Annual Diving Report - Divers Alert Network

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