DDRC Emergency Patient Guide

Emergency Patient Guide

What is DDRC
What is Decompression Sickness
What is Hyperbaric Oxygen Therapy
How does Hyperbaric Oxygen Work
Admission Procedure
Krug Multiplace Chamber
The Therapy
Are there any Safety Precautions
Are there any Side Effects
For your Comfort
Accommodation
Confidentiality
Chaperones
And Finally
The Aims and Objectives of DDRC
Patient Information regarding a Complaint

What is DDRC
The Diving Diseases Research Centre (DDRC) is a charity.
It was originally developed as a treatment centre for divers suffering from 'the bends' (decompression Illness or DCI) and as such was funded mostly by charitable donations from both amateur and professional diving organisations and other interested bodies. As more recognition has been given to the value of Hyperbaric Oxygen Therapy (HBO or HBOT) in the treatment of various other conditions, we now receive funding from the National Health Service (NHS) for the patients we treat, whose conditions have been clinically indicated to benefit from Hyperbaric Oxygen Therapy. We are situated in Plymouth in the South West of England, with a smaller satellite unit at Spire Hospital in Cardiff.
Most of the patients we treat are from Devon, Cornwall and South Wales. We do however also treat patients from as far afield as Birmingham and Derbyshire.
The DDRC staff comprises trained medical, clinical, chamber and administrative support staff, all of whom will be more than happy to help during your visit to the Hyperbaric Medical Centre.

What is Decompression Illness
Nitrogen bubbles forming in the bloodstream and tissues of the body cause decompression illness, also called the bends. The bubbles occur if you move from deep water towards the surface (where the surrounding pressure is lower) in too short a space of time. The symptoms of decompression illness vary because the nitrogen can form in different parts of the body. Symptoms generally appear in a relatively short period of time after completion of the dive. In almost 50 per cent of cases symptoms occur within the first hour following a dive, in 90 per cent within six hours and in 98 per cent within 24 hours.
Symptoms that the diver may experience will vary and can include vertigo, unusual tiredness or fatigue. Sometimes a rash may be evident. Tingling in the arms and legs may be noticed, one or more joints may be painful, muscular weakness and less often paralysis may occur. Very occasionally it is possible for more severe symptoms to be experienced which can result in breathing difficulties, shock and unconsciousness.

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What is Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy (HBO or HBOT) is a means of providing additional oxygen to body tissues. By intermittently increasing the amount of oxygen in the tissues the healing process is enhanced. The therapy is painless and has the potential for good results.
Breathing 100% oxygen under pressure allows the oxygen to be dissolved into plasma (the liquid part of the blood).
When this occurs, the oxygen will be beneficial to the body for a longer period of time.
HBO Therapy can be used for a range of medical problems such as difficult to heal wounds such as diabetic foot ulcers, radiotherapy damaged tissues, burns, failing skin grafts, and bone infections.
In an emergency it can be used for conditions such as gas gangrene, carbon monoxide poisoning, cyanide poisoning, air embolism and of course decompression illness ('the bends').

How does Hyperbaric Oxygen Work

When Hyperbaric Oxygen Therapy is given appropriately there is the potential for the following benefits in the body:

• Reduction of any gas bubbles
• Delivery of increased amounts of oxygen to injured tissues
• Promotion of blood vessel formation, especially in the micro-circulation, to increase blood flow
• Reduction of tissue swelling
• Reduction and inactivation of some infections
• Promotion of wound healing
• Preservation of compromised tissues
• Stimulation of new bone formation
• Reduction of the effects of some specific toxic substances

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Admission Procedure
You, your relative, or friend will have either been referred to us by the emergency services or via the emergency number or on-call Doctor. On entering the Centre, the Doctor will assess the patient and decide on the best course of treatment required to improve the condition. This usually involves a session in the recompression chamber, which may last between 2 and 8 hours. Highly trained staff will oversee the care of the patient throughout the treatment. The doctor will also continually re-assess the patient in order to organise any further treatment which may be required. The term 'dive' is used because the pressure in the chamber is equivalent to being at a certain depth under water. The chamber is dry at all times and does not move!

