The Magazine of Divers Alert Network Asia-Pacific

PANIC AND PTSD

DCS IN VANUATU
OCEAN STEWARDSHIP
KNOW YOUR O2

Quarter 2, 2017
danap.org
 Contents ON THE COVER
A perfectly camouflaged wire coral
crab in north Sulawesi, Indonesia
Image ©️ Stephen Frink
Settings: f/22, 1/80s, ISO 100

72
55 Perspectives
GET FAMILIAR WITH DAN AP’S
EMERGENCY PROCEDURES!
Text by Scott Jamieson

56 DAN Was There For Me Content Coordinator

Stephen Frink
WRECKED IN VANUATU
Text by DAN Asia-Pacific Member Renée Editors
Brian Harper and Diana Palmer
62 Skills In Action Founder, Director of Research &
PANIC AND POST-TRAUMATIC STRESS
Text by David F. Colvard, M.D. Chairman of the Board
John Lippmann
66 Expert Opinions General Manager
AIR, NITROX AND FATIGUE
By Matías Nochetto, M.D. Scott Jamieson

72 Life Aquatic Administration Manager

74
ALERT DIVER’S PHILOSOPHY
Alert Diver is a forum for ideas and information
relative to diving safety, education and practice.
Any material relating to dive safety or dive
medicine or accident management is considered
for publication. Ideas, comments and support are
encouraged and appreciated. The views expressed
by contributors are not necessarily those
advocated by DAN Asia-Pacific. DAN is a neutral
public service organisation which attempts to
interact with all diving-related organisations
or persons with equal deference. Alert Diver is
published for the use of the diving public and it
is not a medical journal. The use and dosage of
any medication by a diver should be under the
supervision of his or her physician.
Sim Huber
CONTINUING A TRADITION OF
OCEAN STEWARDSHIP Marketing & Communications
By David Helvarg
Manager
74 Gear Melissa Cefai
OXYGEN DAN AP Board of Directors
By Patty Seery
John Lippmann, David Natoli,
Malcolm Hill, Dr David Wilkinson,
Mick Jackson, Stan Bugg,
Nicholas Cheong and Dr Andrew Ng
Memberships & Certifications
Heidi Powell, Julie Parsonson,
Alert Diver is published as a separate,
Cynthia Van Zyl, Mina Chiovitti,
independent magazine within Scuba Diver
AUSTRALASIA + OCEAN PLANET (SDAA) + OP Sophie Kayne, and Diane Boyle
magazine. DAN Asia-Pacific is not responsible for
the content provided elsewhere within SDAA + OP, Training
and therefore this content should not be assumed John Lippmann, David Natoli
to represent the views, policies or practices of and Tim Vernon-Smith
DAN Asia-Pacific or Alert Diver magazine.
Marketing Assistants
©Alert Diver text, illustration or photographs Haili Mu & Adam Lippmann
may not be reproduced or reprinted without the
expressed consent of Divers Alert Network and Accounts
its authors, artists and photographers. Many Anny Limbek
articles are reprinted with the kind permission of
DAN America.

Email: info@danap.org DAN AP does not necessarily endorse the

products or services of any organisation
For more information on membership, insurances and training programmes, or company whose advisements appear in
visit our website: www.danap.org Alert Diver

2

Part of the DAN Asia Pacific team.
From left, Mel, Cynthia, Julie,
John, Heidi, Scott, Haili, Anny,
Adam, Sim
Dive Tip
To view DAN AP’s
24-Hour Emergency
Hotlines, scan the
code or visit “Emergency
Procedures” at danap.org.
From DAN Asia-Pacific
GET FAMILIAR WITH DAN AP’S
EMERGENCY PROCEDURES!
Make sure you get prompt and effective assistance in the event
of a diving incident – be sure you know how DAN AP’s Emergency
Procedures work
IN THE EVENT OF A DIVING EMERGENCY
contact a DAN AP supported hotline. The
numbers for these hotlines are on your member
card, on the DAN AP website (Emergency
Procedures), or can be accessed through the QR
code at the bottom of this message.
DAN AP’S SUGGESTION – Save the most
appropriate number in your phone, so you have
it at your fingertips should you ever need to call
DAN for help, for yourself or a dive buddy.
BE PREPARED BEFORE CALLING A
DAN HOTLINE – Ensure you have a call-back
number available (in case the call drops out or
follow-up calls are required) and also remember
to tell the operator that you are a DAN Member.
These hotlines will put you in contact with a
diving doctor who will discuss your symptoms
and may suggest first aid. It is important
Perspectives
to follow this advice. The doctor may also
recommend an evacuation to get you to ongoing
medical care (or to a higher level of care). If
this occurs the doctor will put you in contact
with DAN Case-managers, who will assist with
organising the evacuation.
The doctors who assist on these hotlines
cannot answer insurance-related questions.
DO NOT USE EMAIL OR FACEBOOK TO CONTACT
DAN AP IN AN EMERGENCY Our email accounts
and Facebook page are not monitored 24/7
and will result in a delay should your email or
Facebook message arrive after hours or on
a weekend.
IF YOUR EMERGENCY IS NON-DIVING RELATED,
OR YOU NEED A MEDICAL EVACUATION, OR YOU
CAN’T REACH ONE OF THE DAN AP HOTLINES
you can call the DAN Travel Assist number
(+1 919 684 9111) and they will help you.
IF YOU HAVE A NON-EMERGENCY QUERY or
question regarding your DAN AP Coverage,
you should contact the DAN AP Office during
business hours (9am–5pm Monday to Friday,
Eastern Australia Time) on +61 3 9886 9166.
Non-emergency queries can also be emailed to
DAN AP (info@danap.org). Help us by ensuring
the Hotlines are reserved for emergency
calls only.
DAN AP is available 24/7 to assist in an
emergency but the most efficient and effective
care is enabled when the correct procedures
are followed. Finally, it’s important to note that
DAN AP’s insurers may decline payment for any
evacuations or treatments that occur without
prior approval from DAN AP. So always call
DAN first!
Finally, whilst all divers can call a DAN
Hotline for advice, we can only manage
an evacuation and treatment, and pay for
associated costs for current Members (within
the limits of their coverage).
Dive safely and remember to take DAN with
you on every trip,
Scott Jamieson,
General Manager, DAN Asia-Pacific
3
 Research, Education & Medicine

DAN Was There For Me

WRECKED
IN VANUATU
Advanced diver and DAN Asia-Pacific
Member shares a tale of DCI after diving
the SS President Coolidge in Vanuatu
by DAN Asia-Pacific Member Renée

DAN Was There For Me ABOUT ME

WRECKED
IN VANUATU
An advanced diver and DAN Asia-Pacific
Member shares a tale of DCI after diving
the SS President Coolidge in Vanuatu
By DAN Asia-Pacific Member Renée
I began scuba diving in January 2012 at the age
of 48 and have logged 130 dives. I am a PADI
Advanced Open Water Diver and also have a
Computer Nitrox Diver certification with SDI. I
dive regularly in Sydney and sometimes go away
for diving weekends involving repetitive dives,
generally to around 30 metres. I have also been
on a few overseas diving holidays, including
some four- to five-day liveaboards. When on
liveaboards, I usually dive four dives per day

4
 liked the idea of having specialist dive insurance
and an authority who could answer diving
medical questions.

