"Paramedics airlifted the man to Tallahassee Memorial Hospital, then to an Augusta, Ga., facility with a decompression chamber."
I wonder why he had to be moved to Georgia when there is a hyperbaric chamber in Tallahassee.
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"Paramedics airlifted the man to Tallahassee Memorial Hospital, then to an Augusta, Ga., facility with a decompression chamber."
I wonder why he had to be moved to Georgia when there is a hyperbaric chamber in Tallahassee.
Bingo-I asked that same question!!!! If Tallahassee isn't recompressing divers we are in big trouble. Shands quit recompressing divers and sends them to Tallahassee. If they don't any more then,****,we have a big problem.Quote:
Originally Posted by Zinc
Occupied maybe?
That is possible,or maybe they get a percent of the airlift at around 17k. I am very pessimisitic knowing the state of the chamber situation in Florida,and I am hoping that the bottom line CFOs haven't declared recompressing divers as nonprofitable enough. Too bad for the victim,100 miles north of Tallahassee at Pheobe Putney in Albany,there is a chamber with a top notch recompression doc.Quote:
Originally Posted by PfcAJ
The chamber was in working order this summer. I know someone that used it and took a tour of it. Must have been occupied
Sent from my SAMSUNG-SGH-I777 using Tapatalk 2
Good point Kelly. With Jackson Blue being N. of Marianna my drive time which is just N of Albany is around two hours. And when the Dr. stopped by the Dive Shop it was my understanding he is associated with DAN.Quote:
Originally Posted by Kelly Jessop
Sent from my iPad using Tapatalk HD
The doctor there used to be the chamber doc at Jacksonville,FL,and has a lot of diver experience. I was pleased with my experience with them,not very pleased at getting the hospital to understand DAN insurance and bill for it.Quote:
Originally Posted by SlowDiver
Last time I was a the chamber with the local dive club here, we were told no diver recompression, chamber was for wound care and other scheduled things, but they would not recompress diversQuote:
Originally Posted by Kelly Jessop
I saw in the last issue of Alert Diver that DAN was trying to help with the diver recompression chamber issue.
I think it is a start.
Some of the things listed were:
A List of chambers that are available for diver recompression.
Medical call in support for those chambers
Some funding for chambers?
more streamlined payment from DAN to recompression chambers
I know I would like to see the list of available chambers closest to where I go diving.
I recently (this past Sunday night) had a DCS scare and while working with DAN, I was told that the Tallahassee chamber is currently closed but should reopen very soon. There are many chambers around including at least 2 in Gainesville but as pointed out earlier, are not available for divers. The closest currently available to Ginnie is in Orlando. Thankfully I did not go to Orlando but the hospital I was in verified that this was the closest.
I wonder if it make a difference (keeping the chambers open) if they knew how much money was pumped into the area from divers. Of course, if the chamber is being run for profit, it may be a mute point.
these are in for-profit hospitals. The point might be mute or even moot. As I understand it, the chamber wasn't closed due to funding or lack of interest.Quote:
Originally Posted by sandy
My understanding it was a having a chamber crew scheduled and or on call issue. I assume most people want to work from 9 to 5 Mon thru Fri., but think that may not when a chamber is needed. I got the impression that being a re compression chamber for diving, meant you had to have a crew on call 24, 7 and they didn't want to sign up for that, bet that cost a lot, for very little return.Quote:
Originally Posted by sandy
That was a couple of years ago, and things may have changed
That is correct. I work in a "nonprofit" community-based hospital. Nearly 20 years ago I pursued hyperbaric training and certification to staff our chambers (1 dual-place, 2 mono-place) - a really nice facility. However the hospital in their infinite bureaucratic wisdom place the chambers on the 4th floor of the hospital. Since I work in the ED on the first floor and the chamber is not immediately contiguous to the ED, I can't staff it.Quote:
Originally Posted by a64pilot
Routine scheduled wound-care treatments are the financial backbone of any hyperbaric facility. Don't know of anyone who wants to receive a routine treatment at 0300. Staffing the facility with on-call personelle 24/7 is financial suicide if one relies on the occasional after-hours DCS case to fund same.
Agreed. Would anyone be willing to create a poll to see how many divers on this forum have DAN coverage? I think a yes or no answer would be plenty. I do not how to do this and would apreciate it if someone would be willing to do this and some day I will learn how to do it so this is a one time thing. If done thank you and safe diving.Quote:
Originally Posted by victorzamora
I've always had Dan Platinum. However a few years back when I had an issue,none of the facilities that Dan referred me to were accepting dive related issues. I hope they have resolved the misinformation in their data base.
That's basically correct for Shands. They had some budget cuts within the past five years and lost the on-call team for the chamber as a result of the cuts.Quote:
Originally Posted by a64pilot
You can start a poll, anyone can.Quote:
Originally Posted by next gen
If someone does make such a poll, you might consider having other non-DAN diving insurance as an option. I've heard there are alternatives.Quote:
Originally Posted by FW
and add those people who have DAN coverage,used the benefits,and a) no problem getting payment b) a ****load of headache getting payment while the hospital is sending you a 3rd notice of nonpayment.Quote:
Originally Posted by Squirrel Girl
Skip already started one. He put in non-Dan as an option, but not problems y/n.Quote:
Originally Posted by Squirrel Girl
Yes, they were very good to me at 02:00!Quote:
Originally Posted by Kelly Jessop
If you guys list the poll options I will be happy to put one up for everyone.
