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Appendix E. DAN Classification of Hyperbaric Medical Facilities Appendix E. DAN Classification of Hyperbaric Medical Facilities Matias Nochetto, Petar Denoble For optimal case management of diving injuries, it is of utmost importance to have up-to-date and easily accessible information about available treatment opportunities in the patient’s vicinity. DAN maintains a database of hyperbaric facilities willing to receive injured divers with a detailed interface with Medical Services Call Center (MSCC). Hyperbaric facilities are classified according to their medical and technical capabilities as well as availability during the day. This classification is for the purpose of diving injury case management and referral only. If there is a local Diving Hyperbaric Medicine (DHM) physician in charge of case management, the treatment and disposition of the injured diver are at his discretion; however, DAN is always readily available for consultation when needed. Figure E-1 Hyperbaric facility assessment classification flowchart 112 Annual Diving Report – 2012-2015 Edition
Appendix E. DAN Classification of Hyperbaric Medical Facilities Technical and operational safety Technical and operational safety of the hyperbaric facility is a prerequisite for the referral of patients by DAN. Guidelines for assessment are provided in the book Risk Assessment by Francois Burman and re-printed by DAN. Basic requirements include: • Technical compliance with internationally accepted standards • Sound standard operating procedures in place • Staffed with trained staff The status is compliant, deficient or unknown. 1. Hyperbaric treatment capabilities This criterion aims to describe what level of hyperbaric treatment could be provided. Top capabilities are listed first. • Multi-place chamber, 6+ bar treatment regimens, mixed gas available • Multi- or mono-place, USN TT6 • Multi- or mono-place, HBOT less than USN TT6 2. Medical capabilities • In-chamber ACLS/ICU capabilities • Basic medical procedures: vital functions assessment, iv., urethral catheterization, basic neuro exam • No medical procedures 3. Medical oversight • Diving and Hyperbaric Medicine (DHM) trained and practicing physician • DMT + physician • DMT only Level of care Level 1 Level 2 Table E-1 DAN classification of hyperbaric facilities by level of care Hyperbaric treatment Medical capabilities capabilities 6+ bar, mixed gas) (In-chamber ACLS/ICU capabilities) or 2 - (TT6) (Basic medical procedures: vital functions assessment, (TT6) iv., urethral catheterization, basic neuro exam) Medical supervision (DMO/DHM Specialist) (DMT + physician) Level 3 (less than TT6) (No medical procedures) (DMT only) Overall classification level regresses to the lowest level in any category. Availability of hyperbaric facilities The urgency of hyperbaric treatment in case of diving injuries is considered important. However, the number of 24/7 available facilities are few and decreasing. The chambers are then color-coded based on availability: • Green – available 24/7 • Yellow – normal business hours; must call to check availability • Red – temporarily out of service • Blue – clinical HBO only (not receiving divers) Additional information provided in the flashcard • Multi- or mono-place; maximum treatment pressure; treatment gases • Contact information: facility, medical director, hospital (if applicable) • Notes Annual Diving Report – 2012-2015 Edition 113
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A N N U A L DIVING R E P O R T 2012
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Annual Diving Report 2012-2015 Edit
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Worldwide DAN Offices DAN is compri
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1. Introduction Introduction Since
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1. Dive Fatalities Section 1. Dive
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1. Dive Fatalities Table 1.2-1 (con
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1. Dive Fatalities Table 1.2-2 (con
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1. Dive Fatalities 45 Florida (n=20
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1. Dive Fatalities Among the decede
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1. Dive Fatalities Table 1.5-1 Divi
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1. Dive Fatalities Sea condition (s
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1. Dive Fatalities Breathing gas, (
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1. Dive Fatalities Table 1.7.2-1 (c
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1. Dive Fatalities Plotting the lea
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1. Dive Fatalities Discussion Hunte
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1. Dive Fatalities 12 10 Non Dive P
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1. Dive Fatalities the effectivenes
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1. Dive Fatalities 1.11 Rebreather
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1. Dive Fatalities 11-46: Loss of c
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2. Dive Injuries Section 2. Dive In
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2. Dive Injuries 2.1.3 Where are Di
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2. Dive Injuries 2.1.4 DAN Travel A
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2. Dive Injuries A typical evacuati
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2. Dive Injuries the DAN on-call ca
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2. Dive Injuries blotchy skin and i
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2. Dive Injuries Vertigo Vertigo wa
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2. Dive Injuries Case 2-08: Margina
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2. Dive Injuries He had periods of
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2. Dive Injuries open water and at
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2. Dive Injuries 2.2 Dive Injuries
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2. Dive Injuries 1400 1200 Estimate
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Page 111 and 112: Appendix D - Japanese Diving Certif
Page 113: Appendix D - Japanese Diving Table
Page 117 and 118: Appendix E. DAN Classification of H
Page 119 and 120: Appendix F. Glossary Arterial Gas E
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Page 125 and 126: Appendix F. Glossary Mixed-Gas Any
Page 127 and 128: Appendix F. Glossary Rebreather Sel
Page 129 and 130: Appendix F. Glossary Type I DCS (DC
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