“What’s in your wallet?” is a catchy advertising phrase currently used for a major credit card.
Several years ago, an equally well-known phrase was, “don’t leave home without it.”
If you are a scuba diver both phrases easily apply to the membershipcard you should carryfor the world’s largest association of recreational divers called the Divers Alert Network (DAN). DAN’s missionis to help divers in need of emergencymedical assistance and to promote diver safety through research, products (such as emergency oxygen equipment), diver education and diving services. diving services.
Gary Mace, who with his wife Brenda owns and operatesConch Republic Diversin Tavernier, FL, learned the hard way that “Deep dives, serious symptoms and a remote location underscore the need for DAN.”
Fortunately, Gary is a DAN member. His story is described in DAN’s fall 2011 edition of DAN’sAlertDiveronLine, the Magazine of DAN. See: http://alertdiver.com/Bent_in_Chuuk).
Gary, an accomplished technical diver, was on a week-long adventure on a “live-aboard” dive boatnamed the Odyssey’s in Chuuk, Micronesia, which is known for its numerous wrecks. He, like many of the other divers, was using a rebreather, a type of scuba gear that allows a diver to remain a longer time underwater because a portion of the gas supply is reused.
To get to the boat Gary took several long connecting flights from Miami to Chuuk where he boarded the boat.
Over the next two days he dived four times, all according to plan. At the end of the second day he cleaned his gear, prepared it for the next day of diving and went to his cabin to rest before dinner.
After about an hour he started to get stomach cramps. The cramps got worse; he got lightheaded and went the bathroom where he vomited.
He condition got worse. “My entire body ached, and the stomach cramps, nausea and dizziness persisted. I wanted to tell someone I wasn’t feeling well, but I didn’t have the motor skills to get out of the cabin and climb the stairs,” Gary wrote in AlertDiver.
After about two hours, Gary’s roommate Richie Kohler, returned to the cabin, noticed Gary’s condition and they determined that Gary should start breathing oxygen – a traditional first aid treatment for decompression sickness or the bends.
DAN describes decompression sickness in this way: “During a dive, the body tissues absorb nitrogen from the breathing gas in proportion to the surrounding pressure. As long as the diver remains at pressure, the gas presents no problem. If the pressure is reduced too quickly, however, the nitrogen comes out of solution and forms bubbles in the tissues and bloodstream.”
Despite breathing oxygen Gary’s condition deteriorated. His skin began to show “marbling.” He had a dull throbbing pain in his back and a numb and limp left leg.
It was clear he need medical help. Getting the help wasn’t easy.
The first part involved a 30-minute boat trip back to Chuuk, a painful 45-minute trip in an under equipped “ambulance,” and an overnight stay in ill-equipped hospital with minimal services and no staff available to operate the local hyperbaric chamber.
Gary later wrote: “But unknown to me, the Odyssey’s captain had contacted DAN when it was first evident I needed help. By Wednesday afternoon (the next day), DAN had arranged for a medical transport to fly me to the Dive Locker on the U.S. naval base in Guam. A paramedic and registered nurse arrived with the air transport, looking like two angels in their professional attire. They settled me in, and we embarked on the short flight to Guam.”
After that he received proper care including being given needed food and fluids, treatment in a hyperbaric chamber, and a stay in a properly maintained and operated modern hospital in Guam.
No diver wants to get “bent.” But cases of decompression sickness have occurred even when divers have “followed all the rules.”
Decompression sickness is painful and in extreme cases can cause permanent injury or even death. Gary’s ordeal was especially scary because his accident occurred in a remote location with limited medical services.
What did Gary learn from his experience? He said:
▪ Ensure you are well hydrated prior to diving. Think about adding a few days at the beginning of your trip to recover from travel.
▪ No matter where you dive, ensure you have DAN membership and a dive accident insurance plan. Without DAN, the $60,000 flight and $10,000 hospital bill would have come out of my pocket.
▪ When traveling outside the country, check the local medical facilities and their capabilities. Don’t assume because they are called a “hospital” they can provide a necessary level of care.
▪ If anyone goes through this type of situation, make sure someone is with him at all times. Having someone clear-headed to communicate on your behalf is important.
▪ Know the procedures for contacting DAN; the closest chamber may not be available to you, and they will facilitate the arrangements you need.
Matias Nochetto, M.D., DAN director of operations and outreach, also had some word of advice in the article: “The exotic nature of a location can be both its charm and a nightmare; the comforts offered might be the exception to the rule around you. When planning a trip, consider and plan for potential problems. DCS is not the only risk divers face, and while DAN is always here for you, it cannot comprise your entire emergency action plan.”
OK, you are may be thinking, “I am not a technical diver and I don’t plan a trip to an exotic faraway location. And, there is an excellent hyperbaric chamber right here at Mariner’s hospital in Tavernier.”
But, as anyone who reads the news knows, unexpected accidents can happen (even right here in the Keys) and they can be very expensive to treat. That is when DAN insurance is invaluable.
In addition to dive incident and equipment insurance and a 24-hour emergency hotline, DAN also has numerous other services and programs for dive professionals. They include an information line for non-emergencies, medical FAQs, online seminars, dive safety research, video lectures, and webinars.
According to its website, other DAN services are:
▪ DAN Recompression Chamber Assistance Program(RCAP). Specifically developed for chamber technicians working at remotely located, under-served recompression chambers.
▪ Physician Referral Network. DAN maintains a database of more than 1,000 doctors worldwide who are trained in dive medicine.
▪ MedicalAssistanceServices. DAN medical information staff provide assistance to physicians as well as allied health-care providers - whether evaluating patients with dive-related illness or injury or assessing fitness to dive.
For several years DAN has maintained the world’s largest database of recreational dive accidents. According to Bill Ziefle, DAN president and C.E.O. “We are now putting that database to work in new ways, using the data to present factual and relevant information to our members and to develop educational programs for the dive community.” See the Spring 2017 Alert Diver.
“Though research we have found that a small number of risk factors cause the overwhelming majority of preventable dive injuries and fatalities. These risk factors center around fundamental concepts in diving such as buoyancy control and air management and by directly addressing these factors we strive to prevent the accidents they could cause.”
Being a dive instructor, I have been a big supporter of DAN for several years. During the last few years I have noticed an amazing upgrade in the organization’s publication, Alert Diver. The publication has taken on a new glossy professional appearance and includes features on travel and photography.
One look at the name of the publisher,Keys resident and world famous underwater photographer Stephen Frink, and the reason for the transformation is readily apparent.
In performing background research for this column, I talked to Brian Harper, editorial director for Alert Magazine and our discussion turned to the medical questionnaires that people wishing to undergo dive training must fill out to determine if it is medically safe for them to dive. If they check a “yes” to any specified condition, they are required to obtain approval from a physician to take the course.
This causes frustration for some folks who are on vacation and only have a limited amount of time to take the course. Brian said: “As we discussed, it might be worthwhile to suggest that people contact their dive operator about any and all medical considerations before they travel — so they make better decisions!”
For more on DAN and its programs and services see: http://www.diversalertnetwork.org/
The latest DANdiving report is available at: https://www.diversalertnetwork.org/medical/report/AnnualDivingReport-2017Edition.pdf
Don Rhodes, in addition to a career in government affairs, has taught scuba for 30 years. He and his wife retired to Tavernier five years ago, where he works as an instructor. He can be reached at email@example.com.