RESEARCH, EDUCATION & MEDICINE
Consider this scenario: A diver and his partner travel to an island off Fiji, which is only a relatively short distance from Australia, and therefore a popular diving destination.
As it happens, a serious incident occurs involving paralysis of the lower limbs and loss of vision. A call is made to DAN for the doctor on-call to assess the diver based on the symptoms he is exhibiting, the dive profiles and location of the incident. In this instance, it is quickly determined that the diver needs higher level medical care that cannot be provided at the local medical centre.
DAN AP had preferred to arrange an air ambulance to bring the diver directly to Australia, but that would have taken time 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 Suva hospital, where a chamber was located. The diver was recompressed, but needed a more aggressive treatment plan. DAN decided to evacuate the diver by air ambulance to Australia.
Ultimately, the two air evacuations cost in excess of US$110,000, excluding 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 over 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 and land at Kadavu.
Many people would be unaware of the array of challenges DAN
Case Managers face (in addition to remoteness) when arranging a medical evacuation for a diver. These challenges can lead to time delays and frustration for both parties.
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 seek to explore more remote locations, the travelling diver needs to be aware of the various challenges and take steps to minimise the 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.
Dive safely, Scott Jamieson, General Manager DAN Asia-Pacific