2 members... 2 different incidents... one outcome

Absolutely spot on comments WW. I was leading the dive. And Dave was behind and above me. He was on 29% and I was on air. At the end of the dive I had 0min of no Deco time remaining. He had18 min. Both readings on our Shearwater computers. Because of my proximity to a mandatory Deco stop I signaled I wanted to do a 1min stop at half our max depth of 80ffw. He acknowledged and we slowly ascended to a picture perfect 40ffw stop for a long minute. After that we continued our ascent to 20ffw for an additional 3+ minutes. Then a slow final ascent to the exit platform. We exited the water and walked a feet to our picinic bench. We then started to tear down our gear. It was 45min after we exited the water when his symptoms appeared. That is as undeserved a hit as could imagine.

That is what worries me about undeserved hits and vague symptoms. I am always dizzy due to chronic sinus issues and low lever motion sickness. And a stray ache or pain, really?!?!?!? I am forever having something hurt. Comes with the 4 (damn close to a 5) in my age! I am worried I will not recognize it when it comes.

Fred, his symptoms were severe with a sudden onset. He could hardly open his eyes without severe vertigo. A few minutes later he threw up. I had no doubt we needed EMS whether for a dive problem or a straight medical issue. When in doubt call 911. I'll take the heat every time for calling 911, then the alternative if I don't. I guess my point is you will know if it's a standard ache or pain, or something more serious. It wouldn't hurt any of us to go over our yoscue book once in a while either. I know I'm going too!!

Edited by Jerrymxz, 12 August 2013 - 03:13 PM.

I'm so glad to hear they are both doing better!! Continued prayers will be said!

First off I'd like to thank everyone for the prayers and wishes. It warms my heart to hear from everyone. Second, I'd like to say that the definition of a Great Dive Buddy is Jerry. I couldn't have asked for a better person to have along for my event. I'm fine and expect to go home tomorrow. I won't really know my dive status or health issues until then. But I feel great.

Jerry gave most of the outline of events. Here is it from my perspective. The onslaught of vertigo was instantaneous. I was standing at the back of my car when it hit me. I immediately sat on my bumper and closed my eyes.
The world was spinning very fast to the left. As long as I kept my eyes closed I was okay. MY mind was working perfectly and there was no pain. This continued throughout the whole experience. My only issue was vertigo.

I've been informed that I have to go for an MRI in a few minutes so will be back later to continue the dialog.

Dave

Fred, his symptoms were severe with a sudden onset. He could hardly open his eyes without severe vertigo. A few minutes later he threw up. I had no doubt we needed EMS whether for a dive problem or a straight medical issue. When in doubt call 911. I'll take the heat every time for calling 911, then the alternative if I don't. I guess my point is you will know if it's a standard ache or pain, or something more serious. It wouldn't hurt any of us to go over our yoscue book once in a while either. I know I'm going too!!

Yeah, Jerry that is the easy one. And you did the exact right thing. That is what us paramedics get paid for and not one of us should ever give anyone grief over a 911 call. Your quick action and field education of the paramedics probably helped a lot. From reading this.......

First off I'd like to thank everyone for the prayers and wishes. It warms my heart to hear from everyone. Second, I'd like to say that the definition of a Great Dive Buddy is Jerry. I couldn't have asked for a better person to have along for my event. I'm fine and expect to go home tomorrow. I won't really know my dive status or health issues until then. But I feel great.

Jerry gave most of the outline of events. Here is it from my perspective. The onslaught of vertigo was instantaneous. I was standing at the back of my car when it hit me. I immediately sat on my bumper and closed my eyes.
The world was spinning very fast to the left. As long as I kept my eyes closed I was okay. MY mind was working perfectly and there was no pain. This continued throughout the whole experience. My only issue was vertigo.

I've been informed that I have to go for an MRI in a few minutes so will be back later to continue the dialog.

Dave

....it was a no doubter. It is the subtle ones that worry me. Good to know they are not a subtle as you think.

Dave, I don't think we have ever met. But a friend of Jerry's.......

Hang in there man all good vibes coming your way. And thanks for being so open with us, it will certainly help us earn more about this monster called DCS.

Now I have a question and you can answer or not. There is all kinds of things that cause vertigo. With bad sinuses I know whereof I speak. I once had a case of BPPV. (Benign paroxysmal postural vertigo) The benign part is highly questionable but that's what they call it. So did your symptoms resolve instantly upon hitting the chamber? Definite DCS or are they still looking? Sorry but the paramedic in me is curious. Again your health is your business so please tell me to buzz off if you want to keep it to your self. I will fully understand.

