1. Knowledge Development Five
Question 1
Question 6
Question 2
Question 7
Rescue - Knowledge Review Five
Question 3
Question 8
Question 4
Question 9
Question 5
Question 10
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2. Knowledge Review Five – Question 1
When should you write up a report after a dive accident? What should you avoid doing on a report or when answering questions?
Following an accident that requires first aid and summoning emergency medical care of other emergency personnel.
Do not guess or speculate or offer opinions.
Rescue - Knowledge Review Five
1. Postaccident Reports
When should you write up a report?
a. Following an accident that requires first aid and summoning emergency medical care or other emergency personnel, you may be asked by authorities to file an accident report.
b. By providing as much factual information as possible, an accident report can help investigators determine how to prevent or better respond to similar accidents in the future.
c. Be aware that accident reports are legal documents that could be used in litigation as well as an investigation.
What should you avoid doing on a report or when answering questions?
f. When answering questions or making statements on a report, avoid speculation and guesses. Stick with facts – what you personally witnessed. If you didn’t witness what caused an accident, for example, don’t give your opinion about what caused it.
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3. Knowledge Review Five – Question 2
Explain why administering oxygen to a diver suspected of having decompression illness is crucial.
Research indicates that emergency oxygen provides significant benefit in many (but not all) cases of decompression illness.
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B. Being Prepared for a Diver Emergency
1. Use of Emergency Oxygen
Why is administering emergency oxygen to a diver with suspected of having decompression illness crucial?
a. Administering oxygen for suspected decompression illness is the dive community standard of care.
1. Experience with administering emergency oxygen shows that it provides significant benefit in many (but not all) cases of decompression illness.
2. Medical case histories show that prompt oxygen first aid can improve the effectiveness of recompression treatment and improves the overall probability of complete recovery.
3. However, not all types of decompression illness respond well to oxygen, and there are no guarantees. It’s important to provide oxygen in an emergency, but it’s not a magic potion that instantly cures divers.
4. Recall that you also give emergency oxygen to a near drowning patient.
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4. Knowledge Review Five – Question 3
List six procedures to follow when handling oxygen.
1. Keep unit clean and protected in its box until needed.
2. Never attempt to lubricate oxygen equipment or use standard scuba parts in it.
3. Always open valves on oxygen equipment slowly.
4. Keep your unit assembled to minimize the possibility of contaminates getting into it and to save time in an emergency.
5. Never attempt to clean or service the equipment yourself. Have it serviced regularly as required by the manufacturer.
6. Always extinguish any source of flame before deploying oxygen.
Rescue - Knowledge Review Five
What are six procedures to follow when handling oxygen?
b. Although nonresuscitator demand valve oxygen equipment shares characteristics with scuba equipment, it has handling considerations that differ from your dive gear.
c. This is because pure oxygen can make normally nonflammable materials combustible or even explosive.
d. With proper handling, oxygen systems are safe to have around, provided you keep these points in mind:
1. Keep your unit clean and protected in its box until needed.
Particularly avoid putting the system in contact with greases, oils or even silicone grease.
2. Never attempt to lubricate oxygen equipment or use standard scuba parts in it. Pure oxygen requires that only special lubricants and materials come in contact with the system.
3. Always open valves on oxygen equipment slowly, so as to pressurize the unit slowly. Rapid pressurization creates heat, which can spark a fire if any flammable materials have contaminated the equipment.
4. Keep your unit assembled to minimize the possibility of contaminants getting into it, as well as to save time in an emergency. Wash your hands if possible before handling your equipment; in an emergency, at least try to wipe off any oils or grease (including suntan lotions and oils).
5. Never attempt to clean or service the equipment yourself. Oxygen servicing requires special cleaners and procedures. If your equipment gets wet or contaminated in any way, it needs professional servicing by someone specifically trained to work on medical oxygen systems. Have it serviced regularly as required by the manufacturer, just as you would scuba equipment.
