The state’s only public Hyperbaric Treatment Center capable of treating decompression sickness in divers has temporarily shut its doors due to staffing shortages.

The closure of the center, operated by the University of Hawaii‘s John A. Burns School of Medicine, was prompted by the anticipated departure of the center’s last doctor.

Hawaii’s diving community is worried about the lack of a dependable treatment center, potential repercussions for the tourism industry and hampered research efforts.

As a world-renowned tourism destination, Hawaii is a major hub for recreational divers who come to see the state’s expansive reefs. The state’s waters are also a research hub for marine biologists.

Decompression sickness, commonly known as “bends,” can occur when divers surface after being in a pressurized underwater environment. Gases, such as nitrogen or helium, form bubbles in the diver’s tissue and can cause symptoms ranging from pain to paralysis.

Decompression sickness can occasionally result even when proper safety protocol is followed while rising to the surface of water.

The center has provided seven divers a total of 17 treatments since July, according to a UH press release. From July 2016 to July 2017, 45 divers received a total of 57 treatments.

That’s almost one diver per week, on average.

In that same time frame, 68 people received more than 1,000 treatments for conditions other than decompression sickness.

Surveys show diving is a popular recreational activity in Hawaii. In 2015, 44 percent of American visitors and 17 percent of Japanese visitors surveyed reported snorkeling or scuba diving during their vacation, according to the Department of Business, Economic Development and Tourism databook.

During hyperbaric oxygen therapy, patients breathe pure oxygen in a pressurized chamber. It can treat the illness by reducing the size of gas bubbles and allowing them to pass out of the body.

The majority of patients at the center received hyperbaric oxygen treatment for other health problems, such as diabetes-related wounds or radiation injury.

Finding An Emergency Fix

The Hyperbaric Treatment Center, which is located at Kuakini Medical Center in central Honolulu, was the only center in the state open 24-hours a day, every day of the week, said UH spokesman Dan Meisenzahl.

UH is focused on getting the center up and running, but is trying to create short-term options for patients and long-term plans for the facility in the meantime, he said. 

More concrete plans may be ready by next week, he said. For now, the university is advising those affected by decompression sickness to go to the emergency room and seek alternative treatment.

The treatment center has had standing openings for doctors, Meisenzahl said, but there are limited options because so few people are qualified to practice hyperbaric medicine.

Meisenzahl said UH became aware “some key positions would be vacated” over summer. The center closed when the last of four physicians left.

“We regret that this has happened, but please know that the highest level of leadership and other stakeholders are looking to find a short-term solution,” he said.

He added the Legislature has allocated $1.5 million for renovations and other improvements to the center.

The state’s hyperbaric chambers are ideal for divers, said Dave Pence, a UH Diving Safety officer who trains researchers. The chambers have multiple locks and chambers, allowing physicians to intervene in a separate, pressurized chamber in case of an emergency like a heart attack or seizure.

Roughly 200 UH divers go on 3,500 dives per year for research. The university has two “advanced” diving expeditions scheduled on neighbor islands next month.

But Pence said those trips will have to be cancelled because of the relatively high risk of decompression sickness. Researchers have been working toward those projects for a couple of years.

About a third of UH research dives will have to be postponed because of the closure of the hyperbaric center.

Maintaining a multi-million dollar facility for a handful of decompression sickness patients is a big investment, Pence said, but the consequences of not preparing are catastrophic.

While there are other single-chamber hyperbaric facilities on the island, Pence said those should only be used if physicians are absolutely sure there will be no complications during the treatment.

The U.S. Navy and National Oceanic and Atmospheric Administration both have hyperbaric chambers capable of treating decompression sickness, but Pence said UH can’t rely on the availability of those chambers.

Navy members are given preference for their hyperbaric chambers and one of NOAA’s chambers is kept out at sea. Because the Navy’s resources were stretched thin, the state Hyperbaric Treatment Center first opened under former Gov. George Ariyoshi in 1983 as an alternative to its chambers.

NOAA’s other machine is currently on the mainland.

Pence himself underwent hyperbaric treatment at the center in 2000 for 12 hours. After surfacing from a “perfect” 500-foot-deep dive to recover a lost research instrument, Pence said it “felt like someone shoved a hot knife through my right shoulder.”

He lauded his doctors and said many continued working at the center until recently. The state’s Hyperbaric Treatment Center seems to have had trouble recruiting and retaining physicians, Pence said.

Part of that problem is Hawaii’s high cost of living, but he also said hyperbaric specialists are “rare birds.”

“They’re just not here because we’re a small island in the middle of the Pacific,” Pence said.

Randy Kosaki, deputy superintendent of research and field operations with NOAA, said the agency doesn’t have an official position on deep diving yet.

But Kosaki is very concerned about the closing of the center, given that researchers perform some dives deeper than 300 feet.

He said he doesn’t plan to have any divers completing such expeditions, unless the research is for “remote field work” because NOAA keeps a machine out at sea.

“Diving at home might be impacted,” Kosaki said.

Hurting Tourism?

Jerrod Kowalski, general manager at the diving gear manufacturer Aqua Lung Pacific, speculated that less than 5 percent of Hawaii divers are researchers. The rest are recreational divers, including many tourists.  

Tourists may have unusual sleeping patterns due to a change in time zones, be dehydrated from outdoor activity or have consumed alcohol. Those variables may make them more susceptible to decompression sickness.

“What could result from this change could have a very important impact on everybody in the community, whether they’re visitors, diving professionally, local people — this could cost lives,” he said.

Dive shops constitute a large portion of Aqua Lung’s customer base, Kowalski said, and the company is concerned about the ability for consumers to get access to fast, high-quality treatment.

Divers are aware of the consequences of decompression sickness and if they’re diving in an area without pressurized transportation or hyperbaric treatment options, people understand there’s an additional risk.

“People aren’t going to be more reckless,” he said. “People will feel certainly less comfortable. It could impact their desire to do as many dives” or prompt them to dive in places other than Hawaii.

The Hawaiian Islands Recreational Scuba Association is pulling together an economic impact study to help people understand just how large the diving industry is in Hawaii, even though it’s not as visible as surfing, Kowalski said.