2 members... 2 different incidents... one outcome
#31
Posted 13 August 2013 - 07:10 PM
To everyone reading this: don't hesitate! Make the call. Get oxygen (or Nitrox) if that's what you have. Get to professional medical treatment and raise holy cane if you think it isn't going as well as it should.
Dave glad you're doing well buddy!!!
Each wreck has a tale to tell about its life and its demise.
If you are observant while diving in dark places listen to the account each has to tell, You cannot come away unaffected.
Changes in Latitude, Changes in Attitude
#32
Posted 13 August 2013 - 08:01 PM
BTW Dave , Glad you pulled through..All the Best to you Take it easy..
:
E= pluribus Forum Enjoy the view. ,Do unto others:respect
#33
Posted 13 August 2013 - 09:03 PM
Again DAN is not, and cannot be involved in any of those decisions. I can go on and on as to why the laws are they way they are but they are there for patient protection and in general are a good thing.
So now what do you do? First, do as Jerry did. Make sure the EMS crew knows what they are dealing with. Scream from the rooftops if you have to. Unless you are on the coast, it is highly unlikely that the EMS crew or the physician has a clue about DCS. Embolic problems are a bit different but this is too long already and I will leave that lie. DCS is just not a call we see that often. The good news is that unless they decide to turn off the oxygen, which they won't, there is not much a run of the mill paramedic can do about DCS. You won't get better but you won't get worse either. There is only one thing you need and other than oxygen and some symptom control paramedics just can't help much except get you to the chamber. Next make sure that the ER knows the situation and now get DAN on the phone and find a chamber. Hopefully the DAN doc can talk to ER staff and help grease the wheels and do some instant education. But at this point, you are at the mercy of the system you are in at the time.
I am sorry this got a little more wordy than I wanted but, it is VITAL that everyone understand that DAN in not a substitute for EMS and proper emergency treatment. DAN's transportation stuff applies when you are in a foreign land or when there are no local resources to move you. DAN will take much longer than local systems. But even then they have no authority to change any laws regarding transport.
I hope that helps. Dan (Scubatooth) are both paramedics and can help with this discussion . So please ask more questions.
Fred
Edited by ev780, 13 August 2013 - 09:03 PM.
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#34
Posted 14 August 2013 - 05:35 AM
As quoted by Kamala, below
"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?"
K,I'll be curious to read what the response is from DAN.Also, I would like to hear how Dave does regarding any claim to DAN.
If the Dr.B. from Chicago is following this, can you offer a perspective? And what happen when you went to the chamber?
:
E= pluribus Forum Enjoy the view. ,Do unto others:respect
#35
Posted 14 August 2013 - 07:48 AM
Secondly FRED your comments are spot on and have shed some much needed and very valuable light on the circumstances. (Bill and I will be drafting correspondence for our local EMS, the local hospitals and DAN in order to IMPROVE how diving incidents are handled in the future in this area.)
Third my goal is to BETTER UNDERSTAND how this whole process works INCLUDING the role of DAN or DiveAssure in the process so that I as a trip leader and as an individual will be in a better position to assist others.
In backtracking a bit I notice the words "EVACUATION" on the card.... I'm going to guess that refers to int'l trips only and not local emergencies which would make sense. ALSO NOTE that all my interaction until now has been with DAN or DiveAssure on an int'l trip and never locally in the US. Thinking about it, I'm sure they are handled differently which would also make sense. AGAIN Fred's comments helped to educate me.
And I'm going to guess that DAN simply wants you to notify them of all incidents as they will become future claims AND if the local medical personnel treating someone has any questions THEY can call DAN. In my personal experience to date, if it is an int'l emergency they do not interfere or are even involved in the initial treatment of the emergency...they are only involved from an 'insurance involvement' and if the patient has to come home either dead or alive...hence the words "evacuation".
So I am going to read over DAN's website to see what they say about the handling of claims and/or their involvement and what their role is both as an insurance carrier and as a health adviser.