Stephen Frink
THE TRIP
I joined a 10-day dive trip to Vanuatu organised
by my local shop, for nine dives on the SS
President Coolidge and one dive at Million Dollar
Point. Prior to this trip, the deepest dive I had
completed was to 35 metres.

THE DIVES
Day 1
The first dive was undertaken the day after
arriving in Vanuatu.
Dive 1: Max depth 33m, total dive time (TDT)
44 minutes, safety stop at 5m for around 10
minutes. Surface interval (SI) of 4 hours
45 minutes.

Dive 2: Max depth 34m, TDT 49 minutes, safety

stop at 5m for around 10 minutes.

About three hours after exiting the water I began

to suffer slightly from a migraine with aura,
where half of what I look at disappears and it’s
like a “black hole” in my vision. I drank plenty
of water, went to bed around 9.30pm and didn’t
think much of it. When I woke the following
morning, I felt fine.

Day 2
Dive 1: Max depth 45m, TDT 61 minutes,
including a 2-minute safety stop at 10m, a
2-minute safety stop at 8m and a 20-minute
safety stop at 4–5m.

Just under three hours after exiting the water

my vision began distorting, indicating the onset
of a migraine with aura. I simply thought this
was a recurrence of the migraine from the
previous evening and didn’t think too much
about it. It was very short-lived, and I felt fine in
less than an hour.
After a surface interval of four hours and 29
minutes, we did the second dive of the day.
I had no hesitation in doing the dive, as my
migraine had stopped several hours before the
second dive.

to a maximum depth for each dive of between
20–35m. I generally dive with a nitrox mix of
32–35% oxygen. I am a conservative diver with
good air consumption and generally undertake
fairly long safety stops.
I am in good overall health although I
infrequently suffer from migraines, with aura
(distorted vision).
Ever since I started diving, I have always had
DAN AP cover. Although I never expected I would
need to call DAN for help, or make a claim, I
Dive 2: Max depth 38.9m, TDT 59 minutes.
This included a 2-minute safety stop at 10m,
a 2-minute safety stop at 8m and a 15-minute
safety stop at 4–5m.
I exited the water and after removing my BCD
and wetsuit developed an ache in my abdomen.
I thought the pain was due to my BCD being done
up too tightly, especially as I had tucked torches
into the belt – in the past this has given me
bruises across my abdomen. Within five minutes
A session in a hyperbaric
chamber may seem drastic and
even unnecessary, but timely
treatment can ensure the best
chance of recovery. (Image is
illustrative only and does not
depict the chamber in which
Renée was treated)

5
 Research, Education & Medicine

of exiting the water, the pain was stronger, so the doctor there was lovely, she was a volunteer
much so that I could not bend over to pick up from Denmark, and had only been in Vanuatu
something I had dropped. for two days. She had never come upon a diving
injury, and her reference book was a 1985
I DIDN’T WANT TO MAKE A FUSS edition of a diving book! She also spoke at
Oxygen should always be
To get to and from SS President Coolidge, length to Dr Gawthrope. DAN AP has forwarded administered in any suspected
we travelled by minibus. The bus ride is this medical practice an up-to-date dive case of DCI. (Image is illustrative
only and does not show the
approximately seven to 10 minutes. During that medicine book. people involved in this incident)
time, I began to develop a strong pain in my left
breast and the abdomen pain persisted. I took
some deep breaths and thought the pain would
subside. I was travelling with my (young adult)
children and didn’t want to make a fuss!
When we arrived at the dive shop, I got off
the bus and my legs felt like jelly and would
not support me. I staggered to sit down. When
I told my daughters that I did not feel well, they
immediately alerted our dive shop manager,
Denis, who was part of the tour. He returned
me to the bus and had me breathe oxygen for
20 minutes on then a five-minute break (DAN
AP Note: Air breaks during the provision of
oxygen are not required. DAN’s advice is to
provide ongoing oxygen first aid with no breaks,
until advised otherwise.) This pattern continued
and DAN Asia-Pacific was called. The on-call
doctor (a network of volunteers on the DAN-DES
Hotline), Dr Ian Gawthrope, provided support and
advice that continued for the next week.
Denis continued to monitor my condition.
He also arranged for photos to be taken at
five-minute intervals so that there was a clear
record of my condition at any given time. During
this time, I also developed a strong itch and rash
across my abdomen. Dr Gawthrope diagnosed
DCI and recommended that I be taken to Santo
Hospital, which was done.
Surprisingly, the staff at Santo Hospital had
little or no experience of dive-related injuries,
and seemed more concerned that I presented
with high blood pressure (due to the stress my
body was under, as I don’t suffer from high blood
pressure normally). Fortunately, Denis had
taken the oxygen tank with me to the hospital,
as the staff was extremely slow in administering
oxygen to me. Whilst in the hospital, Denis
took my vital signs every five minutes and
kept a record, as the hospital staff did not
appear to know what to do. I was on oxygen for
several hours at Santo Hospital before some
Australian volunteer doctors arrived. These
doctors also rang Dr Gawthrope for discussion
and advice. I was given the options of staying
in hospital overnight, or returning to my own
accommodation with the oxygen bottle. I took the
latter option!