Jack
Somebody please list them in one reply. Then it will be easier to set up. thanks
re: Dan & other insurance options
As for hyperbaric chambers in Georgia, they are practically in every hospital except for the very smallest, believe it or not and their numbers are growing every day. A couple of you were accurate when you stated they are being used for wound care monday through friday during normal business hours. The down side as some of you mentioned is that emergent hyperbarics, such as treating dive injuries or CO poisoning, happens so seldom that its not worth paying staff, even on call, to be available. The vast majority of chambers are monoplace anyway, which can treat cases of DCS where the patient is stable but that presents its own unique set of problems. I know of one operation that has multi place chambers and has the contract to treat the Army Rangers from Fort Benning but that is a special arrangement. Hyperbarics is not new by any means but has seen tremendous growth in the past 5 to 6 years for wound care and a serious decline for emergent operations because of the law of diminishing returns. I don't know what the answer to all of this is except to have your own portable chamber and a DMT on site when you dive. In all reality getting a diver from Tallahassee to Augusta isn't that big a deal if you are treating DCS, it's about an hour and a half flight, but it is expensive. As far as kick backs to the flight service, as one of you suggested, you can forget that it's VERY illegal and doesn't happen. Personally I have DAN Insurance and it does pay for chamber rides and flight services.
Not to creat confusion but I have seen the exact opposite...chambers are shuting down. Here in Charlotte, NC. When I was a student in Respiratory care there were several chambers open. Now Presbyterian Hospital has their chamber in mothballs, CMC closed their's down as well as I beleve GMH did also. Just saying.
I understand, maybe it's just that it's in two different areas. There is a lot of marketing going on here in Atlanta mainly in the form of education for ED and primary care docs so that they will refer to wound care, which is appropriate. Some facilities have shut down while many more open their doors. I guess my point was that with all of the chambers opening up, none will do emergent treatments and that's unfortunate for us as divers. I was just in a hyperbarics class with some folks from Rock Hill and some other areas in NC and they indicated that chambers were opening up.
Lifeflightmedic...that is good news!
It is cost efficient for chamber use for wound care,because most chambers will accomodate several patients,and they can do several patients at one time-that is where they make money. In an after hours scenario,if you had CO inhalation emergency,then I have my doubts that person would be transported to another facility,if that facility has a chamber. Diving injuries are not getting the same regard. There are so many cases of Shands transporting people to Tallahassee with DCS,and this is not only after hours,but during hours. From a hospital bottom line stand point,one patient,with an HBO crew,especially after hours with overtime,they are losing money. Hospital economics isn't about what is best for the patient frequently,but best for the bottomline,and many times the patient loses out (as a dept head in a hospital at one time,this is something I saw frequently). What I do resent is that some hospitals keep themselves listed as a chamber facility with DAN to treat dive injuries,but they aren't,they are transporting them somewhere else. Good friend sat in Shands ER with a type 2 hit for a long time because DAN said go there it is the nearest chamber. They eventually transported him to Tallahassee,with 8 hours of elapsed time following the incident. May be before going to the hospital with a chamber,to guarantee treatment,I need to breathe some CO,and get a stage 4 pressure sore? I really wish people would share their DCS incidents and where they go,because the cave diving community needs to know where to get treatment in the abscence of DAN knowing. It is unfair to have an accident,follow the rules of calling DAN,and they send you to the nearest facility per their list,only to get transported somewhere else,and delaying treatment. I know of two hospitals that will actively recompress divers -Tallahassee and Albany,GA,and I am driving in those directions while calling DAN.Quote:
Originally Posted by Lifeflightmedic
IWR.Quote:
Originally Posted by Lifeflightmedic
Brrrr!Quote:
Originally Posted by Greenwood_60
The last two posts are commendable examples of brevity. Two posts and two points made with a total of 8 letters and 2 punctuation marks. :)
or PIHC? Portable Individual Hyperbaric ChamberQuote:
Originally Posted by Greenwood_60
http://www.bluefootdiving.com/hyperbarics.html
skip
The Hyperlite will only compress to 75fsw, not the 165ft some treatment tables require.Quote:
Originally Posted by skip
I don't know, but the brochure claimed that 95% of all diving recompression was table 6 (more than one time sometimes too). So it sounds like it might cover the majority of needs. Seems like the NSS/CDS and NACD could get together and purchase one of these to keep handy in cave country. Legal issues probably make it impossible for them to sponsor, but what about signing off on a liability waiver ahead of time, so only those "on the list" would be able to use it? Not sure what training is involved, but that could be figured out.Quote:
Originally Posted by tursiops
Seems better to make our own arrangements, rather than relying on hospitals to buy, maintain, and staff. Some on here complain of "socialism," but then expect hospitals to provide. Self-reliance I say.
skip
About 30 years ago, a dive shop in Branford started a fund to purchase a chamber just for divers. Sadly, the shop owner fell on hard times, and absconded with the chamber fund, and left his dive shop to the creditors. A lot of divers had donated to the fund, some over $1000! A few had invested in the shop itself, and were left with not much more than bills. One of them took over the shop, and made a go of it for nearly 20 more years.Quote:
Originally Posted by skip
I agree with you skip. I'd love to see a community DCS team, with either a portable chamber like you posted, or a serious IWR kit.
