Hyperbaric Chamber on Ambergris Caye
When you land at the airstrip in San Pedro Town, Ambergris Caye, you
may notice an unusual building on the north side of the airstrip. The building
houses a Double-Lock Recompression Chamber owned by Subaquatics of Belize Ltd. It is the only recompression chamber in Belize. The chamber stands on Radio Frequency 14.4600 twenty-four hours a day as the majority of
dive shops and boats in San Pedro are radio
equipped. San Pedro is proud of its safe diving
record and equally proud of its chamber. You can dive with peace of mind and enjoy the hundreds of dive sites found in Belize.
The Medical Director and Manager of S. S. S.
Recompression Clinics provided the following details
about the chamber:
Emergency service is available 24 hour, everyday.
Emergency Phone: 501-226-2851
Dr. Otto Rodríguez: 501-16-3864
Antonia Guerrero: 501-16-3442
Subaquatics of Belize Ltd. opened its doors to the diving community of Belize in 1989. It started its operations with about 8 dive shops, and now it has a total of 35 affiliated dive shops, which represent about 90% of the total dive activity of Belize. It was a mutual effort with the dive shop operators and the SSS Recompression Chamber Network of continued progress. Today, the chamber has treated over 325 dive injuries, which could have been dead or permanently paralyzed if the chamber did not exist. These include local and international tourists and a few employees of the various dive operations. With the cooperation of the dive shops and the efforts of Worldwide SSS Recompression Chamber Network, Subaquatics of Belize Ltd. (SSSB) has been improving its standards of service to the dive community of Belize. It is the only Recompression chamber in the region. SSSB is a clinic specializing in Subacuatic Medicine, it is a Divers Alert Network (DAN) referral center and Platinum DAN sponsor, it forms part of the Undersea Hyperbaric Medical Society (UHMS).
POINTERS FOR TROUBLE-FREE DIVING
If you observe the following recommendations, the chances of getting decompression sickness or the bends are much reduced. This does not guarantee however, that you are 100% RISK-FREE. Most often an aggregate of mild symptoms marks the beginning of the Decompression Syndrome. Never neglect to accept this; do not treat with frivolity. If detected early the outcome chance of being speedy and 100% satisfactory recovery dramatically increases.
DO: Drink plenty of water (prevent dehydration) and dive conservatively within table/computer limits; ascend slowly- no faster than 30 fpm; limit to two (2) dives within twelve hour period, make safety stops after every dive, plan your dives and make sure that you dive your plan.
DON'T: Over-exercise; take hot showers or baths after diving; drink alcohol, coffee and sodas immediately before/or after; avoid getting too cold during and after diving; avoid greasy foods; do not fly immediately after a dive.
(A) Blotchy skin rash
(D) Coughing spasms
(E) Shortness of breath
(B) Extreme fatigue
(F) Skin Rash
(J) Personality change
(L) Reflex change
(M) Bladder Problem.
(A) Check airway, breathing, and circulation - (ABCs)
(B) Administer 100% oxygen
(C) Place diver in recovery position
(D) Treat for shock
(E) Transport to the nearest Hyperbaric facility ASAP.
HIGHLIGHTS & DIVER INSURANCE
To maintain this facility available everyday it is very expensive undertaking and that is the reason why we developed the ACCESS program to subsidize for some operating expenses. The chamber cannot survive solely doing insurance billing because we only have an average of 2 to 3 cases per month, but must be on readiness mode -yet idle of activity over 300 days each year! We ask for the full cooperation of divers who may require our services to provide us with all their insurance information, this way we can continue providing this vital service of safety to all those who may sometime need it.
As an incentive to local dive masters and non-profit organizations, the SSSB proposes diver ACCIDENT AND EVACUTAION COVERAGE to the dive personnel of its members. This is a special package, which is offered to the members at 50% discount, meaning that SSSB absorbs half of this cost. The premium of the insurance is $75 USD per annum and it is offered to our members at $75 BZD. This offer is only for current members of the ACCESS program and subscription must be done at this facility.
NATURE OF ACTIVITIES
The nature of this company is to respond to any pressure related injuries such as Decompression Sickness (DCS) commonly referred to as (The Bends) and Arterial Gas Embolism (AGE) jointly known as Decompression Illness (DCI). This clinic is equipped with Certified Professional Hyperbaric Physicians, a Certified Diving Medical Technician (DMT), and Certified Patient Tenders who are capable to assist a patient in dealing with these situations. A Multiplace Double Lock Recompression Chamber, which is equipped to accommodate up to three patients at the same time plus a Patient Tender who has to be inside at all times.
