PADI Rescue Diver Manual (PDFDrive)

RESCUE DIVER Manual
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DI 2011 307PDE13
PADI
Rescue Diver
Manual
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PADI
Rescue Diver Manual
© PADI 2011
No part of this product may be reproduced, sold or distributed in any form without
the written permission of the publisher.
® indicates a trademark is registered in the U.S. and certain other countries.
Published by PADI
30151 Tomas
Rancho Santa Margarita, CA 92688-2125 USA
ISBN 978-1-878663-09-2
Printed in Canada
Product No. 79102 (Rev. 02/13) Version 3.07
2
Acknowledgments
Editor in Chief
Drew Richardson, Ed.D.
Instructional Design, Development, Consultation and Review

Drew Richardson,Ed.D., Lesley Alexander, Ph.D., Al Hornsby,
Julie Taylor Sanders, Karl Shreeves, Robert Wohlers, Eric Albinsson
International Review and Consultation

Henrick Nimb, PADI Asia Pacific; Pascal Dietrich, PADI Europe; Takayuki
Miyashita and Yasushi Inoue, PADI Japan; Trond Skaare and Hans Olsson,
PADI Nordic; Suzanne Pleydell and Mark Caney, PADI International Ltd.;
Associate Professor Simon J. Mitchel, MB ChB, PhD, DipDHM, DipOccMed,
CertDHM (ANZCA), FANZCA
Design and Production

Joy Zuehls, Dail Schroeder, Kristen Core
Illustrations
Greg Beatty, Joe De La Torre
Photography
Al Hornsby, Karl Shreeves, Robert Wohlers
Reference Sources
1. Emergency Care and Transportation of the Sick and Injured. Fourth Edition, 1987,
American Academy of Orthopedic Surgeons.
2. The Physiology and Medicine of Diving. Fourth Edition, 1993, Editors Peter Bennett
and David H. Elliott, W.B. Saunders Company, Ltd.
3. Divers Alert Network, 1991 Underwater Diving Accident Manual.
Duke University.
4. Oxygen First Aid for Divers. 1992, John Lippmann, J.L. Publications.
5. Patient Care Standards – The PADI Rescue Diver Course follows emer-
gency considerations and protocols from the consensus view of the Basic
Life Support (BLS) Working Group of the International Liaison Committee
on Resuscitation (ILCOR). ILCOR is an international standards group rep-
resenting many of the world’s major resuscitation organizations. A source
authority for the development on content material in the PADI Rescue Diver
Course program is Guidelines 2005 for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care, International Consensus on Science,
Circulation, 2005; 112:IV-1-IV-5; ©2005 American Heart Association,® Inc.
6. Emergency First Response Participant Manual,© Emergency First Response®, Corp.
2007.
3
4 PADI Rescue Diver Manual
Contents
Introduction 7 Chapter Three 113
Course Overview 10 The Psychology of Rescue III 115
Course Philosophy 11 Being Prepared for a Diver Emergency III 119
How to Use This Manual 13 Accident Management III 122

Thermal Problems 126
Chapter One 15 Responding to Diver Emergencies III 129
The Psychology of Rescue I 16 Missing Diver Procedures 135
Recognizing Diver Stress 19
Being Prepared for a Diver Emergency I 25 Chapter Four 145
Emergency Oxygen Delivery Systems 29 The Psychology of Rescue IV 146
Automated External Defibrillators (AEDs) 33 Being Prepared for a Diver 148

Emergency IV
Accident Management I 35
Accident Management IV 154
Responding to Diver Emergencies I 46
Near Drowning 156
Nonswimming Assists and Rescues 52
Responding to Diver Emergencies IV 158
Assisting the Responsive Diver at 55
the Surface Inwater Rescue Breathing Techniques 161
Unresponsive Diver Underwater 166