At the risk of being the voice of doom...Quote:
Originally Posted by tursiops
I am reading more and more reports of bent divers going for hours or days without treatment because there are no chambers available, or they get stuck in a medical system that does not even RECOGNISE the significance of DCS.
It may get down to the point of "anything at all" or nothing.
AND if it does come down to a "group" like NFSA or NACD, CDS, KUR, WKRP, ect having to BUY and STAFF our own volunteer chamber in order to have something available in cave country- count me in for financial support!
There are two things that frighten me about coming down to cave dive in North Florida: DELETED having to be flown up to Duke University if I get bent.
I don't know how "serious" it is, but I have a FFM connected to a 3-way ball valve with 2 Omniswivel QD check valves, and 2 first stages with mating Omniswivel QDs. Toss in a butt load of O2 cylinders and one with air and you're good to go. One of these days I will rig up an O2 rebreather to the mask instead.Quote:
Originally Posted by Greenwood_60
That's a start. I'm thinking FFM, lot's of o2, 80%, 50%, air, some sort of a small deco habitat (may be as simple as a rubbermaid bucket inverted on the cave ceiling), a generator, tankless water heater and pump... all stored in a trailer somewhere between Ginnie and Peacock. A bent diver would send someone to make the call, get back down to a comfortable depth with whatever gas is remaining, and wait for help.Quote:
Originally Posted by kwinter
I wonder if a publicity campaign would make any difference. With the huge amount of diving that goes on in and around Florida, and all the money it brings to the state, one might think that if any place on earth ought to be well supplied with emergency hyperbaric resources, it would be Florida. Especially when the facilities already exist, and it's mostly a matter of funding the on-call staffing.
This reminds me of when trauma centers were first being formally designated in the 1970's. When there was federal money available to develop trauma center programs, lots of hospitals wanted to be trauma centers. When the federal money dried up, and it became evident that lots of trauma patients were uninsured as well as being very expensive to care for, quite a few hospitals dropped their trauma center designations.
Hyperbaric programs are very cost effective for most of what they do: scheduled treatments for patients with slow healing or non-healing wounds. The patients are scheduled one right after the other, and when staff are being paid, patients are in the chamber generating revenue. Hospital financial people like this. What they don't like is having to pay staff to be on call for all the time when the chamber is empty and not generating revenue, on the chance that a bent diver or a CO poisoning patient will come along.
Bent divers are a much different cohort than trauma patients or wound management patients. There are a lot fewer of them (fortunately!), they tend not to be indigent, they are likely to be well insured, and the vast majority of them will be treated as outpatients and not require admission to the hospital after treatment. From a hospital bean-counter point of view, they're a desirable group of patients, except for two things: They tend to show up at odd hours, and they need urgent treatment which doesn't lend itself to being scheduled ahead of time and is apt to disrupt the orderly schedule of wound management patients. I can see why hospital administrators might choose not to spend money to be prepared to manage the very small number of bent divers, except that I'm a cave diver, and I hope that if I get bent and show up at a big tertiary center with a hyperbaric program, like Shands, in need of emergency hyperbaric therapy, they'll provide it.
As much as I whine about the hospital bean-counters, (Hey, I'm an emergency/critical care RN - a certain amount of hostility towards the suits is in my DNA :) ) I do understand that hospitals have been under increasing financial pressure for decades, and it's going to get worse. Fortunately, there aren't many bent divers. Unfortunately, the small number of bent divers doesn't generate enough money to make treating them a financially attractive proposition. If there were enough bent divers to keep the chambers as busy as the cardiac patients keep the cath labs, every hospital would want a chamber and all the bent divers they could get.
So what do we do? Try to raise money to fund on-call staffing at existing chambers? Fund a dedicated chamber? Lobby the legislature to address this on behalf of the thousands of divers and the millions of dollars that diving generates in Florida? I dunno.
Mike
I just learned today that the Tally chamber is down until perhaps February (or later). So just head to Albany :)Quote:
Originally Posted by Kelly Jessop
Thanks for the valuable information. Not to hijack this thread,but divers in general,and cave divers specifically should have a vested interest in knowing about their treatment for DCS before the emergency arrives. The experts we depend on are only able to provide assistance based on out of date information they are given. I would like the CDF moderators to consider a subforum devoted to chamber updates in the region. What hospitals will take divers,what chambers are serviceable,is one out of service etc.Quote:
Originally Posted by barney00
The last four posts on this thread have hit at the point that all of us should be getting together on. And, Skip's right:self reliance to rectify DCS issues would be much better than uncertainty and poorly defined plans.
Two questions
1. Has anybody been bent diving at Peacock?
2. You guy's real sure Albany will treat divers? It's been a couple of years since I was there on a tour, and yes the doc had apparently a lot of experience treating bent divers, but he stated they would no treat divers. You guys sure this has changed?
