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How Good Is Your Emergency Plan?

Prepare Smarter and Join DAN Today
How Good Is Your Emergency Plan? – featured from DAN (Divers Alert Network)Few people actually consider that DAN’s emergency on-call staff answers more than 3,500 calls to the DAN® Emergency Hotline each year. Not surprisingly, a considerable number of these calls involve situations that could have been managed with good planning and a careful eye to preparation. Although contacting DAN can be a vital part of any emergency plan, DAN’s effectiveness as an assistance provider is greatest when it is treated as one component of a larger, more comprehensive plan.When preparing for emergencies, be ready for a variety of scenarios. It’s impossible to anticipate everything, but a good plan can reduce the fear, anxiety and loss associated with an emergency. Not all dive emergency plans are created equal, but all have the same purpose: to list essential considerations and provide a framework for performing key functions in response to an incident. Emergency plans can be divided into three sections: prevention, preparedness and response. How does your plan measure up?

PREVENTION
While it’s true that written emergency plans typically start at “the incident,” attention to factors that cause dive emergencies can avert them altogether. The best dive emergency is the one that never happens.

Physical fitness — Exercise for cardiopulmonary fitness, strength, flexibility and muscular endurance commensurate with your style of diving and the demands of the dive environment.

Medical fitness — Consider both chronic medical issues and short-term health concerns. Congestion increases the risk of ear or sinus barotrauma, and traveling divers often deal with gastrointestinal problems that can affect general health and stamina. Be honest with yourself prior to diving; if you are feeling less than 100 percent healthy, it may be best to postpone diving.

Appropriate training and education — Never stop developing your diving abilities. Continuing education helps refine basic skills and broadens general diving knowledge, both of which increase your ability to prevent or respond to an emergency. Get training for the type of diving you are interested in pursuing, whether it’s drift, reef, wreck, mixed-gas or cave diving, and practice skills like buoyancy and navigation.

Proper and well-maintained diving equipment — Divers must understand the capabilities and limitations of their own equipment and their buddy’s. This means having your gear inspected and getting appropriate training in its use and maintenance.

Safe and conservative diving habits — Take the time to examine and evaluate your dive habits and styles. Work to develop a culture of safety for yourself and your group.

Knowledge of local hazards — Familiarize yourself with potential hazards unique to particular dive sites. Consider hazardous marine life, currents and the potential for rapid changes to weather or sea conditions.

Get DAN Insurance

PREPAREDNESS
Despite our best efforts to prevent them, emergencies still happen. The better prepared you are to deal with them, the better the outcomes will be. Preparedness is about having the right pieces in place when disaster strikes.

Knowledge of local resources — Develop a written list of facilities and emergency resources in the area, including hospitals and clinics, search-and-rescue providers and transportation or evacuation services. Keep the list up to date by periodically verifying the accuracy of the information, and enter the most important numbers in your phone. Remember that injured divers should always be taken to the nearest medical facility, not the closest chamber. Chambers are not always equipped to receive injured divers directly; an evaluation by a physician must come first.

First aid training — Get trained in basic life support and oxygen administration, and know what training and skills your fellow divers have. DAN offers the Basic Life Support and First Aid and the
Oxygen First Aid for Scuba Diving Injuries courses, among others.

Emergency equipment — Have a well-stocked first aid kit and enough oxygen to last at least one injured diver a trip to the hospital. Routinely inspect the contents of your first aid kit to ensure nothing is missing, damaged or expired. Check the hose, O-ring and pressure of your oxygen cylinder.

Information sharing — Tell your buddy about any allergies or medical conditions you have as well as what insurance coverage you have, whether you’re a DAN Member and anything else that might be important in the event you’re not able to participate in your care. If you’re uncomfortable sharing personal information, write it down, seal it in an envelope, and let your buddy know what and where it is. Also, make sure someone on shore knows where you are and when to expect you back.

Mental readiness — Be an aware diver. Know that even when we do everything right, bad things can happen. Don’t be caught off guard when they do. One level head can create calm in the midst of chaos.

RESPONSE
Response is the implementation of the plan. It’s the split-second decisions made and the actions taken that affect the outcome of the day’s events.

Scene management — During an emergency situation, it is important to have preassigned tasks to specific individuals. Determine who will provide care to the injured, who will call 911, who will manage bystanders and who will secure equipment. Make sure your plan accounts for any divers still in the water.

Patient care — Remember that rescuer and bystander safety comes first; don’t forget to wear gloves when providing care. Ensure circulation, airway and breathing. Stop any bleeding you find, and provide oxygen.

Communications and logistics — Good coordination of the various parties involved in an emergency reduces everyone’s stress. Designate someone to liaise among the caregivers, the captain and crew, emergency services personnel and DAN. This person ensures everybody knows what they need to know.

Documentation — Good notes allow caregivers to observe trends in an injured diver’s condition, serve as a reminder of what treatments have been administered and provide legal protection.

Debriefing — Give everyone involved in an emergency the opportunity to discuss what happened. Allow each participant to describe his or her own experiences and ask each other questions in an environment free from judgment. Formal processing of the event can improve psychological well-being and enhance individuals’ ability to respond to future emergencies.