THE DOCTORS’ REFERENCE WAS A DIVING

BOOK FROM 1985
The following morning, upon Dr Gawthrope’s
advice, I attended a local medical centre. Whilst

6
 Whilst I still had a pain across my abdomen,
a pain in my chest and a strong itch, I appeared
otherwise healthy and could walk, eat and carry
on usual functions without any difficulties. I
thought I had just suffered from a mild case of
DCI and that I had fully recovered (although not
enough to do more diving). During the next day,
I breathed oxygen constantly. I was in regular
contact with Dr Gawthrope who provided terrific
advice and support.
Whilst being evacuated by air into Port Vila
for hyperbaric chamber treatment was offered
to me by DAN AP, I didn’t think it was necessary
and was happy to remain at Santo, with my
family, breathing oxygen regularly. The pain in
my abdomen was gradually subsiding, although
the itch remained. I didn’t think I needed to be
placed in a chamber for an itchy belly!
RELAPSE AND EVACUATION
However, two days after the first onset of
symptoms, I appeared to suffer a relapse, with
the pain in my abdomen and chest recurring.
Upon discussing this with Dr Gawthrope it was
decided to evacuate me to Port Vila. DAN AP
acted quickly and efficiently. However, as it was
a low-level flight (of 90 minutes), good light
was essential as navigation was done by sight.
There were concerns about failing light, so it
was decided that I would be airlifted at 6am the
following day.
Following a very scenic low-flight plane
trip to Port Vila, I was immediately put into
the recompression chamber. The chamber
is operated by volunteers, and they do an
outstanding job. They also get support
from DAN. Dr Gawthrope provided constant
monitoring and advice to me, my daughter and
the hyperbaric chamber technicians. The staff
at ProMedical in Port Vila did an outstanding
job in monitoring my condition and arranging
ambulance transportation to and from the
chamber for me and my daughter.
TREATMENT AND RECOVERY
I received three separate recompression
treatments, and had “no fly” orders for a week.
My symptoms disappeared almost
immediately after being put under pressure
in the chamber. The first treatment was six
hours, and the subsequent treatments were
approximately four hours. When I exited the
chamber each time, I felt fine, but during the
evening my symptoms recurred, albeit to a far
lesser degree.
THE REASONS BEHIND MY DCI
A week after returning to Australia I saw a A mottled rash could very
specialist dive physician who referred me possibly be a skin bend, a
symptom of DCI and should
for a bubble test. This involves observing be treated as such. (Image is
the movement of blood through the heart via illustrative only and does not
show the diver involved in this
ultrasound. It showed that I had a PFO (patent incident)
7
 Research, Education & Medicine

Final Comment
by DAN
Asia-Pacific
The four dives completed,
while not excessive, are
relatively deep dives and
would have contributed to
greater bubble loading.
The diver was fortunate
that her dive leader
(also the manager from
her local dive shop in
Australia) was equipped
with the skills to initiate
immediate oxygen first aid
and put a call in to DAN
AP for advice. Continuing
to breathe oxygen for an
extended period resolved
many of the diver’s
symptoms; however,
when the oxygen therapy
stopped, the symptoms
returned, which is not
unusual. Travelling
to Port Vila when first
recommended by DAN
AP may have resulted
in fewer treatments as
it would have prevented
the symptoms from
worsening or embedding.

foramen ovale). I have now had this fixed, as I
was keen to resume diving. I was also concerned
about the increased risk of stroke with a PFO.
Following the surgery (which was a five-minute
operation) the surgeon indicated that regardless
of whether I wanted to continue diving he was
pleased my PFO had been discovered and fixed.
The hole in my heart was very large, and he was
of no doubt that I would have had a major stroke
fairly soon!
Whilst I am still waiting for medical
clearance to dive, I had a follow-up bubble test
to confirm closure, and am pleased to report
that not a single bubble escaped. I will be back in
the water.
LESSONS LEARNED
• There is no simple diagnosis of DCI as there
are so many signs and symptoms. Not in my
wildest dreams would I have thought that a
sore or itchy stomach could be DCI.
• No matter how small the symptoms seek
proper medical advice. Don’t dismiss things –
it is easier to check out minor problems before
they become major. Not wanting to make a
fuss can turn into a disaster.
• DAN AP did an outstanding job in supporting
me and my family. My daughter was constantly
contacted (several times a day) by DAN AP staff
to enquire on my progress and my needs, as
did Dr Growthorpe. Nothing was too much for
DAN AP, and I truly felt my needs and health
were paramount. Once I returned home,
although I had made a full recovery, I was
phoned several times by DAN AP staff just to
check up on me.
• Finally, I cannot stress enough the
importance of:
– Having DAN in your kit – it saved my life, and
may save yours!
– Having a reliable dive buddy.
– Going on dive holidays with a trustworthy and
reliable tour operator. Without Denis on the
scene, I would have just gone back to my
room, and the end result would have been
very different.

8
Alice Grainger
Senior Editor Asian Diver &
Scuba Diver AUSTRALASIA

Why I’m a
DAN Member
I never thought it would happen to me. But, even as an experienced
diver and bit of a ‘safety fascist’, I got hit with DCI. Thankfully,
DAN Asia-Pacific really were there for me, providing the most
incredible support, on every level, during one of the most difficult
times of my life. I am so grateful I have always been a DAN Member
and always had DAN Treatment Insurance. I’d never dive without it.

www.danap.org
9
Headshot courtesy of Aaron Wong
 Research, Education & Medicine

Skills In Action

PANIC AND
POST-TRAUMATIC
STRESS
A dive incident’s psychological
aftermath
By David F. Colvard, M.D.

THE DIVER
The diver was a 48-year-old male with four
years of diving experience and 10 dives in the
previous month. His medical history included
hypertension and gastroesophageal reflux
disease (GERD), which were controlled by
medications. He used a prescription sleeping pill
as needed.

THE INCIDENT
The diver was on a trip to a popular Hawaiian
island. About 10 minutes into his first dive he had
a regulator failure in which his mouthpiece came
apart from his second stage. He thought the
second stage was still in his mouth – though only
the mouthpiece remained – so when he realised
he couldn’t breathe he assumed the first stage
had malfunctioned. He had just finished exhaling
and was ready to take another breath. He began
to panic because he did not think anyone was
close enough to share air with him, and he found
himself fighting the temptation to inhale water.
He was without air for about 25 seconds before
he remembered he had a spare air cylinder. He
took two or three breaths from it before he was
able to reach his buddy’s spare second stage.
The diver had just had his regulator serviced,
and this was his first dive with it since then.
He was fortunate to have purchased the spare
air a year earlier; things could have been
much worse. He was an emergency-room
physician and knew the consequences of
being unprepared.

THE COMPLICATIONS
The diver was “shell-shocked after the event and
since the event” as he dealt with the aftereffects.
He had trouble sleeping due to nightmares and
had flashbacks of running out of air.

