When something goes wrong, the costs of rescue and evacuation can escalate quickly, even in destinations we don’t normally consider remote like Fiji, as this case study demonstrates.
Consider this scenario:
An experienced diver and his partner choose a diving destination they don’t consider remote, assuming that, should an incident occur, treatment and evacuation won’t be a problem.
The destination is Kadavu, an island off Fiji, a short flight from the capital Suva. Being a relatively short distance from Australia, Fiji is a popular diving destination.
Unfortunately, a serious incident does occur, involving paralysis of the lower limbs and loss of vision. A call is made to DAN for the doctor on call to make an assessment, based on the diver’s symptoms, his dive profile and the location. In this instance, it is quickly determined that the diver needs higher level medical care than can be provided at the local medical centre.
DAN AP’s preference was to arrange an air ambulance for the diver directly to Australia, but that would have taken time to arrange, and there was concern the oxygen supply at the local medical facility would run out before the flight was available.
As such the decision was made to evacuate the diver via a short 35-minute helicopter trip to the hospital in Suva, where the Chamber was located. The diver was recompressed but DAN wanted a more aggressive treatment plan, so the diver was evacuated by air ambulance to Australia.
(Note: Currently, there is no Chamber in Fiji, so until a new Chamber opens a Member requiring higher level care would likely be evacuated to Australia)
Ultimately, the two air evacuations cost in excess of US$110,000, adding to the chamber costs, but the diver recovered well, and continued to recover over the coming months.
Challenges involved in an evacuation
Even though DAN are the experts in diving accident management with 30+ years of experience dealing with emergency medical evacuations all over the world, the unique set of circumstances that present for each case can and do create challenges.
In this case, whilst the island of Kadavu has a landing strip, it doesn’t have lights in order to guide a plane in for a safe landing, and therefore night-flight restrictions are imposed. Plus, there was red tape that had to be met for air ambulances to receive permission to enter the country.
Compounding the issue of dealing with a remote location, DAN Case Managers are often faced with an array of challenges that many people are unaware of which go into arranging a medical evacuation for a diver. These challenges can lead to time delays and frustration for the diver and the Case Managers.
These challenges can include:
- Ensuring the diver is stable enough to be evacuated.
- Bad weather preventing an air ambulance from landing or departing.
- Meeting entry and visa requirements.
- Organising a medical team for an air ambulance to fly in from another country.
- Lack of an airport or appropriate landing strip.
- Sometimes an air evacuation isn’t possible, and a boat needs to be sent to meet a liveaboard to evacuate a diver.
- Sometimes it is quicker for the dive operator to organise local transport but this should be done in consultation with DAN if the transport cost is to be covered by DAN.
As divers travel to more and more remote locations, greater awareness of the various challenges is important so steps to minimise their risk. Diving conservatively, taking long surface intervals, remaining hydrated, and getting lots of rest are all important in reducing the risks. Divers should also ensure that the operator they choose to dive with is prepared for a medical emergency with plenty of oxygen on board and a suitable emergency action plan to follow.
Finally, it goes without saying that having DAN coverage is vital. Evacuations such as these are not easy to organise and are certainly not cheap. For DAN members all this is taken care of leaving you with much less to worry about.
DAN Asia-Pacific General Manager