Dan Europe re diving related emergency procedures in Ireland

whosedaddy?

Got email from Dan Europe about "diving related emergency procedures."

Dear DAN Europe Member,

DAN is commited to working with all professional hyperbaric chambers that are prepared to work with us to provide rapid, effective and specialist assistance to divers in distress. This is DAN’s mission worldwide and the recent events and concerns that have been developing in Ireland only bring this commitment into sharper focus.

DAN’s mission confirms that every diver in distress can have unlimited access to the DAN hyperbaric medical skills provided by a hyperbaric doctor in the language of the member. For this specialist service to work, DAN needs the full support of a local chamber and of the local technical staff manning the chamber, and this support is usually forthcoming.

DAN has, as part of its services to divers and at its expense, intiated a programme whereby DAN specialist personnel travel to countries where its members dive, including Ireland, to assess hyperbaric chambers for their ability to provide safe and effective treatment. In return, we provide support, training and specialist advice to enhance these services to our members. This ensures that a strong and robust relationship is developed between DAN and the people on the ground, which is invaluable if co-ordinated assistance is to be provided effectively in an emergency situation.

DAN will work with any chamber that is prepared to work with DAN in its mission and this applies to all chambers in Ireland also.

However, and hopefully on a temporary basis, DAN will be handling all diving related emergency calls received through the DAN Hotline from Ireland as follows:

1. All diving related cases referred for diving and hyperbaric medical evaluation and treatment will be referred to the Emergency Medical Department of the Cork University Hospital for assessment;

2. The Cork University Medical Staff, with open consulting access to the DAN Diving Medical Officer on call, will then refer the diver(s) to the Cork Naval Hyperbaric Facility, as required;

3. The DAN Hotline follow up each case with the Medical Staff of the involved Departments, as well as with the Diver, as required.

This procedure is compliant with the Irish Health Care provisions and ensures that all divers in distress obtain proper and timely specialized medical attention in Ireland.

This procedure will be updated when the Galway Hospital Hyperbaric Facility is again fully operational, and diving accidents requiring a DCI diagnosis will be referred to the A&E Department at the Galway Hospital. From here they will then be referred for treatment at the Hospital's Hyperbaric Treatment Facility. This is once again in-line with Irish national regulations concerning diving accidents, as well as meeting the Cork Naval facility's ultimate role that of supporting Naval diving operations.

As things continue to develop in Ireland, we hope to add or re-establish more referral centers to our approved list. Treatments will be provided in conjunction with diagnosis and management by a professional medical practitioners, and thus all complications or follow-up issues will be identified early and DAN members assured of the appropriate care.

In addition and in the unlikely event that the Cork Naval Facility would not be available, DAN will not hesitate to consider an emergency medical evacuation of a diver diagnosed or suspected to be suffering from serious DCS, to the nearest appropriate suitable chamber in the UK.

We trust that this will provide all DAN members, and in fact all divers in Ireland, with the assurance that DAN is able to offer immediate and appropriate care to divers in distress.

sunshinediver

whosedaddy? wrote: »

Got email from Dan Europe about "diving related emergency procedures."

I also received it. No mention of the National Hyperbaric Centre. I believe by UK facilities they refer to Craigavon. Galway still years away. Its a disgrace this island has such lack of facilities.

Scania

What about the hyperbaric centre in Dublin? It is always advertising its services.

sunshinediver

Scania wrote: »

What about the hyperbaric centre in Dublin? It is always advertising its services.

Thats the National Hyperbaric Centre, they are a private facility. Judging from the DAN email it appears they do not cover treatment at this facility. In any event upon contacting the coastguard It is highly unlikely you will be taken here in an emergency. I know many divers that have been treated here however.

macrubicon

I seem to recall it being reported that the guys in Dublin have stopped taking DAN work ( and maybe others ) until a dispute over treatment of a diver is resolved? - I stand to be corrected but I thought I also read that here...

Keedowah

I thought there was one in Galway, or did something happen to it?

I got the email too and was a bit shocked by the lack of chambers - particularly in the west where a lot of diving takes place!

Benny-c

Keedowah wrote: »

I thought there was one in Galway, or did something happen to it?

I got the email too and was a bit shocked by the lack of chambers - particularly in the west where a lot of diving takes place!

The new Galway Chamber has been delivered on site but AFAIK is 'to be commisioned soon'

testicle

macrubicon wrote: »

I seem to recall it being reported that the guys in Dublin have stopped taking DAN work ( and maybe others ) until a dispute over treatment of a diver is resolved? - I stand to be corrected but I thought I also read that here...