DISCUSSION
The diver experienced a fairly minor equipment
Stephen Frink

failure in the unexpected separation of his

mouthpiece from his second stage. The
regulator had a proprietary mouthpiece clamp
with a cam latch, and upon reflection he
supposed the clamp was not replaced after the

10
service. A manufacturer’s representative told
me, “It is time-proven, and we have no known
issues with it.” A dive shop service technician
told me that his shop usually just uses a zip tie
to secure the mouthpieces to the second stages
as the last step in servicing a regulator. It is
possible that either the clamp was not properly
buckled or the technician neglected to engage
the cam latch at all.
If the mouthpiece was not securely fastened
to the second stage of the regulator, then a
forceful or quick head movement may have
pulled the regulator hose hard enough to
dislodge the mouthpiece from the second stage.
If the mouthpiece was loosely attached to the
regulator it’s also possible it was breathing wet.
This might have prompted a forceful exhalation
to clear it that dislodged the mouthpiece
completely. It seems unlikely that a normal
exhalation would have caused the separation
since he had already been diving with it for about
10 minutes without a problem.
When divers pick up their equipment after
it’s been serviced, they should inspect it and
review the service with the technician who did
the work. If this diver had inspected his regulator
he might have noticed that the mouthpiece was
not properly fastened to the second stage.
The first adverse event the diver experienced
was an apparent equipment failure. His first-
and second-stage regulators were presumably
still functioning. He did not attempt to breathe
directly from the second stage without a
mouthpiece, nor did he attempt to breathe
from his alternate second stage, assuming he
had one.
In a study of more than 12,000 recreational
divers in 2000, about 40 percent of male divers
and 33 percent of female divers reported having
a problem with a regulator leak or free flow
sometime during their dive career*. However,
only five percent of male divers and three
percent of female divers related their first
experience of underwater panic to it. Separation
of the mouthpiece from the second stage was
not specifically surveyed.
The diver incorrectly thought his first-
stage regulator had failed and jumped to the
conclusion that he was out of air. The survey
also found that 40 percent of male divers and
27 percent of female divers reported being “low
on air or out of air” sometime during their dive
career. However, only 18 percent of males and
seven percent of females related their first panic
experience in diving to that experience.
DAN has reported approximately 41 percent
of divers in fatal dives had run out of breathing
gas. While running out of air can be fatal, most
divers handle being low on or out of air
without incident.
The second adverse event that occurred was
the separation of the diver from his buddy. He
did not think other divers were close enough to
give him air as quickly as he needed it. Because
his dive buddy was not within touching distance,
the diver was effectively diving solo. Spare air
was a poor substitute for a dive buddy who could
have immediately offered a functioning regulator
and helped him calm down.
The diver’s report of being “shell-shocked
after the event and since the event” suggests
post-traumatic stress disorder (PTSD). He
faced the threat of death or serious injury and
has persistently re-experienced the event in
traumatic nightmares. He has also avoided
potentially distressing stimuli after the event:
He has not sought professional help because
he has been “too busy”, and he has presumably
not dived since the incident. He also experiences
persistent negative trauma-related emotions
and has demonstrated negative alterations in
cognition and mood with persistent distorted
blame of others (e.g., the regulator service
technician) for causing the traumatic event. His
signs and symptoms are below the threshold
for a diagnosis of PTSD, but they are still quite
distressing to him and warrant help – whether
he wishes to resume diving or not.
Over the years, I have helped divers with
problems such as these by working with
them in the water or by telephone or email
using cognitive behavioural therapy. The
therapy includes instruction in diaphragmatic
breathing for relaxation (available for free on
www.DivePsych.com) and progressive in-vivo
exposure and response prevention.
Typically, traumatised divers avoid dealing
with this type of problem until circumstances
motivate them to tackle it so they can resume
diving. Others abandon scuba diving and take
up snorkelling or other activities they find less
anxiety provoking.
See the Video
Reference The diver featured in this
article was shooting video
*Colvard DF, Colvard at the time the incident
LY. A study of panic in occurred. To watch the
recreational divers. video, visit www.dropbox.
Underwater J, 2003; Q1: com/sh/0mf5fzx349jg01n/
40–44. gOCwva19IQ.
11
 SAFETY 101
SAFETY 101
WHO DO YOU TRUST?
Getting the right advice from the right
people is critical
By DAN Asia-Pacific
Here’s a common scenario: A diver is on holiday,
enjoying a liveaboard trip in a remote location. The
diving has been great but now after the second dive
of the third day he is feeling as though something
isn’t quite right: He has a slight ache in his shoulder
and a rash around his torso, which is tender to touch.
He knows from his dive course and DAN oxygen
training that these could be signs and symptoms of
DCI so he speaks to the dive leader. The dive leader
takes a quick look at the rash and tells him not to
worry; it’s only a heat rash, which is common in the
tropics. The dive leader also dismisses the ache in
the shoulder as strain from lifting heavy gear. And
besides all that, he has dived within the limits of his
dive computer on every dive, so it can’t be DCI.
The diver is not convinced, but he trusts the dive
leader. Still not feeling well he sits out the next dive
The dive and has a restless sleep. The following morning, he
guides in most dives again, despite the persistent ache and still-
dive locations do present rash.
After the dive the symptoms are worse and new
not have medical
symptoms have appeared. The dive guide finally
training – they agrees they should give the DAN Diving Emergency
should not be Service (DES) Hotline a call for advice.
diagnosing DCI,
or denying the THE DAN ON-CALL DOCTOR INSTRUCTS:
diver oxygen • Immediate oxygen first aid to commence, with the
first aid diver breathing high concentration oxygen;
• No more diving; and
• If the symptoms do not resolve completely in a
couple of hours the diver will need to be
Experienced divers can lead by evacuated to a facility for evaluation and
example, modelling good dive
practices recompression in a chamber.
12
If lucky, the symptoms may disappear after
breathing oxygen; if not, the diver may require
treatment in the recompression chamber.
WHAT WAS WRONG WITH THIS SCENARIO?
The dive guides in most dive locations do not have
medical training – they should not be diagnosing
whether or not a diver has DCI, or denying the diver
oxygen first aid.
The diver in this story was correct in identifying
that anything abnormal after diving should be
considered as possible DCI and he should have
insisted on DAN being contacted.
Next, the dive guide should have taken action
based on the worst scenario: Why not give the
diver oxygen and see if things improve? There is no
negative effect from a diver receiving oxygen first aid,
even if they don’t have DCI.
THINGS TO REMEMBER:
• Divers do get DCI while following their
dive computers.
• Continuing to dive with symptoms can cause
symptoms to worsen, making them more difficult
to treat and may require more chamber
treatments than if they had been treated quickly.
• By delaying treatment, the diver may end up with
residual symptoms that may involve a long
journey to the full resolution of symptoms, if they
ever do.
• Calling the DAN DES Hotline provides immediate
medically qualified advice. DAN should always
be called as soon as a diver becomes aware of DCI
symptoms after diving.
• All divers should be familiar with the signs and
symptoms of DCI and should always feel confident
that they can call the DAN Hotline for advice if
any of these appear after diving.
Symptoms Not to Ignore When Diving
Common Signs and Symptoms of DCI
Numbness Headache
Dizziness Nausea
Pain
Unusual fatigue
Weakness
Difficulty walking
Other Signs & Symptoms of DCI
Difficulty breathing
Decreased skin sensation
Visual disturbance
Restlessness
Itching / rash Paralysis
Muscle twitching Unconsciousness
Speech disturbance Personality change
Altered level of consciousness Bladder / bowel problems
Convulsions Hearing loss / ringing ears
If you experience any signs and symptoms of DCI
following diving, be sure to call the DAN Diving
Emergency Service (DES) Hotline for advice
(1800-088-200 toll free from within Australia or
+61-8-8212-9242 outside Australia)
DAN ASIA-PACIFIC MEMBER EXCLUSIVE
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13
 Research, Education & Medicine

