Southeast divers must travel far for emergency care
Scuba diving emergencies can no longer be treated at Bartlett Regional Hospital in Juneau. After more than 30 years, the facility discontinued its hyperbaric chamber program and recently removed the 13-foot chamber.
Now, the closest chambers for public use are in Anchorage or Seattle.
Recently retired physician William Palmer remembers when the hyperbaric chamber came to Juneau.
“I was diving with some of the divers from the NOAA lab and it came up in discussion that if there was a dive accident of any significance in the local waters, there was no backup whatsoever,” Palmer recalls.
Palmer was sent to Florida in the late 1970s to study undersea medicine and hyperbaric chamber operation. The National Oceanic and Atmospheric Administration signed a memorandum of understanding with the city and borough of Juneau in 1980, and loaned a chamber to Bartlett Regional Hospital.
Douglas Schleiger is the dive center manager for NOAA.
“Our interest was to have a chamber there so if something were to happen, our people could get treated there, that was our own vested interest in it. It was also a service to the community and local divers,” he says.
Scuba divers are at risk of decompression illness, also known as the bends, which can be caused by a fast ascent, a deep dive, or a long dive. Pressurized oxygen is pumped into a hyperbaric chamber to recreate the underwater environment. Over a period of time, pressure in the chamber is brought to a normal atmospheric level.
Without immediate treatment, a serious case of decompression illness could lead to paralysis or death.
Over the decades, the chamber at the hospital was also used for carbon monoxide poisoning and healing wounds. Dr. Palmer says within the first six months of its arrival, the chamber was used to treat ten cases of monoxide poisoning.
Robyn Free is the director of diagnostic imaging and respiratory therapy at Bartlett Regional Hospital. She says in recent years, use of the chamber dropped. It was last used in December 2011 for wound care, which requires 20 sessions in the chamber.
“And prior to that it was 12 months since they had anyone in the chamber.”
That’s one of the reasons the hospital decided to discontinue the program. Another is cost.
The federal agency Centers for Medicare and Medicaid Services surveyed the hospital last June and said a fire suppression system had to be put in place to continue running the chamber.
“That was going to be $30,000 to $50,000,” Free explains.
The hospital was in charge of maintaining the chamber. But regulations changed, requiring the work be done by NOAA-certified technicians three times a year. Each visit would cost the hospital $3,400.
“We tried to talk to NOAA and say, ‘Hey, it’s your chamber. If you want it compliant and run a certain way, then we need some help from you,’ and they were like, ‘Well, we can’t do that,’ so there was nowhere to go with that,” says Free.
Dr. Alan McPherson works in Bartlett’s Emergency Department. When the program was still running, he was the main provider of hyperbaric care. He says running the chamber required a crew of five individuals.
“There would be the doctor who had some training or experience in hyperbaric medicine and that generally would be me. There would be the dive supervisor. You’d have a time keeper. You’d have an outside tender to run the levers, and an inside tender to watch the patient.”
Dr. Palmer worked at the hospital when the chamber program started and when it ended.
“I thought it was really, really sad to see, even though infrequently used, this very high tech, unusual emergency facility just fall away,” he says. “The point is really that when you need it, you need it.”
NOAA dive center manager Schleiger says he would prefer to keep the chamber in Juneau.
“If there was a way to work it out where it could be up there and operated by trained, certified folks, and liabilities issues are all worked out, certainly I would do that if it’s feasible because our divers have not gone away. They are still there.”
Currently, there are seven NOAA divers in Juneau. State of Alaska agencies have about 30 divers in southeast. According to the state’s Commercial Fisheries Entry Commission website, there are over 430 active permits for Southeast dive fisheries. And there’s diving for recreation, commercial work, and search and rescue.
Kyle Hebert is the dive safety officer for the department of fish and game. Bartlett’s chamber was once part of the state’s safety plan. Now that includes a flight transfer to Virginia Mason hospital in Seattle. Hebert doesn’t know how much money that would cost the state.
“We’re probably more concerned about the cost in terms of likelihood of serious injury or death,” Hebert says.
The hyperbaric chamber was moved out of Bartlett Regional Hospital three weeks ago, and now sits in NOAA storage in Juneau waiting to be shipped to Seattle.