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Rescue Diver Manual

Knowledge Review Chapter One

The most common cause of diver emergencies is poor judgment.

Three things to consider before attempting an inwater rescue:

  • Do you need to enter the water at all?
  • Do you have the equipment and training necessary for your safety and the victim's safety?
  • Can you reasonably expect to accomplish the rescue without getting into trouble yourself?

Diver stress is defined as physical or mental tension that results in physical, chemical and/or emotional (psychological) changes in the body.

Seven causes of physical stress include:

  • cold and heat
  • nitrogen narcosis
  • illness or injury
  • discomfort or impaired function caused by ill fitted or malfunctioning equipment
  • seasickness
  • fatigue
  • alcohol or drugs

Perceptual narrowing is the decrease in broad awareness through close focus on a perceived threat or the solution to that threat.

Four advantages of a pocket mask include that it:

  • simplifies getting an effective seal and head positioning
  • reduces worries about disease transmission
  • is an effective way to provide inwater rescue breathing for a non-breathing diver
  • can connect it to emergency oxygen

The two types of emergency oxygen equipment recommended for PADI Rescue Divers are:

  • non-resuscitator demand valve units, which operate much like a scuba regulator
  • continuous flow units, which release oxygen continuously

The six steps for emergency management are:

  1. assess the situation
  2. act on you plan
  3. delegate
  4. attend to injuries
  5. control the scene
  6. arrange evacuation to medical care

Five skills to improve your self-rescue abilities include:

  • good buoyancy control
  • proper airway control
  • cramp removal
  • handling air depletion
  • responding to vertigo

When encountering a problem with diving you should Stop. Breathe. Think. Act.

Signs and behaviors that indicate a diver may have a problem at the surface include:

  • giving distress signals
  • struggling on or just below surface
  • high treading or finning
  • rejecting equipment
  • clinging or clambering
  • not moving, unresponsive

Tired divers have a problem, but are adequately managing stress. Panicked divers have a problem and have become overwhelmed by stress and fear. They pose the most risk because they can overpower you.

Rescuer safety takes priority over distressed diver's because you can't help the victim if you're in trouble.

Four types of rescue to consider before entering water are:

  • reaching and extension assists
  • throwing assists
  • wading assists
  • watercraft assists

Steps to rescue a tired diver:

  • approach
  • evaluate
  • make contact
  • reassure the tired diver
  • assists and transport
  • equipment removal

Steps to rescue a panicked diver:

  • approach and evaluate
  • make contact (take control)
  • reassure and transport

Make contact with panicked diver by using underarm lift or knee cradle position. You may need to use a release or escape to regain control.

Knowledge Review Chapter Four

Critical Incident Stress is an emergency involving a serious injury or death.

Sign and symptoms of critical incident stress include:

  • confusion
  • lowered attention span; restlessness
  • denial
  • guilt or depression
  • anger
  • anxiety
  • unusual behavior
  • changes in interactions with others
  • increased or decreased eating
  • uncharacteristic, excessive humor or silence
  • sleeplessness
  • nightmares

To prevent PTSD, critical incident stress should be treated professional via critical incident stress debriefing.

Decompression illness (DCI) encompasses both lung over-expansion injuries and decompression sickness (DCS).

The most common cause of lung overexpansion injuries is running out of air - divers rush to the surface without exhaling continuously.

You can reduce lung overexpansion injuries by checking air often and encouraging others to do the same.

Arterial gas embolism (AGE) arises when expanding air forces through the alveoli into pulmonary capillaries. This forms bubbles that travel in the blood stream.

Mediastinal emphysema occurs when the expanding air becomes lodged in the chest cavity between the lungs. This constricts the heart and lungs.

Subcutaneous emphysema occurs when expanding air accumulates under the skin around the neck and collar bone.

Pneumothorax, or collapsed lung, can occur when the air from overexpansion forces its way in the the space between the lung and chest wall.

