Is centralization in emergency rural medicine always right? Lessons learned from two cases of decompression sickness

The cases of two patients with decompression sickness (DS) are described to add to the discussion about whether centralization, especially when accompanied by air-medical transport, is always justifiable in island emergency medicine. One patient received hyperbaric oxygen (HBO) treatment on another island after island-to-island transfer by boat; the other received HBO treatment on a ship that was anchored, by chance, close to the island where he became ill. Both cases had a good outcome. Island-to-island transport and within-island treatment, rather than island-to-urban-center transport, was effective, indicating that treatment centralization may not be the most effective protocol all cases. A DS treatment strategy is proposed for use in this geographic area; however, DS occurring on remote islands highlights the wider issue of the centralization of health services.