DAN frequently consults on the care, transportation and hyperbaric treatment of injured divers. However, DAN does not generally provide information about the location or availability of chambers. This is because injured divers with suspected decompression illness (DCI) need to be evaluated at a hospital or emergency clinic first.
Divers have driven past health care facilities to get to a recompression chamber, believing a chamber was the solution for just about any malady or injury. Even when divers surface with symptoms of an apparent arterial gas embolism, the best course of action is to have the diver assessed at the closest medical facility. An urgent care clinic or a hospital’s emergency department is better than a dedicated chamber facility.
Recompression Treatment
The best option for an injured diver is always to use the best locally available medical services.
- A differential diagnosis comes first. Not everything that can happen to a diver warrants hyperbaric treatment.
- A physician needs to rule out illnesses such as heart attack and other neurological and musculoskeletal injuries that could be confused with decompression illness.
- Advanced diagnostic procedures will rule out complications (such as a collapsed lung) and other additional factors that could make recompression therapy inappropriate or dangerous.
- A physician needs to make sure the patient can withstand recompression therapy.
Chamber Capabilities
- Not all hyperbaric facilities are capable of dealing with all cases.
- The closest recompression chamber might not be the most appropriate.
- A chamber’s operational status can change.
- Chambers may close for scheduled maintenance or staff vacations or may have limited staff available because of a high daytime patient load.
- The chamber you are driving to may not be available.
- Prior notification from an evaluating facility is usually necessary to begin the call-in procedure to staff a hyperbaric treatment.
- Most hyperbaric facilities have regular daytime business hours and are not staffed in the evenings or on weekends. Some chamber facilities choose not to staff their unit after hours. Others simply do not treat divers.
Hospital Capabilities
- Unlike most freestanding hyperbaric facilities, hospital settings have advanced diagnostic capabilities.
- A multidisciplinary setting ensures proper diagnosis and a stable patient before recompression therapy.
- Hospitals and urgent-care facilities have a virtually unlimited supply of oxygen, intravenous fluids and medications.
Transportation
- A critically ill patient needs to be stabilized before and during transport to a chamber and should be transferred under medical supervision.
- Transporting a diver without a proper evaluation may adversely affect the diver’s health and treatment outcome.
When In Doubt, Call DAN
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.
Once you have begun administering first aid and activated local emergency medical services (EMS), DAN can help you and EMS determine the best course of action for the case as reported. If the need for recompression therapy seems obvious, DAN can confirm chamber availability with the closest facility. The nearest medical facility will not necessarily have hyperbaric medicine but is still the preferred option. Once the diver becomes a patient, transportation will move quickly and efficiently.
Traveling Outside the U.S. and Canada
If you are traveling outside the U.S. or Canada, you can contact the DAN information line for chamber availability information and assistance with an emergency action plan for your destination.
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. The same issues that affect availability with domestic chambers can also affect international chambers.
Dive-Related Injuries
If you suspect a diver has a dive-related injury and needs evaluation, you should:
- Monitor their airway, breathing and circulation.
- Provide 100 percent oxygen if you are a trained oxygen provider.
- Call local EMS for transportation or assistance with the transportation of the injured diver to medical care.
- Call the DAN Emergency Hotline at +1 (919) 684-9111.
- The emergency line will accept collect calls for emergency consultation and advice.
If you are uncertain about symptoms that occur hours or days after diving and there is no emergency or you wish to ask general questions about decompression illness, contact the DAN Medical Information Line at +1 (919) 684-2948, 8:30am to 5:00pm ET, Monday through Friday.