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Krug Multiplace Chamber

The multiplace chamber is like a small room with a large walk-through door. Seats are fitted to the side walls where the patients sit during the therapy. Stretchers can be wheeled into the chamber if patients need to lie down, for instance, if the doctor wishes to monitor the patient's heart rhythm. There are several port-holes that let daylight in but there are lights as well. A trained attendant accompanies the patients inside the chamber at all times. Cameras are placed inside the chamber to allow the doctor, nursing team and the chamber staff to continuously monitor activity during the treatment session.

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The Therapy
A technician controls the chamber from outside at all times and is able to maintain constant audio and visual contact with the attendant inside the chamber (There will always be an attendant inside the chamber looking after the patient during the therapy). Compression of the chamber is noisy and gets fairly warm. This takes about 3 minutes as long as the patient can equalise the pressure in their ears.
You will breathe up to 100% Oxygen using a hood tent or a face mask for periods ranging from 20 minutes up to an hour and a half.
While in the chamber patients will usually be asked to write out the details of the incident, if possible, and also give details such as their GP's name and address. If this is not possible relatives or friends will be asked to assist with relevant information.

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Are there any Safety Precautions

There are some things that MUST NOT be taken or worn inside the chamber these include:

• Lighters/matches Cigarettes
• Newspapers Perfume/aftershave
• Hairspray/oil Nylon clothing
• Ointments/liniments Make-up/nail varnish
• Wigs/hairpieces Watches
• Petroleum/Vaseline products Hearing aids
• Fountain Pens Hard Contact lenses
• Heat Pads Hand Warmers
• Metal-Framed Spectacles Cosmetics

If you are aware of a patient having any of the above on their person, please tell someone immediately. The following items CAN be taken into the Krug (multiplace) chamber, but NOT into the monoplace chamber:

• A book or magazine
• A biro pen
• Plastic Frame Spectacles

In the multiplace chamber you can watch a DVD on one of the screens or listen to music via a headset. In the monoplace you are able to watch TV or a DVD through the wall of the chamber and listen on speakers behind your head.

Are there any Side Effects
Some side effects are possible and the most common are listed below:

• Light-headedness; if this happens it lasts approximately 5 minutes and occurs after treatment is over
• Some people may feel some tingling or a dull ache in the area of an injury, generally this is a temporary effect
• Changes in vision, this can occur as a result of multiple treatments, although it is generally temporary. It may last for a few months after treatment. If necessary we can assist in the cost of temporary glasses. Please ask at Reception for more details

For your Comfort

Our Centre has a kitchen where you can make tea and coffee, and is equipped with a microwave oven and fridge. There is a relaxing patient lounge where you can sit and watch television or read, with south facing gardens where weather permitting, you can sit out and enjoy the sunshine. Relatives are of course very welcome to come and use the above facilities and are encouraged to help us help you.

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Accommodation
HeartSWell Lodge is within 200 metres of DDRC and can provide accommodation for relatives and friends of patients who are receiving treatment. Their telephone number is 01752 315900. The rooms are twin bedded and there are self-catering facilities available. Food is not provided by HeartSWell Lodge, therefore patients will receive a small amount of subsistence for each night's accommodation to assist with the purchase of an evening meal. The nearest shop is within 1 mile of the Centre and an Asda store is within 2.5 miles. Other accommodation nearby is the Jack Rabbit Vintage Inn, Innkeepers Lodge, Derriford, Plymouth PL6 8BD - Room reservations 0845 112 6088.
It is important to remember that all additional costs must be paid by you and not charged to DDRC. DDRC can only pay for the accommodation of the patient being treated.

Confidentiality

Whilst you are with us you might learn some information about a patient, who may or may not be known to you. Whether you are a friend, family member or stranger to that patient, we ask you to respect their right to confidentiality by not repeating the information to anyone else. If we all treat any information we may learn about others in the way we would like information about ourselves to be treated, we believe that we will have created an appropriate environment for all our patients and visitors.

