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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. 114 Annual Diving Report – 2012-2015 Edition
Appendix E. DAN Classification of Hyperbaric Medical Facilities 19:55 GMT Attempted to call again HTF #2 for administrative approval to treat patient. Left message. 19:55 GMT Return call from staff at HTF #4. They can see patient. Have him come to HBO directly instead of ED. 19:56 GMT Called the patient and let him know. 20:10 GMT Received voicemails from HTF #2 again now advising they cannot see emergent cases. Second voicemail from HTF #5. They would love to see the patient but are full right now and could not do a USN TT6. Day 2 17:14 GMT Day 3 17:26 GMT Received a voicemail from patient thanking us for assistance and to provide an update on his treatment. Returned call and left a voicemail. Patient called back. He received USN TT6 first day and improved significantly. He received two more USN TT9 next day and last night. He is very happy with the care received. Annual Diving Report – 2012-2015 Edition 115
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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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2. Dive Injuries Table 2.2-5 Diagno
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Page 67 and 68: 2. Dive Injuries Case number Case n
Page 69 and 70: 3. Diving Incident Reporting System
Page 81 and 82: 4. Breath-hold Dive Incidents Secti
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Page 87 and 88: 4. Breath-hold Dive Incidents It is
Page 89 and 90: 4. Breath-hold Dive Incidents There
Page 91 and 92: Appendix A. Breath-hold Incident Ca
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Page 95 and 96: Appendix B. Diving Related Fataliti
Page 105 and 106: Appendix C. Asia-Pacific Diving Dea
Page 111 and 112: Appendix D - Japanese Diving Certif
Page 113 and 114: Appendix D - Japanese Diving Table
Page 115: Appendix E. DAN Classification of H
Page 119 and 120: Appendix F. Glossary Arterial Gas E
Page 121 and 122: Appendix F. Glossary ness, paralysi
Page 123 and 124: Appendix F. Glossary typically in a
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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