WKRP, that's in Cincinnati, right :)Quote:
Originally Posted by gschaut
Yes. I know of at least one person that has - severely enough that he was airlifted from the scene. A very experienced cave diver, doing a dive he'd done many times before. I believe that he made a full recovery.Quote:
Originally Posted by a64pilot
#1 Yes! Know of people who got bent diving Hendleys and Lower OG,and also there is an incidence of diving a deep system,and then doing a long dive at Peacock,which instead of outgassing,saturated slow tissues.Quote:
Originally Posted by a64pilot
#2 Things change. We all thought Tallahassee was a sure thing,since Gainesville won't. That is the purpose of my comments,we need to collect this information,and post it for all to see. There is the potential for us looking like a bumper pool game trying to find a chamber to treat us.
Maybe a new topic is needed and the moderators move it there. I am sorry about the accident at JB and hope the best for the victim. A secondary topic that has sprung up is about whether a person can expect treatment. This person couldn't get treatment in Tallahassee,which is 70 miles away,and we found out later their chamber is out of service. I would ask the moderators to have a subforum on the status of chambers in the area we dive,because we can't expect DAN to help 100% here when they can have out of date info.Quote:
Originally Posted by Squirrel Girl
Just got off the phone with a Gentleman named Jim, he is a Tech at the Hyperbaric chamber in Albany. http://www.phoebeputney.com/PhoebeCo...e.aspx?nd=1377 He said that if you call them between 9 to 5 Mon thru Fri., they can get you treated for decompression sickness. BTW he was a Navy diver for 20 years, so I assume he knows what he is talking about. After hours he said go to the Emergency room and he was sure they would try to get a team up to treat you or they would call DAN and try to find you a chamber, but no-one is on call, there is no staff to support weekends or after hours.
He stressed if you are bent, call them on the way to the chamber, don't wait. The number for the chamber is (229) 312-7600.
Sounds like maybe before you leave to go anywhere, we need a card with the chamber telephone numbers to give them a heads up we are coming and confirm availability? Sort of a plastic card you can put in your wallet, credit card sized maybe? Call DAN of course, but it sounds like maybe you want to have someone call the chamber right after DAN tells you where to go?
Great news, thanks!
Quote:
Originally Posted by a64pilot
Part of my point is maybe one of the diving organizations could come up with a contact card in plastic having the names, addresses and telephone numbers, operating hours etc. for the existing chambers, or maybe us guy's here could? Maybe even just a "sticky" here that could be kept updated?
While I do not plan on ever being bent, it seems prudent to have a plan on where to go, who to call besides just relying on calling DAN. Not having a plan in place prior to commencing the dive is sort of against the cave diving philosophy of having a back-up for everything?
Maybe time to start boning up on IWR....
I mean really, I agree we ought to know what the treatment options are before entering the water right? It makes no sense to delay treatment bouncing from one facility to another does it?
Just throwing it out there to see what bites.... Food for thought, whatever...
If treatment is going to be delayed/unavailable what's the better option?
Certainly I am not advocating this be undertaken lightly, but is it a tool we should consider for the toolbox?
This is an interesting read. I'm sure many have read it before, but I figure it's worth posting in this discussion.
http://nsgl.gso.uri.edu/hawau/hawaut86001.pdf
Our good friends at Rubicon Foundation updated the Wikipedia page for IWR with good info and links to pubs...
http://en.wikipedia.org/wiki/In-water_recompression
Cheers,
Mike
As long as the symptoms are minor, I can't see why not IWR, but I'm no Doc, much less a diving Doc, just an ignorant redneck. I do know for some reason if you start talking about IWR around those that are medical professionals etc., they have a tendency to get upset, like you were suggesting something really bad. I can only assume that they are thinking about being badly bent, not slightly bent?
Of course I have never been bent, so I cannot even speak from experience. I assume if you have the symptoms and are still geared up, your bent pretty badly and should be going to a real diving Doc and a chamber, and if you experience the symptoms later, your probably not in a position for IWR anyway?
THey might also be concerned about someone doing IWR for something that is not DCS related...
"I have this shooting pain in my left arm..."
If you're only slightly bent, is it really worth getting back in and risking an ox tox? Plus, often times someone thinks they're slightly bent and symptoms progress rapidly with time.Quote:
Originally Posted by a64pilot
It all depends on options. If transport or treatment are going to be delayed, IWR is a good option if you know what you're doing. And rule #1 in my book is to be attended at all times. Going in the water to do IWR by yourself is insane. So that means there are 2 brains that have to agree it's a good idea. That sanity check reduces the risk considerably.Quote:
Originally Posted by jj1987
Anyone remember NASDS? There was a space on the pre-dive page of your logbook to put the address and phone number of the nearest operating chamber. (We were told to ask around and confirm the info was up to date.)Quote:
Originally Posted by a64pilot
Yeah, I'm sure this has all been done before, I think a lot of it is us newbies re-discovering forgotten information.
I'm not so sure I would sign up for IWR, unless I had the equipment (unlikely) and a buddy who knew what they were doing, (probably even less likely). Now if there was NO chamber available, like I was in the South Pacific or something, then that of course is different.
IWR is sort of a last resort for me.
