Soon divers may have to be flown to Britain for treatment for 'the bends' if two Irish recompression units are shut down amid growing concerns about their safety and effectiveness, writes Dr Muiris Houston.
What have David Beckham, a sub-aqua diver and a child with carbon-monoxide poisoning got in common? They have all received medical treatment in a recompression chamber.
In the Republic, we have just one such facility. It is located at University College Hospital, Galway and is staffed and operated entirely on a voluntary basis. However, at 27 years of age, the hyperbaric medical chamber is well past its sell-by date and there are now significant concerns about its safety and effectiveness. With the island's only other chamber in Craigavon, Co Armagh, about to be closed because of safety concerns, the Galway chamber also faces imminent closure unless it is upgraded.
The Galway service was the brainchild of the late Dr Peter O'Beirn, who as a diver and a consultant anaesthetist saw the need for a chamber to treat divers suffering from "the bends". Advances in medical science mean that a much broader range of conditions can now be treated (see panel). David Beckham reportedly made a quicker than usual recovery from an achilles tendon injury as a result of hyperbaric oxygen treatment. Victims of carbon monoxide poisoning have a better chance of recovery when they receive 100 per cent oxygen under high pressure, with studies showing reduced death rates when patients are treated in modern hyperbaric chambers.
But it is for the treatment of decompression sickness, or "the bends" in divers, that a recompression chamber is most needed. According to Dr Noel Flynn, consultant anaesthetist at University College Hospital, Galway and director of the hyperbaric medical service, the present chamber is "27 years old, very small and a seriously ill patient cannot be put into it". He says while he is delighted to have received a recent commitment from the Department of Health to develop a new chamber at the hospital, it is clear that he has grave doubts about the ability of the current dilapidated machinery to survive another diving season.
As Dr Flynn and his colleagues provide their professional services to the unit on a voluntary basis - a rare finding in a modern health service - the chamber is a labour of love. Along with members of the Galway Sub-Aqua Club, who also staff the facility voluntarily, he is "on-call" to treat anyone in the Republic who has a diving accident.
Decompression illness occurs when divers ascend too rapidly from depth. As nitrogen becomes less soluble, bubbles form in blood and other tissue and impair circulation. This leads to a variety of effects throughout the body. When joints are affected, a diver experiences the characteristic "bends", where a knee and even the spine suddenly flexes. This is accompanied by a dull, throbbing pain in the affected joint. In other cases, the nitrogen bubbles can enter the spine leading to paralysis. In one of the most serious cases of decompression illness seen here in recent years, a visiting diver who was exploring the wreck of the Lusitania suffered permanent paralysis.
Decompression illness can also present itself more subtly. A diver may notice a skin rash or a specific area of pins and needles in the hours after a dive. Headaches, dizziness and extreme fatigue may also occur.
Early treatment is very important. The diver must be transferred quickly - usually by helicopter - to University College Hospital Galway. Following a medical assessment, he will be placed in the recompression chamber accompanied by an experienced diver from the Galway Sub-Aqua Club. Two other club divers will also attend. According to Dr Flynn, the minimum treatment cycle in the chamber is one hour and 20 minutes, rising to five or six hours for more complex cases.
However, the Galway hyperbaric chamber is unsuitable for people with severe "bends". Because it is so small, with a diameter of only 54 inches, it is impossible to manoeuvre a seriously ill patient within the chamber. Nor is the 27-year-old machine able to accommodate modern resuscitation and monitoring equipment. So if a patient with a severe paralysis arrives in Galway this summer, it will be necessary to call for assistance from Britain. This is a costly exercise; the Western Health Board estimates the annual cost of treating divers - currently cared for in Galway - in the UK would be over £4 million sterling.
A spokesperson for the Western Health Board says it submitted a detailed proposal to the Department of Health for a full hyperbaric medicine service early last year. Following a visit from department officials to the current chamber in autumn 2002, the board was asked to submit a trimmed-down proposal which would essentially replace the current chamber and allow the continued treatment of divers on a voluntary basis. The board is now addressing this. According to Dr Sheelah Ryan, CEO of the Western Health Board, the estimated total cost of replacing the hyperbaric chamber is in the region of €1.6 million.
Divers are happy that the Minister for Health, Micheál Martin has signalled his intention to support the replacement option. Michael Loftus, president of the Irish Underwater Council which represents 84 diving clubs in the Republic, says: "In fairness to the Government they do see a need for a replacement chamber. At the same time, there would be a massive benefit to the country to see a full medical hyperbaric service. However we would like to see some action this year".
There is a growing tourism industry centred on diving: it is estimated that divers from Britain alone contribute €13 million to the economy. According to Loftus, this adds to the cost-effectiveness of developing the Galway service.
John Leech, CEO of Irish Water Safety, while paying tribute to the voluntary efforts of medical staff at UCHG as well as local divers, says: "I would welcome the addition of a modern, state-of-the-art therapeutic recompression chamber at UCHG to provide an essential facility for our maritime nation". A spokesperson for the Minister for Health confirmed "the Minister accepts the need to replace the recompression chamber at University College Hospital Galway".
It looks as if the long wait for better medical facilities for divers may be almost over. For the growing number of patients with conditions other than decompression illness, however, it will be some time yet before they can benefit from a fully functioning national hyperbaric medicine service.