DIVING

Appendix E. DAN Classification of Hyperbaric Medical Facilities
Hyperbaric Facility
Capabilities
Table E-2 Matching patient with facility
Patient classification
A – Severe:
Progressive DCI,
Concomitant serious medical
conditions
B – Stable neurological DCI,
patient conscious and breathing
spontaneously
Level 1 + + +
Level 2 + +
Level 3 +
C – Mild DCI
Pain only, skin rash only,
minor static numbness and
tingling
Why DAN does not publish a list and contact information of hyperbaric facilities
DAN invests a lot in maintaining the most complete and up-to-date database of hyperbaric facilities available to provide
recompression and hyperbaric oxygen treatment to injured divers. However, due to daily changes in the status of hyperbaric
facilities and their readiness and availability, there is no publishable up-to-date list that could serve the public.
Every time a referral is needed, a DAN case manager verifies before referral that the chamber is available.
The case below is one of many that illustrates what it takes, in some cases, to get an injured diver to a proper facility.
The caller was male, in his fifties, calling on our emergency services line with a complaint of possible DCS. The caller
was diving the day before from a friend’s boat and was spearfishing. He made three dives each to about 120 fsw (37
msw) for an estimated bottom time of 20-30 minutes. He believed the surface intervals were 90-120 minutes but was
unsure. He was unsure of the breathing gas but suspected it was just air. They were not using computers or tables for
dive planning. No safety stops were completed on any dive. On the last dive, he was at 100 ft (30 m) and saw he was
down to 600 psi and was going to make an ascent but he saw a fish and his gun was still loaded. He pursued the fish to
at least 110 fsw (34 msw). On his way back up he was inflating his BC for buoyancy assistance and had great difficulty
at 30-40 fsw (9-12 msw) drawing breath from his regulator. He then made an out of air ascent.
Within 10 minutes he started to feel some pain in the elbows followed by paresthesia and weakness of the legs. There
was no oxygen onboard. The boat captain took the patient back in the water to a depth of 35 feet (11 meters) for about
30 minutes in an attempt to decompress. The patient then drove back home few hours away.
The day after, he called because he continued to have paresthesia and strange feeling in his both legs. He said he could
walk normally and most of the feeling had returned. He also complained of muffled hearing in his ears. Below is a time
sequence of the DAN case manager’s actions.
DAN case manager called hyperbaric treatment facility one (HTF #1) to advise of this patient. They said they had only
one nurse practitioner present that day and would not be able to treat the patient as needed. They suggested contacting
the hospital.
18:51 GMT Attempted to call hospital. Spoke with technician in Hyperbaric Medicine Department (HTF
#2). They usually do not treat emergency cases but advised to call back in a little while as she
tries to get administrative approval.
18:52 GMT Attempted call to hospital. Unable to reach anyone in HBO.
19:00 GMT Call back to patient to advise we were having trouble finding an available facility. Diver was
advised to admit to nearest emergency department for work up and may need to be transferred.
Patient is not happy since he knows he needs to be treated as soon as possible.
19:10 GMT Call to a military facility (HTF #3). They are not able to treat. Suggests calling HTF #4.
19:12 GMT Call to HTF #4 and spoke to staff in HBO department. He will find out if they can see the patient
and he will call back.
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Annual Diving Report – 2012-2015 Edition