Chapter Two 65 Equipment Removal 169
The Psychology of Rescue II 66
Being Prepared for a Diver Emergency II 70 Chapter Five 177
Common Equipment Problems 83 The Psychology of Rescue V 178
Release Function and Problems 87 Being Prepared for a Diver Emergency V 181
Accident Management II 91 Accident Management V 187
Responding to Diver Emergencies II 96 Responding to Diver Emergencies V 189
Exits with a Responsive Diver 102
Post Attendance 106 Appendix / Index 201
5
Introduction
It’s been a great, long,

shallow dive on a reef
so beautiful, you ran
out of film half an
hour before. You and
a group of eight divers
ascend a short swim
from the charter boat;
no sooner do you break
the surface, when
someone in the group
shouts, “Ow! My leg.”
You turn to see a diver
about 3 metres/10 feet
away grimacing, grab-
bing his calf, confirm-
ing your instinctive suspicion: leg cramp. For a second, you pause, sizing
up the situation: no immediate danger, but the diver has no regulator or
snorkel in his mouth, and his BCD is empty. He’s kicking with one leg
to stay at the surface while he massages his calf.
You hand your camera to your buddy, and with three strong kicks, reach
the diver.
“Let me help you. Are you okay?” you ask.
“Leg cramp,” the diver puffs, breathing hard as he fights to keep his
head out of the water.
Introduction 7
“Relax. Is this better?” you ask, inflating his BCD.
“Yeah, thanks.”
“Put your foot on my chest,” you suggest. The diver does, and you mas-
sage his calf, helping him stretch the muscle. “How’s that?”
“Much better, thanks,” he says, lying back to relax.
“Good.” With that, you grasp him gently under his arm and begin to
push him toward the dive boat.
“I think I can swim back now,” the diver says when you’re about half
way to the boat.
“Okay,” you say, “but if you start to
cramp again, just say so. It’s no big
deal to give you a ride.”
“Thanks.”
The diver makes it back under his
own power. Later, he pauses to
thank you for your help.
“Well, I didn’t really do much, but
you’re welcome. I’ve had leg cramps
myself, and I knew it’s easier to
relieve them if someone holds your
foot,” you reply, “And, by the way,
that was smart to ask for a hand.
Sometimes people won’t ask for help
until they’re in serious trouble.”

T
he previous situation typifies the most common assist
divers encounter. At first glance, it might not look like
it takes any more knowledge and training than when
you learned how to assist a tired diver as a PADI
Open Water Diver. However, the skills of a rescue diver may be
subtle, and it’s worth looking closer:
First, you (the rescuer) were mentally and physically prepared
to handle the matter. Then, you accurately assessed the situation,
noting that because the diver wasn’t buoyant and wasn’t breathing
from his regulator or snorkel, if you didn’t intervene, the problem
could potentially become more serious. Next, you acted decisively
and correctly, first preventing the situation from becoming worse,
and then to relieve the diver’s immedi-
ate difficulty (the cramp). Finally, once
aboard, you delicately managed the
diver’s feelings by reinforcing the deci-
sion to ask for help and by not acting
like a hero at his expense. These are
all principles and techniques that you’ll
learn and master as you become certi-
fied as a PADI Rescue Diver.
When you first learned to dive in
the PADI Open Water Diver course,
you focused primarily on yourself and
mastered knowledge and skills for tak-
ing care of yourself underwater. In the
Adventures in Diving program, your
focus broadened to include the envi-
ronment in a variety of situations. In the Most certified PADI Rescue
PADI Rescue Diver course, you’re about to enter the next stage, in Divers look back on their rescue
training as one of the most chal-
which your focus broadens further to include other divers. lenging
The PADI Rescue Diver program prepares you to help pre- – sometimes demanding – and
therefore most rewarding pro-
vent, and if necessary, manage dive emergencies, minor and grams they’ve taken.
major, with a variety of techniques. What you’re about to learn will The subject is serious, but the
training is fun.
improve your skill and confidence as a diver, and prepare you to
move on to the PADI Master Scuba Diver and PADI Divemaster
levels. Most certified PADI Rescue Divers look back on their res-
cue training as one of the most challenging – sometimes demand-
ing – and therefore most rewarding programs they’ve taken. The
subject is serious, but the training is fun.
Introduction 9
Course Overview
The PADI Rescue Diver course consists of three segments: knowl-
edge development, rescue training exercises and open water
rescue scenarios. Knowledge development provides you with the
principles, theories and concepts that you’ll apply in the course.
You’ll accomplish knowledge development by reading this manual,
watching the PADI Rescue Diver Video and completing the knowledge
reviews at the end of each chapter on your own.
Your instructor will check over your knowledge reviews and
discuss what you’ve studied in short briefings or classroom ses-
sions. You’ll take a comprehensive examination after you’ve com-
pleted the five knowledge development sections.
During the rescue training exercises,
you’ll apply what you’ve been studying as
you develop and practice rescue skills in
a pool or confined water site, or in open
water in good conditions. Each rescue
training exercise begins by introducing new
skills. After you demonstrate capability with
the new skill, your instructor will integrate
them with what you’ve already learned
by running numerous practice drills that
simulate different conditions and situations.
This teaches you to think before you act,
and to adapt what you’ve learned to the
variables of each situation, such as your
physical attributes, the victim’s size, the
environment and conditions, and so on.
After you’ve successfully completed
the knowledge development and rescue
training exercise portions of the course,
you’ll be ready for the open water rescue
scenarios. The scenarios take place at one
or more open water dive sites typical of your local environment.
Each scenario simulates aspects of an emergency similar to what
you could actually face in the local environment. Your instructor
will try to make the situation as realistic as possible, giving you the
opportunity to apply what you’ve learned in realistic circumstances.
After you’ve successfully completed the scenarios (which usually
take place over one or two days), you’ll have earned the PADI
Rescue Diver certification.