Expert Opinions Compressed air has been the standard

AIR, NITROX and most widely used breathing mix in
recreational diving for decades. Breathing-
AND FATIGUE gas mixtures with a lower nitrogen content
and higher oxygen content (enriched air
nitrox) have gained popularity among divers
Why might divers report feeling less looking to increase their bottom times or
tired after diving with nitrox? reduce the decompression stress of typical-
By Matías Nochetto, M.D. duration dives. Today, after some 25 years
of nitrox use in recreational diving, divers
and scientists have gained very valuable
operational experience. But some divers have
made an observation for which science does
Shutterstock

14
not provide any evidence. Namely, they often
report feeling less tired after diving on nitrox.
IS THERE ANY SOLID EVIDENCE TO SUPPORT
THE OBSERVATION THAT NITROX REDUCES
FATIGUE? WHAT IS A POSSIBLE SCIENTIFIC
EXPLANATION FOR THIS PHENOMENON?
Tiredness, or physical fatigue, is a
physiological consequence of extraordinary
physical activity. It is characterised by a
subjective feeling of a transient reduced
capacity to perform ordinary physical
activities; it is often associated with
tterstock
somnolence and lethargy and sometimes with Controversy
suboptimal cognitive performance. Fatigue surrounds
is not uncommon following inconsequential divers’ subjective
dives in the absence of apparent reports of
decompression sickness (DCS), but it’s also reduced fatigue
frequently reported as a symptom of DCS. following nitrox
Controversy surrounds divers’ subjective dives
reports of reduced fatigue following nitrox
dives. Contrary to these perceptions, objective
studies have not found a reliable difference
in fatigue or cognitive performance following
dives on air versus nitrox.
Given an equal depth/time exposure, it is
generally accepted that the higher the partial
pressure of the inspired oxygen (PO2) and
the lower the partial pressure of the inert
gas (PN2), the less decompression stress
will be experienced. It is then tempting to
assume that lower decompression stress
accompanies reduced perceptions of
tiredness. However, a higher PO2 elicits more
oxidative stress, and the PO2 of nitrox will be
higher than that of air at a given depth.
Some studies of divers suggest that
oxidative stress generated by nitrox’s
higher PO2 might cause mild endothelial
dysfunction, which may itself lead to some
vague symptoms that may be perceived as
tiredness. Observations from hyperbaric-
medicine clinicians, who report that greater
oxidative stress during hyperbaric oxygen
therapy is associated with greater fatigue
following treatment, support these findings.
We consulted two subject-matter experts
to help us reconcile divers’ impressions of
nitrox’s beneficial effects on post-dive fatigue
with some controversial findings in studies of
the phenomenon.
WHAT ARE SOME POSSIBLE CAUSES OF
POST-DIVE TIREDNESS?
Richard Harris: Post-dive tiredness can be
the result of multiple factors. Some of them
could be dive related, such as thermal stress,
decompression stress, energy expenditure,
high and prolonged oxygen exposure, anxiety
and seasickness. But there are many more
potentially unrelated causes such as lack of
sleep on holidays, alcohol, jet lag, etc.
Neal Pollock: Many people do not fully
appreciate the physiological impact of being
immersed in water. An immediate response to
the hydrostatic pressure is that a substantial
amount of blood normally remaining in the
capacitance vessels (veins) of the legs is
pushed to the central volume (in the chest). A
well-known study of this effect found that an
average of 700 ml of blood is pushed to the
heart during the resting phase of the cardiac
cycle. The heart is stretched by the increased
blood volume and responds immediately
15
 Research, Education & Medicine

by contracting harder and then, over a short

period, by suppressing certain hormones to
promote increased fluid elimination through
the kidneys. This is a healthy response to the
physiological perception of the presence of
excess fluid volume. Practically, this is why
people have to urinate even after fairly short
periods of immersion.
After leaving the water, the diver may
experience an immediate drop in the volume of
blood returning to the heart. I specifically said
“may” because a constricting wetsuit may shift
some of the blood to the chest even without
immersion. Post-dive (or post-wetsuit removal),
the diver will experience a decline in the central
blood volume and blood pressure. The effect
exceeds the simple loss of hydrostatic pressure
because the body has been actively reducing
the fluid volume during the diving (or wetsuit-
wearing) period. Effectively, this set of events
likely explains a substantial portion of the
normal post-dive tiredness. Most important,
fatigue is due to immersion, independent of
depth and decompression stress.

ARE THERE ANY RELIABLE DATA TO SUPPORT

CLAIMS ABOUT NITROX CAUSING LESS POST-
DIVE TIREDNESS THAN AIR?
Harris: No. Three articles in the peer-reviewed
literature (see the first three in the references
box at the end of this article) contribute
evidence to the nitrox and fatigue question,
but I am not convinced that the size and
power of any of them have addressed the
problem comprehensively.

Pollock: The data supporting these claims are

not compelling. This is not surprising since PO2
increases substantially in response to depth
alone. However, there is no reason to argue
over whether a person feels less fatigued.
Research has shown that the placebo effect has
physiological impact, so let the diver enjoy the
sense. The important thing is for divers to stay
within the PO2 limits to avoid oxygen toxicity.

Nitrox Safety Tip

Whenever you plan to use nitrox, make sure you plan your dive
with a clear view of your goals. Using nitrox means juggling
between three possible benefits: extended bottom times,
reduced surface intervals or reduced decompression stress.
Whichever benefit you choose to pursue, remember to be
respectful of the increased risk of oxygen toxicity.
If you choose to minimise decompression stress, you should
not count on longer dives and/or shorter surface intervals.
If you want longer dives, your decompression stress may
not be reduced, and your surface intervals should not be any
shorter. (Note: The decompression stress of diving with nitrox
to its no-decompression limit is comparable to diving air to its
Stephen Frink

no-decompression limit.)
The decompression benefit provided by nitrox may not be
sufficient if surface intervals are too short.
Increasing the oxygen fraction reduces the depth at which
oxygen toxicity can occur. Never exceed the maximum operating
depth (MOD) for the mixture.