I am sorry that I got frustrated...because the role of EMT's and emergency responders is now so convoluted and complicated...its become so far removed from the lay person who sees actions that do not make sense to them. Then if they ACTUALLY do something that does not make sense...you tend to get 'hot' and fortunately this forum has allowed me to vent some of that steam BEFORE we start our dialog of change here locally and perhaps with DAN. Kamala
Contact me directly at Kamala@SingleDivers.com for your private or group travel needs or 864-557-6079 AND don't miss SD's 2018-2021 Trips! ....here! Most are once in a lifetime opportunities...don't miss the chance to go!!
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#36
Posted 14 August 2013 - 10:23 AM
Ok first let me work to do my part in diffusing some of the fire/flames I threw into the mix in my frustration over it taking so much time to get one of the patients from point A to B and into a chamber.
Secondly FRED your comments are spot on and have shed some much needed and very valuable light on the circumstances. (Bill and I will be drafting correspondence for our local EMS, the local hospitals and DAN in order to IMPROVE how diving incidents are handled in the future in this area.)
Third my goal is to BETTER UNDERSTAND how this whole process works INCLUDING the role of DAN or DiveAssure in the process so that I as a trip leader and as an individual will be in a better position to assist others.
In backtracking a bit I notice the words "EVACUATION" on the card.... I'm going to guess that refers to int'l trips only and not local emergencies which would make sense. ALSO NOTE that all my interaction until now has been with DAN or DiveAssure on an int'l trip and never locally in the US. Thinking about it, I'm sure they are handled differently which would also make sense. AGAIN Fred's comments helped to educate me.
And I'm going to guess that DAN simply wants you to notify them of all incidents as they will become future claims AND if the local medical personnel treating someone has any questions THEY can call DAN. In my personal experience to date, if it is an int'l emergency they do not interfere or are even involved in the initial treatment of the emergency...they are only involved from an 'insurance involvement' and if the patient has to come home either dead or alive...hence the words "evacuation".
So I am going to read over DAN's website to see what they say about the handling of claims and/or their involvement and what their role is both as an insurance carrier and as a health adviser.
I am sorry that I got frustrated...because the role of EMT's and emergency responders is now so convoluted and complicated...its become so far removed from the lay person who sees actions that do not make sense to them. Then if they ACTUALLY do something that does not make sense...you tend to get 'hot' and fortunately this forum has allowed me to vent some of that steam BEFORE we start our dialog of change here locally and perhaps with DAN. Kamala
Kamala,
There are frustrations for even the people inside the system. It is complicated, sometimes inflexible, and different depending on where your feet happen to be planted at the moment.
Your plan is a great one!!! Most local EMS and hospitals love to have conversations about how to improve. They have people who's entire job is to work on these things. Meetings happen daily in systems like this to address incidents that do not go well. Engage them, offer your expertise, and they will respond. Might be at glacial speed but if you have a good system they will listen. If you have a great system you will get more that you bargained for. In a good way.
In EMS there is only about 2 or 3 degrees of separation. I know some people in North Carolina that can probably hook me up with the right people in your area. Just let me know.
#37
Posted 14 August 2013 - 01:02 PM
You are correct on evacuations. Inside the US the protocols and methodologies for transferring patients is pretty much well laid out, by federal law and even insurance companies don't dare interfere. On the International air medical transport you want to talk about a logistical challenge it can be a nightmare. This is where DANs experience really helps as they have the contacts and resources to get the appropriate aircraft, pilots, medical crew, fuel, supplies, permits/visas. None of that comes cheap and if you go arranging it on your own you could get a deal or screwed as international air medical transport can runs 100's of Thousands of Dollars.
