Incident Assessment: act fast, and call DAN for advice

A recent case in Thailand illustrates why it’s important to act fast, and call DAN, before self-diagnosing – for the best treatment and insurance cover.

Hyperbaric Chamber Phuket

A recent case in Thailand illustrates why it’s important to act fast, and call DAN, before self-diagnosing – for the best treatment and insurance cover.

Koh Tao, Thailand: A 48-year-old male diving instructor, with a history of 1,000 dives.

Day 1:

  • Dive 1: 19m for 37 minutes. Surface Interval (SI) of 1 hour.
  • Dive 2:  23m for 37 minutes, SI of 3 hours.
  • Dive 3: 10m for 48 minutes.

Completed safety stops on all dives.

Day 2:

  • Dive 1: 30m for 37 minutes, SI of 1 hour 30 minutes.
  • Dive 2: 13m for 53 minutes, SI of 3 hours.
  • Dive 3: 14m for 50 minutes, SI of 1 hour 30 minutes.
  • Dive 4: 15m for 50 minutes.

Safety stops completed on all dives.

The diver noticed he was becoming progressively more tired after each dive, but he continued diving.

The next morning he woke with bilateral swelling in his feet, fatigue, tinnitus, and his shoulders felt “heavy”.

Although he was a Member, he didn’t contact DAN, rather he presented at the recompression chamber seven days later complaining of numbness and swelling in both feet and hands, as well as fatigue.

DAN was eventually contacted as the Chamber required a Guarantee of Payment before they would treat the Member. The next day, he underwent a Table 6 Treatment (TT6). He said his symptoms had cleared following the treatment, but he underwent a second short (TT5) treatment the following day.

The diver was asymptomatic following the two chamber treatments (TT6 & TT5).

Diagnosis: Possible DCS.

DISCUSSION

There are a couple of concerning issues in this case that warrant discussion:

1.     Not contacting DAN for advice: As a dive professional, this diver should have known the importance of seeking prompt help for symptoms presenting post-diving and the benefit of oxygen in helping to manage these symptoms. At DAN, we are constantly trying to convey to divers the importance of prompt oxygen first aid and calling DAN for advice. This instructor did not seek help and put himself at risk of his symptoms worsening as well as potentially risking his ability to continue teaching. As it turns out, DAN was only contacted when the issue of payment arose.

2.     Arranging his own treatment: Rather than contacting DAN and speaking to our Medical Team, who would have assessed the diver and determined the most appropriate treatment plan, he presented at the local chamber, where they demanded money upfront before they would offer him treatment. A requirement of DAN Coverage is that DAN is contacted to determine a treatment plan: We encourage all Members to follow this advice.

3.     Different Chambers Charge Different Amounts for Treatment and have different advantages and disadvantages. Depending on where the diver is, and whether they have coverage, they can be charged significantly larger sums to receive treatment. And as mentioned above, if a diver does not have any coverage (DAN or other), they can be denied treatment if they cannot cover the fee upfront.

In this case, the treatment cost at one chamber was far higher than the equivalent treatment at an alternative and reputable chamber where DAN preferred to refer the diver. However, against DAN advice, the diver underwent this non-emergency treatment at the original facility.

DAN has pre-arranged relationships with Chambers, where we know the facility meets our standards, and will accept a guarantee of payment via email, or in some cases word, to treat a Member. And we also have negotiated fair rates for the treatment. A diver going against DAN’s advice may sometimes be required to cover additional costs.

We hope this case has helped to clarify some important issues and provides an insight into the realities of a diving incident. If you are not yet a DAN Member and will be travelling to dive, we encourage you to take out coverage before you depart.

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