1. Diver First Responder (DFR) Module C: Diving Emergencies 2 Non-Pressure Related Emergencies

2. DFR Course ModuleTitleContent APHECC CFR CourseBasic Life Support & AED BDiving Emergencies 1Barotrauma CDiving Emergencies 2Non-Pressure Related Emergencies DDiving Emergencies 3Emergency Care EOxygen TreatmentTheory and Practice 2 DFR JAN 2011: MODULE C: EMERG 2

3. In Module C: we will Cover Non-Pressure Related Emergencies Dive Site Accident Management Gas toxicity Near drowning Minor barotrauma Good diving practise 3 DFR JAN 2011: MODULE C: EMERG 2

4. Common Terminology TermDefinition IndicationUses for a medication / drug Contra-indicationCircumstances where a medication should not be given Medical EmergencyAcute injury or illness that poses an immediate risk to a person's life or long term health SymptomWhat the patient experiences SignWhat the care-giver sees 4 DFR JAN 2011: MODULE C: EMERG 2

5. Dive Site Accident Management DFR JAN 2011: MODULE C: EMERG 2

6. Dive Site Accident Management Be aware of all symptoms An unwell diver should exit the water Presume illness is dive-related Have 02 and emergency kit to hand Alert Emergency Medical Services (EMS) (Dial 999 or 112) 6 DFR JAN 2011: MODULE C: EMERG 2

7. Treatment of the Injured or Ill Diver Get diver back on boat or ashore If altered consciousness on surfacing, ensure jacket inflated & weights removed Loosen tight clothing History / examination – Symptoms / signs What is the key problem /condition …? Monitor A-B-C / Administer 100% oxygen Alert EMS 7 DFR JAN 2011: MODULE C: EMERG 2

8. Role of Cox’n in an Emergency Ensure VHF radio is working Ensure EMS is alerted Know your exact position Follow instructions of EMS Ensure a record is kept 8 DFR JAN 2011: MODULE C: EMERG 2

9. Gas Toxicity Oxygen (0 2 ) Nitrogen (N 2 ) Carbon Dioxide (C0 2 ) Carbon Monoxide (CO) DFR JAN 2011: MODULE C: EMERG 2

10. Oxygen (0 2 ) Toxicity (hyperoxia) 10 DFR JAN 2011: MODULE C: EMERG 2 Oxygen at partial pressure >1.6 bar is toxic Oxygen at partial pressure >1.6 bar is toxic Poisonous to various body tissues - especially the brain and nervous tissues Poisonous to various body tissues - especially the brain and nervous tissues First Aid O 2 delivered at 1 bar is safe First Aid O 2 delivered at 1 bar is safe

11. Oxygen (0 2 ) Toxicity (hyperoxia) 11 CONVENTID) SYMPTOMS (CONVENTID) CONConvulsions VVisual disturbances/Tunnel vision EEars ringing (Tinnitus) NNausea TTingling or twitching (facial) IIrritability DDizziness or vertigo SIGNS (TWO PHASES) Tonic phase: the muscles “tone” or stiffen Tonic phase: the muscles “tone” or stiffen Clonic phase: the muscles start to jerk Clonic phase: the muscles start to jerk CONVENTID) SYMPTOMS (CONVENTID) CONConvulsions VVisual disturbances/Tunnel vision EEars ringing (Tinnitus) NNausea TTingling or twitching (facial) IIrritability DDizziness or vertigo SIGNS (TWO PHASES) Tonic phase: the muscles “tone” or stiffen Tonic phase: the muscles “tone” or stiffen Clonic phase: the muscles start to jerk Clonic phase: the muscles start to jerk DFR JAN 2011: MODULE C: EMERG 2

12. Oxygen (0 2 ) Toxicity (hyperoxia) 12 Treatment Underwater Provide breathing gas with correct PpO 2 Bring to the surface Attempt lift after ‘Tonic’ phase has passed Treatment On Surface Monitor ABC / Administer 100% oxygen Alert Emergency Medical Services (EMS) Treatment Underwater Provide breathing gas with correct PpO 2 Bring to the surface Attempt lift after ‘Tonic’ phase has passed Treatment On Surface Monitor ABC / Administer 100% oxygen Alert Emergency Medical Services (EMS) DFR JAN 2011: MODULE C: EMERG 2