Diving should be a positive experience. Dive with care. Remember that DAN is here to answer any questions you may have about your emergency plan, but we can’t create it for you. DAN is a part of your emergency plan, but there are many other parts you must put into place yourself. Incorporating these important elements and promoting good planning to divers of all levels, from novice to instructor, contributes to safer diving for everyone.

For more tips and information, visit Alert Diver Online .

Oxygen Unit

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Wayne Ford Chamber Supervisor.

Here at DES we are always looking for things to blog about. So this time we thought we would blog about our staff. Most of the staff here work on a part time basis and therefore have other jobs and hobbies. I thought we would start off with Wayne.


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Wayne Ford

CHT, DMT, ALST Supervisor, Instructor & Diver

Wayne has been with the company for about 7 1/2 years. Starting off as a student on our Hyperbaric Operator/Attendant course. Following on, he was offered a few days a month working at our hyperbaric facility in East London. Over the years, the amount of shifts he works have increased, alond with his knowledge of the work. He is now one of our supervisors and works at the unit three days a week. However, he is on call 24/7 – meaning that he can be called in to deal with any of our out-of-hours emergency cases.

Dry Dives

Wayne also coordinates the educational 40 meter dry dives that we run throughout the Winter period.

Topics covered include:
-banned items and why they are banned.
-the clothes we wear and why.
-possible barotrauma damage, O2 toxicity, DCI, nitrogen narcosis and how to avoid these.

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We will also talk about the dive profile and the experiments that we will do inside the chamber at pressure. We will discuss when we go on O2 and the different gases we can use such as Heliox 50/50.  There are various experiments inside the chamber show how the pressure affects air and water. We visually show gas bubbles being drawn back into solution, air density and a narcosis test. We use 100% O2 at 9 metres; this is to show the divers what it’s like if they would ever need treatment.

It’s a 40 metre dive, bottom time 15mins and a total dive time of 32mins.Dive computers, cameras/video equipment with housing can be taken in to the chamber; this makes the experience something you can share or use as a promotional tool for your club.


Other Activities

This kind of schedule works well for Wayne. He is also a PADI instructor and a safety diver working with The Underwater Studio based in Basildon.

He can’t always tell us about the different shoots he works on, owing to confidentiality agreements. Although when he is allowed to, we never tire of hearing about the films, pop videos, TV series and varied other projects he has been part of.

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Dry Diving With St Ives and Bramston Sub-Aqua Clubs

The St Ives and Bramston Sub-Aqua Clubs recently attended one of the Dry Diving sessions at our Hyperbaric Chamber in London. And they kindly made the following report of their day:

A Dive to 40m with Ocean Divers in East London!

Our branch, St Ives SAC (Cambs) 0833, and Bramston SAC attended a Dry Dive SDC at Whips Cross Hyperbaric facility in August.

The intention of the SDC is to remove some of the mythology and apprehension about recompression treatment. The hope is that divers will be more likely to admit the possibility of decompression illness (a bend) and present earlier at the chamber for treatment. Early treatment greatly improves the likelihood of a full recovery and reduces the amount of treatment required.

After the usual form filling (signing away your life), we where separated into two groups. Those from the Bramston club where decked out in hospital scrubs to ensure that there was no risk of introducing combustible contaminants into the oxygen rich environment. Those entering the chamber also needed to be free of makeup, aftershave, hairspray etc. To complete the preparation, each person was fitted with an oral-nasal masks which were to be used on the 9m and 6m decompression stops at the end of the dive.

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So like medical extras from Casualty, the first group of divers from the Bramston branch entered the chamber and had their ‘dive briefing’. The rest of us watched the show from the outside.

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The chamber is controlled via a pre-programmed computer profile of the intended ‘dive’. The chamber operator has overall control and can interrupt or modify the profile if required.

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A peculiarity of a ‘dry dive’ is that you need to clear your ears more frequently during the descent compared with a ‘wet dive’ – basically, once every breath! For the Bramston group this proved to be more of a problem as they halted the descent a number of times as individuals experienced difficulty in clearing their ears. Because of this, the chamber operator modified the profile and ran the chamber in ‘manual mode’. This allowed him to reduce the bottom time to compensate for the longer descent time.

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Next, it was SISAC’s turn to don the green scrubs, fit the oral-nasal masks and take their seats in the chamber. We had the briefing and the oral-nasal masks were each plugged in to their own demand value which would supply 100% oxygen on the stops. Our descent proceeded smoothly and once on the bottom we took part in some exercises to demonstrate the effects of pressure and nitrogen narcosis.

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This included the ‘parachutist’ which took about 2 seconds to fall to the ground outside the chamber and around 10 seconds when we were at 40m where the air was 5 times more dense.

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Then there was the beach ball which compressed as we descended, expanded on our ascent, returning to its original shape at the end of the dive.

The bottle of coke which was shaken violently at 40m and then opened failed to spray everyone demonstrating the effect of gas compression at 40m.

At 40m, we also blew up a balloon and watched it expand during the ascent.