Hmmm... Honey, I have a pain in my left arm. Think I'll go down to Peacock for a 90 minute IWR dive just in case.Quote:
Originally Posted by diveconjeff
I still keep a dive journal that accompanies me on every trip with all kind of extra information but not this. But I will add it tonight in addition to my phone. Thanks for the idea Russell.Quote:
Originally Posted by Slüdge
Remember, DAN only pays IF you call them and have them arrange transportation or agree for you to drive or be driven.... You call DAN after the fact and you pay. So best to call DAN and tell DAN the number to Hospital/Chamber you think is best. DAN will verify and get back to you with an OK or alternate plan. You call the chamber directly, DAN is no longer required to pay.Quote:
Originally Posted by a64pilot
Also, the chamber may or may not still be open for divers next month, so this is something that needs to be updated personally prior to every dive trip. What you read on the forum in November may not be true in December.
skip
Let me see....IWR. What's the cost/benefit ratio? 20 feet deep on O2? 1.6 ppO2. How long? 20 minutes with air breaks... really? First off 20 feet won't do much to crush the bubbles small enough to do much good. You are better off on pure O2 on the boat or shore. You need at least 60 feet to reduce bubble size, and now what mix to breath? About any mix you choose will result in on-gassing of nitrogen. Not what you want to be doing. And even if you do go back into the water at 20 feet on O2... and symptoms get worse? Or you misdiagnosed and the real problem was your heart, or lungs, or your appendix.
Self-Diagnosis and Treatment. Why would anyone think that's safe?
Table 6 is 60 feet of depth, on pure O2. You get the reduced bubble size to ease off-gassing, and you get pure O2 to prevent on-gassing more nitrogen. this cannot be done in the water. IWR is a myth. Unless you are with a team that includes a diving doctor, a couple of diving EMT's, FFM, etc. Even then it's dang near useless. Getting those bubble down to small size is essential and 20 feet just doesn't do it.
skip
Then go deeper. You don't HAVE to be on o2.
+1Quote:
Originally Posted by PfcAJ
Pretty interesting reading on how some of the IWR methodologies have been developed and deployed. Most of them appear to start with a decent on air to a depth sufficient to alleviate the symptoms, i.e. "crush the bubbles". Then only returning to O2 once you again approach the surface with a controlled ascent. YMMV :)
FWIW, IANTD offers this:
http://www.iantd.com/index.php/compo...pression-diver
Among other things it requires a full face mask, appropriate training, and so forth.
My first option? Get on O2 and Get to a chamber. However, I believe properly administered, IWR has a place in the toolbox.
How many hammers is too many?
Oh damn! I have too much ammo….
If only I could get bent with access to a fully staffed chamber.
Sometimes you may just have to play the cards in your hand, that's all I am saying.
Lets see,you call DAN and are told to go to hospital xyz,and that takes you an hour to get there,then you sit in their ER for 4 hours before someone says we can't recompress you in our chamber,so we have to send you somewhere else. They arrange transportation and then you get to hospital abc who need to evaluate you. By the time you have started treatment,8+ hours have elapsed. This isn't ficitional,but fairly common place. I am all about having a professional address my problem,but in light of the fact that nothing is guaranteed,why not IWR. My cave class in the 90's included the theory behind IWR,and how to do it. If I am going to have to wait 8 hours how much tissue trauma has already occurred versus doing IWR right away.Quote:
Originally Posted by skip
Skip,
First I don't plan on getting bent, but I don't have DAN, so for me it's not a concern if DAN will pay or not. I believe being bent is an emergency, I'll bet the chamber I call will believe so too, and if it's an emergency, I don't believe I have to have a mother may I slip from Tri-care, if I show up and a Doc says no emergency, then great!
From what it seems I'm hearing, DAN doesn't sound so good?
So if your relying on DAN, what's the problem with calling the chamber they tell you to go to? If the chamber says come on, then great, if they say we can't treat, call DAN back, you may have saved several hours.
IANTD recently unveiled their IWR course.
I've had two experiences (three if you count my buddy, as well as myself, on the same dive). One was a cave dive , with aforementioned buddy, to 140' for approx. :60 minutes...1981 or so, no DAN insurance available, no notrox, air at depth, O2 from 30 ft. (I Know, but it was acceptable at that time...everything was pretty much experimental or taken from Navy tables/procedures, etc.). Did the required deco, drove home, started getting increasing pains in left shoulder about two and a half hours after surfacing. Decided after about an hour I need to recompress, drove back to site, geared up (lots of gas in 104's left, plenty of 02)....went back down solo (couldn't get a hold of buddy, turns out he had symptoms as well, chos e an entirely different method of relief , which didn't work out as well) to 120' in the basin of the sink...immediate relief of symptoms. Took my time, approx. :40 minutes, up to 30', then about another :40 mins. on O2. Surfaced, waited in the water (about 3:00 a.m.) for about :15 mins....no issues. Scared the hell out of a local convenience store clerk when I walked in the door asking him to unzip my drysuit!
Ended up with some skin mottling on the shoulder (cutis marmotta (sp?), still have it to this day....fun to stump the dermatologists on annual checks, asking them to diagnose.
I've been tested for PFO....negative diagnosis.