Course Philosophy
As you go through the PADI Rescue Diver course,
you’ll discover that there’s not really any one right
way to assist or rescue someone. Anything that
does the job as best as reasonably and humanly
possible is right. The course philosophy is to equip
you with knowledge and skills that you can draw
upon and apply depending upon the circumstances.
The only one right thing that applies to
any rescue is that you must think, then IMPORTANT
act. Throughout the rescue you con-
While you can learn many aspects of
stantly think, revising your plans and rescue by reading the PADI Rescue Diver
actions based upon what happens. Manual and by watching the PADI Rescue
You and a fellow student diver may Diver Video, nothing replaces actual train-
handle, for example, a panicked diver ing from a qualified PADI Instructor.
with somewhat different techniques – Practicing rescue techniques without
and both be sufficiently effective. the proper supervision can create haz-
ardous situations. See your local PADI
Instructor, Dive Center or Resort if you
Chapter Rescue have not yet enrolled in a PADI Rescue

Diver course.
Scenarios
Each chapter begins with a res-
cue scenario. As you read through the chapter, apply what
you’re learning by thinking about what resources you’d like to
have in each situation, and how you might have handled it.
At the end of each chapter, you’ll find the outcome to each,
with an analysis of what went well, what didn’t and how a
similar accident could be avoided in the future.
PROVIDE COURSE FEEDBACK

PADI Course Evaluation Questionnaires (CEQs) are student surveys
that are used to recognize outstanding performance and to verify that all
training elements were included in every course. PADI distributes these
CEQs to a portion of each PADI Instructor’s students via email or paper.
Student CEQs are powerful tools used by PADI to ensure thorough
training has occurred. If you receive one, help PADI maintain the highest
standards in diving by taking a few moments to complete it. After you
receive your certification card, and if you have not received a CEQ, you
can have one sent electronically by contacting your PADI Office.
Introduction 11
Getting the Most from the
PADI Rescue Diver Video
The companion video to this program is the PADI Rescue Diver
Video, which shows you the rescue techniques you’ll read
about here and practice with your PADI Instructor. Studying
with the video enhances learning because you’ll see role
model demonstrations of techniques, with emphasis on
key areas as needed. You can also slow down, rewind and
rewatch sections as necessary.
You’ll find the video speeds learning whether you watch
it first, then read this manual, or vice versa. The following
method represents an optimum study method, but people dif-
fer in how they learn. As long as you integrate manual and
video study, feel free to use a different approach if it suits
you better:
Begin by watching the video in a comfortable area,
such as your living room. The idea is to get an overview
of what you’ll be learning, both in this manual and during
your training exercises. Stop the tape and take a break
periodically.
Next, read this manual in sections as directed by your
instructor. Be sure to highlight/underline study objective
material, answer the exercises and complete the knowledge
review. As you do so, you’ll recognize the principles and phi-
losophies behind the techniques you saw in the video, with
some of the detail now enhanced.
Rewatch the corresponding portion of the video. After
reading the manual, you’ll comprehend more detail from what
you see, and what you’ve learned will be refreshed and rein-
forced. This best prepares you for the training exercise.
Finally, rewatch the PADI Rescue Diver Video periodically
after you’ve completed the course. This is an effective way to
keep your rescue knowledge refreshed, and a good review
prior to practicing rescue techniques to keep them current.

