title: Is centralization in emergency rural medicine always right? Lessons learned from two cases of decompression sickness.
abstract: The cases of two patients with decompression sickness (DS) are described to add to the discussion about whether centralization, especially when accompanied by air-medical transport, is always justifiable in island emergency medicine. One patient received hyperbaric oxygen (HBO) treatment on another island after island-to-island transfer by boat; the other received HBO treatment on a ship that was anchored, by chance, close to the island where he became ill. Both cases had a good outcome. Island-to-island transport and within-island treatment, rather than island-to-urban-center transport, was effective, indicating that treatment centralization may not be the most effective protocol all cases. A DS treatment strategy is proposed for use in this geographic area; however, DS occurring on remote islands highlights the wider issue of the centralization of health services.
authors.affiliation: Toshima National Health Insurance Clinic, Toshima, Tokyo, Japan. 98035ts@jichi.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Iga
authors.forename: K
authors.initials: K
authors.lastname: Nagashima
authors.forename: S
authors.initials: S
authors.lastname: Matsubara
mesh_terms: D002497:Centralized Hospital Services; D003665:Decompression Sickness / Q000175:diagnosis / Q000628:therapy*; D004635:Emergency Medicine; D006801:Humans; D006931:Hyperbaric Oxygenation; D007564:Japan; D008875:Middle Aged; D019035:Rural Health Services; D012767:Ships; D014187:Transportation of Patients / Q000379:methods*; D016896:Treatment Outcome