6. Always extinguish any source of flame (such as cigarettes) before deploying oxygen. Use the equipment as far away as possible from engines, gasoline or anything combustible, preferably in a ventilated area.
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5. Knowledge Review Five – Question 4
Describe the procedures for administering oxygen to a breathing diver.
Slowly open the valve and test the unit by inhaling from the mask.
Say to the injured diver, “This is oxygen. It will help you. May I give it to you?”
Assuming agreement, place the mask on the diver's face and instruct the person to breathe normally.
Monitor the oxygen pressure gauge and do not let it run empty with the mask still on the diver.
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How do you administer oxygen to a breathing injured diver and to a nonbreathing injured diver?
e. Give a breathing injured diver 100 percent oxygen supplied by a nonresuscitator demand valve unit. Follow these steps:
1. Open the oxygen kit. The kit should be set up in advance according to manufacturer’s instructions.
2. Slowly turn open the valve and then test the unit by inhaling from the mask. Do not exhale into the mask.
3. Secure the tank and protect it from being knocked over or rolling loose. The best place for it is cradled in its box.
4. Say to the injured diver, “This is oxygen. It will help you. May I give it to you?”
5. Assuming agreement, place the mask on the diver’s face and instruct the person to breath normally. A responsive diver can hold the mask in place. This makes the patient feel more in control and frees you to do other things.
6. If the diver is unresponsive and breathing, assume that the diver would want oxygen, and supply it (called implied consent) with the nonresuscitator demand valve unit.
7. Monitor the oxygen pressure gauge. Don’t let the unit run empty with the mask still on the diver.
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6. Knowledge Review Five – Question 5
Describe the procedure for administering oxygen to a weakly breathing diver.
Slowly open the valve and set the continuous flow rate to 15 litres per minute.
Using a nonrebreather mask, hold your thumb over the inlet inside the mask and allow the reservoir bag to inflate.
Say to the injured diver, “This is oxygen. It will help you. May I give it to you?”
Assuming agreement, place the mask on the diver's face and instruct the person to breathe normally.
Use the head strap to secure the mask.
If the reservoir bag collapses completely when the diver inhales, increase the flow rate to 25 litres per minute.
Monitor the oxygen pressure gauge and do not let it run empty with the mask still on the diver.
Rescue - Knowledge Review Five
f. If the injured diver is breathing very weakly, use the continuous flow outlet and setting with a nonrebreather mask. Follow these steps:
1. Open the kit and attach the tube from the nonrebreather mask to the continuous flow outlet on the regulator (if this is not done in advance).
2. Slowly turn open the valve and set the continuous flow rate to 15 litres per minute.
3. Using a nonrebreather mask, hold your thumb over the inlet inside the mask and allow the reservoir bag to inflate
4. Say to the injured diver, “This is oxygen. It will help you. May I give it to you?”
5. Assuming agreement, place the mask on the diver’s face and instruct the person to breath normally. Use the head strap and be sure the mask fits snugly. You may assume implied consent with an unresponsive diver.
6. If the reservoir bag collapses completely when the diver inhales, increase the flow rate to 25 litres per minute.
7. Monitor the oxygen pressure gauge. Don’t let the unit run empty with the mask still on the diver.
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7. Knowledge Review Five – Question 6
Describe the procedure for administering oxygen to a nonbreathing diver.
Slowly open the valve and set the continuous flow rate to 15 litres per minute.
Give rescue breaths through the pocket mask.
If diver begins to breathe, switch to the demand or nonrebreather masks.
Rescue - Knowledge Review Five
g. If you have an unresponsive nonbreathing diver, you’ll use a pocket mask with oxygen inlet valve and continuous flow oxygen.
1. Have someone open the kit while you continue rescue breaths and attach the oxygen tube from the continuous flow outlet to the pocket mask (if not already done). Don’t let this interfere with rescue breathing or CPR procedures.