We also carried out a few simple reasoning exercises, reaction tests and puzzles to demonstrate the effects of narcosis on concentration, coordination and task narrowing.

Prior to the ascent phase, we filled a bottle with water and sealed it tightly.

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During the ascent we stopped at 9m where we all put on our oral-nasal masks. Looking like extras in an air force movie, we all started breathing 100% oxygen. There was an initial stop at 9m for 2 minutes followed by the continued ascent to 6m where we continued to breathe 100% oxygen for a further 11minutes. Once we returned to the ‘surface’ we opened the bottle of water which fizzed a little demonstrating the effect of a rapid ascent on the gas dissolved in a fluid.

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 On completion of the dive we had a presentation about DCI, the chamber and the treatments it could be used for – both diving and non-diving related. The presentation was entertaining and educational and we had the chance to ask questions and clear up any misconceptions that we may have had.

Those attending the dry dive had a wide range of diving experience and qualifications – Ocean Dives through to First Class, instructors, nitrox through to trimix, open circuit and rebreathers. We all agreed that it was very reassuring to have seen and experienced the chamber in action and that if we are subsequently unlucky enough to need recompression treatment, a lot of the apprehension would be reduced.

I believe that diver training has ensured that those with obvious decompression or diving related issues directly after a dive are evacuated for treatment quickly, resulting in a high likelihood of a positive outcome. The area that divers are poor at identifying are issues relating to late-presenting symptoms – aches and pains that occur hours after diving.

During the day, the chamber staff reinforced that all divers should be more conscious of those niggles that they may suffer hours after a dive and that they would prefer to be contacted sooner rather later if a diver suspects there is a problem. Whipps Cross Chamber is at its busiest with diving-related treatments, not over the weekend, but three to four days later, when the discomfort from that niggle from the weekend becomes more than an irritation and divers finally acknowledge that it could be more serious!

You can now find out about the Dry Dive sessions we run and even book online on our website

Believe it or not, they are actually a friendly bunch, and the chamber operators are all divers.

I would like to thank all those at Whipps Cross for the time and enthusiasm, and for making the SDC both enjoyable and informative.

Article and pictures, G J Leyshon and S J Miller.

The contact at Whips Cross Univeristy Hospital Hyperbaric Unit was Wayne
wayne@londonhyperbaric.com

 St Ives Sub-Aqua Club (Cambs). Branch 0833

Website www.sisac.co.uk
Forum www.sisac.co.uk/forum
Contact can be made through the website via email.
The Branch meets every Sunday evening (with the exception of bank holidays) from 20:15 – 21:15 at the St Ivo recreation centre swimming pool.

Bramston SAC.
Website http://www.bsac.com/clublanding.asp?section=000140000034

The branch meets every Thursday evening 20:30 at the Bramston Sport Centre. 

 

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Multi-agency training day

From time to time we take part in ‘Multi-Agency Training Days’. These are full-scale tests of our systems and processes; they help ensure that the various agencies involved can effectively co-ordinate the response to different emergencies.

Decompression Illness Treatment Scenario

The day started with a call from a Police Dive Supervisor advising us of an incident; one of their divers had a rapid, uncontrolled ascent from a depth of 22 metres.

Decompression Illness treatment was required quickly; the Police had informed the Coast Guard and a Sea King helicopter had been dispatched for pick-up.

This call was received by the Duty Supervisor at London Hyperbaric Medicine  based at Whipps Cross University Hospital.

Seaking landing in Epping Forest.

Seaking landing in Epping Forest.

Team clearing the area looking for foreign objects

Team clearing the area looking for foreign objects

Diving Emergency – A Logistical Response

When we receive a call of this nature, advising of a diving emergency coming to us by helicopter, the Hyperbaric Supervisor must inform various agencies:

Police

The police need to be contacted as they are responsible for crowd control at the landing zone (LZ) in Epping Forest; this is a public area that’s well used during summer months with picnicking families.

Ambulance

Ambulance crews need to be on site to transport the patient from the LZ to Whipps A+E

Forest Rangers

Epping forest rangers will open up the locked gates around the area to allow access for the ambulance and police, they also help with clearing the area.

Hyperbaric Crew

The hyperbaric crew need to be mobilised to get the chamber ready to receive the patient.

This all needs to be done in a very short space of time; a Sea King helicopter can fly from the South coast to the LZ in about 30 minutes.

Outcomes

The whole exercise can be stressful but also very rewarding when everything goes like clockwork just as it did on this day. The outcome was that the patient was transferred efficiently with no problems and minimal disruption.

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10 Best Scuba Diving Destinations

10 Best Scuba Diving Destinations

Scuba diving is more then just a sport. It’s an adventure. The clear waters, the beautiful coral reefs teeming with life, the thrill of discovering a wreck or a cave,  this are just some of the reasons people like scuba diving. The ability to explore the mysterious underwater world, so different from ours entices many travelers to visit some of the world’s most remote and picturesque coasts. Wheather it’s for your mere enjoyment or if you want to relax while photographing brightly colored exotic fish, here are 10 of the best scuba diving destinations that will offer you the adventure of a lifetime.