How to Use This Manual
The PADI Rescue Diver Manual is an interactive book that doesn’t
simply present the material, but directs your attention to what you
need to learn and then guides you in assessing your progress as
you go. By taking advantage of the manual’s instructional design,
you’ll learn the material faster and retain it longer.
Begin by reading in the right environment, namely, some
place free of distractions where you can pay attention to what
you’re reading. Preview the section you’ll be reading by skimming
through it noting the subheads, photos and captions and sidebars.
What you’re doing is creating a mental framework that your brain
will use to hang information on as you read for detail.
Return to the section beginning. You’ll notice Study
Objectives stated as questions, which appear throughout the text.
Read these first, then look for the answers as you go through the
material. As you find the Study Objective answers, underline or
highlight the text in the manual. It’s important that you actually write in
your manual, since the physical process of doing so reinforces what
you’re learning. (It’ll also make it easier when you review for the
examination.)
At the end of each subsection, you’ll find a short exercise to
check your learning and to help you master the material. Answer
the questions, again actually marking in your manual, then check
your answers to see how you did. If you missed something, go
back to the related material and reread it until you understand
where you went wrong.
When you reach the end of each chapter, you’ll find the chap-
ter’s knowledge review. Complete the review (use extra paper if
you like) and tear it out of the manual to turn in to your instructor.
If you don’t understand or remember something when completing
the knowledge review, go back and look it up. If you still don’t get
it, be sure to ask your instructor.
Realize that it’s imperative that you read each
chapter, complete the exercises and fill out the knowl-
edge reviews as scheduled by your instructor. What you
learn here applies to what you practice in the corresponding res-
cue training exercise; you may not participate in the rescue train-
ing exercise until you’ve successfully completed the knowledge
development. Failure to meet your responsibility to study indepen-
dently may delay or interrupt your training.
Introduction 13
Chapter One
“Low on air,” Thomas signaled his buddy, Jacques. “Okay,” Jacques

signaled back, followed reluctantly by, “Up.”
Jacques’ reluctance came from the fact that they were surfacing away
from the boat with a strong current running. For the past 15 minutes,
they’d tried unsuccessfully to relocate the anchor line before they ran too
low on air to continue.
On reaching the surface, Jacques and Thomas found themselves well
away from the boat and directly off the starboard. Despite the long trail
line, it would take a hard swim fighting
the current to reach the boat.
With Jacques leading, both divers started
swimming at an angle to the boat, fight-
ing the current and swimming across it at
the same time. The divemaster on board
spotted the divers and signaled, “Okay?”
Jacques signaled “Okay!” back. The two
swam on, with Jacques periodically looking
back to check on Thomas and signaling
“Okay!” to the divemaster.
Unknown to Jacques, Thomas was growing very tired. Although Jacques
was checking on Thomas regularly, Thomas couldn’t signal that he was
getting exhausted as he used his arms as well as his fins to fight the cur-
rent. Combined with this, the chop was breaking over his snorkel, so
he wasn’t able to breathe effectively. As they struggled toward the boat,
Thomas grew weaker, choking on more and more water as time went by.
Chapter One 15
B
ecoming a PADI Rescue Diver begins with learning to
think like a rescuer. Chapter One begins this process
by answering the common – but critical – question,
“What causes diver emergencies?” From there you’ll
learn the three things that you do in your head when trouble arises
before you do anything else, and you’ll learn about stress – what it
is, when it’s good and when it causes problems. The chapter also
introduces you to equipment used in diver emergencies, followed
by a look at your possible roles at an accident scene. As you’ll
see, that will depend on the nature of the emergency and who else
is present.
You’ll also get into some skills and techniques relating to rescuing
responsive divers at the surface. These skills are among those
you’ll practice during the first three Rescue Training Exercises.
The Psychology
of Rescue I
Highlight/underline the The Cause of Diver
Emergencies
answers to the follow-
ing questions as you
read: There’s no denying that diving takes us into a potentially
1. What is the most hazardous environment. We can’t breathe water, so there’s
common cause of some risk from relying on a mechanical device to supply air.
diver emergencies? Potentially harmful organisms make their homes in some
2. What three things aquatic environments, creating risks. Currents and waves
should you consider can overpower human beings, carrying them away from
before attempting safety or into hazardous areas, creating risk. Diving enjoys
an inwater rescue
an enviable safety record, but one must accept that trouble
of someone in the
water? can arise at any time due to a myriad of conditions ranging
from a diver’s undiagnosed medical conditions to unfore-
seeable mechanical malfunction. Divers get into trouble
because they either fail to foresee a potential hazard or
variable, or they foresee it, but fail to act accordingly.
The most common cause of diver emergencies is poor judg-
ment. The majority of diver accidents are actually preventable; you
can trace most of them back to a poor decision that begins a
series of events that culminates in trouble. Remember that plan-

