DAN insurance trouble - there is no pat answer...
Gordon W - PhD / Director
September 3, 2008 at 20:38:24
The specific answers to the questions concerning the hourly cost of a hyperbaric chamber operation and the minimum treatment time are extremely variable.
As the Director of two hyperbaric facilities, I can assuredly say that the absolute minimum cost of operation would be $100 per hour. This would vary accordingly as the nature of the victim demands greater medical response.
I would point out that for the one hour of use that a bent diver would like to use the chamber, and the associated $100 charge-out rate, the chamber must be financed for the entire year. The operational costs of a hyperbaric chamber - particularly designated for diving related illness, as opposed to clinical hyperbaric oxygen therapy - are much the same in the consideration of staffing and equipping a fire department. The one hour of billing for putting out the fire must cover the operational cost of the remaining 8,735 hours in the year.
As far as the question concerning the minimum treatment time for the bends, the answer is highly variable.
In treating DCS, a pressure test would be the absolute minimum duration. This would be one hour of billing for the chamber time. It would not include the calling of additional support staff just in case the victim/patient went critical. It would not include the over-time pay of the operator, since, in all likelihood the diver would not present to the facility until after the bar or lounge has closed for the night [and I mean that tongue and cheek, with some intended humor] and the booze did not alleviate the symptoms.
If, god-forbid, the diver was an actual victim and presented with real DCS/DCI, then the scheduled time would be extremely... and I do mean extremely!!!!... unpredictable and variable.
In the worst case scenario, the diver would not be responsive to a United States Treatment Table (USN TT) 6. After 12 hours in this treatment procedure, without resolution of the bends, then the medical supervisor would authorize a USN TT7. In this scenario, there is only one of two ways the procedure would terminate... either the victim gets better, or they die. Either way, it would take the victim and all attending staff in the chamber a full 36 hours to decompress. That would be why decompression treatment chambers have two locks... so you can lock out the body instead of being trapped for thirty-six hours with the corpse. [that would be a morbid operator joke]
So, at a $100 per hour, the additive costs would be the 4 hours overtime spent on a USN TT6 [assuming the diver presented at the very start of the shift], plus the overtime for the undefined duration at a USN TT7, plus the 36 hours of overtime for the decompression, plus the on-call dive physician, plus the emergency/critical-care staff, plus the Pizza Hut delivery guy's tip for getting food to the operators on such short notice.
That last one would be an optional charge. [a not so morbid operator joke]
In an ideal world, there would be no first question to a diver, let alone wondering about insurance when they present to a hyperbaric facility. Most ideally, it would not be a question, but rather a statement... "please watch your head"... as you step into the chamber to be tested for the bends.
The appropriate response to anyone presenting with suspicion of the bends is to treat [conduct a test of pressure] as you ask the defining questions. Any miscalculation or mis-diagnosis would mean that some poor chap could spend the rest of their life drooling from their wheelchair. That is not something I would wish on my worst enemy... let alone a fellow diver.
Unfortunately, the world is defined by money in the way it functions. Chambers are costly and the staff are professional [with a lot of idealism] and they too would like an income that would permit diving holidays.
So, although you might get bent over the business of hyperbarics, it is far better than getting bent over your sport or occupation.
I have nothing to add concerning the controversy over the DAN issues other than to say that it is a sad day in any sport or profession when politics [of money, power, etc] overshadow the ideals.
Thumb down... see you at 60. Gordon W