Fiji Islands, South Pacific
Fiji offers an incredible scuba diving experience. It is the “Soft Coral Capital of the World”, the home of the “Great White Wall”, the “Yellow Tunnel” and other famous underwater marvels. Scuba diving conditions and visibility are unrivalled year-round. Because of its clear water and dazzling coral Fiji is a favorite hangout for professional underwater photographers.

Belize

Boasting some of the world’s best preserved marine ecosystems, but undiscovered by excessive tourism, Belize is a natural destination for scuba divers. The Blue Hole in Belize made famous by Jacques Cousteau who declared it one of the top ten scuba diving sites in the world offers divers crystal clear waters and several types of reef sharks, bull sharks and hammerheads.
Best Scuba Diving Destinations In The World
Scuba diving in Belize by Serge Melki
Cozumel and Riviera Maya, Mexico
Cozumel is every diver’s dream and one of the best scuba diving locations in the world. Teaming with schools of fish and boasting amazing views, Cozumel offers the avid scuba diver a vast playground. Cancun’s new underwater sculpture museum features life-sized casts of humans and you can scuba dive, snorkel or enjoy the view from a glass-bottom boat just the same.
Great Barrier Reef, Australia
The Great Barrier Reef is the largest coral reef system in the world and the only living thing on earth that can be seen from space. The Great Barrier Reef is a must see for anybody visiting Australia and it offers hundreds of spots perfect for beginners and advanced divers.

Palau, Micronesia

Palau is between the best scuba diving spots in the world because of its blue holes, huge caverns, a large variety of rare and exotic marine species (reef sharks, jellyfish, barracuda) and Truk Chuuk, where the wrecks of Japanese naval vessels from WWII are to be found. The reefs surrounding each of the islands are largely unexplored and the coral is among the most beautiful and colorful in the underwater world. Not to mention the amazing Jellyfish Lake from Palau, but that’s snorkelling only!

Best Scuba Diving Destinations In The World
Scuba diving in Palau by John Owens
Hawaii
The islands of Hawaii each have their own personality and characteristics. Scuba diving in Hawaii’s year round warm waters is fun and adventurous. Giant sea turtles, enormous stingrays, sharks and whales gather near Hawaii to live in its fertile volcanic ecosystem.
Best Scuba Diving Destinations In The World
Scuba diving in Hawaii by Joe Routon

Red Sea, Egypt

The Red Sea, considered to be one of the 7 Wonders of the Underwater World, is the habitat of a myriad of incredible invertebrate species, soft and hard corals, and other marine wildlife. This all year round dive destination on the eastern edge of the Sahara  is a great spot especially for those divers from Europe who want to escape winter. The best places for diving are less developed regions such as Quseir, Marsa Alam and St John’s Reef.
Best Scuba Diving Destinations In The World
Red Sea Diving by Giorgio
Lake Baikal, Russia
Located in southern Siberia, Lake Baikal is commonly referred to as “the Blue Eye of Siberia.” Lake Baikal is the deepest freshwater lake in the world, a tectonic crack in the Earth crust, so sheer walls, overhangs and dramatic rock formations are typical. You can practice ice diving, night diving and wreck diving.
Best Scuba Diving Destinations In The World
Scuba diving in Lake Baikal by BaikalNature
Galapagos Islands
Galapagos, the islands that inspired Charles Darwin to develope the theory of evolution, are remote, unique, isolated and nevertheless, famous. Many of the species found here are endemic to these islands and, most remarkably, there are obvious distinctions in some species from island to island. Among the cast of unlikely characters are swimming iguanas and equator-dwelling penguins.
Best Scuba Diving Destinations In The World
Scuba diving  in Galapagos by Tristan Brown
Sipadan, Malaysia
This is the jewel in the crown of diving in Malaysia. The place is teeming with life, from turtles, reef sharks, dolphins, schools of fish, bright coral and bright fish to spiralling vortexes of barracudas, so large that the sunlight is often clouded out. The dive sites are peppered around the island and none is more than a short speedboat ride away from the nearby dive resorts. The island is located just of the shores of the Sabah Bay, and would make a great day-trip addition for vacationers staying in nearby Kota Kinabalu hotels.
Best Scuba Diving Destinations In The World
Scuba diving in Malaysia by Felix Esteban
Wheather you are an expert scuba diver or just a beginner, here are some scuba diving books you might like to check out: Fifty Places to Dive Before You Die: Diving Experts Share the World’s Greatest DestinationsScuba Diving & Snorkeling for Dummies andThe Scuba Diving Handbook: The Complete Guide to Safe and Exciting Scuba Diving.

What are your favorite scuba diving destinations?

 

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Infographic How, When and Where Sharks Attack

Sharks have been roaming our oceans for millions of years. But will they still roam our oceans in 50 years from now? Fisherman have been harvesting sharks like it was corn from a field whiteout any reluctance. Now we came to a point that many sharks species are endangered and on the brink of extinction.

Sharks are our friends

Luckily governments all over the word are waking up and bills are being passed to save sharks from extinction. Now we need to educate younger generations that sharks are not brutal men eaters and that a living shark is worth much more than a dead shark.