Some dive accidents require a very specialized medjet (Gulfstream IV)that can be pressurized to sea level so that the on-board hyperbaric chamber can keep the patient compressed/treated in flight. That is not a cheap aircraft and running this set up burns alot of jet fuel and reduces the range big time. Normal range on a GulfStream IV is 3800-4200 nautical miles (roughly 0.7-1.0 gallons of Jet-A (~$4.75-$6.00 a gallon) per mile, this jet gets 1/3 of that when pressurized to sea level and chamber in operation. There are other specialized medjets similar like this but this is the only one I know of in the United States.
I know of two international evacuations one from: (Do not ask for further details as not going to happen)
* Germany back to the US: from start to finish took 3.5 days as the aircraft had to be repositioned from Seattle to Chicago then to Munich and back to Chicago (10hr Flight time each way, plus 4 flight hours each way for repositioning). Total cost 125K paid in cash by the family of the patient. This is a very good price considering jets for trips like this are typically $8-14K per flight hour just for the aircraft not including medical crew, supplies and misc.
* CZM-MIA - This was for a Type II DCS Hit with AGE. The specialized G4 mentioned above was sent on this trip. Cozumel to Miami direct is 557 miles but most pilots will round this to 650-700 miles for alternate airport and ATC /En-Route changes. Flight time of 80 mins each way and used 4800 gallons of fuel. Cost of evacuation was >$300K by the time it was all said and done total cost for treatment, evacuation and rehab over half million.
Setting up a plan with local EMS is actually a very good idea as will establish a report with local fire EMS and get familiarity on both sides. Will help in the event of an accident
Fred - Thank you on EMTALA I brain farted the term, even though something I deal with all the time either with 911 or transfer side of things.
Edited by Scubatooth, 14 August 2013 - 02:22 PM.
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#38
Posted 14 August 2013 - 01:35 PM
And I'm beyond happy that we've got someone as passionate as Kamala on our side! I won't dive abroad without you! Wench, your passion is what generated this discourse, and as a result we are all more educated, and unlike most other forums, this group of divers really keeps the focus on the greater good of it's fellow divers. So thank you to all who have contributed their knowledge and expertise in this area, it is appreciated!
#39
Posted 14 August 2013 - 02:40 PM
I called DAN this morning to start a case file for when the bills start coming in. They were very polite and helpful. This was not the emergency number but the insurance number. Nobody said I should have called them on Saturday, when it happened, or that I needed prior approval for the helicopter ride. They are also number 3 on my insurance company list. So we will see over the next months how things go.
All in all, having a great dive buddy and being in a prime hospital area go along way to getting the proper help. I shudder to think of this happening in some of the more remote and 3rd world places I have dived.
Great discussion on a subject that usually gets swept under the radar.
Dave
#40
Posted 14 August 2013 - 03:56 PM
Glad to hear everyone is OK and it seems like they might be able to dive again sooner than they originally thought!
#41
Posted 15 August 2013 - 08:11 AM
And I'm beyond happy that we've got someone as passionate as Kamala on our side! I won't dive abroad without you! Wench, your passion is what generated this discourse, and as a result we are all more educated, and unlike most other forums, this group of divers really keeps the focus on the greater good of it's fellow divers. So thank you to all who have contributed their knowledge and expertise in this area, it is appreciated!
Thank you! I know I speak for everyone when I say "its nice to be appreciated". Kamala
Contact me directly at Kamala@SingleDivers.com for your private or group travel needs or 864-557-6079 AND don't miss SD's 2018-2021 Trips! ....here! Most are once in a lifetime opportunities...don't miss the chance to go!!
SD LEGACY/OLD/MANUAL Forms & Documents.... here !
Click here TO PAY for Merchandise, Membership, or Travel
"Imitation is the sincerest flattery." - Gandhi
"Imitation is proof that originality is rare." - ScubaHawk
SingleDivers.com...often imitated...never duplicated!
Kamala Shadduck c/o SingleDivers.com LLC
2234 North Federal Hwy, #1010 Boca Raton, FL 33431
formerly...
