Specialist advice may improve patient selection for decompression therapy following diving accidents: a retrospective observational study

Abstract

BackgroundEven in a landlocked country like Switzerland recreational diving is becoming more and more popular. Smaller lakes in the Alps are located at an altitude of 2500 m above sea level. The incidence of diving accidents among all helicopter emergency service missions and the consecutive medical knowledge about decompression injuries is low. Thus, a collaboration between the Swiss Air-Ambulance (Rega) and the divers alert network (DAN) was initiated to improve patient treatment and identification of decompression injury and necessity of hyperbaric oxygen therapy (HBO).MethodsRetrospective observational study that includes all patients treated by the Rega which have been classified to have had a diving accident from 2005 to 2014. Patient and diving epidemiology was assessed and the impact of DAN collaboration on patient selection and identification of patients needing transport to HBO facilities were analysed.ResultsIn the 10-year observational period 116 patients with diving accidents were treated by Rega. Mean patient age was 40 (SD 11) years and 95 (82%) were male. If the Rega emergency physician suspected a decompression injury (DCI), without DAN contact 27/28 (96%) of these patients were transported directly to a HBO facility, whereas with DAN contact only 53/63 (84%) needed transport to a HBO facility. DAN was involved in 66/96 (69%) of the cases with suspected DCI on scene, with a significant increase over time (p = 0.001). Mean flight time to HBO facilities was significantly longer (28.9, SD 17.7 min.), compared to non-HBO facilities (7.1, SD 3.2 min., p < 0.001). Due to specialist advice, patients may have been selected who finally did not need a transport to a HBO facility, although DCI was primarily suspected by the emergency physician on the scene. These patients experienced a significantly reduced flight time to the (non-HBO) hospital of 25.6 (SD 6.5) min. (p < 0.001).DiscussionCollaboration of DAN and Rega may allow a safe patient selection and a consecutive reduction of flight time and costs. Due to international collaborations, evacuation to HBO-facilities for acute recompression therapy can be provided by HEMS within less than 30 min all over Switzerland.ConclusionsFor diving accidents among HEMS missions, specialist advice by diving medicine specialists (DAN) appears mandatory to accurately identify and transport patients with decompression injury, as exposure of emergency physicians towards diving accidents and the diagnosis of DCI is low.

Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

“…Secondly, the type of diving influences the risk for DCS, with certain diving behaviorsuch as deep decompression diving, technical diving -yielding a significantly higher risk than no-decompression recreational diving (Germonpre, 2006). Third, DCS is characterized by a highly variable spectrum of symptoms, making the diagnosis often difficult; both over-reporting and underreporting are frequently observed (Steffensmeier et al, 2017;Hubbard et al, 2018). Lastly, the diagnostic accuracy of PFO detection is highly dependent on the technology and technique used for PFO detection (Gin et al, 1993;Wilmshurst et al, 2003;Attaran et al, 2006;Johansson et al, 2010).…”

Data_Sheet_1.pdf

“…Secondly, the type of diving influences the risk for DCS, with certain diving behaviorsuch as deep decompression diving, technical diving -yielding a significantly higher risk than no-decompression recreational diving (Germonpre, 2006). Third, DCS is characterized by a highly variable spectrum of symptoms, making the diagnosis often difficult; both over-reporting and underreporting are frequently observed (Steffensmeier et al, 2017;Hubbard et al, 2018). Lastly, the diagnostic accuracy of PFO detection is highly dependent on the technology and technique used for PFO detection (Gin et al, 1993;Wilmshurst et al, 2003;Attaran et al, 2006;Johansson et al, 2010).…”