Second time was just this summer....60 miles out in the Gulf, open water spearfishing, Short bottom time in 125', shot some red snapper, buddy (healthy, fit 45 year old ER doctor) did same, but stayed down a few minutes longer, I stayed 30-40 ft. above him, top cover...both did slow ascents to 30' or so then slower ascent to safety stop at :15' (computers both totally cleared). Got on the boat. He started to have increasing pains in the groin area, getting to the very painful stage, then he started to get numbness in the same leg. Put him on surface O2 (DAN kit)....still worsening. Decided to get him back down to depth...I suggested 60', then slow up to 30', then :20 mins or so up to surface. He went to only 30' or so (I was covering in the water), immediate relief there, then surfaced after only about :15 minutes or so. No more symptoms. I mentioned he should get tested for PFO, which he was obviously familiar with as a doc (and his wife is a nurse in a heart cath facility). He eventually did, and was tested positive for a small PFO.
My opinion only, but if a chamber is not available withing :90 mins. or so (earlier with extreme symptoms), IWR is preferable, as long as you have buddy support (in water), thermal protection , and enough/proper breathing gasses to accelerate off-gassing.
Last year most dives after the dive (JB) my shoulder would hurt for the rest of the day and be sore, started to wonder if this was just a tiny bit of DCS. (I had started doing longer dives, double stages and of course longer deco). Once after the dive on the way home my fingers started tingling and my arm was becoming numb on that same side the shoulder hurt. Started to really be concerned that this was DCS, then realized my arm had just fallen asleep :)
Since then I have realized my shoulder may not be DCS, just old age, so I make William hump the tanks and my symptoms of DCS have gone away :)
That's the funniest thing I've read all week! You are a lucky man, my 17 yr old daughter would look at me like I was smoking crack...Quote:
Originally Posted by a64pilot
Skip,Quote:
Originally Posted by skip
I respectfully suggest you read up on IWR and understand what you are talking about. Is it for everyone and for every DCS situation? Certainly not. But if you are looking at a serious case, or chamber treatment is multiple hours away, and you have the available resources (very important) and capability to conduct an improvised IWR application, there is no question to me that IWR is the more prudent and effective action. And IMHO it is not as "scientific" as some publications would lead you to believe. It's essentially the same as a hospital chamber ride - treat them until they are better.
Like Steve's examples, I had a particularly significant situation where not getting back in the water could likely have left me with paralysis to some extent. The event snowballed very quickly following an uneventful, easy dive to 320 feet offshore the Florida Panhandle (no USCG chopper coverage). Pain increased dramatically and I lost strength in one side of my body. My friends had to help me back in the water and a buddy tended to me during an extra prolonged soak starting at 90-100'. I got out of the water whipped, but with all major issues avoided. Immediacy of treatment is key, and is perhaps the one thing hyperbaric physicians will agree with even if they are opposed to IWR in general.
YMMV.
Cheers,
Mike
What do you mean lucky? Payment was three classes from EDD and gear. I think I got a good deal. :smile:Quote:
Originally Posted by gasdiver
Anyone know if a SCBA or SA FFM be used underwater? Can they be adapted for use with a scuba tank?
Dry land SCBA facepieces (fire service, ect) are generally not adaptable to U/W use for several technical reasons. All having to do with water pressure.Quote:
Originally Posted by h2ojoe
There ARE several brands of FFM that are designed to be either surface supply or SCUBA supplied thru demand regulators built into the mask.
Don't know if I'm allowed to mention brand names...
I was also wondering if they could be used for O2 emergency use. Positive pressure on demand FFM instead of the little mouth and nose mask generally used.Quote:
Originally Posted by gschaut
You're not a dealer trying to surreptitiously push your product - mention away!Quote:
Originally Posted by gschaut
The IANTD IWR course promotes an FFM as a requirement for their IWR certification. Makes an awful lot of sense if someone were to loose consciousness
J
There are several brands of positive pressure FFM used by the fire and hazmat services. Don't know if any of them are oxygen clean. But they all use about the same (100-140psi) intermediate pressure as SCUBA regulators.Quote:
Originally Posted by h2ojoe
If you are talking in-water FFM, go on scuba boards for the Interspiro MKii. Should be able to pick one up second hand for under $500. And the Interspiro can be oxygen cleaned. Second stage regulator is built into the mask assembly, so whatever you buy WILL need rebuilding.
Attachment 10035
For $500 you can get one with Buddy Phone comms. And it won't need rebuilding since it would be coming from a certified tech. Hint, hint...........Quote:
Originally Posted by gschaut
Although I have done 650 dives (only 75 cave) without getting bent, I suspect that advancing age will get me bent sometime. One consideration in choosing a vacation site is safety. Part of my increasing fondness for the Mayan Riviera is the presence of a multi-lock chamber in Playa del Carmen.
One of the reasons I like Bonaire.Quote:
Originally Posted by allen
Little islands like Bonaire and Roatan have chambers readily available for treating divers, but Florida, with over 19,000,000 people and a whole pile of hospitals including several world class tertiary centers, doesn't???!!!
Unintended consequences of over-regulation.
