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In a suspected diving accident the first question is 'Did the victim take a breath underwater?' from a SCUBA tank, hose, bucket, submerged car, or any compressed air source, regardless of depth.
If the answer is no, give CPR and oxygen if needed and evaluate at the nearest medical facility as a problem not related to diving.
If the injured diver did breathe underwater and only mild symptoms are present (fatigue and itching only), place the patient in the Recovery position if possible and administer oxygen and oral fluids while maintaining close observation for 30 minutes. DO NOT GIVE ORAL FLUIDS TO PATIENTS SUFFERING DIZZINESS OR NAUSEA DUE TO POSSIBILITY OF VOMITING.
If these symptoms do not clear 'ACTIVATE THE HYPERBARIC CHAMBER ALERT".
If the injured diver did breathe underwater and has serious symptoms, the Dive Operator must accompany the patient and do the following:
Administer CPR if required with the victim supine.
Keep airway open and prevent aspiration of vomit. An unconscious diver should be intubated by trained personnel if possible.
Administer oxygen by tight-fitting transparent double seal mask at the highest possible oxygen concentration. Do not remove oxygen except to re-open the airway or if the victim shows signs of convulsions.
Keep victim in the Recovery position if symptoms occurred within 10 minutes of surfacing and steps 1-3 have been completed.
If convulsion occurs do not forcefully restrain. Turn victim on side (supporting head and neck), maintain airway, sweep away any vomit. Hold victim loosely to prevent self injury and do not forcefully insert any airway or tongue blade, resume oxygen administration.
Protect the injured diver from excessive heat, cold, wetness, or noxious fumes.
For conscious patients only, give conscious patients non-alcoholic liquids such as water or fruit juices.
Call On Call Hyperbaric Doctor: 927 7386 / 977 1611 and initiate Chamber Alert .
If necessary and the Hyperbaric Doctor will advise Transport, then Evaluate and stabilize patient at the nearest Medical Centre/Hospital emergency room prior to transfer to the Hyperbaric Chamber Facility.
For Doctors or Paramedics only:
Intravenous fluid replacement with electrolyte solutions is preferred for unconscious or seriously injured victims. Ringers lactate, normal saline, or 5% dextrose in saline may be used. Do not use 5% dextrose in water. Intravenous fluid treatment requires professional care. Do not attempt unless you have proper training.
Should the patient be moved to a Medical Centre the Fiji Government Doctor will stabilize the patient, the Dive Operator must ensure communications are frequent to the Hyperbaric Doctor at the Hyperbaric Unit.
When you initiated the Hyperbaric Chamber Alert, the Hyperbaric Unit will have put all personnel on a state of readiness i.e. The Chamber, Ambulances and the quickest method for MEDEVAC will be on standby readiness to depart. The Ministry of Health Doctor and Hyperbaric Chamber Doctor must authorize all patients (Fiji Citizens, Beche-de-mer Divers, Tourist/Recreational divers, staff, salvage and commercial dive companies) Medevacs, and treatment at the Hyperbaric Unit.
The patient should remain on oxygen and preferably kept lying down supine during transport to Hyperbaric Unit.
If air evacuation Is used, IT MUST BE ARRANGED BY THE HYPERBARIC UNIT. It is critical that the patient not be exposed to decreased barometric pressure at altitude. Flight crews must fly at the lowest safe altitude in un-pressurised aircraft. CAAF have agreed 500 feet weather permitting. It is essential that you the Operator personally ask the pilot to confirm he has been briefed on this critically important aspect.
Colonial War Memorial Hospital (CWM), 24Hr, Tel 331 3444
Emergency rotating mobile numbers for Hyperbaric Doctors Tel: 927 7386 / 977 1611
The CWMH Hyperbaric Unit operates every day on week days with routine hyperbaric treatments. They have a 24hr emergency call list for emergencies after hours and weekends. On arrival at the hospital, please report to the emergency room, where a hyperbaric staff member will meet and assist you. Call one of the mobiles on arrival if there is no hyperbaric staff there.
SPH has a procedure in place for medical evacuation using helicopters from Island Hoppers direct to Suva, landing on CWM roof heli-pad. Treatment will then be undertaken at the Hyperbaric Unit at CWM, coordinated with inpatient admission at Suva Private Hospital.
The costs of med-evac and recompression chamber treatment can be substantial. It is recommended that all divers diving in Fiji carry Dive Medical Insurance available through DAN, PADI or similar organisation.
An alternative if communications in Fiji are difficult would be to call Diver Alert Network (DAN) in Australia on +61-8-8212-9242. They can liaise with the local med-evac system and chamber for treatment.