710 Dive Buddy Lane; Salem, SC 29676
864-557-6079 tel/celfone/office or tollfree fax 888-480-0906
#42
Posted 15 August 2013 - 09:18 PM
See those little jumps? According to the docs Jerry talked to , in BPPV this will settle down after a few seconds when the brain figures out what is happening and compensates. In Inner Ear DCS it will not. I am going to yell this next part on purpose. ANYTIME YOU SEE A HORIZONTAL NYSTAGMUS IN A SOBER PERSON, THEY GO VIA AMBULANCE TO THE NEAREST TRAUMA CENTER. This exam is just a tool not a way to definitively diagnose anything. In any event nystagmus in not a good thing. So add this to your repertoire in a neuro exam. It is a safe test and will tell you lots about the brain of the patient. Next time you are out drinking with friends do this test and watch the results. Good practice. Of course you have to be sober enough to judge the results.
So in the end this is most likely an inner ear DCS hit. Dave is still undergoing testing and treatment so that diagnosis may change. Here is a great article describing Dave and Jerry's day. It is out of Munich and has a very good summary of inner ear DCS.
http://www.divemeddo...s-inner-ear-dcs
Does any of this sound familiar? Classic presentation.
Interestingly, the literature suggests a link between a right to left shunt and inner ear DCS. The most common shunt is PFO (Patent Foramen Ovale) The Foramen Ovale is the little hole in your heart that seals up quickly after birth. In some it remains open (patent) and generally is not a problem. In diving and extreme athletics it might be.
Here are several abstracts of studies showing that this is indeed a serious thing and not as rare as first thought.
http://www.ncbi.nlm....pubmed/22400449
http://www.ncbi.nlm....pubmed/11359165
http://www.ncbi.nlm....pubmed/14660917
It is really easy to blow off dizziness but with inner ear DCS that will not likely happen as the symptoms are severe and rapid. But then again so is BPPV.
Dave, I looked and looked for some long term outlooks on recovery and return to diving. I was unable to find much good news. The recovery is long and slow. But generally the symptom subside. DAN may have a better handle on the long term prognosis but the interweb was pretty weak on this information. Not uncommon as long term follow up is hard to do. But you were treated early and aggressively and that looks to be the key. Hang in there and keep us posted. And for sure tell us what you learn from DAN.
So I am now done. I have researched this thing to death and I know my scientific curiosity got the best of me, but I learned a thing or two and I hope this helps others somewhere down the line. Thanks Dave for opening up your case so we could learn from you.
Edited by ev780, 15 August 2013 - 09:21 PM.
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#43
Posted 16 August 2013 - 04:40 AM
Dave
#44
Posted 16 August 2013 - 06:42 AM
Each wreck has a tale to tell about its life and its demise.
If you are observant while diving in dark places listen to the account each has to tell, You cannot come away unaffected.
Changes in Latitude, Changes in Attitude
#45
Posted 16 August 2013 - 07:15 AM
That said, I also want to offer for I believe everyone here some additional thanks to Dan aka Scubatooth, Fred aka ev780, Jerry aka Jerrymxz (yet again) and Kamala/Bill for their combined contributions in this thread to flesh out and make understandable the technical minutiae and nuance surrounding Dave's DCS incident in particular and DCS emergency response, from assessment to triage to treatment, in general. Even Jerry's sense of frustration felt with DAN response and, per his post an hour ago, the time it took to get Dave formally diagnosed and into the chamber was conveyed in a way I can grasp and translate into a smarter emergency call tree (call 911 FIRST and STAY ENGAGED with EMS) in future potential DCS situations. The resulting information so much better prepares us to help our buddies and provide useful information to qualified first responders, and IMO is the platinum standard for what a diving community should aspire to be. I am prouder than ever to say I am part of the SingleDivers.com community.
Finally broken to the plow and harnessed to the traces. How may I help you today? Questions welcomed to charlies@singledivers.com
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