. The more pressure it will create on folks that are actually in the position to do something about it nad hence improve the situation.
And provocation seems what is needed here, as with Wallowa (one of the few actually trying to do what appears to be necessary preparation) exiting this discussion just shows the level of lack of interest in this.

I am not surprised at all btw, so no one would be able to scare me away with their reaction but I do emphasize with Wallowa's reaction.

And btw a little secret. Even in Northern Germany the availability of chambers that will treat divers is an issue and noty only recently. But also there it is an effect of for profit orghanisations running the hosiptals and they just think if they have a chamber at all it makes much more money to use it for other treatments. Luckily if you know the trigger points because of the law you can still strangarm them into treatment (at least during their operation hours) but you will have to strongarm them in such emergency, so better have a plan and know which chambers are operational at which hours, because without it you might be sent somehwere where crucial time is lost.
If this is something you are willing to accept.. Up to you, I am better safe than sorry, but along with what has been written I might also be one of those that due to that has lower chances ever needing a chamber as surely I try to adress it by the root cause already trying to rduce risk factors for DCS as much as I can.
Having said that I already did have a hit, that wasn't treated with a chamber at all though (another long story)

I don't respond well to being provoked by accusations or assumptions based on faulty logic or appeals to extremes or strawmen or outrageous hypotheticals, etc. Or to long, involved, hard -to-follow diatribes.
So, press on, try to make your situation in Northern Germany better; it probably has little relevance to the system where I live.