Many people still believe that sharks are a threat to humans, but they forget that vending machines kill more people every year in the US. We humans are a threat to sharks though and if we keep killing them we will take down a whole eco system which we so much rely on.

Please share and help preserve sharks for future generations.

When Sharks Attack

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5 Minute Neurological Exam

Any diver can follow this 5 minute Neuro

 

  1.                   Orientation.–  Does the diver know name and age? Location? What time, day and year it is? Note: even though the diver appears alert, the answers to the question may reveal confusion, so do not omit them.
  2.                   Eyes. – Have the diver count the number of fingers you display using 2 or 3 different numbers. Check each eye separately and then together. Have the diver identify a distant object. Tell the diver to hold his head still, or you gently hold it still, while placing your other hand about 18” in front of their face.  Ask the diver to follow your hand with his eyes. Move your hand up, down, side to side. The divers’ eyes should smoothly follow your hand and should not jerk to one side and return. Check pupils are of equal size. Note: Often AGE victims have different dilation in one eye than the other. Also look for Nystagmus (fluttering of the eyes either vertically or horizontally). This is a sign of neurological problems, with vertical fluttering being associated with more severe damage.
  3.                   Face. – Ask the diver to whistle. Look carefully to see that both sides of the face have the same expression while whistling. Ask the diver to grit his teeth. Feel the jaw muscles to confirm that they are contracted equally. Instruct the diver to close their eyes while you lightly touch your fingertips across the forehead and face to be sure sensation is present and the same everywhere.
  4.                   Hearing. – Can be evaluated by holding your hands about 2 feet from the diver’s ears and rubbing your thumb and finger together. Check both ears, moving your hand closer until the diver hears it. If the surroundings are noisy (i.e.: a crowed beach), the test can be difficult to evaluate. Ask bystanders to be quite and turn off unneeded machinery.
  5.                   Swallow reflex. – Instruct the diver to swallow while you watch the Adams apple to be sure that it moves up and down.
  6.                   Tongue. – Instruct the diver to stick out their tongue. It should come out straight in the middle of the mouth without deviating to either side.
  7.                   Muscle strength. – Instruct the diver to shrug the shoulders while you bear down on them to observe for equal muscle strength. Check the divers arms by bring the elbows up level with the shoulders, hands level with the arms and touch the chest. Instruct the diver to resist while you pull the arms away, push them back, up and down. The strength should be approximately equal in both arms in each direction. Check leg strength by having the diver lie flat and raise and lower the legs while you gently resist the movement.
  8.                   Sensory perception.The divers eyes should be closed during this procedure. Check both sides by touching as done on the face. Start at the top of the body and compare sides while moving downwards to cover the entire body. The diver should confirm the sensation in each area before you move to another area.
  9.                   Balance and coordination.Be prepared to protect the diver from injury when performing this test. Have the diver stand with feet together, close eyes and stretch out arms. The diver should be able to maintain balance if the platform is stable. Your arms should be around the diver, but not touching the diver. Be prepared to catch the diver who starts to fall. Note: If the diver is already messed up you may want to avoid this one. If he can’t stand check coordination by having the diver move an index back and forth rapidly between divers’ nose and your finger held approximately 18” from the divers face. Instruct the diver to slide the heel of one foot down the shin of the other leg. The diver should be lying down when attempting this test.  Check these test on both legs and observe carefully for unusual clumsiness on either side.

 Remember to note all your findings.

 

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What Will the Doctor Do?

Diagnosing decompression illness

Whether you’re exploring Australia’s coral reefs, drifting through warm Caribbean waters or diving into a crisp Canadian lake, nothing puts a damper on a dive vacation quite like a trip to the emergency room (ER). Anxiety and uncertainty accompany most illnesses and injuries — from cuts that need stitches to more serious problems like chest pain. Unfortunately, even the most well-planned dives by careful and experienced divers may result in ER visits. A little knowledge, whether about ear squeezes or decompression sickness (DCS), can go a long way in reducing anxiety around trips to the ER.

DAN’s medical staff is available to offer advice about dive injuries and provide recommendations about the need for medical care. In complex and more serious cases DAN can work with local facilities to help coordinate care or arrange emergency medical evacuations. If you experience symptoms after diving, activate local emergency medical services or safely get yourself to the nearest ER. Call the DAN Emergency Hotline at +1-919-684-9111 if you wish to discuss your symptoms with an expert in dive medicine.

One of the most common problems in the management of dive accidents is delay in seeking care. If you are worried you may be suffering from a diving-related medical problem, don’t hesitate to make the call. Whether a DAN medic advises you to seek care or you decide on your own to do so, the best course of action is to go to the nearest hospital — not the closest hyperbaric chamber. Chambers are not generally equipped to receive patients directly; patients must be evaluated in an ER first. People with severe burns don’t seek out the closest burn center — they go directly to the hospital. Symptoms after diving warrant the same approach.

The Doctor Meets the Diver


A detailed discussion of medical history and recent diving history is
essential for diagnosing DCI.

