Vanishing Access to Emergency Hyperbarics
Bill Lester, AEMT, DMT
It’s something most divers take for granted. But you may have a harder time getting there than ever before. Your dive instructor, your certifying agency, and DAN (Divers Alert Network) have been preaching for years that if you think you might be suffering from DCS/DCI, you should get to a recompression facility as soon as possible. Of course, the very first thing you should do is contact DAN and that is more important today than ever before. The reason, emergency access to hyperbaric facilities has been on a rapid decline due to changing trends in how hyperbaric treatments are provided.
Hyperbaric medicine is used primarily to treat conditions not related to diving. It is used extensively for wound care and treating post operative patients. In previous years, hyperbaric medicine was mainly handled by hospitals here in the United States. During the past few years private clinics have opened that are competing for the available insurance dollars and this has caused a budget crisis in many hospital’s HBOT (hyperbaric oxygen therapy) departments. This budget crisis forces the affected hospital to scale back the budget for HBOT departments which shows up as cut backs in available hours and personnel.
This not only limits emergency access for diving emergencies, but medical emergencies too. In my hometown of Atlanta, there is currently no access at any facility for emergency hyperbaric treatment. Last year a man suffered an AGE (arterial gas embolism) as a result from air being introduced into his arterial system during surgery. After a considerable time, a facility was found in a neighboring state that would treat the man. He had to undergo a lengthy ambulance ride of several hours to reach the distant chamber; and despite extensive care and aggressive treatment he failed to improve measurably. He was committed to long-term care where he remains.*1
Divers should recognize the term AGE previously mentioned. It is a malady which can affect divers too. In divers, an AGE (pronounced A…G…E, just say the letters) is most often associated with two conditions. One is called a PFO. A “Patent Foramen Ovale” is a small whole between the chambers of the heart. It is a normal thing in newborns and infants which seals itself, usually by early childhood. The “hole” allows blood to bypass the lungs while the baby is in the womb, but is not needed once we are breathing air. In about 10%± the hole does not seal and allows a small amount of blood to keep bypassing the lungs. In most people, this is not much of a problem. But divers are not most people. When we go diving, we saturate our bodies with excessive nitrogen. It’s the bad part of the air we breathe, well at least it’s bad for us divers. In divers with a PFO, bubbles can cross over from the venous side of the circulatory system, where they aren’t as critical, to the arterial side where they can be life threatening. The result is an AGE. The treatment is emergency recompression.
The second way divers can get an AGE is rapid ascent. A rapid ascent can cause bubbles to develop or cause gas to expand, bursting the alveoli in the lungs and allowing gas to enter into the arterial system. The result is an AGE. By now you should know the treatment.
In Atlanta and many other cities, due to the changing model of hyperbaric treatment, emergency access is simply not available at the present time. I guess what you are thinking is, “but how does Atlanta apply to where I dive, since it is five hours from any ocean”. Well, I’m sorry to tell you that out of more than 70 hyperbaric facilities in Florida, only seven are available for emergency access.*1 Yes, I said only SEVEN. For the entire state of Florida with it’s thousands of dive sites, hundreds of dive operators, and perhaps millions of dives performed every year, only seven facilities will even accept you for treatment of adiving malady and they may be busy or on diversion.
So what am I supposed to do about it?
The very first thing you should do is support DAN www.diversalertnetwork.org. You should keep your DAN accident insurance up-to-date and support DAN’s efforts to increase access to emergency hyperbarics. Seek out your local DAN instructor and take one or more of their emergency courses.
Secondly, plan your dive and dive your plan. It’s as true today as when Hal Watts said it many years ago. Know what you are going to be doing before you get in the water with compressed gas. Know your gas consumption rates and plan accordingly. Further, monitor your gas supply often while diving and be aware of things that make your breathing rate change, since this will affect how much gas you use. Things like current, temperature, anxiety, workload, and your fitness level, all can influence how much gas you breathe. A leading cause of rapid ascent related AGE is running out of gas underwater and a diver bolting to the surface.
Next, don’t engage in risky behavior. If you don’t have formal training in a particular type of diving, don’t do that type of diving until you have been trained. As a cave and technical diving instructor for 10 years I can tell you that “it ain’t as easy as we make it look”. I’ve been a technical diver for more than 20 years now and what is a walk in the park for me is most people’s idea of a really bad day. It’s not arrogance, it is practice and experience. Which are things I encourage all divers to do often. When was the last time you put on your gear and just jumped in the pool? While you were there did you spend 30 minutes just hovering six inches off the bottom of the pool, never touching anything but water? A mastery of skills will make you a better diver, capable of handling tricky situations with more confidence and give you the ability to make better decisions, which will lead to safer diving.
My first hyperbarics instructor Dick Rutowski (yes that is Mr. Nitrox himself) says, “Bubbles act like bullets to the body”. (Hyperbarics International Website) This is very true. They disrupt tissues and prevent proper oxygenation of tissues, leading to shock and trauma. So the best way to avoid “getting shot” while diving is to not get bent. Be smart, use common sense, take more classes, dive within your limits, keep your DAN insurance up-to-date, and have great time. Dive safely and hopefully you will never need to visit the chamber unless you’re on a tour!
*1 Dick Clarke, CHT – Alert Diver Magazine, Winter 2012
Bill Lester is an advanced technical diver and instructor with more than 2800 logged dives over 25 years. He is an Advanced Emergency Medical Technician (AEMT) and Diving Medical Technician (DMT), Member of the Board of Directors for the National Association for Cave Diving (NACD), former Diving Resort Owner (Neptune Divers at Weeki Wachee Springs), Silver Wakulla Award recipient (500+ safe cave dives), as well as, the Journal Editor and Equipment & Technology Committee Chairman for the NACD. For more information or to contact Bill please visit the Southeastern Technical Divers Website.