Hang tough and enjoy the jello.

ev, no problem on the questions. The symptoms hit so quick that there was no real time to deny that I had a problem. I understand that people tend to deny they've had a hit but in my case I was pretty incapacitated right away. I can't say enough positive things about the EMT people at the dive site and the ambulance crew and all the hospital crews. I was taken first to a local hospital. As long as I kept my eyes closed I was ok. The first hospital began to give me a medication for motion sickness. This began to bring the vertigo under control. I took a helicopter ride to U of Penn In :Philadelphia right away. I was in their chamber pretty quickly. I can't really say when symptoms got better since my only manifest physical problems were the vertigo. I was laying on my side the whole time. The vertigo was much better after the first ride. I've had a total of three rides and am about 99% back to normal. Throughout the whole experience I had no pain or any of the other physical reactions that I had associated with a hit.

Well, I have to run for now. The doctor teams are assembling and after the discussions I've been led to believe I will be discharged. I'll be happy to keep this discussion going as I never knew what to expect from such an incident. They still haven't been able to suggest why it happened. As Jerry told it, i was well within safe dive limits by all the charts and both of my dive computers. We did two great dives well within our limits.

Dave

Thanks Dave. Keep us updated as to what they find.

Fred

First off Dave that is GREAT NEWS!!! And continued prayers are coming your way...and have been! Secondly when Jerry called me on the day this happened he was not getting appropriate responses from DAN despite the fact that they tell you to call them first and they will initiate the appropriate medical response. I told him to call back and be more demanding the 2nd time and that worked. My concern is why it took two calls... and we had a similar issue with the DCS here in SC. Clearly we do not understand the role of DAN in the early stages or how to ensure the proper treatment/transport to a chamber is occurring or will occur timely.

I am in the process of gathering information so that I can follow up with DAN on both issues. I have no doubt that proper care will be given IF proper care is dispatched but there seems to be a disconnect in getting proper care dispatched timely or once its dispatched that it is effective and THAT IS HIGHLY TROUBLING.

I will keep you all informed of my findings.

Kamala

Remember outside of diving, diving emergencies are something that most Fire/EMS/First Responders see once in a blue moon, same goes for dispatchers and EMD's that answer 911. DAN likes to be in the loop but if its a emergent life threatening situation, time is best spent talking with responders/ 911 first and DAN second.

As for going to a local hospital first in a unstable situation is protocol. Then once evaluated at that hospital arrange for a transfer to the appropriate level of care. In this case is was via medical helicopter doing

Im not sure about how medievac protocols are in the NE but around here calling for the launch of an aircraft is based on time/distance/event or nature of injury/illness. We can call for either a scene response (they come to me, or meet me at a prearranged point including at a hospitals helipad without going into the ER - that changes it from a scene response to a inter-facility transfer and a different ballgame). If the patient is unstable and needs to to be stabilized with treatment I cant provide on scene/transport I will divert to the nearest hospital and notify them that a medievac inter facility flight is highly recommended for which very rarely is .

Personally since I have a background in dive medicine and my credentials I can make a better call then someone who last learned of dive emergencies in school. If I hear the word dive accident or key indicators of DCS/DCI/AGE, I would call for an airborne standby/launch from initial dispatch (with one caveat being altitude). I would also be on the phone finding out chamber status through my dispatch or going through DAN if I had the time. Then a average citizen calling for the launch of a medical aircraft is going to be denied as way to much liability involved. How many people would be willing to take on the liability for a $15-150K bill for a flight if deemed "not medically necessary"... not me.


DaveL good to hear you are doing better. Dr Chris Logue I have talked to recently and is a very good guy. Prayers for a speedy recovery.

My .02 cents

Also DAN not talking to people other then the patient/insured is relevant to HIPAA unless there are known written information/privacy releases. Its a legal/liability CYA thing. Then considering the way the government and this administration has hammered and levied fines under HIPAA its not surprising people are a bit hesitant to say anything.

If the patient can not call for themselves then who is supposed to call to initiate a claim or start the care process?

In both instances the patient was unable to call for themselves so others did it for them. No one was asking for medical info or updates on a specific person...they were simply trying to get the ball rolling and GIVE information to DAN. No one said "have you called 911? Have you talked to TravelAssist" "Do any of the local docs need assistance with diving question?" They took the information and that was it.

My understanding is you call DAN and Travel Assist (which appears to be part of DAN now) if you have DAN and they take over from there making the triage decisions you made...i.e. do they need a bus or a airbus? What hospital should they be routed too?

If the person taking the call says "Thank you" and does nothing or does not offer to call you back or direct you to call Travel Assist next so you know the chain of care has started how do you know if anything has happened? DAN insists you call them first so they can help do exactly what you said.

And if DAN is NOT responsible for assisting with proper DCS related triaging... then how do you educate local EMS/EMT people to make the right decisions?