The doctor will ask about your medical history and conduct a physical exam. Provide as much information as you can about your symptoms and dives. Be prepared to tell the doctor the number of dives you made over the past few days, the depths and times of the most recent dives, the maximum depth of the deepest dive in the series and the gases you breathed. Also, make sure to mention any rapid ascents, omitted decompression or other problems.

Be honest and thorough when describing your symptoms and the events leading up to your injury. An unanticipated problem or error during a dive may provide clues that will help with the diagnosis. Bring your dive computer with you; it can provide information such as dive profiles and ascent rates that may be of interest to the doctor.

The Physical and Neurological Exams

In the course of the physical exam, the doctor will try to identify any abnormalities that will help in making a diagnosis and determining the best treatment. For a patient who was diving, the most important parts of the physical exam are the assessments of the ears, lungs, heart, skin and neurological function.


A thorough neurological exam may include patellar reflex, finger-to-nose, sharpened Romberg and eye-movement tests.

The doctor will check your ears for signs of barotrauma, such as visible damage to the eardrums and blood or other fluid in the middle ears, will listen to your lungs and heart for abnormal sounds and will examine your skin for any rashes that might be suggestive of DCS. The neurological exam may seem a little unusual, but it is a critical part of the evaluation, and subtle deficits may be significant. The exam is a series of observations, questions and measurements used to evaluate motor strength and sensation all over the body, the function of the 12 cranial nerves, reflexes, balance, coordination and cognition. Impaired balance or coordination is relatively common in people with neurological decompression illness (DCI). Some of the specific evaluations used to detect impairments include the Romberg and sharpened Romberg tests, in which you will be asked to stand still with your eyes closed and your feet close together, the finger-to-nose test and the heel-to-shin test. The doctor may also carefully examine your gait for signs of unsteadiness and evaluate your ability to perform rapid, alternating movements.

Making the Diagnosis


A heel-to-shin test assesses coordination, which may be impaired in people with DCI.

During the evaluation, the physician may make frequent adjustments to a list of possible diagnoses. This list is called the differential diagnosis. When it comes to diving-related medical conditions, diagnosis may be especially difficult since both forms of DCI — DCS (or “the bends”) and arterial gas embolism (AGE) — are clinical diagnoses. This means there are no definitive medical tests that can prove these conditions are present. The diagnosis is instead the result of a thorough history, identification of abnormalities during the physical exam and data gathered from other tests and observations.

Remember that just because you were diving you are not necessarily suffering from a diving-specific medical problem. Many medical conditions can mimic the symptoms of DCI, which further complicates the process of making a diagnosis. Other possible explanations of symptoms that commonly occur after diving include food-borne illnesses like ciguatera, infectious diseases including viral and parasitic syndromes and, perhaps most notably, exertion or trauma that leads to muscle strains or joint pain. But don’t be too quick to decide your symptoms are the result of something other than DCI; leave that decision to the doctor.

Other Tests

When you arrive at the ER, the nurses will check your vital signs: heart rate, blood pressure, respiratory rate, temperature, pulse oximetry (which measures oxygen saturation of hemoglobin) and level of pain.

If your symptoms are serious, a nurse will obtain intravenous (IV) access by inserting a needle into a peripheral vein, usually in your arm or hand. Blood will be taken and sent to the lab for testing, and a tiny plastic tube through which fluids and medications can be administered will be placed into the vein. Common blood tests that may be conducted include a complete blood count (which checks blood cells), a metabolic panel (which checks electrolytes, kidney function, blood sugar and liver function) and cardiac and other biomarkers (which check for heart and muscle damage).

Your doctor may also order a chest X-ray to check for problems with your lungs, including such conditions as pneumothorax (a collection of air in the space around the lungs) or evidence that air has leaked outside the lung into other areas such as the mediastinum (the area around the heart) or in subcutaneous (under the skin) spaces. In addition, a chest X-ray can identify fluid in the lungs that may suggest cardiac problems, immersion pulmonary edema or water aspiration.

Your doctor may also ask for an electrocardiogram (ECG or EKG). This test involves placing electrodes on your chest, arms and legs to collect information about your heart’s electrical system. It can identify an abnormal heart rhythm and reveal evidence of a recent heart attack.

If you had a loss of consciousness or are experiencing neurological symptoms, it is likely the doctor will order a computed tomography (CT) scan of your head. During this test you will lie on a table that moves you through a circular, donut-shaped X-ray machine. This machine will rapidly take a series of pictures of your head and brain as you pass through and will display a detailed three-dimensional image. The doctor will review this image for brain abnormalities such as evidence of AGE, bleeding or a stroke.

If a lung injury (i.e., pulmonary barotrauma) cannot be ruled out, the doctor may also order a CT scan of your chest. This can allow detection of a small pneumothorax or small collections of gas in the chest that may not be visible on the chest X-ray. A CT scan performed in conjunction with the injection of a contrast dye through your IV can help identify blockages in arterial blood flow from blood clots or gas bubbles.

The doctor, if concerned about your heart, may order an echocardiogram. This test uses ultrasound to create a video of your heart in action. It involves the placement of gel and a probe on your chest. Echocardiography checks for problems with the heart muscle, heart valves or the flow of blood through the heart.