And lack of tort reform...Quote:
Originally Posted by Greenwood_60
Quote:
Originally Posted by Greenwood_60
Lack of tort reform may play some role, but not any more than any other procedure performed by hospitals. Surgery has much more risk for lawsuit than running a chamber, but I am not aware of any major hospital that doesn't have a surgery department. Legal fees, payouts, and related insurance only add up to a few percent of US health care costs anyway so while tort reform is probably needed it's not going to make or break the system.Quote:
Originally Posted by gasdiver
Over regulation can't be the issue either. Bonaire is part of the Netherlands. The health care system in the Netherlands is know for being among the best in the world based on stats like death from preventable diseases and infant mortality rate. Their health care system would be considered socialized medicine by US standards so clearly they aren't less regulated than we are. Roatan is part of Honduras which also has a form of socialized medicine. However, Honduras is a very poor country with very little wealth to work with so their system only provides very basic care (still enough to afford a chamber though). The point is that the government has more control of their health system, not less.
The problem we face in the US is that our health care system is a for profit system. Our insurance companies, hospitals, and pharmaceutical companies all operate as businesses. Any good businessman knows that a business can't provide products/services that don't generate profit. Providing emergency chamber services is not only not profitable, it's creating a big loss in most cases. Bonaire and Roatan have emergency chamber services because it is needed. US hospitals don't because it's not a money maker. Different priorities.
Just to be clear, I'm not trying to start a debate about the advantages or disadvantages of the US health care system compared to other nations. However, I do believe that the motivations of hospitals need to be clearly understood if we are going make any attempt to help the issue of disappearing chamber services.
Cleavitt, I won't disagree with any of your points, but were it not for liability issues, it might be possible for our community to stand up a chamber for emergency use. I think FW said there was a shop who considered the notion, once upon a time. Running a chamber is not rocket science. Heck, I treated more than one diver during the few years I worked offshore and I was just a high school grad with 5 months of commercial diver training. I know there are a lot of other issues around a community based recompression chamber, like money, but no one in their right mind would even consider it today because of the liability.
What is you're not considering, Cleavitt, is why the cost of "staffing" a chamber is so expensive. You're also making the fallacious argument that you can compare the quantity of regulation to the quality of regulation. Both systems are over regulated, and you can pick out data points to make either look good.
I would also point out that in Bonaire and Roatan, divers' dollars are a huge percentage of revenues as compared to Florida.
Cleavitt's logic is sound. the cost of "staffing" a chamber is tied up with profit and regulation. In the USA we require specifically trained technicians, specific number of personnel on hand, enormous malpractice insurance, etc. So the regulation side and profit side form a perfect storm. A socialized system reduces or eliminates much of the hassle. Tort reform would help, but when you operate for a profit and you see that X dollars per year are sitting there waiting for something to happen that is not likely to happen but once in awhile, there is clearly a place to save money by not offering the service. It's simply not a profit-increasing proposition. This is where socialism produces a better outcome. It costs money to operate a chamber, we all kick in the $ to keep it operational despite the fact it never makes anyone any money, and actually costs us money. We lose dollars, but gain security. I love socialism. We all should. Remember, our military is socialism, our congress is socialism. It's the rest of us that don't get to have socialism.
skip
Skip, the massive difference between your examples is voluntary participation. Socialism isn't a bad word, coercion is.
@gasdiver, Greenwood_60,
I see where you are coming from. I was mainly talking about hospitals and licensed staff, but I agree with both of you that an independently run emergency chamber or un-licensed staff is probably not feasible in large part because of regulations and fear of a lawsuit. In the context of treating a diver with DCS it would probably fall under the "practicing medicine without a license" regulation/law and the probability of a lawsuit would be very high.
However, I feel that it is not an ideal solution anyway and it's also not addressing the root cause of the issue in my opinion. It would be better than nothing, but it's not an economically efficient solution and it could be very problematic if a patient shows up with issues in addition to DCS or complications directly related to the DCS.
There are already hospitals all over the state that have made the capital investment for the chamber and other equipment. They already have properly trained and licensed staff. There are already emergency services (life flight/ambulances) in place to get injured divers to these places. They are 95% of the way there, but they are closing down their emergency chamber services anyway. They already meet or exceed the regulations and they already successfully deal with the risk of lawsuit in every other area of their business. The only remaining requirement is for them to pay on call pay and a small amount of overtime, but they won't because the costs are higher than the revenue for this service.
So who provides the money to get that last 5% for on-call and overtime pay? You can't expect any business to pay for anything that doesn't produce profit.
Fair enough. That would explain why the Florida health care market doesn't seem to care that this service is disappearing since it is a small issue in the grand scheme of Florida's economy. However, my guess is that while diving may be a smaller percentage of Florida's economy compared to Bonaire and Roatan, in terms of raw dollars it's probably at least as much if not more. If that is the case then it's safe to assume that Florida can somehow afford to continue to offer these services too.Quote:
Originally Posted by Slüdge
One of the great things about the United States is that, unlike most "socialist countries" I'm aware of, you are free to go elsewhere.Quote:
Originally Posted by skip
Yup. In the US system, it's less about what's needed and more about what's profitable. That's why there are so many different meds for GERD, ED, and constipation on the TV - meds for common recurring minor problems are profitable. But if you have a rare disease or an uncommon problem like being bent, there's no opportunity for anyone to make money treating you, so you might be SOL.Quote:
Originally Posted by Cleavitt
Even non-profit hospitals (and all of the hospitals in my home state of Vermont are non-profit) are under a lot of financial pressure. My local hospital (not the one I work at) cares for a lot of Medicaid patients, for whom they're reimbured 29 cents on the dollar. And the sequester took two million dollars off the top of their revenue in 2013. That's a lot for a small rural community hospital to absorb, even though they don't have shareholders to keep happy. They're certainly not in a position to add services that will cost them money to provide.
