Rescue Diver - Chapter Three

Question 1

What is an emergency action plan and what five areas of information may it include?

Answer 1

The information you will need, at a particular dive site, in the event of a dive accident.

1. the sequence of steps to follow hat may be affected by the local environment
2. a list of emergency phone numbers
3. a script for what to say when calling emergency services
4. the procedures for responding to, moving and transporting an injured diver out of the area to within reach of emergency medical care
5. procedures for completing any required accident and incident reports

Question 2

What are the three benefits of practicing emergency procedures regularly based on your emergency action plan?

Answer 2

1. It refines your response skills
2. It makes a real emergency less stressful
3. After practicing, you can evaluate your performance and refine the plan

Question 3

What is meant by ‘Basic Life Support’ and what types of dive accidents can require BLS?

Answer 3

BLS includes monitoring and enacting emergency procedures for patient respiratory and/or cardiovascular system failure.

Dive accidents involving drowning, decompression sickness and lung overexpansion injuries may require BLS, as well as heat stroke, hypothermia and overexertion.

Question 4

How does time affect Basic Life Support?

Answer 4

Respiratory and/or cardiac arrest cuts off oxygen to the body. Without oxygen, brain damage can occur in four to six minutes.

Question 5

What are the recommended steps, in order of priority, for conducting a primary assessment?

Answer 5

1. Assess the situation
2. Establish responsiveness
3. Upon discovering unresponsiveness or other serious medical emergency, call for help as soon as possible
4. Establish an airway if the diver is unresponsive
5. Check for breathing
6. Check for circulation (heartbeat)
7. Check for bleeding

Question 6

How do diving circumstances affect primary assessment?

Answer 6

1. Water can conceal potential dangers when assessing the situation
2. You may not be able to contact help as quickly from the water
3. Establishing an airway and checking for breathing requires special techniques in the water
4. CPR is only possible when the victim is out of the water, and it’s too difficult to determine if the victim has a heartbeat in the water, so the protocol is that you don’t waste time trying
5. If the victim is bleeding, it may be difficult to apply pressure through an exposure suit, and the body’s clotting mechanism may be slowed by water

Question 7

What are the nine signs and symptoms of shock?

Answer 7

1. Rapid, weak pulse
2. Pale or bluish tissue colour
3. Moist, clammy skin, possibly with shivering
4. Mental confusion, anxiety, restlessness or irrability
5. Altered consciousness
6. Nausea and perhaps vomiting
7. Thirst
8. Lackluster eyes, dazed look
9. Shallow but rapid, laboured breathing

Question 8

How may shock occur in a dive accident?

Answer 8

Anything that causes a serious wound or trauma can cause shock, for example decompression sickness, lung overexpansion injuries, aquatic life injuries, heat stroke or exhaustion, hypothermia and near drowning.

Question 9

What is the procedure for treating shock, and how may diving circumstances affect it?

Answer 9

• Primary assessment, AB-CABS
• Maintain the patient’s body temperature, removing their exposure suit and protecting them from heat if necessary (stay in the shade)
• Keep the patient lying down
• Generally avoid giving the patient anything to eat or drink, except possibly water in order to maintain hydration

Question 10

What are the procedures for conducting a secondary assessment of a responsive ill or injured patient?

Answer 10

• Examine the diver as learned in EFR training, checking for sensitive areas, looking for deformities, fluid, swelling or reaction to pain
• Don’t remove an exposure suit if spinal injury is suspected, unless overheating is likely, in which case carefully cut off the exposure suit while keeping the patient immobile
• Begin first aid for any injuries

Question 11

What is heat exhaustion and how do you treat it?

Answer 11

Heat exhaustion when the body’s ability to cool becomes taxed. Signs and symptoms include:

• Profuse sweating
• Nausea
• Dizziness
• Weakness
• Faintness

Move the patient to a cool, shaded area, remove the exposure suit and have them drink water. If symptoms don’t subside in approximately 30 minutes, contact EMS.

Question 12

What is heat stroke and how do you treat it?

Answer 12

Heat stroke is a life threatening condition when the body’s cooling mechanisms fail, and the core temperature begins to rise. This can destroy tissue and cause permanent disability. Signs include:

• hot, dry flushed skin
• no perspiration

Begin with primary assessment, move the patient into a cool area, remove the exposure suit, and immerse the patient in cold water or apply cool wet towels. Contact EMS while monitoring the patient’s lifeline.

Question 13

What are the seven signs and symptoms of hypothermia?

Answer 13

1. Shivering (in severe cases, body systems fail and shivering stops)
2. Numbness
3. Blueness in fingers, lips and toes (may be difficult to see underwater)
4. Loss of coordination
5. Weakness
6. Confusion
7. Loss of consciousness

Question 14

What are the proper procedures for rewarming a patient with hypothermia?

Answer 14

• Begin with primary assessment
• Keep the patient lying down and not exercising
• Take an alert patient with mild hypothermia to warmth, remove the exposure suit and dry the patient, rewarming by covering the head and applying heat to the neck, armpits and groin
• For severe hypothermia, contact EMS and protect the patient from further cooling, but leave rewarming to EMS because doing so is medically complicated

Question 15

What signs indicate a diver may have a problem underwater?

