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DAN – ER First, Chamber Second

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Two divers bob in the swell, their surface marker buoy deployed, waiting on a pickup from their dive boat. After an 80-foot wall dive and a whale shark sighting, morale is high.

By Caitlyn Ruskell, DAN Content Writer/Editor

About an hour later the divers hike back to their bungalow. One of them feels pretty spent after the dive and decides to take it easy and rest a while in the hammock on the porch. When he awakes from his four-hour nap, he gets out of the hammock and experiences severe pain in his upper left arm and some tingling in his extremities. His wife assumes he’s bent — she’s familiar with the symptoms and recalls seeing a sign for a hyperbaric facility just a few miles away. She loads her husband into their rented Jeep, and the two make haste toward the chamber.

When they arrive, they meet two staff members at the entrance. The woman explains that she and her husband have been diving all week and now, just a few hours after their dives today, her husband is experiencing symptoms of decompression sickness (DCS). The attendants ask to see their referral paperwork. Referral paperwork?

Almost every hyperbaric chamber that treats divers requires the injured diver to be referred to the chamber by a physician.

The staff explain to the couple that the man needs to be evaluated by a physician before he can be treated — and fast. DCS is a life-threatening condition that is most effective if treatment begins soon after symptoms appear. Luckily for this couple the nearest emergency room was only about 15 minutes away.

On the way to the emergency department, the man began to experience shortness of breath and chest pain. This really set his wife into panic mode, so she put the pedal to the metal. When they arrived at the hospital, he was immediately triaged and taken in to see a physician. The diagnosis: myocardial infarction. Heart attack.

Fortunately for this diver, the delay in care that resulted from travelling to the chamber first did not cost him his life. DCS can be an ambiguous condition: It shares symptoms with many other conditions, and delays in care can be costly, so you must seek emergency care if you suspect DCS.

Many hyperbaric chambers do not have physicians on staff to evaluate divers that come in to seek treatment, and many more do not have the capacity to treat divers. Even if chambers do treat divers they require referrals to ensure that any immediately life-threatening conditions are addressed. Referrals also help to ensure that injured divers receive the best possible treatment.

When emergency department physicians diagnose DCS they often begin by assessing diver’s symptoms and running diagnostic testing to rule out other conditions. In this diver’s case, the symptoms and diagnostic testing immediately revealed that his case of suspected DCS was actually a heart attack, which warranted immediate intervention that could only be effected in a hospital setting.

If you suspect DCS, administer emergency oxygen and activate emergency medical services or bring the injured diver to an emergency department for evaluation. When you can, call DAN. Our medics can give guidance on where to seek treatment and can even help walk you through first aid, telling you what steps to take. Calling DAN also keeps you from violating any insurance protocols, ensuring that your DAN dive accident coverage will cover your accident. For these divers, DAN would have told them to skip the hyperbaric facility and head straight for the emergency room, saving them time they could barely afford to lose. 

See more at www.dan.org.