The company follows standard treatment tables set by the United States Navy. These protocols are applied depending on the severity of the case and on the Physicians recommendation. Upon the physician making the diagnosis and prescribing the adequate treatment, the Diving Medical Technician (DMT) takes over by instructing the patient and tender to get prepared to initiate treatment. The patient will be given a series of treatments until all symptoms are resolved completely.
Perhaps the single most important factor in aiding to secure a good outcome in treating DCI is early detection, followed by early treatment. This is why SSSB takes great pains in extending free educational programs to the dive operators and their staff. Needless to say, there is an enormous cost of being also "close" to the accidents (Reef), which means being away from large infrastructure (cities)..........But the outcome of our patients is a true "success story". Thanks in good part to these joint education program and early assistance.
WHAT IS DCS AND AGE
Decompression Sickness (DCS) - results from the formation of bubbles in the blood or body tissues, and is caused by inadequate elimination of dissolved gas after a dive or other exposure to high pressure. Decompression sickness may also occur with exposure to subatmospheric pressure (altitude exposure), as in an altitude chamber or sudden loss of cabin pressure in an aircraft. In certain individuals, decompression sickness may occur from no-decompression dives, or decompression dives even when decompression procedures are followed meticulously. Various conditions in the diver or in the diver's surroundings may cause absorption of an excessive amount of inert gas or may inhibit the elimination of the dissolved gas during normal controlled decompression. Any decompression sickness that occurs must be treated by recompression.
Arterial Gas Embolism (AGE) - sometimes simply called gas embolism is caused by entry of gas bubbles into the arterial circulation which then act as blood vessel obstruction called emboli. These emboli are frequently the result of pulmonary barotraumas caused by the expansion of gas taken into the lungs while breathing under pressure and held in the lungs during ascent. The gas might have been retained in the lungs by choice (voluntary breathholding) or by accident (blocked air passages). The gas could have become trapped in an obstructed portion of the lungs that has been damaged from some previous disease or accident; or the diver, reacting with panic to a difficult situation may breathhold without realizing it. If there is enough gas and if it expands sufficiently, the pressure will force gas through the alveolar walls into surrounding tissues and into the bloodstream. If the gas enters the arterial circulation, it will be dispersed to all organs of the body. The organs that are especially susceptible to arterial gas embolism and that are responsible for the life-threatening symptoms are the central nervous system (CNS) and heart. In all cases of arterial gas embolism, associated pneumothorax is possible and should not be overlooked.
AGE may develop within minutes of surfacing; causing severe symptoms that must be diagnosed and treated quickly and correctly. Because the supply of blood to the central nervous system is almost always involved, unless treated promptly and properly by recompression, AGE is likely to result in death or permanent brain damage.
HYPER = HIGH BARIC = PRESSURE
The therapy consists of pressure, 100% oxygen, oral fluids, and air, these are applied using a set of tables established and certified by the United States Navy. The most commonly used tables are the United States Table Treatment 6 (USNTT6) and the United States Navy Table Treatment 5 (USNTT5); there are other tables, which are used for very unusual cases, seldom (if ever) seen in recreational divers.
The USNTT6 is initiated by pressurizing the chamber to 60 fsw or 3 atmospheres, and breathing oxygen for intervals of 20 minutes oxygen and 5 minutes air. Later the ascent begins on pure oxygen until the next static depth (30 fsw) - another intermittent gas period takes place before the final ascent to surface on oxygen. The length of the USNTT6 is 4 hours 45 minutes. This table can be extended an additional 50 min at 60 fsw and 150 min at 30 fsw if necessary.
The USNTT5 is a shorter table, it follows the same trend of pressure, oxygen, oral fluid, and air, but its length is only 2 hours 15 minutes. After every Hyperbaric Treatment, the patient should drink plenty of fluids, avoid hot showers or baths, non-prescribed medications, caffeine, carbonated beverages, alcohol, strenuous exercise, oily spicy foods, avoid exposure to higher elevations (more than 1000 ft) or fly until 72 hours after the last treatment or cleared by the doctor.
CHAMBER ACCESS PROGRAM
The chamber access program is a system whereby the dive shops pay a membership fee to become part of the program. After they become members, the dive shops are asked to collect a nominal levy or fee (typically $1 USD for each tank dived) - and forward to the chamber at the end of every month. This money is used to pay for stand-by operating expenses, which include doctors, utilities, technical maintenance, upgrades, salaries etc.