What About Treatment?

If DCS or AGE is suspected, high-flow oxygen should be administered through a mask. In addition, unless you have an underlying cardiac problem, you will probably be given fluids through your IV to help address possible dehydration. If you are experiencing pain, the doctor may offer you pain medication either orally or via IV. If you are experiencing nausea or vomiting, you may also be given medication for that.

If you have a pneumothorax the doctor may need to place a tube through your chest wall to release air and allow your lung to reexpand. A pneumothorax can become life-threatening if it is not appropriately managed prior to treatment in a hyperbaric chamber.

Will I Need a Chamber?


Once a doctor has diagnosed DCI, the next stop is usually the chamber.

Hyperbaric oxygen therapy involves the administration of 100 percent oxygen during compression in a hyperbaric chamber. Both forms of DCI warrant chamber therapy, but other diving-related medical conditions do not.

Physicians in the ER who manage patients with diving-related illnesses are encouraged to call DAN for consultation and information about nearby dive-medicine specialists and hyperbaric chambers. As a patient, it is important to be your own advocate; ask your doctor to call DAN for consultation about your diagnosis and treatment.

If hyperbaric treatment is indicated, you may need to be transported to a chamber at a different location. This may involve transport in an air ambulance (helicopter or fixed-wing). Helicopter crews are typically instructed to minimize altitude exposure by flying as low as safely possible when transporting dive-accident patients. Most fixed-wing air ambulances are pressurized to very low altitudes or even sea level.

The Chamber


Hyperbaric technicians or nurses operate chambers from consoles just outside.

Once you arrive at a facility with a hyperbaric chamber you may experience déjà vu as it is likely you will pass through another emergency department where you will be registered, have your vital signs rechecked and be reexamined by a doctor.

You will meet the hyperbaric physician and staff who will take you to the chamber to begin your treatment. The most common hyperbaric treatment protocol used for DCS and AGE is the U.S. Navy Treatment Table 6. The initial descent will take you and the inside attendant (if the chamber can accommodate one) to 60 feet, the maximum depth of a Table 6. The total time of the treatment is at least four hours and 45 minutes. Dive physicians sometimes use other treatments, but they’re all long enough that a trip to the bathroom is highly recommended before you enter the chamber.

What Happens Next?

Depending on the severity of your symptoms and your response to treatment, you will either be admitted to the hospital or allowed to go home after you exit the chamber. If your symptoms were severe or your response incomplete, it is likely you will need additional “tailing,” or subsequent, hyperbaric treatments during the following days.

Once you are discharged, you should talk to your primary-care physician about what happened. Your recovery may take days, weeks, months or, in some rare cases, years. DAN is available as a resource for you during your recovery and can provide advice about safely returning to diving.

Once your recovery is complete, a doctor trained in dive medicine should evaluate you to make sure it is safe for you to return to diving. The doctor may recommend modifications in your diving procedures and habits.

Diving is a rewarding sport with beautiful and thrilling sites to see. The ability to explore the underwater world is a privilege that comes with significant responsibility. Divers must practice and sharpen their skills, demand excellence in education and training programs and adhere to the highest standards of diver etiquette. Education and preparation reduce the risk of dive accidents, but accidents can and do happen. Knowing how to handle a dive emergency and what to anticipate should one occur helps alleviate anxiety and empowers you to be an active participant in the process.

© Alert Diver — Fall 2012

– See more at: http://www.alertdiver.com/Doctor#sthash.eSxGpOcv.dpuf

 

 

 

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Two weeks in the Red Sea, February 2014

Mattijn’s dive blog – two weeks in the Red Sea, February 2014

 

Despite the recent political unrest, the Red Sea is still a good place for recreational and technical diving. It’s close to home, cheap and warm! Up till now there has been no violence in the Red Sea towns. Let’s keep our fingers crossed…

This was going to be a two tiered diving holiday. Joran (my 16 years old son) and Emiliano (long-time friend) joined me to do their courses. I finally persuaded Emi to do his OWC and this was the week it was going to happen (I thought). Joran was here to do his advanced nitrox course with Cat from Tekstreme.

We checked in at the old familiar Seagarden hotel in Hurghada. It was 3 yrs ago but they still remembered us. Must have been the tipping… The next day we were surprised to find the recently opened Hurghada Emperor Divers resort in Tia heights in the process of closing down. Declining tourist numbers has had its toll. It did not affect our diving but it was funny to see Joran clinging to the fridge to get a last coke while the whole thing was shifted out. Joran did very well in his advanced nitrox course. See you tube video. He has a natural build in buoyancy and had no trouble at all doing all the skills Cat Braun from Tekstreme threw at him. “Make him eighteen” was all she said. Both father and son can’t wait for that to happen so that Joran can do his tech courses and become an OC or CCR diver as well. Joran loved making dive plans, calculating SAC rates, OTU’s and a theoretical decompression plan. His SMB deployment is excellent. Yes, I am a proud father. I can’t wait for him to be eighteen so he can start with his tech courses OC or CCR.