13. Nitrogen (N 2 ) Narcosis 13 Increased ppN 2 causes a form of ‘narcosis’ or intoxication Symptoms Elation / false sense of well-being / sight and sound altered Feeling of unease, panic/fear Signs Unusual behaviour / Loss of judgement and dexterity Panic / stupor and/or unconsciousness Diver’s subsequent actions may lead to injury or drowning Treatment Ascend to a shallower depth – or to the surface if necessary Increased ppN 2 causes a form of ‘narcosis’ or intoxication Symptoms Elation / false sense of well-being / sight and sound altered Feeling of unease, panic/fear Signs Unusual behaviour / Loss of judgement and dexterity Panic / stupor and/or unconsciousness Diver’s subsequent actions may lead to injury or drowning Treatment Ascend to a shallower depth – or to the surface if necessary DFR JAN 2011: MODULE C: EMERG 2

14. Carbon Monoxide (CO) Toxicity 14 Colourless, tasteless, odourless, non-irritating gas Colourless, tasteless, odourless, non-irritating gas Produced when carbon is incompletely burned; fuels such as wood, petrol or diesel Produced when carbon is incompletely burned; fuels such as wood, petrol or diesel Enters through lungs; delivered to blood Enters through lungs; delivered to blood Red blood cells pick up CO instead of oxygen Red blood cells pick up CO instead of oxygen Haemoglobin attracts CO 250 times more than oxygen Haemoglobin attracts CO 250 times more than oxygen CO inhibits blood oxygenation and distribution to organs CO inhibits blood oxygenation and distribution to organs Colourless, tasteless, odourless, non-irritating gas Colourless, tasteless, odourless, non-irritating gas Produced when carbon is incompletely burned; fuels such as wood, petrol or diesel Produced when carbon is incompletely burned; fuels such as wood, petrol or diesel Enters through lungs; delivered to blood Enters through lungs; delivered to blood Red blood cells pick up CO instead of oxygen Red blood cells pick up CO instead of oxygen Haemoglobin attracts CO 250 times more than oxygen Haemoglobin attracts CO 250 times more than oxygen CO inhibits blood oxygenation and distribution to organs CO inhibits blood oxygenation and distribution to organs DFR JAN 2011: MODULE C: EMERG 2

15. Carbon Monoxide (CO) Toxicity 15 SYMPTOMS Breathlessness on exertion/ Fatigue, nausea headaches Vertigo / noises in the ears ‘Pins and needles’ / confusion and disorientationSIGNS Loss of consciousness without warning / red lips Respiratory arrest SYMPTOMS Breathlessness on exertion/ Fatigue, nausea headaches Vertigo / noises in the ears ‘Pins and needles’ / confusion and disorientationSIGNS Loss of consciousness without warning / red lips Respiratory arrest DFR JAN 2011: MODULE C: EMERG 2

16. Carbon Monoxide (CO) Toxicity 16 DFR JAN 2011: MODULE C: EMERG 2 TREATMENT Monitor ABC’s / 100% Oxygen / Contact EMS if necessary Monitor ABC’s / 100% Oxygen / Contact EMS if necessary Monitor all divers who used same air source Monitor all divers who used same air source Retain cylinder for inspection Retain cylinder for inspection Medical assessment and hyperbaric oxygen Medical assessment and hyperbaric oxygen