2. Slowly turn open the valve and set the flow rate at 15 litres per minute.
3. Give rescue breaths through the pocket mask as usual. Each rescue breath will carry in extra oxygen from the continuous flow.
4. If the diver begins to breathe, switch to the demand or nonrebreather masks as above.
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8. Knowledge Review Five – Question 7
Describe what to do for a diver after beginning primary care, secondary care, oxygen and other first aid while waiting for emergency medical care to arrive.
The priority is to continue to monitor the patient’s lifeline and the ABCD’S.
Protect the patient from excess heat or cold (shock management).
Control bystanders to keep the area open for arriving emergency medical personnel.
Keep a responsive patient comfortable, but lying down.
Try to collect information regarding the accident and write it down to send with the injured diver.
Rescue - Knowledge Review Five
C. Accident Management
1. Managing the Scene Until Help Arrives
After beginning primary care, secondary care, oxygen and other first aid as needed for a patient, what do you do for the diver while waiting for emergency care to arrive?
a. In any diver emergency requiring first aid and summoning emergency medical care, maintain a vigilant watch over the primary ABCD’S.
1. An injured diver’s conditions can easily change from breathing to nonbreathing and from responsive to unresponsive.
2. Protect the diver from excess heat or cold.
3. Control bystanders to keep the area open and unconfused for emergency medical personnel.
4. Pressure-related injuries usually require recompression in a hyperbaric chamber. Maintain contact with your local diver emergency service.
5. Keep the diver as comfortable as possible, but lying down.
6. Provide oxygen until you get the diver to emergency care.
• If you find yourself in a situation where you won’t have enough oxygen, give the highest concentration possible for as long as it lasts. This benefits the diver with a pressure-related injury more than trying to extend the oxygen by reducing the flow rate or switching it on and off.
• If the oxygen runs out, but there’s enriched air nitrox available at the site, a responsive diver can breathe it from a scuba regulator. This isn’t as beneficial as pure oxygen, but may offer more benefit than breathing air.
7. Remember, do not attempt to recompress someone in the water.
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9. Knowledge Review Five – Question 8
What information should you collect to send with the injured diver upon the arrival of emergency medical services?
Diver’s name and contact information.
Significant medical history.
First aid procedures initiated.
Dive profile information.
Comments relative to emergency care received.
Contact information for local diver emergency system and name of doctor or personnel you’ve spoken with.
Rescue - Knowledge Review Five
What information should you collect to send with the injured diver upon the arrival of emergency medical services?
b. Information that should be collected and written down to be sent with the injured diver (use the PADI Accident Management Slate) includes:
1. Diver’s name and contact information
2. Significant medical history
3. First aid procedures initiated
4. Dive profile information
5. Comments relative to emergency care received
6. Contact information for local diver emergency system and name of doctor or personnel you’ve spoken with.
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10. Knowledge Review Five – Question 9
Describe how to perform the lifeguard exit.
Rescuer places injured diver’s hands on the deck.
The rescuer gets out of the water keeping one hand on the victim’s hands so the victim doesn’t slide back into the water.
Holding the diver by the wrists and standing, the rescuer lifts the victim’s waist to dock level, then lowers the diver face down on the deck.
From there, the rescuer rolls the victim over, and may drag the person the rest of the way from the water.
Rescue - Knowledge Review Five
5. Lifeguard exit – place the injured diver’s hands on the deck. Lift yourself from the water with one hand on the victim’s hands so the victim doesn’t slide back in. Hold the diver by the wrists and stand, bring victim’s waist to dock level. Lower the diver face down on the deck, then roll the victim over. Drag the rest of the way from the water if necessary.
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11. Knowledge Review Five – Question 10
Explain how circumstances may affect exiting with an unresponsive diver.
Shore exits: give two full breaths then carry or drag the victim ashore.
Exit through surf: protect the victim’s airway.
Over rocks: let the water carry you and the victim up the rocks in stages.
Swim steps, low docks, and small boats: use lifeguard exit.