Emiliano was a different story. He did all his skills but could not get further down then 1.2 meter. His ears just could not equalize. He had a history of glue ears and grommets but both of us thought he had grown out of it. Unfortunately this was not the case. After 3 days of trying he had a grade 2-3 barotrauma and he had to surrender. As there is absolutely nothing to do in Hurghada besides diving, he changed his flight and flew back the next morning.

My challenge was getting used to the combination off a dry suit and a CCR. I had been avoiding it for years but finally I bought a Bare trilaminate dry suit. In February even the Red Sea is cold at 60 msw. The first dives were OK. But my first zodiac entry was ehh….. Experienced dry suit divers can guess what happened. Slowly but surely my buoyancy control got better and after I had learned to squeeze out most of the air before rolling off the zodiac, I started to like my new suit.

The Emperor Elite

Friday I boarded the Emperor Elite for the technical safari. Joran played hideaway for one night in my cabin and flew back to Schiphol very early in the morning. At 9 AM the boat left for Gota Abu Ramada to do our check out dive. I use an Evolution plus with PLDT travel frame.  Two x 3 litre cylinders,  2 x 10 L bail cylinders and the dry suit created the need for 12 kg of lead. Who said that CCR is less heavy compared to OC….

Tekstreme is a red sea based company. Apart from doing technical courses the whole year round, they organize technical safari’s 3 times a year. I have done practically all of my OC and CCR training with them. This time there were 13 divers plus 3 Tekstreme staff members. A German, a Fin, Brits, a Russian and the odd Dutchman. Experience varied from a recreational CCR diver up to very experienced hard core OC divers who do 120 m plus. It is a bit like a floating hotel. This time there were two chefs in the little kitchen, one was a pastry chef! Everybody has put on weight, that’s for sure. The dive deck is very impressive. Loads of equipment, cylinders and a blending panel.

Time to set up my equipment, check the rebreather. Oh no…. cell failure of nr 3! Before leaving Holland I had replaced all of my cells as they were getting old. Now I had no spares left. Cat Braun was kind enough to give me a replacement cell. Scrubber changed, zipper waxed and fluid repleted, I was ready for the safari’s first dive.

Date Location Max depth Run time Dil mixture  
22-2-14 Gota Abu Ramada (reef) 13 44 air Check out dive
22-2-14 Umm Gamar (reef) 40 51 air  
23-2-14 Rosalie Muller (wreck bombed in 1941) 40 61 air Explored stern section
23-2-14 Rosalie Muller bow section 43 69 air Bow section, engine room too silted out to enter
24-2-14 The Lara (wreck) 60 20 min @ 60 msw, TRT 71 min Tx 16/35 Searched for 10 min!, could only explore the top part
24-2-14 Reef dive       Skipped the second dive because of N2 load
25-2-14 Thomas canyon 60 20 min “60msw, 10 min@45msw, TRT 80min Tx 16/35 Very nice dive!

See you tube video

25-2-14 The Dunraven (wreck sunk in 1876)       Grrrr

Cell failure again, no dive…..

26-2-14 Jolanda and shark reef 34 61 Tx 18/25 No deco dive, see you tube video for all the bath tubs and toilets
26-2-14 Abu Nuhas 30 110 Tx 18/25 Crazy dive
27-2-14         Very strong wind and waves, skipped the dive

The last dive was a memorable one. My two dive buddies, Ron and Craig wanted to do all four wrecks at Abu Nuhas in one two-hour dive! Kimon M, Chrissola K, the Carnatic  and the Giahannis D (all in the 20-30 msw range) We spent 15 min at each of the first three wrecks and all was fine. However, it was the swim between the wrecks that got us. After 90 min, with the Giahannis D looming in the distance, Ron was knackered (at least that was what he wrote on his slate) and it was time to abort the dive. He went up and then it I found out that Craig still had 25 min of deco to do. He was on OC, me and Ron were on CCR and had no deco time! LOL.  See Abu Nuhas: The Movie

Dive medicine

I had brought my V-scan (a very portable transthoracic echo machine) to get experience in doing post-dive TTE’s to look for bubbles. As the resolution of this midget machine is not as good as that of his big brothers I needed an echogenic diver with a considerable nitrogen load to begin with. Guess who was the Guiney pig. Joran did an air dive very close to his NDL. Fourty minutes post-dive some bubbles were discernable in his right ventricle. Then I echoed two technical divers 40-60 min post-dive. No bubbles! Perhaps not surprising as they had a thorough decompression with 80% oxygen.  Next step is to look at a technical diver at the end of a week of repetitive diving. Most technical divers are very interested in dive medicine. I gave a talk about decompression theory/ physiology and pre-dive optimisation strategies. Especially pre-dive exertion and the use of post-dive oxygen got their attention.

It was a very good trip. I have learned to dive with a dry suit and I have made new friends.  The after party was memorable as well! See Tekstreme diving blog. My next tech safari will be in September this year.

Mattijn Buwalda, anaesthesiologist-intensivist DMP DESA EDIC

Hyperbaric physician @ London Hyperbaric Medicine

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