The life-saving machine is used to treat everything from carbon monoxide poisoning to decompression sickness.

The hospital's decision to stop treating patients who require a stretcher was triggered by concerns about back injury and decompression illness among medical staff working in the cramped machine, says Dr. Wilfred Cassar-DeMajo, who heads the hospital's hyperbaric unit.

"It is not safe for staff to be in the chamber with a stretcher," he says. "According to labour laws, we have no option but to safeguard the health of employees."

Toronto-area patients requiring stretchers, such as divers with the bends or fire victims with smoke inhalation, will now have to be transferred by air or ambulance to chambers in Hamilton, Ottawa or Buffalo.

And that delay could have tragic implications, says Bill Roman, president of the Canadian Council on Hyperbaric Medicine, a group that represents 110 hospital-based hyperbaric medical staff across the country.

"If there's a serious accident today involving a diver, you could either have a death or you could be crippled for the rest of your life," he says. "Ontario is now like a Third World country when it comes to hyperbaric care."

The prospect of sending injured divers to other cities for emergency treatment is a concern, says Sergeant Bill Kemp, head of the Toronto police underwater search and recovery team.

"I'd much rather have the guys go to Toronto than be shipped off, because that's delaying," says Kemp.

"Obviously, the closer the better.... I just want the best medical facilities available for guys in case of an accident."

Kemp's team of 14 divers scours the bottom of Toronto Harbour conducting security checks, and recovering evidence and human bodies.

Two of those officers were treated in Toronto General's hyperbaric chamber in the past two years following diving accidents, he says.

The decision to cut off hyperbaric care to critically sick patients on stretchers came after an occupational health and safety assessment found a potential risk to medical staff, Cassar-DeMajo says. Patients on stretchers represent an added burden because of the space they take up inside the already tight quarters of the submarine-shaped chamber.

But Cassar-DeMajo says the decision will not increase the risk to patients.

"The risk is really not significant," he says, adding that stretcher patients should be just as easily accommodated by hospitals in Hamilton, Ottawa or Buffalo.

But other hyperbaric experts question that assessment.

Dr. Eric Kindwall, an international expert in hyperbaric medicine and a former consultant for Toronto General, says the hospital's decision to eliminate critical hyperbaric care for stretcher patients could result in "increased mortality."

"If you want to let bureaucracy cost human lives, that's up to the citizens of Toronto," he said in a recent interview.

"If you have very critical smoke inhalations with monoxide poisoning, these people often require intensive care. And coming out of fires and so on, these people may not make it unless they can be fully managed in a chamber."

In 2002, Kindwall was hired by Toronto General to assess the hospital's hyperbaric program.

In his report, he concluded, "the present blurred direction of the (Toronto General) unit appears to be a major cause of its dysfunction."

Hyperbaric physicians at the hospital, who spoke to the Star on condition of anonymity for fear of professional reprisals, say that problem is the hospital's own making for buying an inappropriate chamber in the first place.

"Why did they buy a poorly designed chamber that had not been intended for such use?" said one hyperbaric doctor at Toronto General. "They ignored the recommendations of staff and bought a faulty chamber at a cost to the taxpayer. It is a reflection in my mind of incompetence on the part of the administration."

Cassar-DeMajo says staff were consulted before the current chamber was purchased.

Stopping hyperbaric treatments for stretcher patients will affect four to six patients a year, he says. But hyperbaric physicians at the hospital say a closer yearly estimate would be between 14 and 20 patients whose health could be threatened by lack of emergency care.

Dr. Brian Egier, medical director of the Firefighter's Hyperbaric Unit at Hamilton General Hospital, says his facility will make every effort to accommodate emergency hyperbaric patients from Toronto.

But depending on the injury and where it happens, the trip to Hamilton could affect the outcome, Egier says.

"The lack of access to hospital-based chambers in Ontario is a frustration. This certainly makes the situation worse."

(Article by Toronto Star)

Some comments on the story were:

June 3.

As a sport diver who primarily dives in Ontario waters, I am appalled by Toronto General Hospital's decision to close down its interim hyperbaric chamber until a replacement unit is installed sometime in June, 2005. TGH's interim chamber is the largest hospital-based chamber of the three cities mentioned with hyperbaric chambers (Hamilton, Ottawa, Toronto), and is still the best option available to treat critical-care patients until a new chamber is installed and online. TGH has been trying to shut this chamber down for a while now and seems to be looking for any excuse to do so. I also take exception to Dr. Wilfred Cassar-DeMajo's statement that stretcher patients should be just as easily accommodated by hospitals in Hamilton and Ottawa. Ottawa, I believe, has an even smaller two-person chamber and Hamilton has two single-place chambers that can accommodate stretchers, but no attendants. TGH also has two single-place chambers, but they are not equipped the same way as Hamilton's chambers. That leaves Buffalo or other facilities in the United States.

Hyperbaric treatment is not just for divers, as the article mentions. Victims critically injured due to smoke inhalation and carbon monoxide poisoning will all suffer from the delay in getting to adequate facilities, most likely in Buffalo. The first "golden hour'' in getting a critically injured patient who requires hyperbaric treatment to proper medical facilities has now been unnecessarily prolonged due to TGH's decision to close its chamber.

Of secondary concern, will OHIP cover all costs associated with treatments and transport to American facilities? I suggest that all divers who dive in Ontario now obtain secondary medical insurance.