By Matias Nochetto, M.D.
The DAN® Emergency Hotline receives an average of 5,200 calls per year. DAN medics and physicians work 24 hours a day, 365 days a year to provide emergency medical assistance to divers in need. No matter where they are or what they are doing, these dedicated medical professionals answer the call. The following is a timeline of a recent case that exemplifies how things unfold when a diver calls DAN in an emergency.
2:28 a.m. ET: Dutch Caribbean — Dive Resort
Mr. Smith, who is 56 years old, cannot sleep. His urge to urinate is painful, and upon sitting up in bed he realizes his legs are numb. He is unsure if he can even stand up. Something is wrong. He wonders, “Am I bent? How is this possible? I did everything right.” Mrs. Smith advises her husband to call DAN.
The DAN medical department has a tested and effective protocol that governs every call to the emergency hotline.
2:35 a.m. ET: Durham, North Carolina — Home of a DAN Medic
A DAN medic’s mobile phone rings. The operator passes along Mr. Smith’s name, phone number and location. Mr. Smith reports eight dives over the past two days and describes his symptoms. The DAN medic recognizes that this may be serious decompression sickness (DCS), which requires a timely response. The medic recommends that Mr. Smith seek an evaluation at the closest medical facility and call DAN once he is there so a medic can speak to the examining physician. Mr. Smith agrees to ask his dive buddy to help him get to the local clinic.
2:45 a.m. ET
The DAN medic calls the hyperbaric chamber on the island to alert them of a possible case of DCS. This case will likely push the limits of the facility’s capabilities. The hyperbaric doctor on staff agrees this could be a spinal cord hit and alerts the staff.
3:05 a.m. ET: Dutch Caribbean — Medical Clinic
Mr. Smith and the evaluating physician call DAN for a consultation. The physician reports that his patient has bilateral lower-extremity weakness, decreased sensation and urinary retention. He agrees with DAN’s initial assessment that Mr. Smith likely has DCS. The DAN medic informs the physician that he has already alerted the local hyperbaric facility, and the physician arranges for an ambulance to transport the patient to the chamber.
3:45 a.m. ET: Dutch Caribbean — Recompression Chamber Facility
Mr. Smith requires assistance to get into the chamber because he cannot walk and has a urinary catheter in place. The hyperbaric physician had agreed to treat the diver, but upon examination he realizes the case requires a higher level of care than his chamber can provide. He administers an initial hyperbaric chamber treatment while the DAN medic begins arranging an evacuation to a better-suited facility.
4:05 a.m. ET: Durham, North Carolina — Home of a DAN Medic
The DAN medic contacts DAN’s medical director to brief him on the case; he concurs with the plan. The medic then contacts DAN TravelAssist, which arranges emergency medical evacuations, and briefs them on the case. It is determined that the most appropriate chamber facility for Mr. Smith is in Miami, Florida.
4:30 a.m. ET: Stevens Point, Wisconsin — DAN TravelAssist Headquarters
A DAN TravelAssist representative contacts Mercy Hospital in Miami, which agrees to receive the patient. They alert the treating physician at the chamber in the Dutch Caribbean that a medical evacuation is being arranged.
5:00 a.m. ET: Dutch Caribbean — Recompression Chamber Facility
Mr. Smith reports some improvement during the treatment. He is starting to feel his legs again but is still too weak to resume normal walking. The treating physician explains this is normal and is a good sign. This first treatment will be completed at 9 a.m. ET.
8:30 a.m. ET: Durham, North Carolina — DAN Headquarters
The medic is now at DAN headquarters. DAN TravelAssist confirms that an air ambulance has been contracted to conduct the evacuation, during which the aircraft will maintain sea-level pressure. They will be ready to take off from Ft. Lauderdale, Florida, at 9 a.m. ET and should arrive in the Dutch Caribbean at 12 noon ET.
10:00 a.m. ET: Dutch Caribbean — Recompression Chamber Facility
Mr. Smith has completed his first treatment, and the treating physician reports the patient has recovered some motor function and some sensation. Mr. Smith and his wife will be ready for the medical evacuation by noon.
11:30 a.m. ET: Dutch Caribbean — Airport
The treating physician, a nurse, a paramedic, Mr. Smith and his wife arrive at the airport, and the air ambulance jet lands soon afterward. After the jet refuels and personnel complete documentation, the patient, his wife, a flight nurse, paramedic, treating physician and the pilots board the plane, which takes off less than an hour after it landed.
3:35 p.m. ET
The air ambulance lands in Miami, where a ground ambulance is waiting on the tarmac. The travelers promptly clear immigration and customs under special emergency procedures.
4:15 p.m. ET
The ground ambulance travels 9 miles to Mercy Hospital in less than 20 minutes.
4:45 p.m. ET: Miami, Florida — Mercy Hospital
Mr. Smith is admitted to the hospital, and a hyperbaric medicine specialist receives him at the emergency department. The doctor and nurses perform examinations, draw blood, confirm the patient’s medical history, complete the necessary paperwork and contact DAN to confirm Mr. Smith’s insurance.
5:30 p.m. ET
The hyperbaric doctor initiates a second chamber treatment, a U.S. Navy Treatment Table 6.
10:30 p.m. ET
Following the treatment, Mr. Smith is tired but happy to be regaining strength. The hyperbaric specialist explains that he is doing well but that these cases are serious and need to be treated aggressively.
Over the next two days Mr. Smith receives four U.S. Navy Treatment Table 5 hyperbaric treatments and has physical therapy between treatments. Medical staff remove the urinary catheter after the fourth Treatment Table 5. Mr. Smith still has residual weakness in both legs but can walk with less assistance.
In the next few days Mr. Smith has four U.S. Navy Treatment Table 9 regimens, and his residual weakness remains unchanged after each of the last three treatments. The treating physician realizes that Mr. Smith has reached a clinical plateau and that further hyperbaric therapy is of no value. Time and continued physical therapy are now the appropriate treatment.
After three months Mr. Smith recovers full strength in his left leg and has only a slight decrement in his right. After two additional months, the strength in his right leg also returns to normal.
© Alert Diver — Q1 Winter 2019