DAN Recompression Chamber Network: A High Standard of Care

The first installment features Foundation Recompression Chamber Bonaire in Krajliendijk, Bonaire, and the Center for Wound Care and Hyperbaric Medicine in Mobile, Ala.

Not all hyperbaric facilities are the same. To provide optimal management of pressure-related injuries, DAN maintains up-to-date information about available hyperbaric facilities and, more important, facilities that will receive injured divers. The following recompression chambers are part of the DAN Referral Network because they treat divers and meet a high standard of care.
INTERNATIONAL FACILITY: Foundation Recompression Chamber Bonaire (FRCB), Krajliendijk, Bonaire
The Foundation Recompression Chamber Bonaire (FRCB) in Krajliendijk, Bonaire, is the island's only hyperbaric facility. Established in 1986, this Level 1, six-seat multiplace chamber is a 24/7 intensive care unit. FRCB, which has a close working relationship with the local hospital, provides services to Aruba in addition to treating incidents that happen around Bonaire. The facility's goal is to provide treatment for diving incidents and hyperbaric wound care.

History plays a role in FRCB's investment in treating divers. "The Royal Dutch Navy donated the original chamber to care for diving injuries," said Dr. Richard van der Vaart, program and education director for FRCB. "We worked with that chamber for 20 years, and since then we've seen incidents decrease because of better education. We only later started treating wounds."

As a high-utilization chamber, FRCB treats about 35-40 recreational divers in addition to approximately 6-10 patients for nondiving clinical hyperbaric oxygen (HBO) conditions each year. Some patients may require multiple treatments for their condition, so the number of treatments FRCB provides each year varies and reaches well into the hundreds. The facility, which is operated by two physicians and 37 other trained staff, can be ready to receive a patient within 15 minutes, thanks in part to the staff's proximity to the facility on the small island.

"We keep a high level of education and require people to upgrade their knowledge," Van der Vaart said. In addition to providing in-house training, FRCB will send a team for training at International ATMO, a world-renowned provider of education services in wound care and hyperbaric medicine.

Treating divers requires personnel trained in managing dive-related injuries and requires a large financial and academic investment. FRCB relies on donations as well as patient fees to keep costs as low as possible for those requiring treatments. Van der Vaart is clear on his interest in providing exceptional care: "We love divers!" he said. "Diving was always the main goal of the chamber, it's the beginning of the whole science."

DOMESTIC FACILITY: Center for Wound Care and Hyperbaric Medicine, Mobile, Ala.
The Center for Wound Care and Hyperbaric Medicine (CWCH) in Mobile, Ala., is part of Springhill Medical Center, a community-based, privately owned hospital system that has been operational since 1988. CWCH is a Level 1 facility that has been accredited by the Undersea and Hyperbaric Medical Society (UHMS) four times. The facility has two Perry Baromedical Sigma II dual-place chambers and is the only facility available for divers in the region.

The hospital system "feels strongly about providing services to the community regardless of the nature of the injury," said Julio Garcia, CHT, RN, director of CWCH. They believe in education and provide an introductory course and safety director course in hyperbaric medicine.

Designated as a high-utilization facility, CWCH treats about 10-15 dive injuries and an additional 50-60 patients for clinical HBO each year, averaging several hundred treatments annually. Two physicians and 10 other trained staff operate the center. Call team members have one hour to report to the hospital once they are paged. It takes an additional hour for the patient's registration, diagnostics and evaluation prior to beginning recompression therapy.

"I am willing to scrutinize to make sure I am providing a gold standard," Garcia said, which is important because CWCH covers an enormous area — 200 miles to the north of Mobile, Ala., and more than 200 miles of the Florida coastline to the east — despite the existence of more than 10 hyperbaric facilities in the area that do not provide services for the diving community. This lack of access can result in a delay to care; the average transport time to CWCH is four to five hours, and it can take about eight hours from incident reporting to the first chamber treatment.

CWCH also provides primary or secondary backup care for 14 other facilities, including SEAL Team 2, the U.S. Department of Homeland Security, the Federal Bureau of Investigation (FBI) and the Royal Dutch Navy.
DAN Referral Network Facts
To be included in the DAN Referral Network, facilities must meet the following criteria:
  • Medical director and licensed physician(s) trained in hyperbaric and diving medicine
  • 24-hour availability
  • Hospital-based chamber is preferred but not required
  • Resources to administer U.S. Navy treatment tables
  • Interest in providing care for injured divers

The Undersea and Hyperbaric Medical Society (UHMS), estimates there are more than 4,500 hyperbaric chambers in the world. Of those, 500 are part of the DAN Referral Network.

DAN considers a facility to be high utilization if it treats at least five dive-related injuries a year.

About 10 to 12 percent of the calls to DAN's Emergency Hotline each year come from physicians and hospital emergency room staff.

The number of treatments a patient receives will vary depending on the injury, severity and response to treatment.
Driving to the closest hyperbaric chamber is not advised. If decompression illness (DCI) is suspected, proper medical evaluation is key. Once evaluated, a diver must be directed to the correct, available chamber. Call the DAN Emergency Hotline (+1-919-684-9111) for accurate information about managing a dive-related illness and identifying diver-friendly chambers. For more information about hyperbaric facilities, visit DAN.org.