Delays and Misdiagnosis

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Setting the Stage

A physician named George took a tropical dive vacation with his wife Eve and teenage son Todd. The family took advantage of the two boat dives per day and unlimited shore diving offered by their resort. By Friday, George and his family were 13 dives into their weeklong vacation and planned only two morning boat dives so that they would have a 24-hour surface interval before their Saturday afternoon flight home.

The Accident

When they surfaced at the stern of the dive boat after their second dive Friday morning, George and Todd let Eve board first. George started to tell Todd that he felt something was wrong when he suddenly lost consciousness.

Todd swam to his father immediately and yelled for help. The crew jumped into action and promptly got George and Todd out of the water and out of their dive gear. George regained consciousness quickly and, other than feeling out of sorts, he seemed to be all right.

While the crew secured the boat, George's symptoms worsened. Because English was not the boat crew's primary language, the family had difficulty communicating with them. No neurological exam was performed, no first aid was provided and George, the only person on hand with any medical training, was in no shape to provide a diagnosis. On the ride back to shore, the crew told the family that George must have been stung by something in the water and he would be better soon. They volunteered to arrange a ride to a local medical clinic.

When they arrived on shore, the dive guide called a cab, and George and his family went on their way. But the cab driver, seeing they were scuba divers, took them to the local hyperbaric chamber rather than the clinic. While paperwork was being completed and a medical exam was started for George, the dive guide from the boat caught up with them. The dive guide convinced George that he should go to the clinic, rather than be treated at the chamber.

After some delay, the clinic began administering oxygen, but stopped the oxygen treatment during the night when the oxygen supply was needed for another patient. The next day, with worsening symptoms, George was returned to the hyperbaric chamber and treated.

After multiple treatments at the local chamber and then back home, George was left with residual damage that precluded his continuing to perform surgery as part of his medical practice. He brought a legal action that was decided in his favor at trial.

Analysis

George likely suffered from a poorly understood form of decompression illness that appears to be caused when a minor arterial gas embolism occurs in a diver who has significant nitrogen loading. This causes a hard-to-treat form of decompression sickness, Type III DCS.

Administering oxygen promptly to an injured diver is the best first aid, and getting hyperbaric oxygen therapy without needless delays is the definitive treatment.

Lessons for Life

If a diver suffers a lapse of consciousness upon surfacing, immediately suspect arterial gas embolism, administer first aid and get proper medical care.
Carry dive accident insurance so there is no question about payment for treatment.
Be assertive. Insist on medical care, and make it clear to the medical professionals that the injured person has been scuba diving.
Contact Divers Alert Network (919-684-4326) and enlist their help to find proper medical support or to consult with local physicians for you.
To the best of your ability, ensure that the dive boats you use have radios and oxygen, and that the crew is trained and prepared to use them. At least one crew member should be able to recognize and deal with the signs and symptoms of diving accidents. In countries where English is not the primary language, try to determine if the boat crews can function in English, even if things become difficult.