But as has been pointed out several times in this thread, almost all of what's needed for treating bent divers in Florida is already there. It's just a matter of coming up with the money to pay for some on-call staff.
Perhaps we could support the staffing of the chamber at Shands. One way would be for Cathy, Bill, Wayne, Jim to add a "chamber surcharge" to the price of airfills and send it to Shands. Another way would be for a large number of divers to buy chamber insurance directly from Shands. Another possibility would be for DAN, NACD, NSS, TDI, and IANTD to support the chamber. It migh be possible to form a "Cave Country Dive Safety Club" that could meet the costs of having staff on call at Shands.
In the last year I have had some personal experience and encountered some literature that may explain a lot about this.Quote:
Originally Posted by a64pilot
1. I started having the same symptoms you describe on several occasions last winter, especially after long dives wearing my backmounted steel 108s. Fortunately, at about the same time I started having similar problem unrelated to diving, like carrying my granddaughter around on my shoulders or carrying a golf bag for an extended period of time. I suspected it was carrying weight that was my problem, not DCS.
2. I had X-rays followed by MRI followed by investigation by a spine specialist. The result: I've got spinal stenosis, a narrowing of the spinal cord in the neck area, which is pinching the nerves that extend out into the arm. Carrying weight on the shoulders aggravates it. Physical therapy helps, and there are exercises that help as well.
3. I read a report posted in the medical section of ScubaBoard in which a study indicated that people with spinal stenosis are more prone to DCS than the general population. They looked at a group of divers who had been treated for spinal chord DCS in the past and compared it a group who had not. They found a significantly higher level of spinal stenosis in the group that had been treated for DCS than in the other group.
4. In another thread related to DAN and recompression chambers, a letter from DAN was reprinted, and in that letter DAN was arguing for the need for truly qualified people making medical decisions regarding recompression treatment. They said that many people who are treated for DCS do not actually have it. They cited spinal stenosis as a common example of a misdiagnosis leading to unnecessary chamber treatments.
5. I put #3 and #4 together and looked back on the methodology for the study that said people with spinal stenosis are more likely to get DCS. They studied a group of people who had been treated for DCS some time in the past. Did all those people actually have DCS when they were treated, or were many of them misdiagnosed because they had symptoms associated with spinal stenosis? There is no way of knowing if they actually had DCS. When I have a problem along those lines after diving, it goes away on its own at about the same rate as it would if I got a chamber ride.
In conclusion, don't just mark this up to old age and let it go. Find out if you have it. In my case, the spine specialist said it is not yet bad enough to warrant surgery, but it may eventually get bad enough. IN that case, surgery may provide relief.
Oh, and I just went to Edd and got my sidemount training so I don't have to walk to and from the cave entrances with double 108s on my back.
My cave diving buddy Bill Lester wrote this article that explains a lot.
http://www.floridadiveconnection.com...y-hyperbarics/
Good article
Sent from my iPhone using Tapatalk
Obviously you can't run a large multiplace Recompression Chamber as an independent business operation treating diving casualties only -there's no way it can financially sustain itself.Quote:
Originally Posted by MORGAN
The solution and the point of models like the Catalina Hyperbaric Chamber for Dive Accidents Only is that you're gonna need some combination of tax-supported county dept of health, hospital & EMS services, volunteer chamber crew, and annual monetary donations & organized charity drives from the regional diving community to make this venture work. 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 great as running a full service weekday 9-to-5 Hyperbaric Clinic facility with full-time employees and a physician treating diabetic wound care, burns and other medical conditions, because DCI cases in comparison are rare, uncommon and sporadic.
As for legal issues, you have to set-up something like a volunteer fire dept paradigm under county gov't support as a means to mitigate personal liability risk. The way we do it here in SoCal as stand-by Volunteer Crew for the Catalina Hyperbaric Chamber is that we are classified as "volunteer workers" with Workman's Comp Insurance coverage acting under the responsible auspices and training of the Los Angeles County Dept of Health Services and the University of Southern California, of which the Catalina Island Hyperbaric Chamber is declared as a remote extension of the mainland LA County/USC General Hospital's Emergency Medicine Department.
Again, the concept is similar to running a volunteer fire department -the call volume is not as great or frequent as a major metropolitan city or county, but the Emergency Service is still there on stand-by ready to respond. As a motivating idea, why don't you make a pitch to Halcyon Mfg over there to help donate, set-up, establish & house this Recompression Chamber on 24/7 stand-by in the High Springs Fire Station?
Here are your two models of the only two Recompression Chambers in the US on full 24/7, 365 days stand-by solely for the emergency treatment of civilian recreational diving accident casualties:
https://vimeo.com/120335768
And the Catalina Hyperbaric Chamber. . .