"We have withdrawn our services from DAN Europe as at the 27th March 2009."

http://www.hyperbaricireland.com/Diving_Press%20.htm

robertpatterson

And yet on their homepage they say they are a dan europe referral centre
Confused? You soon will be!

testicle

I suspect the NHC withdrawing their services prompted the email from DAN quoted above...

whosedaddy?

testicle wrote: »

I suspect the NHC withdrawing their services prompted the email from DAN quoted above...

No, if you read the full "divers press release", its about Pharmacological treatment as part of the oxygen therapy.

I assume that DAn refuses insurance cover if the chamber doesn't comply with DAN guidelines on treatment - i.e is Aspirin advisable or not.

There are other divers insurances out there that cover hyperbaric treatment.
I've contacted both NHC and one dive insurance organisation* in order to find out whether there is a way out for west-coast divers to avail of treatment in Dublin.

(* I'm neither affiliated with, nor customer of aqua-med)

stephane 1967

re chamber treatment in ireland. NOT IMPRESSED. WE NEED AND EXPECT MORE THEN THAT FROM THEM.
here is the mail i sent them and you ll find their reply below:"Sirs,

I am a CMAS diver based in Dublin, Ireland. I have been a Dan Member (130297) for quite some time. I am the diving officer for our club (marlin sub aqua approx. 40 members) and 90 % of our diving is done in the Irish territory.

Last year, one of our club member had a DCS and the service we received both from yourselves and the national Hyperbaric centre was exemplary. Our victim was taken from first symptoms to being inside the chamber in record time and within one hour he was receiving the vital treatment. I was present throughout and I could not praise the services enough to the extend that we did an enrolment drive within the club and other affiliate clubs to make sure that all would receive similar premium treatment if another unfortunate case was to arise.



it is, therefore with great surprise and disappointment, I receive this week your new policy on hyperbaric services in Ireland. The new policy is a far cry from what was available previously and does not offer any different treatment than our current CFT/CMAS cover.

Why pay for a service twice when both suppliers offer the same minimum standard supported by a poor public system?



Medico, as you probably know, is based in Cork. 3,5 hours drive from Dublin. being conservative 75% of all diving in Ireland is based around the Dublin bay or within 50 km of it.



Question no1: - as you are probably aware, the only public facility currently available in Ireland is in cork, it is also a mobile military unit which withdraws its services regularly when the Navy or the Police force are in training or deployed. This was done last summer on no less then 3 weekends, leaving no facility cover in the country. Where do we go then? Shouldn't DAN inform all its membership of chamber withdrawal when this occurs? Do we suspend all diving activities until THE ONLY CHAMBER is released back to the paying public in order to fulfill our duty of care?



Question no 2:- Do you consider travelling by private vehicle 3,5 hours with a DCS victim the safest and best standard of practice?



Question no3: -Knowing this, is DAN complying with its duty of care to its members? Is DAN offering the quickest, nearest and least harmfull to its membership?



Question no4:- Knowing the performance of the Accident and Emergency facilities in the country and the fact that 80% of DCS cases happen up to 8 hours following a dive, Does DAN recommend that we are transported by public ambulance service to an already full Emergency department with very little knowledge of DCS treatment attached to a random hospital (tales of horror can be relayed to you on this subject if you wish to know more)? If at this stage, the DCS victim is still conscious, and after begging to be treated for several hours (average A&E waiting time currently 3 hours min.), somebody might eventually dispatch the said victim by helivac (at best) or by road (more then likely) to arrive at the Medico facilities some 6 to 10 hours later. Are you seriously offering this as best cover possible, with the knowledge that a purpose built facility is available within the hour?



Question no5: - the big one. Are Dan members diving in Ireland the victims of a political football between parties unknown to them or just victim to the number crunchers both in our public/governement office and DAN organization?



Awaiting anxiously for your reply



respectfully

Stephane 1967 Club diving officer"

DAN s reply was copied and sent to several of our membres with no sign of them even reading the mail:"Thank you for sharing DAN's concerns on the limited hyperbaric facilities available to divers in distress in Ireland. The situation can and will no doubt improve with time but until it does so DAN will work with those facilities prepared to co-operate with DAN and work to European Committee for Hyperbaric Medicine Best Medical Practice Guidelines.
We sincerely hope that our position persuades all available Irish facilities to collaborate with DAN and to work to acknowledged best practice medical standards. This would be to the immediate benefit of all our members, to DAN and to the facility itself and we would therefore ask for your understanding and support to achieve these necessary and desirable aims.

