In essence, some of your concerns are well founded. Here's a quick look at this complex issue.
During 2003, the DAN 24-Hour Diving Emergency Hotline received nearly 3,000 calls for assistance to the Hotline. Roughly one-third of these calls resulted in referrals to hyperbaric centers where a diver can be examined for a possible dive-related illness. Although many areas of the world are well populated with hyperbaric chambers, locating the nearest appropriate chamber can sometimes be a challenge.
Complex issues face many hyperbaric centers; such issues may even define their availability in the future. DAN means many things to many people. For injured divers, it can mean much-needed help at a critical time. This assistance often comes in the form of helping divers reach definitive hyperbaric care. DAN maintains an active database of operational chambers that serve divers. In additional, DAN has the communications infrastructure to verify a chamber's availability, no matter where in the world a diver is injured, as well as the ability to get the injured diver to that chamber via the fastest and most appropriate route. When you suspect a pressure-related injury in diving, call DAN. DAN's relationships with hyperbaric physicians and centers can open doors to an array of facilities.
More than 4,500 hyperbaric chambers operate throughout the world according to the Undersea and Hyperbaric Medical Society (UHMS). DAN draws on a database of about 500 active hyperbaric facilities attended by physicians who evaluate and treat divers globally.
In all, there are about 700 chambers operating inside the immediate DAN America regions of Canada, the Caribbean and Central America. Within North and Central America (including the Caribbean), DAN works primarily with 160 of these 700 hyperbaric centers because of their ability to treat divers; this is approximately 30 percent of the total chambers available for the region. These centers are known throughout the hyperbaric medicine community as being part of DAN's network of referral facilities. Other centers lack the requisite training, resources and interests to provide appropriate care for injured divers.
The criteria for inclusion criteria in DAN's referral network are not rigid. They do require a medical director and licensed physician(s) trained in hyperbaric and diving medicine and 24-hour availability. A hospital-based chamber is preferred, but not required; it must have resources to administer U.S. Navy treatment tables, and it must have an interest in providing care for injured divers. Herein lies one of the biggest challenges.
Divers often represent a complex set of problems for hyperbaric centers, and these problems are not always easy to evaluate. Injured divers usually show up in busy emergency departments at odd hours, often with vague symptoms that can represent a wide variety of possible medical conditions. Since injured divers rarely make scheduled appearances, they frequently undergo evaluation by physicians and staff who are relatively unfamiliar with assessing dive-related illnesses.
As an unfortunate consequence, these patients may become delayed in hospital waiting rooms, or worse, faced with a battery of tests of questionable benefit in the diagnosis of decompression illness (DCI).
There is a bright side to this. About 10 to 12 percent of the calls to DAN's 24-Hour Diving Emergency Hotline each year come from physicians and hospital emergency room staff seeking consultation and guidance for the assessment of dive-related injuries. Situations like these allow DAN to provide the evaluating physician with the ability to recognize DCI and establish an action plan that is likely to include identifying and contacting the nearest appropriate hyperbaric center.
Unfortunately, DAN loses the resources of a number of diver-friendly chambers each year as they close down. The hardest hit area with this loss is the state of Florida: seven facilities in the last three years have become unavailable for the treatment of DCI. Some have simply closed their doors due to lack of business, some have withdrawn their 24-hour availability, and others feel they are just not prepared to deal with the complex issues of treating divers (e.g., staffing, training, and such). Despite these losses, DAN always manages to identify alternative resources to accommodate the diving community.
For more than two decades, DAN has been working to provide emergency medical advice and assistance for divers. Accurate information on managing a dive-related illness and identifying the diver-friendly chambers is only a telephone call away. As the network of hyperbaric chambers evolves, DAN works proactively to assure that the interests of the recreational diving community are served at the highest levels.