Chaperones
All patients may request the presence of a chaperone during any consultation, examination or procedure. If you feel you would like a chaperone to be present during a consultation or examination please mention this at any time during your treatment at DDRC.
In the interests of both patients and clinicians it is the policy of DDRC to provide female patients with a chaperone when undergoing an examination or procedure of an intimate nature by a male clinician (doctor, nurse or other healthcare practitioner). Following the examination a separate opportunity can be provided for private conversation between the patient and doctor.
Patients are advised that they may decline the presence of a chaperone but they will be asked to sign a DDRC disclaimer to this effect. Chaperones will either be qualified nurses or other healthcare staff who have received training for this role.

And Finally..
We look forward to welcoming you to our centre and the treatment you will be receiving. We hope that the information on this page has answered your questions about our centre and the treatment you, your relative or friend will be receiving.
However please do not hesitate to ask any member of staff any questions that you may have and they will be pleased to help you where they can.
Patients, their friends and relatives are at liberty to read any of DDRC's policies and procedures. If you wish to do so at any time please ask at the DDRC Reception.
Please remember that it is the policy of the NHS and DDRC to treat every patient's condition and any information regarding a patient in a confidential manner. As you will associate with fellow patients and their families, please remember to treat any information you may gain in the same confidential manner. If you have any concerns, please speak to any member of staff.
If you would like to comment on the usefulness of this web page, or suggest further topics for inclusion please email info@ddrc.org or let a member of staff know while you are at DDRC - Thank you

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The Aims and Objectives of the Diving Diseases Research Centre
To work within the charity's Memorandum and Articles and as a provider of health care to comply with the following ideals:

• To provide high quality care for patients referred to the centre for hyperbaric oxygen therapy (HBOT) and/or wound care in the clinical areas recommended by the Undersea and Hyperbaric Medical Society
• To undertake research into the effects of altered pressure environments on the human condition; and with ethical approval and in collaboration with NHS and non-NHS professionals, through Evidence Based research provide HBO therapy for patients with medical conditions that may improve through HBO treatment
• Provide an environment of education and learning for all patients and staff, students and visitors, in order to enhance each person's experience and advance the role of HBO therapy in UK medicine
• As a charity to undertake appropriate fundraising activities to fund further research
• The charity aims to work in a collaborative fashion with partners and tenants to improve the scientific and medical environment both locally and nationally. To that end they will choose tenants with this in mind

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Patient Information regarding a Complaint
We hope that the situation never arises, but if you do find yourself in the position where you feel that you wish to make a complaint about anything to do with your treatment or stay here at DDRC, we would like to help and hopefully resolve the situation as quickly as possible.
In the first instance please share your concern with either your doctor, nurse or a chamber team member, who will do their best to help you. If this is inappropriate or fails to get the result you desire, please ask to speak to one of the management team, who will speak to you as soon as possible, and make every effort to deal satisfactorily with your complaint. If you are not satisfied with the results please put your complaint in writing to the Chief Executive, or ask a friend or relative to speak or write on your behalf. Your complaint will be treated in confidence and dealt with under our Complaints Procedure which is available for you to see from the Administration Office.
If all the above fail to satisfy you please contact the Care Quality Commission, with whom we are registered and by whom we are inspected. They can be contacted at the address below:

CQC South West
PO Box 1251
Newcastle Upon Tyne
NE99 5AN
Email: southwest@cqc.org.uk
Tel: 03000 616161
http://www.cqc.org.uk/

The services provided at the Hyperbaric Medical Centre are usually paid for by the NHS, and if you prefer to complain to the commissioner of the services please contact:

The Complaints and Litigation Office

Plymouth PCT
Nuffield Clinic
Lipson Road
Plymouth
PL4 8NQ
Telephone: 01752 314167
Email: complaints@pcs-tr.swest.nhs.uk

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