Just before Christmas, a DAN member who was diving in Abaco, Bahamas, experienced an incident that resulted in decompression illness. When he contacted DAN and tried to access the benefits of his DAN membership and insurance, he did not receive the level of service he should have. Although we are still collecting information about DAN’s response to this incident, we can offer the following additional context to what was previously reported.
It’s important to note that DAN has been dealing with diving emergencies and arranging evacuations for over 40 years and has successfully completed thousands of these missions. When things occasionally go wrong, DAN has responded by improving its infrastructure and updating standard operating procedures based on what was learned. This incident is no different, and members can be assured that DAN has already taken steps to prevent something like this from happening again.
1. DCI Diagnosis – During the initial call the member’s dive buddy reported a provocative exposure followed by signs and symptoms compatible with decompression illness (DCI). At the time, the member was under the care of a physician who was completing his initial examination but had not yet rendered a diagnosis. After the initial call, the medic discussed the case with their supervisor. Following that discussion (7 minutes later) the DAN medic called the member back to confirm a higher level of suspicion for DCI. This is standard operating procedure.
Understand that this was not a medical diagnosis by DAN. The responsibility to diagnose rests with the evaluating physician (or other on-site medical personnel). DAN is there to support, not replace, the treating physician. It is the treating physician who makes all medical decisions based on their examination of the patient (something DAN can’t do remotely). In this instance, the treating physician, who lacked training in diving medicine, was offered peer-to-peer consultation with DAN’s medical director. However, this offer was never accepted.
IMMEDIATE ACTION – Reinforce to all DAN medics that DAN’s medical director is available for consultation with the treating physician. If the treating physician lacks the skill or education needed to diagnose a diving injury, the DAN medic will strongly recommend an immediate consultation with DAN’s medical director to determine what’s best for the injured diver.
2. Medical Evacuation / Payment of Costs – Once it became apparent that evacuation to a higher level of care was required, the effort began to complete a medical evacuation from Abaco (the site of the incident) to Nassau (the location of the hyperbaric chamber). To coordinate medical transfers such as this one, DAN has a contract with the world’s top-rated travel assistance company. Per existing DAN standard operating procedures (SOPs), this case was transferred by the DAN medic to DAN’s travel assistance provider so they could arrange the evacuation.
At this point it appears that several issues arose. Although we’ve not yet reviewed transcripts of the calls between the member and DAN’s travel assistance provider, the information we’ve collected reveals several possible departures from DAN SOPs. It seems that, among other things, DAN’s travel assistance provider failed to provide the benefits and services owed to the member under his DAN membership and insurance.
- Despite being told that the situation required an immediate medevac, the travel assistance company failed to timely find an approved carrier that could conduct a nighttime evacuation. Others involved in the incident (on site) helped the member arrange his own evacuation from a local air ambulance company.
- The member was required to complete a DAN “Claim Form” prior to getting needed assistance. This is a requirement imposed by the insurance carrier, but one which DAN will no longer enforce while an emergency exists. Once the emergency passes, there will be plenty of time to complete any necessary paperwork.
- The member was required to complete a “Fitness to Fly” form. This is not a DAN requirement but is needed by most air ambulance companies before they can initiate a medical transfer. This form is one page and must be completed by the treating physician. This is SOP when a medical evacuation is required.
- The member was required to pay for both the medevac and the hospital visit — despite DAN having SOPs in place to make these payments when requested. The transcripts will show who advised the member that DAN would not pay, but the fact is DAN was not able to facilitate these payments. This was a deviation from DAN SOPs. DAN is there to pay for the member. We are investigating with our travel assistance provider to determine why this didn’t happen. Although the member had to self-pay in this situation, he was fully reimbursed by DAN less than a week later.
Regardless of the reason for these failures, it appears that DAN’s travel assistance provider did not meet the needs of this DAN member. This is unacceptable to DAN, and we’ve taken action to address the situation.
IMMEDIATE ACTION – Effective immediately DAN is changing its SOPs as follows:
- DAN will remain the primary point of contact for case management. The DAN Medic assigned to the case will participate in all calls between DAN’s travel assistance provider and the member to reinforce the urgency of taking action and to make sure the member gets all the benefits and services they are entitled to under their DAN membership and insurance.
- In emergency situations where a medevac delay may affect the medical outcome, the search for available service providers (air ambulance providers) is being expanded to include local resources not previously known to DAN or the assistance services team. All DAN medics have been advised to always ask if anyone involved in the incident knows of local medevac options. These will then be considered if medevac is necessary.
- In emergency situations the requirement that a DAN claim form be completed will be deferred until the emergency passes.
- In situations where payment is required prior to or at the time of service, the DAN medic will engage other DAN staff as needed to approve charges, issue guarantees of payment, and effect payments (by credit card and/or wire transfer). At DAN, our constant aim is to ensure that a DAN member never has to make direct out-of-pocket payments.
ADDITIONAL ACTION – The following initiatives will be rolled out in the coming weeks as staff are added and support resources put in place:
- An update to DAN’s systems and database to allow collection of information on key airports and local provider options for air transportation (similar to what we have for hyperbaric chambers).
- Development of detailed emergency action plans for key dive destinations. This will be done in conjunction with developing the local medevac provider database to give us a more complete picture of what needs to happen in specific situations.
LONG-TERM SOLUTION
Prior to this incident, DAN determined that it would be in the long-term best interest of DAN and its members for DAN to expand its in-house “assistance services” capabilities. A part of DAN’s medical services operation, the new DAN Assistance Services group will replace DAN’s travel assistance provider. This expansion of services was approved at a recent meeting of DAN’s board of directors. While originally scheduled for rollout later this year, plans are being accelerated to allow DAN to assume responsibility for all member assistance services at the earliest possible date. More information will be provided about this expanded service as it becomes available.
We understand that an incident like this can affect members’ confidence in DAN’s ability to help them if they have a diving accident. DAN takes this matter very seriously and believes the actions we’ve taken will prevent a recurrence. DAN has been serving divers for over 40 years and you can rest assured that if you have a diving emergency, DAN will be there for you.
Safe diving,
Bill Ziefle