Diving Emergencies

[uglyEMT]

Hey everyone. Was thinking about some stuff while reading and refreshing the old brain. I recently became a certified rescue diver (not public safety diver) and while I know we don't deal with the in water emergency as EMTs / Medics we do take the hand off. So with me learning the in water side I thought about the handoff. I went back to my text books and protocols and came to find a little bit of disconnect between the two.

In water besides applying O2 or if necessary CPR and AED a rescue diver or higher certified diver actually does quite a bit that I feel the EMTs or Medics would benefit from but do not seem to be taught or have protocols for to even think of asking for. Every State has some form of scuba diving so even if you are land locked chances are you have local scuba diving. So my purpose of this post is two things.

1) Let you know what I do as a rescue diver that I believe is important to the handoff.

2) Hear from you all about what you were taught or what protocols are in place in your area.

Ok first, what I do. I want to preface this with the understanding when I am talking about the rescue diver I will be talking about a non EMT (any level) trained diver. The rescue diver is trained to handle diving emergencies from the bottom all the way to the surface and take over on the surface until higher care can be involved. They are trained in O2 therapy, no airways just NRB and pocket masks, CPR, AED and neurological deficiencies. Also we are taught to at least know where the local recompression chambers are. We also have the Diver Alert Network which are physicians trained in diver emergencies and available 24/7/365 anywhere in the world if needed.

The other thing all divers follow is a dive profile. What our maximum depth will be, how long our bottom time at depth will be, what kind of gas or gasses we will be breathing, and total underwater time. This is a part of the diver emergency that I know wasn’t in the text books or even in our local protocols to even ask for. I think this is a big disconnect, an emergency at 20 feet down will be different from one at 60 feet or one with different gasses used.

Also the neurological side is important. We use a check off slate to track deficiencies such as pupils, eye tracking, AO, and breathing. We also have a slate for tracking signs and symptoms of Decompression Sickness (the bends). We recheck these vitals every 5 minutes. Again I know I was never taught or have in our protocols to ask for these.

I think it is important to let others in EMS know that these are available to them and should ask for them to aid in giving the best care possible. Even knowing where the nearest hospital with a recompression chamber is could possibly change the decision for transport options.

Hopefully this information can and will help you in your area if a diver emergency happens and I will answer any questions as best as I can.

I would like to hear from others if they knew about these things in their area or if they are in your protocols and if they are what they are.

Thanks In advance everyone

[Arctickat]

nice work Ug.

[scubanurse]

I haven't seen much regarding diving emergencies in protocol books that I've been exposed to. I think the most important piece to note for EMS providers and ER docs is the DAN hotline. They are an incredibly valuable resource when it comes to diving emergencies.

One training dive I did, a girl started to vomit underwater and go in and out of consciousness. We ascended her and got her to shore, but the DAN docs were great for guiding a treatment plan, when in reality she was preggo and dehydrated.

The dive profile is helpful to DAN when you call them, but the average joe will look at it and likely be clueless.

[uglyEMT]

Thanks Arctickat.

Scubanurse that's something I am trying, hopefully, to educate folks on. Hopefully others get involved in this thread and we can spread the information. I was amazed during my refresher when the instructors breezed through (basically one sentence) diver emergencies. When they asked if anyone had questions I raised my hand and said what about asking for a diver profile or calling DAN and got the deer in headlights look.

I think as providers we should know about these things. DAN especially. For those wondering what DAN is besides what I mentioned in the OP think of it as calling Medical Control. Pick up the phone, call the DR's and get specific help.

The hand off from diver to higher care is something I hope we discuss and enlighten folks on. Just because they are not(I am generalizing) EMT's they shouldn't be dismissed as not knowing what to do. They should be looked at as an asset and their assessment should be used in the EMT's differential. The EMT might not understand what a Diver Profile is but the diver can communicate what it means. I would like to think of the hand off from the diver to the EMT the same way as an EMT to a Medic.

Hopefully we can, in this thread, communicate some of our knowledge to others and get everyone thinking about this.

Side question: Scubanurse did the girl know she was preggo? I know when my wife became pregnant the first thing off the list was diving. It was funny calling DAN and asking about it, it was right before a big trip we found out, and the Dr's saying their was no clinical studies about it but being diving is a choice why risk it. Needless to say we cancelled the trip, hoping to go at another time, really want to see the Galapagos.

[island emt]

good topic Ugly:

We are on an island surrounded by the atlantic ocean, so we work fairly regularly with 2 agencies that provide dive teams. State police and county sheriff's office both have teams.

Unfortunately they usually are in recovery mode.

We also have a large Scallop &' urchin diving economy that puts divers in the water during the coldest months of the year due to the seasonal limits put on them by marine fisheries.

We have had several training sessions with the team over the years and try to keep current contact info available.

Our nearest hyperbaric chamber is at St Mary''s hospital in Lewiston Maine.

[uglyEMT]

Thanks Island.

Glad to hear you do work with divers on occasion and know where the recompression chamber is. Are you mostly doing it in a standby capacity in case of an emergency during training or are you dispatched along with the PSDs? Got to love cold water junkies Might have to come up your way for some lobster now that I think about it

Another thing I do want to stress to others is you don't just have to be by the ocean for Diver Emergencies. All 50 states have some form of diving spots from quarries to caverns to lakes and rivers. Some may not realize just how close they are to one of these places.

[Just Plain Ruff]

Yes, the best place to start is contacting DAN and asking them what the closest dive recomp chambers are to you. Then you need to set up some sort of transport protocol on how to get those patients to the recomp chamber in the most safe and medically efficient method. Be that by air or by ground.

There is a lot to know but the first call which should always be to DAN for a diving emergency will put into motion most of the correct and prudent steps to treat the patient in the best manner possible.

[Arctickat]

I've been a DAN member since I started diving. Calling DAN for a diving emergency should be as common sense as calling the Poison Control Centre for a poisoning or Medic Alert for someone with an ID bracelet. They are invaluable tools.

[scubanurse]

No, she was 10 weeks along.

Hubby and I are taking a diving trip in November to get out of town and get some dives out before we start trying again for a baby.

[chbare]

I'd also add that special modalities are something to consider as well. For example, people diving a rebreather may experience issues that open circuit divers would not.