ning a dive is partly a risk assessment; the divers considering the
potential hazards and how to handle them. Failure to use good
judgment in determining potential hazards or in response to identi-
fied hazards sets the stage for emergencies.
Poor judgment includes participating in an activity beyond a
vdiver’s training or experience, like entering a cave
without cave diver certification. Poor decisions dur-
ing a dive, such as disregarding a rising current
or continuing a dive with what seems like a trivial
equipment malfunction, can also lead to an emer-
gency. Before a dive, it’s poor judgment to skip
equipment safety checks or basic dive planning,
both of which help prevent accidents.
As a PADI Rescue Diver, learning to notice
poor decisions others make gives you the oppor-
tunity to prevent accidents. While you can’t be
responsible for what other people do, you can tact-
fully raise questions about whether there might be
a better choice. If you’re part of the buddy team, you
can always use good judgment and abort or adjust
a dive, even if a dive partner is willing to, for exam-
ple, continue the dive with a leaking low pressure
inflator. At the very least, being aware of a bad deci-
sion allows you to mentally prepare for the problem Before you do anything, consider whether you need to
that may result. enter the water at all, whether you have the equipment
and training necessary for your safety and the victim’s
In the aftermath of an accident or close call,
safety and whether you reasonably expect to accomplish
there’s wisdom in trying to determine what caused the rescue without getting into trouble yourself.
or almost caused it. Perhaps the most important rea-
son is so that you don’t make the same mistake, or
repeat your own.
Three Considerations Before

Attempting a Rescue
When someone gets into trouble, the immediate urge for most
people is to do something. Some people freeze, paralyzed by
indecision and not knowing what to do, while others act instinc-
tively based on the first thing that pops into their minds. Knowing
how to help others is important because it eliminates the first reac-
tion. But, you need to avoid jumping to help without forethought,
because it’s crucial that you protect yourself first. We’ll get more into
this shortly, but realize that this is as much for the victim’s benefit
as your own.
Chapter One 17
Before you do anything, consider these three points in this order:
1. Assuming you’re not already in the water near the victim, do
you need to enter the water at all? It’s always better to reach
the person, extend something, throw flotation or go in a small
boat or watercraft than to jump into the water to help.
2. Assuming inwater rescue is required, in the context of the situ-

ation, do you have the equipment and training necessary for
your safety and the victim’s safety? Being a properly equipped
PADI Rescue Diver doesn’t mean you can always answer
“yes.” For example, if the emergency is someone lost in an
underwater cave, unless you’re a trained and certified cave
diver, and have your cave equipment with you, the answer is a
solid “no.”
3. Assuming inwater rescue is required, can you reasonably

expect to accomplish the rescue without getting into trouble
yourself? It’s reasonable to accept some risk beyond what you
might ordinarily to give help (this is a personal decision you’ll
have to make), but if you’re not likely to be able to help by
attempting a rescue, then don’t. For example, suppose there’s
a panicked diver who’s significantly stronger and larger than
you – so much so that despite whatever technique you use,
the most likely outcome would be that the victim would over-
power you and put you in significant peril. In this instance, you
should not attempt the rescue – at least not while the danger
exists. It may be better to ask a large, strong qualified person
to go instead, if willing, for example.
Note that when an emergency arises, the first things you should
do are stop and think. We’ll come back to this.
Exercise 1-1
1. The most common cause of diver emergencies is:

