Just before Christmas, a DAN member who was diving in Abaco, Bahamas, experienced an incident that resulted in decompression illness. When he contacted DAN and tried to access the benefits of his DAN membership and insurance, he did not receive the level of service he should have. Although we are still collecting information about DAN’s response to this incident, we can offer the following additional context to what was previously reported.
It’s important to note that DAN has been dealing with diving emergencies and arranging evacuations for over 40 years and has successfully completed thousands of these missions. When things occasionally go wrong, DAN has responded by improving its infrastructure and updating standard operating procedures based on what was learned. This incident is no different, and members can be assured that DAN has already taken steps to prevent something like this from happening again.
1. Diagnóstico de una ED: – During the initial call the member’s dive buddy reported a provocative exposure followed by signs and symptoms compatible with decompression illness (DCI). At the time, the member was under the care of a physician who was completing his initial examination but had not yet rendered a diagnosis. After the initial call, the medic discussed the case with their supervisor. Following that discussion (7 minutes later) the DAN medic called the member back to confirm a higher level of suspicion for DCI. This is standard operating procedure.
Understand that this was not a medical diagnosis by DAN. The responsibility to diagnose rests with the evaluating physician (or other on-site medical personnel). DAN is there to support, not replace, the treating physician. It is the treating physician who makes all medical decisions based on their examination of the patient (something DAN can’t do remotely). In this instance, the treating physician, who lacked training in diving medicine, was offered peer-to-peer consultation with DAN’s medical director. However, this offer was never accepted.
INTERVENCIÓN INMEDIATA: – Reinforce to all DAN medics that DAN’s medical director is available for consultation with the treating physician. If the treating physician lacks the skill or education needed to diagnose a diving injury, the DAN medic will strongly recommend an immediate consultation with DAN’s medical director to determine what’s best for the injured diver.
2. Evacuación médica/pago de costos: – Once it became apparent that evacuation to a higher level of care was required, the effort began to complete a medical evacuation from Abaco (the site of the incident) to Nassau (the location of the hyperbaric chamber). To coordinate medical transfers such as this one, DAN has a contract with the world’s top-rated travel assistance company. Per existing DAN standard operating procedures (SOPs), this case was transferred by the DAN medic to DAN’s travel assistance provider so they could arrange the evacuation.
At this point it appears that several issues arose. Although we’ve not yet reviewed transcripts of the calls between the member and DAN’s travel assistance provider, the information we’ve collected reveals several possible departures from DAN SOPs. It seems that, among other things, DAN’s travel assistance provider failed to provide the benefits and services owed to the member under his DAN membership and insurance.
- A pesar de que se le informó que la situación requería una evacuación médica inmediata, la compañía de asistencia en viaje no pudo encontrar oportunamente un transportista aprobado que pudiera realizar una evacuación nocturna. Otras personas involucradas en el incidente (que estaban en el lugar) ayudaron al miembro a organizar su propia evacuación con una empresa de ambulancias aéreas local.
- The member was required to complete a DAN “Claim Form” prior to getting needed assistance. This is a requirement imposed by the insurance carrier, but one which DAN will no longer enforce while an emergency exists. Once the emergency passes, there will be plenty of time to complete any necessary paperwork.
- The member was required to complete a “Fitness to Fly” form. This is not a DAN requirement but is needed by most air ambulance companies before they can initiate a medical transfer. This form is one page and must be completed by the treating physician. This is SOP when a medical evacuation is required.
- The member was required to pay for both the medevac and the hospital visit — despite DAN having SOPs in place to make these payments when requested. The transcripts will show who advised the member that DAN would not pay, but the fact is DAN was not able to facilitate these payments. This was a deviation from DAN SOPs. DAN is there to pay for the member. We are investigating with our travel assistance provider to determine why this didn’t happen. Although the member had to self-pay in this situation, he was fully reimbursed by DAN less than a week later.
Regardless of the reason for these failures, it appears that DAN’s travel assistance provider did not meet the needs of this DAN member. This is unacceptable to DAN, and we’ve taken action to address the situation.
INTERVENCIÓN INMEDIATA: – Effective immediately DAN is changing its SOPs as follows:
- DAN will remain the primary point of contact for case management. The DAN Medic assigned to the case will participate in all calls between DAN’s travel assistance provider and the member to reinforce the urgency of taking action and to make sure the member gets all the benefits and services they are entitled to under their DAN membership and insurance.
- En situaciones de emergencia donde una demora en la evacuación sanitaria puede afectar el resultado médico, la búsqueda de proveedores de servicios disponibles (proveedores de ambulancias aéreas) se está expandiendo para que incluya recursos locales no conocidos anteriormente por DAN o el equipo de servicios de asistencia. Se ha recomendado a todos los miembros del personal médico de DAN que siempre pregunten si alguna de las personas involucradas en el incidente conoce las opciones de evacuación sanitaria locales. Estas opciones se tendrán en cuenta si es necesario realizar una evacuación médica.
- En situaciones de emergencia el requisito por el que se debe completar un formulario de reclamo de DAN se aplazará hasta que la emergencia haya pasado.
- En situaciones donde se requiera algún pago antes o en el momento de la prestación del servicio, el miembro del personal médico de DAN involucrará a otros miembros del personal de DAN conforme sea necesario para aprobar cargos, emitir garantías de pago y efectuar pagos (con tarjeta de crédito o transferencia bancaria). En DAN, nuestro objetivo constante es garantizar que un miembro de DAN nunca tenga que realizar pagos de su propio bolsillo.
MEDIDAS ADICIONALES – The following initiatives will be rolled out in the coming weeks as staff are added and support resources put in place:
- An update to DAN’s systems and database to allow collection of information on key airports and local provider options for air transportation (similar to what we have for hyperbaric chambers).
- Desarrollo de planes de acción de emergencia detallados para destinos de buceo clave. Esto se realizará junto con el desarrollo de la base de datos de proveedores de evacuaciones sanitarias locales para brindarnos un panorama más completo de lo que debe suceder en situaciones específicas.
SOLUCIÓN A LARGO PLAZO
Prior to this incident, DAN determined that it would be in the long-term best interest of DAN and its members for DAN to expand its in-house “assistance services” capabilities. A part of DAN’s medical services operation, the new servicios de asistencia de DAN group will replace DAN’s travel assistance provider. This expansion of services was approved at a recent meeting of DAN’s board of directors. While originally scheduled for rollout later this year, plans are being accelerated to allow DAN to assume responsibility for all member assistance services at the earliest possible date. More information will be provided about this expanded service as it becomes available.
We understand that an incident like this can affect members’ confidence in DAN’s ability to help them if they have a diving accident. DAN takes this matter very seriously and believes the actions we’ve taken will prevent a recurrence. DAN has been serving divers for over 40 years and you can rest assured that if you have a diving emergency, DAN will be there for you.
Esperamos tengan un buceo seguro.
Bill Ziefle