This program gives direct access to chamber service at anytime for dive shops that are part of the program and are current with their payments. The contribution however, is not an insurance, the diver will still be asked to supply the chamber with all their insurance information. The company will bill the insurance carrier of the patient. If patient is lacking any health/accident insurance, the chamber shall apply a nominal cost recovery fee.
WAIVING THE CONTRIBUTION
If you refuse to make the $1 usd contribution per tank dived and you may require our services, you will be requested to make a cash deposit of $2500 usd even if you have insurance. You will then be charged a fee of $850.00 usd per hour treatment. The company will provide you with medical records and evidence so that you can file for a refund in case you're adequately insured.
CONTRIBUTOR, BUT UNINSURED PATIENT
If the diver requiring treatment contributed their $1 usd per tank dived but does not have any kind of insurance (ie. No valid policy, rather than a policy with crafty exclusions), then the chamber will apply a mere cost-recovery fee, which is a nominal payment.
Diving is a relatively safe sport, however, there will always be potential emergencies. Whether these emergencies evolve into a full-blown accident or death often depends on the immediate care the victim receives. All divers should be aware of the causes, signs, and symptoms of potential diving emergencies and be prepared. Ensuring dive buddies are properly trained in emergencies is just as important; the victim may not always be someone else, it could be you!!
DAN EMERGENCY CONTACT NUMBERS
DAN 24 Hr. Emergency 001-919-684-8111
DAN Travel Assist: 001-202-296-9620
DAN Member services 001-919-684-2948 Ext. 333
For more information, follow these links:
San Pedro Hyperbaric Chamber|
What would we do
with out it?
by Lydia Chuc
Several weeks ago I was on a shallow dive at Hol Chan and suffered an arterial gas embolism because I surfaced too quickly. I received treatment at the San Pedro Hyperbaric Chamber and was tended to by Antonio Guerrero, the hyperbaric chamber technician, and Dr. Otto Rodriguez. My treatment went well and I was cared for with the greatest compassion and professionalism. Thanks for everything Antonio and Dr, Otto.
After spending the better part of three days receiving treatments I was out to give up on diving for good. (Well not quite, but almost.) I also spent a great deal of time talking to Antonia and Dr. Otto. "When the chamber was brought to San Pedro in 1989 by Sub-Aquatic Safety Services I was very skeptical about it," recalled Dr. Otto. I did not know very much out the treatment for decompression sickness and there was not very much about it in our medical text books." He said that he visited the chamber office when they were setting up the equipment and was fascinated. Almost ten years later, Dr. Otto is the doctor stationed at the hyberbaric chamber office.
One of the most interesting questions that came up during our discussions was, how did people who suffer from embolisms and decompression sickness receive treatment before the hyperbaric chamber was brought to San Pedro in 1989? According to Dr. Otto, there were not many people diving before 1989 and the few cases that he saw were transferred to Cancun or Houston where there was a chamber. He said that he knew of people who couldn't afford to travel to the states to receive treatment or who refused treatment and are today permanently crippled, walk with a limp or have limited use of certain limbs. Antonio mentioned that she knew of a man from X'calak who had decompression sickness and never got treatment. I see him some times limping around San Pedro" she said, "he visits sometime."
During the height of tourist season no less than two persons per month are treated for either decompression sickness or embolisms. During the off season there are months when there are no patients at all. (Which is good.) Dr. Otto said that the biggest problem they face is trying to operate the chamber without the full cooperation of the dive shops in Belize. "Some dive shops don't pay the $1.00 per tank monthly fee or they don't pay a dollar for every tank," explained Antonia. "To be a member of the $1 Per Tank Diving Chamber Affiliation you are required to pay the fee. Sometimes we know that they make a lot more dives than they say but what can we do?" The dollar ensures that if a diver, diving with a dive shop which is a member of the affiliation, becomes affected with decompression sickness, treatment will be provided free of cost. The hyperbaric chamber staff would like to encourage dive shops to pay the fee and protect their staff and customers from unfortunate mishaps.
If you have qualms about not paying the dollar per tank just think about all the people who get treated every year for decompression sickness or embolisms at the chamber. Think about all the people you could help by being a member of the affiliation. Better yet, consider what would happen if one day you were injured in a diving accident, wouldn't you want to have treatment readily available to you? For more information about the hyperbaric chamber please call 2852.
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