First aid steps for decompression illness:

  • primary assessment
  • document information about dive
  • administer oxygen
  • keep patient lying done
  • maintain lifeline
  • call emergency services

First aids steps for near drowning

  • rescue breathing
  • CPR if no heartbeat
  • be alert for vomiting, especially if breathing resumes
  • keep patient lying down
  • call emergency services

If rescuing an unresponsive, non-breathing diver at surface less than 5 minutes from safety then tow diver there while continuing to provide rescue breaths. Get diver out of water and perform CPR. If more than 5 minutes from safety then give rescue breaths for 1-2 minutes while watching the victim for responses to ventilation. If there is no response then cardiac arrest is likely - get diver out of water and perform CPR.

Give rescue breaths to diver with no apparent heartbeat because one may actually be present. Rescues breaths can correct respiratory arrest before the onset of cardiac arrest.

If you have a pocket mask then:

  • move above victim
  • place mask on face
  • hold mask with thumbs while fingers on bony part of jaw
  • administer two initial breaths
  • secure mask strap
  • listen/feel for breathing
  • give rescues breath every 5 seconds until breathing
  • maintain airway open
  • concurrently tow diver to safety

If you find an unresponsive diver underwater, getting them to the surface takes priority over everything except your personal safety.

  1. Note the diver's position, state of regulator and mask, and any clues about accident.
  2. If regulator is in victim's mouth then hold in place, but don't waste trying to put it back if it is not
  3. Hold the victim from behind to hold regulator (if necessary) and hold head in place
  4. Use your own BCD to ascend. You may need to release air from victim's BCD.
  5. Keep victim's head in normal position
  6. As you ascent thing about steps you're take at surface
  7. Drop the victim's weights

When rescuing an unresponsive diver, equipment removal is a low priority. Remove gear if doing so more than offsets the time required to remove it. Removal technique considerations:

  1. Think buoyancy
  2. Do things in logical order, keeping one hand on airway to ensure it stays open.
  3. Keep a rhythm. Do things between rescue breaths.
  4. Keep moving. Towing to safety should be continuous.

Knowledge Review Chapter Five

You should write up a report after a dive accident that requires first aid and summoning emergency medical care or other emergency personnel. You should avoid guessing or speculation when doing a report or answering questions.

Administrating oxygen to a diver suspect of decompression illness is crucial because they may not respond to it, but it does no harm.

Six procedures to follow when handling oxygen are:

  1. keep unit clean and protected
  2. never lubricate equipment
  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
  6. always extinguish source of flame

The procedure for administrating oxygen to a breathing diver:

  • open kit
  • slowly turn open valve
  • secure tank
  • "this is oxygen"
  • place mask on face
  • if unresponsive use non-resuscitator demand valve unit
  • monitor oxygen pressure gauge

The procedure for administrating oxygen to a weakly breathing diver:

  • open kit and attach nonrebreather
  • slowly turn open valve to 15 liters/minute
  • hold thumb over the inlet inside mask and allow reservoir bag to inflate
  • "this is oxygen"
  • place mask on face
  • if bag collapses increase flow to 25 liters/minute
  • monitor oxygen pressure gauge

The procedure for administrating oxygen to a nonbreathing diver:

  • have someone open kit while you administer rescue breaths
  • slowly turn open valve to 15 liters/minute
  • give rescue breaths
  • if starts breathing switch to demand or nonrebreather

After beginning primary care, secondary care, oxygen and other first aid while waiting for emergency medical care to arrive:

  • maintain lifeline
  • Protect victim from shock
  • control bystanders
  • keep victim lying down
  • administer oxygen
  • collect information about diver and incident

You should collect information to send with injured diver upon arrival of emergency medical services:

  • name and contact
  • significant medical history
  • first aid procedures
  • dive profile information
  • comments relative to emergency care received
  • contact information for local diver emergency system and name

Perform the lifeguard exit

  • place injured diver's hands on deck
  • push yourself out of water keeping one hand on victim's hands
  • stand and hold diver by wrists, lift waist to dock level, then lower face down on deck
  • roll victim over

Circumstances may affect exiting with an unresponsive diver.

  • Remember maintaining rescue breaths take priority.
  • exit through surf: Protect diver's airway from crashing waves
  • over rocks: let 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 technique