17. Carbon Dioxide Poisoning (Hypercapnia) re-inhalation of C0 2 17 CO 2 is a natural by-product of metabolism High concentrations of CO 2 can displace oxygen in the air Hypoxia may be combined with CO 2 toxicity Hypercapnia may exacerbate conditions: narcosis, Hypothermia, DCI SYMPTOMS Headache / confusion / disorientation / lethargy SIGNS Panic / hyperventilation / convulsions / unconsciousness TREATMENT Remove from source, i.e. surface / abort dive Monitor ABC’s / Administer 100% oxygen / alert EMS0 CO 2 is a natural by-product of metabolism High concentrations of CO 2 can displace oxygen in the air Hypoxia may be combined with CO 2 toxicity Hypercapnia may exacerbate conditions: narcosis, Hypothermia, DCI SYMPTOMS Headache / confusion / disorientation / lethargy SIGNS Panic / hyperventilation / convulsions / unconsciousness TREATMENT Remove from source, i.e. surface / abort dive Monitor ABC’s / Administer 100% oxygen / alert EMS0 DFR JAN 2011: MODULE C: EMERG 2

18. 18 DFR JAN 2011: MODULE C: EMERG 2

19. Near Drowning DFR JAN 2011: MODULE C: EMERG 2

20. Near Drowning 20 Near drowning........... the survival of a drowning event involving unconsciousness or water inhalation........... can lead to serious secondary complications, including death, after the event...... There may be deterioration later – important to closely monitor patient closely following event Near drowning........... the survival of a drowning event involving unconsciousness or water inhalation........... can lead to serious secondary complications, including death, after the event...... There may be deterioration later – important to closely monitor patient closely following event DFR JAN 2011: MODULE C: EMERG 2

21. Near Drowning 21 SYMPTOMS Respiratory distress: cough, wheeze, shortness of breath SIGNS Altered consciousness / Cyanosis: Grey/blue skin Froth around lips and nose Respiratory arrest Nothing initially… TRETATMENT Remove from water, discontinue activity, check for other injuries, keep warm Monitor ABC’s / 100% oxygen / Alert EMS Hospital for observation - ‘secondary drowning’ SYMPTOMS Respiratory distress: cough, wheeze, shortness of breath SIGNS Altered consciousness / Cyanosis: Grey/blue skin Froth around lips and nose Respiratory arrest Nothing initially… TRETATMENT Remove from water, discontinue activity, check for other injuries, keep warm Monitor ABC’s / 100% oxygen / Alert EMS Hospital for observation - ‘secondary drowning’ DFR JAN 2011: MODULE C: EMERG 2

22. 22 Oxygen Therapy DFR JAN 2011: MODULE C: EMERG 2 This slide for info only: PHECC Clinical Practice Guidelines [CPG] SUBMERSION INCIDENT (DCI) For use by trained: EMT PARAMEDIC ADVANCED PARAMEDIC This slide for info only: PHECC Clinical Practice Guidelines [CPG] SUBMERSION INCIDENT (DCI) For use by trained: EMT PARAMEDIC ADVANCED PARAMEDIC

23. Other Pressure Related Illness DENTAL BAROTRAUMADENTAL BAROTRAUMA –Loose fillings, badly fitting crown – pain on ascent / descent –Regular dental visits / check-ups EAR PROBLEMSEAR PROBLEMS –Caused by mucus build-up, cold, perforation in ear drum –Don’t dive if you have a cold/infection –Visit GP if problems persist 23 DFR JAN 2011: MODULE C: EMERG 2

24. Prevention - Good Diving Practise DOD: dive planning Location/profile planned Maintain dive log Fly ‘A’ Diving Flag during dive Brief all re emergency procedures Monitor divers location throughout dive 24 DFR JAN 2011: MODULE C: EMERG 2

25. Safety at Sea Plan your dive – dive your plan Tides / charts / weather Contingency and emergency plans First aid and oxygen kits SMB’s / hi-visibility clothing / flares / lights Whistles / sound generators In an Emergency: Channel 16: Tel 999 or 112 25 DFR JAN 2011: MODULE C: EMERG 2

26. Module C: Diving Emergencies 2 Non-Pressure Related Emergencies Has covered – –Dive accident site management – –Gas toxicity – –Near drowning – –Minor barotrauma – –Prevention - good diving practise 26 DFR JAN 2011: MODULE C: EMERG 2

27. 27 DFR JAN 2011: MODULE C: EMERG 2