16
SINCE NITROX’S HIGHER OXYGEN CONTENT
SEEMS TO CAUSE INCREASED OXIDATIVE
STRESS, HOW WOULD YOU RECONCILE THESE
APPARENTLY COUNTERINTUITIVE EFFECTS
OF NITROX?
Harris: One interesting comment from Pierre
Lafère’s article is that oxidative stress can
inhibit neuronal activity (as with alcohol,
for example), and this can affect inhibitory
neurons, thus (temporarily) increasing
arousal levels. On a personal note, my
teammates and I have felt very good after
8- to 17-hour cave dives in 6°C (43°F) water
and maximum depths of more than 200
metres (656 feet). Considering the thermal,
decompression, physical, oxidative and
psychological stresses endured on these
dives, how could we reconcile this? Maybe we
were just happy to be alive! But I have also
felt dreadful, tired and “chesty” after much
shallower dives with lower O2 exposures and
shorter run times in warmer water. There
are too many other variables to consistently
detect a difference just with a simple
gas change.

Pollock: Oxidative stress certainly has the

potential to be problematic, but probably far
less so with the typically short exposures
associated with most recreational diving.

Stephen Frink

17
 Research, Education & Medicine

MEET THE
EXPERTS
Richard Harris,
BMBS, FANZCA,
DipDHM, FFEWM,
is an Australian
anaesthesiologist
who works in diving
medicine and
aeromedical retrieval.
He has qualifications
in expedition and
wilderness medicine
and is an active
exploration caver and
cave diver. A diver for
more than 30 years,
his images and videos
are widely published
in the diving media.
His current research
interests include
decompression illness
in technical divers.

Neal W. Pollock,
Ph.D., is Research
Director at DAN and
a research associate
in the Center for
Hyperbaric Medicine
and Environmental

Further research is required to assess the
physiological impact.
WOULD YOU CONSIDER TIREDNESS/FATIGUE A
SIGN OF SUBCLINICAL DCS?
Harris: I believe that fatigue can be a
symptom of DCS, but it needs to be something
very marked to impress me. Severe fatigue,
such as feeling like you have the flu rather
than just being “a bit more tired than usual
after diving”, is a more serious issue. Rather
than use the term subclinical DCS, which I do
not favour, I would only call fatigue DCS if it is
part of a constellation of symptoms.
Pollock: Normal patterns of post-dive
tiredness would not qualify, but “unusual
fatigue” markedly in excess of typical levels
could be a sign or more likely a symptom.
Having the diver describe the nature and
degree of the effect is important to help
distinguish normal from unusual.
Despite a common impression that
diving on nitrox may cause less fatigue
than performing the same dive using an
air mixture, scientific research to date has
not found solid evidence to support such an
assumption. As mentioned, the placebo effect
should not be underestimated and has yet to
be fully studied.
Regardless of what questions future
research on this front might answer, it is still
Shutterstock
Physiology at Duke
University Medical
Center, both in
Durham, N.C. His
academic training is
in zoology, exercise
physiology and
environmental
appropriate to promote wise use of oxygen- physiology. His
enriched mixtures – not necessarily as a way research interests
focus on human health
to extend bottom times but rather as a way and safety in extreme
to help minimise decompression stress. environments. He
is actively involved
If diving with nitrox makes you feel less tired in projects of diving
after your day of diving, whether you have and freediving
safety, astronaut
scientific support for your experience or not, decompression and
feel free to use it – just make sure you enjoy ultrasonic assessment
it safely. of decompression-
induced bubbles.
References and Suggested Reading
• Chapman SD, Plato PA. Measurement of fatigue following
18 msw open-water dives breathing air or EAN36. In:
Brueggeman P, Pollock NW, eds. Diving for Science 2008.
Proceedings of the American Academy of Underwater
Sciences 27th Symposium, 2008; 1–11.
• Harris RJD, Doolette DJ, Wilkinson DC, Williams DJ.
Measurement of fatigue following 18 msw dry chamber dives
breathing air on enriched air nitrox. Undersea Hyperb Med.
2003; 30(4): 285–91.
• Lafère P, Balestra C, Hemelryck W, Donda N, Sakr A,
Taher A, Marroni S, Germonpré P. Evaluation of critical
flicker fusion frequency and perceived fatigue in divers after
air and enriched air nitrox diving. Diving Hyperb Med. 2010
September; 40(3): 114–8.
• Marinovic J, Ljubkovic M, Breskovic T, Gunjaca G, Obad
A, Modun D, Bilopavlovic N, Tsikas D, Dujic Z. Effects of
successive air and nitrox dives on human vascular function.
Eur J Appl Physiol, 2012 June; 112(6): 2131–7.
• Obad A, Palada I, Valic Z, Ivancev V, Bakavoic D, Wisløff U,
Brubakk AO, Dujic Z. The effects of acute oral antioxidants on
diving-induced alterations in human cardiovascular function.
J Physiol. 2007; 578(3): 859–70.

18
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 Water Planet
Stephen Frink

Life Aquatic

CONTINUING A
TRADITION OF OCEAN
STEWARDSHIP
An interview with Palau President
Tommy Remengesau Jr.
By David Helvarg

Palau’s famed Rock Islands give
a sense of the interconnectivity
of the land and the sea
President Remengesau walks on
the beach in front of the Palau
Pacific Resort
After helping to establish the world’s first
shark sanctuary in his nation’s waters in 2009,
President Tommy Remengesau Jr. of the
Republic of Palau signed legislation last year
that set aside 80 percent of his small west
Pacific island nation’s ocean as a fully protected
marine sanctuary. The world’s sixth-largest
reserve, the Palau sanctuary covers an area
larger than California and has the greatest
percentage of any nation’s waters off limits
to fishing.
“Creating this sanctuary is a bold move that
the people of Palau recognise as essential to our
survival,” Remengesau explained. To protect this
vast tract, he also signed an international treaty
targeting illegal, unreported and unregulated
(IUU) fishing. “Palau will not tolerate poachers
in our ocean,” he warned. His administration
followed up on that warning by confiscating
and burning vessels from Vietnam and the
Philippines caught illegally fishing in
Palau’s waters.
In May 2016 Remengesau was awarded the
Peter Benchley Ocean Award for Excellence in
National Stewardship. In June, David Helvarg
David Helvarg
visited Palau and interviewed Remengesau for
Alert Diver.
Alert Diver: What led Palau to become a world
leader in ocean conservation?
Tommy Remengesau Jr.: Ocean conservation is
very much a part of our tradition and livelihood,
and we know to sustain our future existence
as island people we must balance Nature
and development.
AD: What in your own life brought you to the
idea of ocean stewardship?
TR: As a young Palauan you’re taught from early
on not to take more than you need for today,
to think about your children and their children
and to live in harmony with Nature. This is an
integral part of growing up in Palau, so it’s
natural for me to lead by rallying the people to
do what we’ve been taught from a young age.