□ a. hazardous marine life □ c. equipment failure
□ b. poor judgment □ d. bad dive planning
2. The first thing to consider before attempting an inwater rescue
is how fast you should swim.
□ True □ False
How did you do?
1. b. 2. False. The first thing you should consider is whether you need to get in
the water at all.

Recognizing
Diver Stress
In most emergencies, you’ll find that stress is either a con- Highlight/underline the
tributor or a direct cause. Stress is defined as physical or answers to the fol-
lowing questions as
mental tension that results in physical, chemical and/or
you read:
emotional (psychological) changes in the body. It can cause
both positive and negative reactions; a degree of stress 1. What is diver stress?
causes biochemical changes that temporarily make you 2. What are seven
stronger, think faster and more pain tolerant. But excessive causes and exam-
stress can cause you to flee when confronted by something ples of physical
stress?
frightening, or overwhelm you emotionally so that you can-
not handle the situation rationally. 3. What are three
The ingredients and examples of psycho-
logical (emotional)
sequence for stress start with
stress caused by
the initial cause, which can be physical stress?
an incident, a thought, an image,
4. What are four
fear or perception. Next, the
causes of psycholog-
diver’s disposition to the stressor ical stress other than
affects the perception that it gen- physical stress?
erates – does the diver see it as
5. What is perceptual
a major or minor concern? Is it a narrowing?
challenge or a problem? Finally,
6. What effects can
how stress will affect subsequent
stress produce in a
behavior depends on how the diver?
diver deals with it. If the diver
handles the stressor in a healthy
manner, then the stress will not likely
affect subsequent behavior. Healthy
responses include employing specific
techniques to eliminate the stressor, rec-
ognizing the stressor as trivial (if it really
Stress is defined as physical or mental tension that
results in physical, chemical and/or emotional (psycho-
is) or canceling the dive if nothing else
logical) changes in the body. eliminates the threat.
Problematic responses include
denial or rationalization and continuing the dive, magnifying a fear
through worry, all the way to the worst case, panic, which is blind,
instinctive reaction. A problematic response can be latent, such
as fearing a specific potential event such as seeing a shark. If the
diver makes the dive without seeing a shark, the stressor may
Chapter One 19
have little effect beyond distracting the diver. But, if a shark shows
up, the occurrence of the diver’s fear may overwhelm the individu-
al and cause a panicked response, even if the shark does not act
in a threatening or aggressive manner.
Physical Stress. Physical stressors are those that affect

the body, causing discomfort, loss of strength and other effects.
Even minor annoyances can cause stress, and if left uncorrected,
lead to more serious problems. Common physical stress causes
include:
• Cold and heat • Seasickness
• Nitrogen narcosis • Fatigue
• Illness or injury • Alcohol or drugs
• Discomfort or impaired function caused by ill fitted or
malfunctioning equipment
Whether any of these cause significant stress depends on the
diver’s condition, how extreme the stress and how long the diver
must endure it. For instance, standing in the hot sun in a full dry
suit, given enough time, will cause almost anyone to suffer heat
exhaustion. A diver who’s in good fitness can probably tolerate
that amount of heat stress for quite awhile; an overweight individu-
al with poor fitness probably much less, especially if dehydrated to
start. What’s stressful one day may not be the next, such as a long
swim after a sleepless night versus one after adequate rest.
Physical stress can also be subtle. A leaky mask can be an
annoying distraction that’s not really a problem itself, but leads to
a problem if it distracts the diver from safety tasks, such as ade-
quately monitoring depth and air supply.
There’s no way to eliminate many of the potential physical
stress causes in a dive environment: cold, the walk to the beach,
a rolling boat, a long surface swim to the dive site. Preventing
stress, therefore, lies with the diver, who, for example, wears
proper exposure protection, maintains physical fitness, takes anti-
seasickness medications (if necessary), or makes a long surface
swim at a relaxed pace, respectively. If conditions exist beyond the
diver’s physical ability to cope, the diver should cancel the dive.
However, as a PADI Rescue Diver, realize that divers – including
you – may not perceive that they’re pushing or exceeding their
physical limits until excessive stress has already begun. The pri-
mary danger with physical stress, therefore, is failing to recognize
its effects.