Or if they (DAN) do not start that process or do not let you know and the patient can't do it...then what? And what if it takes 6+ hrs after being called to finally get the patient into the chamber that is only 1hr 15 mins away? In the latter case an ambulance showed up then EMS and despite several of them being divers they did not take the patient to the ONLY hospital in the area that treats diving incidents DESPITE it clearly being a diving accident with the patient alert and knowledgeable saying they've had a diving incident. The diving hospital was never called so they could be ready (should have been by DAN or Travel Assist) and so they were not ready and after going to wrong hospital and waiting over an hour in the airbus to be admitted to ER then it took over 3 hrs for ER to decide it was a diving accident and he was stable enough to be sent to the ONLY hospital that treats divers which is 15mins away from the hospital he was sent too. So by the time he finally got into the chamber it was 6hrs + after the call to DAN. Not acceptable in my book hence my research so I can contact DAN directly. Scubatooth if you have any insight from your days at DAN please contact me. Thank you, Kamala

Some of it may have to be retroactive, even on there own page state in a life threatening situation to call 911 first then DAN when/if time allows. DAN is a special situation that is outside the normal way things are handled and has the potential to throw a monkey wrench into things and could grind things to a halt. It sounds like along the way a ball got dropped or didn't make the right connection, CQI will handle this.

Suggestion go to Dan Nord or Dr Nick Bird as they are closer to that end of things the Orr. Don't me wrong Dan Orr is a good guy but Nord and Dr. Bird are oversee the medical line and such.

Transfers between hospitals are not a snap of the fingers thing, they take time, doc to doc, nurse to nurse, transfer of paperwork and imaging, transportation etc. Then taking a patient who is not stable to the nearest facility is protocol dictated by a medical director. Transport decisions fall under that; there are medical directors that wont let a unit transport a patient more then x miles outside of there district. EMT & Paramedics DONT dare question protocols unless they can state a iron clad case to via online medical control. Alot of whats in protocols now a days is because of lawsuits (ill leave it at that as my opinion on gas lights into politics PDQ), and there is one lawsuit in play now that could very well change the face of how first responders, EMT and paramedic crews act. BTW a conscious and alert patient does not make someone stable... can be anything but stable, if anything they can cause the worst pucker factor in your life.

In both of these cases I wasnt there so I am way out of the loop and can only say from the outside looking in. I can offer my insight and what I would do but that is all as I do not hold a PA State Paramedic license nor work in the Ditch Springs area. Too many factors that could be in play; patient condition/ status / time remaining in the golden hour, Wind, Weather, Temperature, MEL's, NOTAM, Airspace/ATC Restrictions, fuel requirements/reserves, road conditions, time/distance, unit availability, capability and onboard supplies and many more. Sadly alot of what people see as "delays" now a days are the result of a scumbag ambulance chasing lawyer or someone wanting a payday for nothing lawsuits. So everyone involved is going to CYA A CYA A CYA and beyond.

The back of your DAN CARD SAYS...

FOR EMERGENCIES
DAN EMERGENCY HOTLINE
1-919-684-9111

Available 24/7 for diving and non-diving emergencies
(including TravelAssist services)

DAN MUST ARRANGE ALL TRANSPORTATION PRIOR TO EVACUATION

Collect EMERGENCY calls are accepted.

FOR NON-EMERGENCIES
Medical questions, member services, benefits, questions, and toehr DAN Services
1-800-446-2671
Available M-F 8:30am - 5pm ET

So I ask you where it says to call 911 first?
I ask you what is DAN supposed to do?

They say call them first and they must be involved in transport yet they were not involved as near as I can tell other than to answer the phone and take info down basically acknowledging that a claim would be coming their way. Or are they ONLY involved in international transport needs and assistance?

I'm home now and am in excellent shape. Won't be cleared for diving for a few more weeks or maybe a month or so. My luck was where this incident happened. U of Penn is at the forefront of diver injuries. Everyone knew what to do from the dive site to the chamber. Having Jerry as my dive buddy was a Godsend. Things really seemed to happen at the snap of the fingers. Everyone seemed to be aware that time was of the essence.

I was in no condition to call DAN myself. It was all I could do to keep my eyes closed. I'll have to see how the whole insurance thing works out. I can't believe I have to call DAN before 911 to get an ok for transport. If there is a problem with DAN I think the dive community at large needs to know about it. I don't know if I have a problem there or not. Will have to wait and see on that one. As I said, we'll see how that plays out.

I think this is a great discussion going forward. I never knew what to expect and never thought it would happen to me. We were well within safe dive windows, so no sure why the hit occurred. I'll find out more as we go forward and relate back.

Dr Chris Logue and his staff are outstanding. He is the guy that pushed my gurney from the helicopter to the chamber. The whole crew at Penn were wonderful.

Dave