20
AD: What is a bul?
TR: Bul is part of our traditional practices. It
literally translates as prohibition – it means
conservation and thinking about the future.
When the chief of a village and the fishermen
notice the fish population of a certain area of
the reef declining, the chief would institute a
bul, telling the local villagers to stop fishing that
particular location. People would comply with a
bul because the whole community policed it. We
noticed over generations that fish populations
in those prohibited areas would eventually
rebound, so the leaders would open up the bul
and allow fishing again.
So now we have a bul for the ocean. When
you talk about an 80-percent marine sanctuary,
it’s not just for that 80 percent; this will
repopulate and re-energise the 20 percent that
we are opening up for domestic fishing and
other activities. We have proven that the benefits
of a bul extend outside of the protected area.
With 80 percent of our waters protected, the
spillover effect is not small. This will benefit not
only us but the Philippines, Indonesia and FSM
(Federated States of Micronesia) as well. This is
our contribution to the Pacific and to the world.
AD: You’ve often said that your environment is
your economy. Could you expand on that?
TR: We believe you cannot separate the two. Our
economy is based on tourism – people coming to
experience our natural resources. Our livelihood
as Palauans therefore is based on how we
protect our resources for our visitors and for
ourselves in terms of our food security. We have
a long history of looking to the ocean to provide
us with fish.
AD: Fishermen often say sharks are taking
their fish or that sharks should be targeted for
their fins, but in 2009 you created the world’s
first nationwide shark sanctuary.
TR: We believe every living thing on this Earth is
here for a reason – the shark is a part of the reef
ecosystem. Besides that, we’ve done research
and found that a live shark is worth USD1.9
million over its 60- to 70-year lifespan. A dead
shark’s fins, in contrast, are worth about USD45
per kilo just once. It’s been a good partnership
with the sharks, so to speak.
AD: When you signed the Palau National
Marine Sanctuary Act into law, what impacts
did you expect?
TR: Eighty percent is the culmination of the
Micronesia Challenge we embarked on 10 years
ago. This initiative targeted 20 percent of our
reef and 30 percent of our terrestrial areas for
protection. At 20 percent we said, “Why not go
to 80 percent?” – and that’s where we are now.
Again, the benefits of a marine protected area
are not confined to that area: It is very effective
at repopulating other areas. Imagine the benefits if
every country had a sizable marine protected area?
AD: Another big challenge you face is
climate change.
TR: It’s on! Sea-level rise is a challenge we are
already dealing with. We have agricultural lands
that have been flooded by salt water, and low-
lying atoll communities threatened by the sea.
Global warming is contributing to unpredictable
storms, severe typhoons and more. We’re seeing
all of this here, and the only way to address
it is for the world community to begin to stop
contributing to the problem. Here in Palau we do
have some high areas, but the Marshall Islands,
for example, are all sandy atolls, and the people
there have no high ground to go to.
AD: I hear you’re a fisherman. What are your
other favourite ocean activities?
TR: Anything that has to do with the ocean is
a favourite activity of Palauans. Did you know
the most eligible bachelor in Palau is the good
fisherman? If you’re a good fisherman, you’ll
likely find a wife.
As an island boy, freediving and fishing, I
thought I knew what the ocean was all about.
But when you get into scuba, you really begin
to understand the world beneath the waves and
how the organisms depend on one another to
survive. I strongly encourage people to learn
how to scuba dive. When you really spend some
time down there, you can enjoy the underwater
beauty and learn how everything is connected.
Also, did you know nobody has been killed
by a shark in Palau? Not in our entire history. Remengesau confers with
then U.S. Secretary of State
That’s a fact we’re very proud of. Crocodiles – John Kerry during the Our
yes, there have been some unfortunate incidents Ocean conference at the State
Department in Washington, D.C.,
with crocodiles, but never with sharks. in June 2014
EPA/Jim Lo Scalzo
21
 Gear

OXYGEN
An essential piece of your dive gear
By Patty Seery

Oxygen has long been recognised as the

primary first aid for scuba diving injuries,
specifically decompression sickness (DCS) and
arterial gas embolism (AGE). Inhalation of high
concentration oxygen works by accelerating
the diffusion and elimination of the excess
nitrogen absorbed during diving, improving
circulation (thereby promoting reoxygenation of
tissues) and reducing swelling and associated
inflammatory responses. For oxygen first aid to
be most effective, the patient needs to breathe
100 percent oxygen delivered by a certified
oxygen provider at an appropriate flow rate and
with a good mask fit (see “Tips for Better Oxygen
Administration,” www.danap.org/DAN_diving_
safety/o2_admin_tips.php

A BRIEF HISTORY OF OXYGEN USE IN DIVING

FIRST AID
In 1878 French physiologist Paul Bert,
while treating compressed-air divers and
Stephen Frink

caisson workers, began using oxygen to relieve

Most cases of DCS occur in
people who were diving within
no-decompression limits. Having
oxygen available every time you
dive protects you in the unlikely
event of a DCS hit
symptoms of what is now recognised as DCS.
His experimental research on animals
corroborated his clinical findings, which led
him to be the first to propose using pressurised
oxygen to treat “caisson disease”. Despite
the fact that surface-pressure oxygen long
remained the only available treatment for
decompression, it was nearly a century before
its use became widespread.
In the early 1960s the expansion of
recreational scuba diving led to the use of
hyperbaric oxygen to treat dive injuries. It
was still another decade before oxygen was
recommended while transporting an injured
diver to medical care. The use of oxygen first
aid for diving injuries increased over the years,
but implementation was slow. A review of DAN
America dive accident data in 1987 revealed that
only 37 percent of injured divers received oxygen
first aid and that oxygen use in first aid actually
dropped between 1987 and 1990. To promote
oxygen use, DAN introduced the DAN Oxygen
First Aid Program in 1991, which has evolved
over the years as understanding of treatment
and equipment has grown.
DAN’S MISSION
In light of compelling evidence in favour of
oxygen first aid, one of DAN’s stated missions
is to ensure that oxygen first aid equipment and
people trained in its use are at every dive site,
which means dive instructors and even divers
may need to own their own oxygen units, which
they care for and maintain.
STORAGE AND MAINTENANCE OF OXYGEN
EQUIPMENT
• Oxygen units should be stored assembled
but depressurised in protective cases. This
ensures the equipment is ready to use and
protects it not only from damage but also from
exposure to oils and grease, which increases
the risk of fire.
• To further reduce the fire hazard, the
equipment should also be kept away from
open flames, people smoking or other sources
of ignition.
• Oxygen units should not be exposed to
temperatures higher than 50°C, so they
should not be stored in motorised vehicles on
hot days.
• When transporting units to and from dive sites,
the equipment should be secured such that it
will not fall or roll.
• Note that oxygen cylinders are required to
undergo hydrostatic testing, usually every
one to five years, depending on the country
However, if they have been submerged

