Triage and emergency evacuation of recreational divers: a case series analysis.
BACKGROUND
It is unknown if the benefits of rapid treatment always outweigh the risks of emergency evacuation for recreational divers. To investigate current triage practice, we reviewed a three-year consecutive series of evacuations and analyzed the relationship of evacuation completion time (EvCT) to outcome in the decompression illness (DCI) cases.


METHODS
Checkbox-keyword searches of calls to Divers Alert Network (DAN) between 4/06 and 2/09 identified cases for review.


RESULTS
Of 24,275 calls, 107 were evacuations. Median EvCT, (defined as time from injury to arrival at treatment facility) was 20 hours (mean +/- SD, 27.3 +/- 27.2). Indications were: DCI 56% (60), medical illness 28% (30) or trauma 16% (17). Twenty-five percent of medically indicated evacuations were for pre-existing conditions. One-third of all DCI air evacuations (17 of 51) were for mild cases (pain or tingling only). EvCT and presentation severity were not significant predictors of DCI outcome; however, early data (< 6 hours) was sparse.


CONCLUSIONS
More data are needed assess the benefits of faster evacuations. However, in real-world scenarios with EvCTs in the 20-hour range, time did not influence outcome. Risk-benefit analysis of emergency transport is advised, especially for mild cases of DCI with a low probability of symptom progression.
Zeindler
P R
PR
Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Freiberger
J J
JJ
D000704:Analysis of Variance; D003665:Decompression Sickness / Q000628:therapy*; D004242:Diving / Q000009:adverse effects / Q000293:injuries / Q000706:statistics & numerical data*; D004630:Emergencies / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D018570:Risk Assessment; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014218:Triage / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology