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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.


WaynePic

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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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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Tips for Reducing Pre-dive Nervousness

Zenobia

Zenobia

 

You had been saving up for it for many months, have upgraded your gear, may have travelled overseas, and finally made it to the dive site you’ve been dreaming of.

Yet, with the big wide ocean now in front of you, and your dive buddies all excited and gearing up next to you on the boat, all of a sudden you start feeling funny.  Butterflies in your stomach? Sweaty hands?  Having a little difficulty breathing, perhaps?  You’re not alone.  Many divers experience this once in a while, from beginners to old-timers — especially those who haven’t gone underwater for a long time.  So you wonder how others deal with pre-dive jitters and still manage to enjoy a great dive.

One can easily recognize a diver who is uncomfortable or nervous before a dive:

 

  1. A friendly or sociable person suddenly becomes withdrawn;
  2. One who’s quiet becomes too talkative;
  3. Somebody normally upbeat and enthusiastic becomes negative about the dive;
  4. One who’s relaxed and easygoing stiffens up and starts to turn pale; and
  5. The person keeps going to the loo too often.

 

These are just some of the outward indications of pre-dive jitters.  But much of the problem lies internally, within the person’s mind.  He or she may have had problems in the past that he hasn’t overcome yet.  Mishaps like getting entangled, getting lost or trapped while doing a wreck penetration, getting separated from one’s buddy and going out of air, being swept by a strong current or being hit by a boat, perhaps.  Others may have had traumatic experiences outside of diving – such as drowning while on a regular swimming trip.

 

What can we do to reduce the pre-dive nerves, and get the most amount of joy and satisfaction from each plunge?

 

  1. Keep your mind focused on the joy of diving and not on any possible problem. Most fears are psychological in nature – drowning or being eaten by a shark tops the list. To prepare yourself mentally, it would help to do these things:
    1. Watch underwater videos like those of the BBC, National Geographic and Discovery. Try to recall and think about the positive underwater experiences you yourself have had in the past.  By keeping your mind focused on the good things, you won’t be dwelling on the roughness of the sea in front of you or whatever dangers you perceive to be lurking in the water.  If you’re feeling some shortness of breath, take a deep breath and just imagine all the good stuff you will be seeing during the dive.
    2. Before the trip, read about the exciting marine life or wreck you will be exploring.  During the trip itself, talk to your guide, the boat crew or any of the locals who live, swim, sail and dive in the area.  Find out as much as you can about the terrain.  Knowledge is power, and with power comes much confidence.
    3. Share some of your apprehensions with other — more experienced — divers.  They can give you tips on how they’ve overcome their own fears, reassure you about the concerns you have, and even quell any unfounded fears.

 

  1. Buoyancy is crucial. Most divers are over weighted. You need to make sure you are neutrally buoyant at the surface. That means your weights are enough to make you float at eye level with an empty tank and no air in your BC and drysuit. Doing so will allow you to move comfortably underwater, consume less air and, most of all, you will be certain of your equipment’s ability to keep you afloat.

 

  1. Make sure your regulator is properly serviced — it will give you the added assurance that your gear will always function properly during the dive.

 

Above all else, be excited! You have been waiting for this for a long time, so relax and just DIVE!

 

Scuba Diving opens a whole new world.

Scuba Diving opens a whole new world.

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Clearing your Ears In Water and Other Pressurised Environments.

As a diver, clearing your ears may be second nature. However we all had to learn at some stage and damage to your ears from over forceful clearing techniques is possible. So a quick reminder of the many techniques available may be useful.

The theory:

Your ears have an external tunnel that ends with a flexible ear drum. Imagine a real drum that gets compressed if you increase the pressure around it. (See a. in Figure 1.) The frame of the drum is like your skull and the skin of the drum is like your ear drum. Thankfully your ears differ significantly from a real drum! (See Ear anatomy picture below) For example, ach ear has a tube (See b. in Figure 2), which runs from behind the ear drum to the back of your throat. To stop your ear drum being pushed inwards, you need to increase the internal pressure behind your ear drum. You can do this by actively pushing air up these tubes. Unfortunately these tubes can work like flutter valves, hence can get stuck closed if you try too hard or allow the pressure to get too great before clearing your ears. Blockage can also occur when you have a cold and diving may not be possible. So you must not dive if you can’t clear your ears.

The external water pressure on the drum (Figure 1) and internal pressure generated by you (Figure 2):

 

The Techniques:

Try any of the techniques below early and often but perhaps start with 1. and  2. Everyone does it differently and works out which method works best for them. You will know when you have been successful when your ears “pop” and your hearing and perhaps balance returns to normal. Some of these are easier, in a recompression chamber rather than when diving.

1.         Swallowing, which is known as the Toynbee manoeuvre, drinking, sucking sweets, yawning, coughing, blowing your nose are all things we are used to doing and can be useful.

2.         Pinch your nose, close your mouth and try to blow out of your ears gently. Too hard will not work and can do damage. Watch other divers if you need to know how hard to try. This is known as the valsalva manoeuvre.

3.         The Lowry technique involves using all the above.

4.         Edmonds technique involves rocking the lower jaw from left to right and up and down and forwards and backwards, so that the lower teeth project in front of the upper teeth.

5.         Edmonds 2 advice: “Block your nose, close your mouth, then suck in your cheeks then puff them out quickly.”

6.         Try an otovent. (In chamber only) Occlude one nostril and blow up the balloon with the other nostril.  [youtube]http://www.youtube.com/watch?v=yr5wdwn_Xmk[/youtube]

7.         A difficult one to describe is the Frenzel manoevre. This involves closing the mouth and nose and push the back of your tongue up to the roof of your mouth as you swallow.

8.         Some people get good at clearing their ears and can do it without seeming to do anything. This is an advanced technique not discussed here, but everyone started off by holding their nose and blowing gently out of their ears!

Blocked or painful ears are very common while the pressure is increasing and difficulty clearing your ears is nothing to be ashamed of, but pain is a sign of possible barotrauma and definitely to be avoided. Some people simply find it difficult, but the longer and deeper you leave it, the less likely you will be able to clear your ears.

Ear Anatomy

 

(Kindly reproduced from Wikipedia)

Question 1: Who was Valsalva?

He was a 17th Century Italian anatomist, who described this method for expelling pus from the middle ear through a perforated ear drum.

Question 2:

Can I cause a perforated ear drum by clearing my ears too hard?

Yes, but this thankfully only happens rarely and is probably most commonly associated with a pre-existing weakness in the ear drum. Round window rupture and disruption of the middle ear bones are also possible and barotrauma is possible from as little as 2m. Grommets are artificial tubes placed in the ear drum to allow passive ear clearing, but completely preclude diving. Perforated ear drums seem to me to be most commonly caused by jumping into water ‘ear first’

Question 3:

Can I use decongestants to help clear my ears?

Definitely avoid these and do not dive if you cannot clear your ears. If the medications wear off, the ‘reverse block’ may cause barotrauma, intense dizziness and prevent ascent due to pain.

Question 4:

How can I be sure that I am clearing my ears properly?

Practise gently in water and follow the advice from your instructor. If clearing your ears is still causing pain, avoid diving with an upper respiratory infection. Try descending feet first to reduce venous congestion and using the anchor chain to fine tune to the speed of descent. Small ascents may relieve a blockage due to the flutter valve effect. Finally, there may be a correctable cause and a visit to your doctor may be useful.

Question 5:

How can I tell the difference between inner ear DCI and inner ear barotrauma?

This is an important question as the treatments are entirely different. Inner ear DCI requires recompression, but this will worsen inner ear barotrauma. However both may present with dizziness, nystagmus, (eye flicking) nausea, vomiting and unsteadiness. Both are serious conditions and require assessment by a doctor experienced in diving medicine. Inner ear barotrauma is more likely when symptoms begin on compression, with a shallow dive profile and forceful ear clearing. There may be associated ear barotrauma signs and symptoms, such as pain, fullness, unable to clear your ears and red/damaged ear drum.

Whereas the symptoms of inner ear DCI may start after the beginning of the ascent from longer, deeper, mixed gas dives and there may be signs and symptoms of neurological DCI, such as numbness and weakness in the limbs

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Dry Diving with the school with No Name

We would like to thank David Carty, for arranging for him and 7 fellow divers to come to the Divers Emergency Service HQ, based at Whipps Cross Hospital for a dry dive and look around the unit.

After a safety briefing and tour, the group went in the chamber and were taken down to 40 metres. As always, the squeaky voices and compulsory outfits combined with the effects of nitrogen narcosis had everybody smiling, although many serious facts were learnt at the same time.

After returning to the ‘surface’ everyone chatted about the changes to their voices, how they felt and the tests they had done at depth.

Everyone interacted on the bend watch, a few decompression lectures and videos and it was job done.

PADI Recompression Chamber Awareness tickets were handed out to: David Carty, Damon Offer, Judy Shanahan, Lisa Greenhalgh, Kyle Minter, Stan Minter, Darren Robb and David Hale.

We thank them for coming and hope to see them again soon.

Don’t forget, more details about dry dives are on our website under dry diving.

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Narked with Waterfront Scuba, what a dry dive.

Firstly, the staff at the chamber would like to thank Waterfront Scuba for allowing us to film their dry dive which will soon be released. Matthew Butcher did a great job with the logistics for the 16 enthusiastic and excited divers.

Once medical forms had been checked and signed, coffees in hand, the safety brief began. Barotrauma, Decompression Illness, Nitrogen narcosis, O2 Toxicity and the banned items were thoroughly explained while the worried faces looked on. If this was explained before every dive, we would think twice about getting in. The excitement was building up. The group was divided in to two; group one with Wayne Ford and group two with JP.

We were on our way to 40 metres. The temperature starts to rise, total movement was 12°C and then the fun and games begin. Various experiments were conducted at 40msw, showing air density, volume, gas bubbles drawn back into solution and finally the dreaded mental test. The famous lines: “I don’t get narked” followed by “I’m not narked”.  Well, let’s have a look at the results before that’s decided. The thermocline in the chamber as we went back to the surface was amazing. What a pleasure to dive with.

Group two, however, were in hysterics.  We could hear the laughter through four inches of steel!  They had a fantastic time too.

Congratulations to Matthew Butcher, Theresa and Jaspal Singh, Paul Eaton, Laura Jackson, Peter Matheson, Stephen Welch, Gary O’Brien, Mary Butcher, Lay Ong, D Bowdler, Jamie Shaw, Lesley Hedges and David Kendrick-White who all completed their PADI chamber awareness tickets.