Medical line

Where’s the Nearest Chamber?

The Undersea and Hyperbaric Medical Society (UHMS) estimates more than 4,500 hyperbaric chambers operate throughout the world. DAN draws on a worldwide database of about 500 active hyperbaric facilities attended by physicians who have particular expertise in the evaluation and treatment of scuba divers.  In the DAN America region, there are about 700 chambers. DAN America works primarily with only 160 hyperbaric centers, which are part of the DAN Recompression Chamber Referral Network. ( European Editorial Note: in the DAN Europe Region there is a further estimated number of chambers of about 350. DAN Europe has about 100 of them as Referral Institutions) In addition to providing hyperbaric oxygen therapy (HBO2) for approved medical indications, chamber personnel are trained to treat dive injuries.

It’s important to recognize that although a hyperbaric facility can provide hyperbaric oxygen, only a small percentage of hyperbaric centers have the ability, training and desire to treat diving illness or injury. In fact, the number of ‘diver-friendly’ hyperbaric centers gets smaller each year, as those facilities struggle with training, staffing and financial issues, including insurance reimbursement.  During 2004, the DAN 24-Hour Diving Emergency Hotline received nearly 3,000 calls for assistance; one-third of these calls resulted in referrals to hyperbaric centers where a diver was examined for a possible dive-related illness. Although many areas of the world are well-populated with hyperbaric chambers, locating the nearest appropriate chamber often presents a challenge.

The DAN Policy On Chamber Location
DAN frequently offers assistance with care, transport and the hyperbaric treatment of injured divers. In general, however, DAN does not provide chamber information for emergency planning purposes directly to divers in advance.
The reason for this? The best option is to use the existing local emergency services first for an injured diver. With any suspected case of decompression illness or dive-related injury, the emphasis is to get divers into hospital care first. Once the injured diver is in a hospital setting (or en route), this is when contact with DAN can help determine the nearest appropriate facility for treatment of the injury if it is found to be decompression-related.

Many chambers aren’t open on a 24-hour basis and they may need advance notice – from a doctor or DAN – so they can be adequately staffed and ready. DAN has learned from experience that actual chamber locations, availability and the contact information change frequently. On occasion, some divers have been driven past excellent healthcare facilities just to get to a recompression chamber when hyperbaric care was not really what the diver needed. It’s safer and wiser to get any injured diver to an emergency room first. Even when divers surface with clear symptoms of an arterial gas embolism, the treatment of choice is basic life support first, including 100 percent oxygen during transport to the local emergency service or hospital. If you have other nonemergency diver-related questions, call DAN at +39 06 4211 8685. We’re here to make sure you get the facts and the best care possible. Injured Divers Need Medical Treatment First.

The reasons:

• Hospitals and urgent care facilities have an unlimited supply of oxygen, intravenous fluids and medications.
• A physician/emergency care provider needs to rule out other illness such as pneumothorax (collapsed lung), myocardial infarction (heart attack) and neurological and musculoskeletal injuries with symptoms similar to decompression illness.
• An injured patient needs to be stabilized before and during transport, and should be transferred under medical supervision.
• Transporting a diver without a proper evaluation may adversely affect the diver’s health and treatment outcome.
• A chamber’s operational status changes. Chambers may close for scheduled maintenance, staff vacation, or a limited staff because of a high daytime patient treatment load. The chamber you are driving to may not be available.
• Most cases of decompression sickness report for evaluation after normal business hours. In general, hyperbaric facilities have regular daytime business hours and are not always staffed in the evenings and on weekends. In fact, some chamber facilities choose not to staff their units after hours and do not wish to treat divers. Prior notification from an evaluating facility is usually necessary to begin the call-in procedure to staff a hyperbaric treatment.

Finally . . .
If you suspect a diver has a dive-related injury and needs evaluation, you should safely:

• Monitor airway, breathing, circulation and provide 100 percent oxygen if you are a trained oxygen provider
• Call the local EMS for transport or assist in the transport of the injured diver to medical care
• Call the DAN Emergency number +39 06 4211 8685 for consultation and advice.

Perhaps you’re uncertain about symptoms after diving and there is no emergency, or you may wish to ask questions about the signs and symptoms of DCI. If so you can also contact the DAN Europe Hotline at +39 06 4211 8685.