Tall dock or boat pier: use the roll up technique.
Rescue - Knowledge Review Five
How can circumstances affect your exit with an unresponsive diver?
b. Environmental conditions and other circumstances will affect which technique to use when exiting the water. Here are a few suggestions:
For shore exits without help, give two slow breaths and then carry the diver ashore using the saddleback carry, fireman’s carry or the packstrap carry. If the diver is too heavy to carry, simply drag the victim ashore by the two wrists. Resume rescue breathing with two slow breaths within 30 seconds.
2. When you exit through surf, do your best to protect the victim’s airway from crashing waves (a pocket mask is the easiest way). If you have trouble standing, crawl out with the diver rather than walk.
3. Exits over rock can be difficult. Proceed cautiously and allow the water to carry you and the injured diver up the rocks in stages. Brace yourself for the next wave. Avoid exits with rock if at all possible; a longer swim to an easier exit may prove the fastest way to get the victim out of the water.
4. If you expect help shortly, consider staying in the water, maintaining the airway and/or giving rescue breaths until help arrives. This may be more effective than attempting a difficult exit alone.
5. Exits onto swim steps, low docks and small, stable boats may be easiest using the lifeguard exit. For a tall dock, boat or pier, you might be able to use the roll up technique with a tarp, net, rope or even several lengths of fire hose.
6. A second rescuer can help with any portion of the rescue, but especially the exit. One rescuer can continue rescue breathing while another goes ahead and prepares exit equipment, or the strength of two people may be applied to lift a victim ashore. Always ask for help if it’s available.
7. The priorities are maintaining rescue breathing and contacting emergency medical care (if you’ve not been able to do so already). In some situations, it may be impossible to exit the water without interrupting rescue breaths more than 30 seconds (for example, you’re alone and have to carry the victim up a tall ladder). In this case, do the best you can and resume rescue breathing/start CPR as soon as possible. The victim has a better chance out of the water than in it.
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12. Knowledge Review Five – Question 1
Avoid speculation and guesses.
Stick to the facts – what you personally witnessed.
Refer media questions to the proper authorities.
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13. Knowledge Review Five – Question 2
Administering oxygen for suspected decompression illness is the dive community standard of care.
Medical case histories show that prompt oxygen first aid can improve the effectiveness of recompression treatment.
Rescue - Knowledge Review Five
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14. Knowledge Review Five – Question 3
Keep your emergency oxygen system professionally serviced as required by the manufacturer.
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15. Knowledge Review Five – Question 4
Give a breathing injured diver 100 percent oxygen supplied by a nonresuscitator demand valve unit.
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16. Knowledge Review Five – Question 5
If the diver is breathing very weakly, use the continuous flow outlet and setting with a nonrebreather mask.
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17. Knowledge Review Five – Question 6
If you have an unresponsive nonbreathing diver, you’ll use a pocket mask with oxygen inlet valve and continuous flow oxygen.
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18. Knowledge Review Five – Question 7
Maintain a vigilant watch over the primary ABCD’S.
An injured diver’s condition can change from breathing to nonbreathing and from responsive to unresponsive quickly.
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19. Knowledge Review Five – Question 8
Use the PADI Accident Management Workslate to collect valuable information for EMS.
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20. Knowledge Review Five – Question 9
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21. Knowledge Review Five – Question 10
Exit
Circumstances to consider
Exits over rock (avoid if at all possible).
Proceed cautiously and allow the water to carry you and the injured diver up the rocks in stages.
Expecting help.
Consider staying in the water, maintaining the airway and/or giving rescue breaths until help arrives.
Exits onto swim steps.
Swim steps, low docks and small, stable boats may be easiest using the lifeguard exit.
A second rescuer available.
One rescuer can continue rescue breathing while the other goes ahead and prepares exit equipment.
Interrupting rescue breaths.
The priorities are maintaining rescue breathing and contacting emergency medical care.
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