The medical reasons why DAN works worldwide and not just in Ireland to these standards and with great success in minimising diver risk and maximising effective diver treatment are fairly clear and obvious. Less obvious is the fact that 99.5% of all diving claims handled and settled by DAN worldwide annually are managed by DAN Diving Medical Officers in partnership with a treating hyperbaric facility and then settled directly by DAN to the facility. These facilities are situated in all sorts of places and countries and welcome the training, support, guidance and assistance we provide them and our members.

We would also confirm that DAN does not oblige or require members involved in a diving medical emergency to contact DAN although 99.5% of our members logically do so and rely on our advice and assistance when in such an emergency situation. The DAN insurance package provides each and every DAN member with the right to manage any diving medical emergency situation directly without referral to DAN. This is an integral part of the DAN insurance and although members opting for this route will be subject to reduced benefit limits DAN does not otherwise restrict the coverage provided. In these situations where treatment is managed directly without DAN medical advice and support the member retains the right to claim for indemnity (reimbursement) of his treatment costs by submitting documents, medical reports and invoices for consideration by DAN's insurers but must first pay for these treatment costs.

DAN's greatest membership benefit is the real time specialist emergency service provided with the ability and preparedness to guarantee immediate payment of contractor or facility fees ensuring prompt and urgent care so critical to effective treatment and a full and fast recovery. DAN DMO's assist, advise, guarantee payment and settle directly with transportation contractors and/or the facility. This results in immediate and urgent transportation to a facility and immediate treatment.

Where such agreements are not in place or for one reason or another breakdown your emergency treatment is left to chance or to your financial means as any treatment costs must first be paid by the member before they can be submitted to DAN's insurers for reimbursement within policy terms.

The specialist advantages of contacting DAN's 24/7 Emergency Facilities are the reason why nearly all diving emergencies are notified to DAN and supported by DAN DMO's and these advantages only function when DAN collaborate with facilities working to best practice guidelines and when these facilities are prepared to work in partnership with DAN and our DMO's.

DAN's promise to its members is to provide real time support and medical advice backed up by insurance and payment on your behalf whenever you need these services as a result of a diving emergency. DAN will be posting fuller and more detailed explanations on what it is doing in Ireland to improve on the hyperbaric facilities available to all divers and you are free to check our web site to keep abreast of developments. Furthermore DAN's ongoing initiatives to ensure the emergency preparedness of hyperbaric facilities worldwide including Ireland will also be made available on our web site for public view.

We encourage you to keep the dialogue and your concerns flowing and to work with us to improve diving emergency preparedness. DAN works to national and international best practice standards with facilities worldwide and this also applies to Ireland. Facilities willing to commit and adhere to these standards and make their facilities available to DAN or to any diver Irish or otherwise requiring assistance will be supported by DAN either under our Preferred Provider Programme for hyperbaric facilities or on a case by case basis if and when a DAN member submits a documented insurance claim for re-imbursement.

Whilst we are open to provide our medical service and assistance to all Irish members on any diving emergency and maintain that this is the most effective emergency management option available to our members we can and have assisted members who prefer to manage such emergencies directly.

Best Regards,

whosedaddy?

ok. as I said I would... I spoke to Des Quigley at the national hyperbaric centre in Dublin about their withdrawal of services for divers.

The reason of their withdrawal is that they believe another hyperbaric facility in this jurisdiction is being sued for incorrect / inappropriate treatment by two divers who were left Quadriplegic. And such lawsuits in the US have resulted in multimillion dollar payouts...

DAN offered to imdemnify the NHC, but then the century old debate of prescribing drugs during hyperbaric treatment. But this has less to do with Apririn or not Aspirin, but with the fact that a doctor that is not registered with the medical council is prescribing drugs over the phone...
I can understand that the NHC needs to limit their exposure to possible law-suits.

I wouldn't be surprised if that is the same reason why CFT has advised its menbers only to attend a hyperbaric facility attached to a hospital. But why are CFT members not up in arms about that - do they think they are immune to "the bends"????

The NHC is probably the only chance a serious DCS case has on this side of the country. Its the lack of legal framework and medical guidelines and expertise that caused this situation.

I haven't figured out where to go next - not only to raise awareness, but the get things improved....