Annual Diving Report - Divers Alert Network

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2. PROJECT DIVE EXPLORATION 0 0 50 100 150 200 250 300 350 400 450 -20 -40 -60 -80 -100 -120 PDCS = 1.8% PDCS = 2.3% Time (min) Figure 2.5.4-4 Tightness in chest, a feeling of being unwell, and fainting were relieved by recompression. Classified as cardio-pulmonary DCS (DCS II). Annual Diving Report: 2006 Edition 31
3. DIVE INJURIES 3. DIVE INJURIES The investigation of recreational diving injuries is an important part of DAN's mission to improve diving safety. DAN has collected information on recreational scuba diving injuries since 1987. The Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II), however, significantly affected how DAN could collect clinical data and led to a decrease in injury reports submitted over the past two years (Figure 1.1-3). HIPAA has changed not only the way in which DAN collects data but also how DAN manages calls to the Emergency Medical Hotline. To make this process both HIPAA compliant and more efficient, a new online system has been developed designated the Medical Services Call Center (MSCC). With appropriate security authorizations, the MSCC allows medics, physicians, chambers, and evacuation services in different geographic locations to communicate quickly over the Web and so improve the speed and safety with which injured divers are triaged and delivered to care. A prototype version of the MSCC was implemented in the spring of 2006 and has already reduced the data entry workload and improved reliability. The MSCC includes an electronic version of the Scuba Epidemiology Report Form (SERF), the replacement for the Diving Injury Report Form (DIRF), and allows chambers to enter and retrieve their own case data online. The primary purpose of the MSCC is clinical management, but by design, it captures all the information needed to address key questions for diving injury research. Advantages of the MSCC over DAN’s previous systems (DIRF and DARF – Diving Accident Report Form) include: (a) data entry in real time while the information is fresh; (b) availability of anonymized data to the international diving medicine community through the Web; (c) case follow-up from onset through resolution of residual symptoms after treatment is finished; (d) avoidance of time-consuming and error-prone duplicate data entry; and (e) improved Quality Assurance review capability. The Injury Section of the 2006 Diving Report falls within the HIPAA-mandated transition to the MSCC from the previous injury collection systems. When the transition is complete, clinical data from the MSCC will be stripped of patient-identifying information to make it compliant with HIPAA regulations. This research data will be available as de-identified cases with information about dive profiles, symptom onset and severity, therapies, and resolution of residual symptoms. Longitudinal analysis of these data will someday allow assessment of: (a) the probability and severity of decompression injury for a given dive profile; (b) the natural history of injury resolution; (c) the effects of therapeutic interventions; and (d) the probability of injury resolution. The transition data discussed below are less extensive and less accurate than in the past because of changes required by HIPAA. Beginning with the 2008 Diving Report when transition to the MSCC is complete, more cases of greater accuracy will be available for analysis. 3.1 Data Sources, Case Classification, Onset Time and Diagnostic Confidence Hyperbaric chambers throughout the world, particularly in the US, Caribbean, and Latin America, voluntarily send information to DAN on cases they treated. In 2004, 218 chambers sent 640 usable injury reports, but fewer reports were received from areas where injuries are usually 32 Annual Diving Report: 2006 Edition
Page 1 and 2: ANNUAL DIVING REPORT 2006 EDITION F
Page 3 and 4: Acknowledgments Data for the 2006 R
Page 5 and 6: International DAN Offices DAN Ameri
Page 7 and 8: 1. INTRODUCTION PDE is a prospectiv
Page 9 and 10: 1.2 Annual Diving Injury and Fatali
Page 11 and 12: 1. INTRODUCTION 48 years from 1989
Page 13 and 14: 2. PROJECT DIVE EXPLORATION The Sca
Page 15 and 16: 2. PROJECT DIVE EXPLORATION Table 2
Page 17 and 18: 70 60 50 40 30 20 10 0 2. PROJECT D
Page 19 and 20: 2.4 Dive Profiles 2. PROJECT DIVE E
Page 21 and 22: Percentage of Dives Percent of Dive
Page 23 and 24: Percentage of Dives 80 60 40 20 0 C
Page 25 and 26: 2. PROJECT DIVE EXPLORATION Ambiguo
Page 27 and 28: 2.5.2 Non-DCI Injury or Symptoms 2.
Page 29 and 30: 0 -40 -60 -80 -100 -120 -140 -160 2
Page 31: Case #3. Mild neurological DCS (DCS
Page 35 and 36: 3. DIVE INJURIES treat fewer than 1
Page 37 and 38: 3. DIVE INJURIES The frequency of d
Page 39 and 40: Dizziness/Vertigo Skin Pulmonary He
Page 41 and 42: 3. DIVE INJURIES Figure 3.4-5 indic
Page 43 and 44: Percent of Cases 50 40 30 20 10 0 C
Page 45 and 46: 4. DIVE FATALITIES Table 4.1-1 Numb
Page 47 and 48: Percent of Fatalities 45 40 35 30 2
Page 49 and 50: 4. DIVE FATALITIES Figure 4.2-5 sho
Page 51 and 52: 4. DIVE FATALITIES Figure 4.3-3 sho
Page 53 and 54: 50 40 30 20 10 0 Surface pre-dive D
Page 55 and 56: Percent of Fatalities 30 20 10 70 6
Page 57 and 58: 4. DIVE FATALITIES Emergency ascent
Page 59 and 60: 4. DIVE FATALITIES The number of di
Page 61 and 62: 5. BREATH-HOLD DIVING Details on th
Page 63 and 64: Number of Cases of Cases 10 8 6 4 2
Page 65 and 66: APPENDIX A. DIVE INJURY CASE REPORT
Page 71 and 72: APPENDIX B. DIVE FATALITY CASE REPO
Page 83 and 84:
APPENDIX B. DIVE FATALITY CASE REPO
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Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
APPENDIX C. BREATH-HOLD INCIDENT CA
Page 95 and 96:
2004 Publications Refereed Articles
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computers. Undersea Hyperb Med 2004
Page 99 and 100:
Vann RD, Wachholz CJ, Nord DA, Deno
Page 101 and 102:
NOTES 100 Annual Diving Report: 200
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