Answer 15

• Rapid breathing
• Awkward kicking
• Other signs indicating exhuastion and tiring
• Wide eyes
• Rapid breathing
• Maintaining a vertical posture
• Jerky movements
• Using arms to swim
• Sinking while swimming upward
• Rejecting the mask and regulator and bolting for the surface

Question 16

What do you do to help a diver with overexertion underwater?

Answer 16

• Have the diver stop everything and rest
• Make contact and have them hold on to something stationary, but make sure there’s nothing that could sting or cut the diver on the object
• Encourage the diver to relax and breathe normally by signalling or writing on your slate
• Keep watching them after they recovering to avoid accidental overexertion again

Question 17

What do you do to help a diver with an uncontrolled descent?

Answer 17

• Signal the diver to add air to the ABD and level off
• Make contact with the diver to arrest the descent
• Use caution and avoid descending below safe depths when swimming after the diver
• Grasp the diver’s BCD or tank valve and add air to the BCD
• If their BCD doesn’t work, use your own but keep in mind that you will be excessively buoyant if you let go
• Drop the weights only if necessary as this may cause excessive buoyancy
• Watch for overexertion

Question 18

What do you do to help a diver with excessive buoyancy?

Answer 18

• Escort an underweighted diver to the surface and get the right amount of weight
• Get them to carry rocks
• With a diver having a runaway ascent, make contact, use the quick dump on the diver’s BCD if possible and dump your own BCD
• If the diver’s inflator is stuck, disconnect the low pressure hose
• If you can’t stop the ascent, let go and signal the victim to flare arms and legs to create drag
• Ascend at a normal, safe rate and check the victim hasn’t been injured

Question 19

What do you do to help a diver with cramps underwater?

Answer 19

• Point to the muscle you suspect has cramps and confirm with the ‘cramp’ signal (rapidly clenching your fist)
• Relieve the cramp, encourage a slower pace and stay close just in case

Question 20

What do you do to help a diver with entanglement?

Answer 20

• Have the victim hold still; signal ‘stop’
• Reassure the diver as you disentangle them
• If you must cut the diver free, use caution
• A smaller, sharp dive knife may be more effective than a large, heavy duty dive knife

Question 21

What do you do to help a diver with entrapment?

Answer 21

• Ensure adequate air supply while working to free the diver
• If you believe you won’t be able to free the victim before you run out of air, ascend and get more
• Mark the site in any way possible so you can return easily with additional tanks
• You may consider leaving your scuba unit with the victim and making an assisted or emergency ascent
• Seek qualified help and do not attempt to rescue a diver from an overhead environment if you aren’t properly trained or don’t have the right equipment

Question 22

What do you do to help a diver with passive panic?

Answer 22

• Approach from the front and signal ‘Okay?’
• If you get no response, go behind the diver and, holding the regulator in place, take the diver to the surface
• It is important to help from behind in case they change to active panic
• Once at the surface, establish buoyancy for the victim and yourself, and help them out of the water

Question 23

What do you do to help a diver with active panic?

Answer 23

• Grab their foot or leg to prevent an uncontrolled ascent
• Hang on and flare out to control the ascent rate
• If the victim is breath holding, delay is your best bet to get them to resume breathing before ascending too far
• If the victim has dropped the regulator, slow the ascent and provide your alternate air source
• You may have to force the mouthpiece into the mouth while depressing the purge button lightly
• Once at the surface, establish positive buoyancy and exercise control

Question 24

Why is time critical in a missing diver situation?

Answer 24

If the victim isn’t breathing, permanent brain damage is likely after six minutes.

Question 25

What steps should you take if you discover that a diver is missing?

Answer 25

1. Call for emergency help and find out where anyone last saw the missing diver
2. Assign spotters to look in that area for bubbles and direct rescuers to the area
3. Try to determine if the diver may have left without telling anyone by looking for their belongings
4. Assign qualified divers to don scuba equipment and begin an underwater search
5. If available, send two or more skin divers to mark the search area with buoys, but don’t waste time with this step if it won’t make the rescue more efficient

Question 26

What four search patterns may be useful for finding a missing diver?

Answer 26

1. U-pattern (useful for covering a large area using minimal equipment with several search teams)
2. Expanding square (useful for moderate visibility when you believe the diver hasn’t gone far and you only have a single search team)
3. Circular search (good in poor visibility, but takes longer to set up and is only possible over a relatively unobstructed bottom)
4. Surface led search (useful for covering a large complex area in shallow water)

Question 27

What considerations should you take into account when implementing a search for a missing diver?

Answer 27

1. Have a way to recall searchers
2. Permit searchers in buddy teams only, and make sure they have ample air and no decompression time to perform the search
3. Begin searches where someone last saw the diver
4. If you think the diver lsot consciousness on the surface and sank, have rescuers descend from that point without swimming to simulate a sinking unresponsive diver
5. Keep in mind that strong currents, tidal currents and surge may affect where an unresponsive diver ends up
6. If no qualified divers are present for the search, you may need to choose a buddy and begin the search yourself
7. Search for 30 minutes, until you find the victim, until you reach the safe limit of air supply, no decompression time or exposure for the searchers, on until relieved by professional assistance
8. If unsuccessful to this point, turn the search over to professionals