22

or exposed to high temperatures, earlier
visual inspection and likely hydrostatic testing
is required, depending on the circumstances.
• The standard procedure for oxygen-regulator
maintenance involves service every two years
or as the manufacturer recommends.
However, if the regulator is obviously in poor
condition (e.g., evidence of substantial
corrosion), earlier inspection is required.
• Along with the regulator service, check the
oxygen washer to ensure it is free of cracks,
dirt, grease and oil. If any of these are
present, change the washer. When reseating
the regulator, confirm that the pins are aligned
with the oxygen tank valve, and test for leaks
by turning on the system. As always,
remember to depressurise the system
before storing it. Keep spare washers as they
are cheap and the equipment is useless
without them.
• Service the oxygen-delivery mechanism
(demand valve or manually triggered ventilator
[MTV]) every two years or as recommended
by the manufacturer (earlier if indicated as
mentioned above). Correct operation
is particularly important with triggered
resuscitators to ensure the flow-rates and
pressure relief valve setting are correct.
• In addition, test MTVs and verify their function
before each use. Test the demand valve by
inhaling through the mask and exhaling
away from it. Check the MTV by depressing the
activation button then covering the ventilation
outlet with the palm of your hand. It should
automatically shut off. If it doesn’t, don’t use it,
and send it in for servicing.
• Visually check hoses and tubes for cracks
or stress marks before each outing and when
the system is serviced. Replace these
as necessary.
• Finally, inspect masks for cleanliness and
signs of age and substantial deformation.
Eric Douglas
Gear
FILLING OXYGEN CYLINDERS
The requirements that must be met for filling
of oxygen cylinders varies throughout the
Asia- Pacific region and checking with local
fillers regarding these requirements is
recommended. Generally, one of the following
conditions must be met: (i) with a prescription,
and (ii) with documentation of training (must
be current). In areas where a prescription
is required local doctors will need to be
consulted and some may be reluctant to issue a
prescription for a medical condition that has not
yet occurred. Documentation of training could
include a copy of your certificate for DAN Oxygen
First Aid in Dive Accidents or similar training.
The new Oxygen First
(You can read more about this course at Aid for Divers book is
http://danap.org/training/oxygen_provision.php). now available! John
Lippmann’s classic text
However, with the availability of oxygen for nitrox about oxygen first aid
and other enriched mix diving, many operators has been revised to focus
on safely and effectively
decant oxygen from larger cylinders. However, providing oxygen to injured
the safety of this process can be variable. or ill divers. Available from
DAN AP
AFTER EACH USE, CLEAN THE SYSTEM USING
THE FOLLOWING PROCEDURE:
• Wipe down the cylinder and hoses to remove
sand or dirt.
• Disassemble the demand valve or MTV.
• Rinse the appropriate parts in cold,
flowing water.
• Soak the appropriate parts in a mild bleach
solution for 10 minutes, rinse with fresh water,
and allow to air dry.
• Do the same with the oronasal resuscitation
mask, but discard the one-way valve if it has
been used.
• When all parts are dry, place a new one-way
valve (if necessary) on the oronasal mask,
reassemble the system, and store it in its
protective case.
• Non-rebreather masks and bag-valve masks
are single-use items and should be discarded
after use.
To Learn More
For detailed information
and hands-on practice,
sign up for a DAN Oxygen
First Aid in Dive Accidents
course (http://danap.org/
training/oxygen_provision.
php).
23
 HERE’S WHAT YOU’RE MISSING IN THIS ISSUE OF
SCUBA DIVER AUSTRALASIA
Scuba Diver Scuba Diver AUSTRALASIA is one of the most well
AUSTRALASIA respected dive magazines, full of mind-blowing images
from the world’s best photojournalists, the low-down
is the official on the newest dive equipment, the most exciting
media partner of destinations, stories from the world of science and
conservation, and much, much more!
DAN Asia-Pacific.

FROM THE EDITOR

To travel well is to discover more than the physical nature of the places you
visit: If you let them, journeys can change you, altering how you see the world,
and your place in it.
Being able to venture out to see our liquid planet in person, and meet the
animals we share it with, is such a privilege. For many it is also a humbling
experience, one that can help us to realise that we are part of a stunning, living
tapestry, an interconnected web.
This ocean world is inhabited by extraordinary beings that also traverse

14
incredible distances. Exactly how they all do it remains a mystery, though, every
day, we are discovering more about the why. And the more we learn, the more
extraordinary these creatures are revealed to be, and the more we discover the
ways that human activities are impacting their lives and migrations.
As you travel through these pages, I hope you will be inspired to join us
ADEX 2017
in the ongoing journey towards a more sustainable world, in which the future Taking the dive show to another level, this
of our fellow life forms – and our own – is more secure. Never forget that was an event that the world is going to be
wherever we go, places will change us, but we will also leave a mark. Let’s let talking about for a long time yet!

40
that mark be a positive one.

DIVING MAKES
A DIFFERENCE
By Various Contributors
www.uw360.asia/SD
On the cover
Green kelp reaches towards Proving that the scuba diving industry can
the blue water’s surface in be harnessed as a force in the fight to
California’s Channel Islands save the oceans, meet the four inspiring
marine protected area winners of the first annual BlueGreen360
Image ©️ Antonio Busiello
Awards!

DEC FEB MAY AUG NOV

THROUGH THE LENS
Collectors’ Edition

ONE OCEAN, ONE LOVE

ONE OCEAN, ONE LOVE

ONE OCEAN, ONE LOVE

ONE OCEAN, ONE LOVE

a

sealife wow
28 Sea Sponges 38 Wild About Life
Ernest H. Brooks II

An animal that rarely gets Tracking the steady erosion of

the recognition it deserves: an iconic dive site in the heart of
Sponges are revealed as the Coral Triangle proves how
the super-critters they are – vital it is for divers to step up to
filtering the water to keep the make a difference
oceans healthy!
82
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No.108 Issue 2/2017

BLUE & GREEN EDI T ION

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