Psychological Stress. Psychological stress is stress due
to the diver’s reaction to perceived “threats” in the environment,
including perceived causes of actual bodily harm, and “threats” to
self esteem. The diver’s beliefs and attitudes play a major role in
psychological stress, so the stressor may be imagined or real.
Psychological stress often results from physical stress. For
example, fatigue or being tired can trigger psychological stress
if the diver fears being unable to make it safely to boat or shore.
An overexerting diver can feel air starved and fear that the regu-
lator can’t deliver enough air. A task loaded diver who’s faced
with more physical tasks to manage than the person is physically
capable of may feel overwhelmed, unable to control the situation,
including preserving personal safety.
Handling Peer Pressure

Logically speaking, few if any divers would rather have an
accident than lose face or be embarrassed among their
peers. Yet on an emotional level, peer pressure can be pow-
erful, sometimes leading people to do things that they other-
wise wouldn’t. Among divers, this can lead to accidents. As a
Rescue Diver, you can help prevent this by setting a good
example. If you don’t feel comfortable
making a dive, say so and don’t make the
dive. This shows others that there’s no
shame in being a smart, careful diver.
Some dive communities, especially
cave divers, apply the following guideline:
Any diver can end any dive at any time
for any reason with no explanation. When
you accept this, peer pressure goes the
other way – it pressures divers to speak up
when they don’t feel good about a dive. Adopting this guide-
line turns peer pressure into a positive force that helps
diver safety.
Finally, although a diver shouldn’t let peer pressure be
a factor, if the need to save face could overwhelm good judg-
ment, an easy way to cancel or abort a dive without embar-
rassment is to signal or say, “I can’t equalize.” After all, who
but the diver really knows?
Chapter One 21
However, threats don’t have to be physical, logical or real.
Any perception that something threatens a diver’s well being will
cause psychological stress. We just discussed physical causes;
psychological causes include an individual’s beliefs and
attitudes about a dive. Stress can arise if a diver believes,
for example, that despite a risk the dive is too expensive
(money or time taken to get there) to miss, creating inter-
nal pressures to dive despite misgivings about it.
Another psychological stressor is mental task load-
ing – trying to pay attention to too many variables at once,
leaving the diver fearing the inability to keep up and man-
age the situation. Peer pressure creates
psychological pressure through a threat to
self image, so that a diver may fear look-
ing like a coward, and thereby feel pres-
sured to make the dive despite concerns
about it. Psychological stress can arise in
any circumstance in which the diver per-
ceives the risk to be greater than normal
or expected, or more specifically, if the
diver perceives that potential hazards are
beyond the diver’s ability to reasonably
manage. As mentioned, psychological
stress stimuli can be real or imagined, but
either way, the resulting stress is very real
to the diver experiencing it. With the perception of a threat, the
body responds with physiological and behavioral changes to deal
with the threat. As it prepares for emergency action, the adrenal
gland releases epinephrine (a.k.a. adrenaline), which increases
breathing and heart rate. While this is a useful response in normal
circumstances, for the unaware diver underwater this can contrib-
Stress Response Cycle ute to rapid, shallow breathing and the symptoms of overexertion
Chart
and air starvation.
As stress rises, the diver may experience perceptual narrowing,
which is a decrease in broad awareness through close focus on a
perceived threat or the solution to that threat. Again, to a degree
this is a good thing, giving the individual intense concentration in
dealing with an problem. However beyond a point, perceptual nar-
rowing becomes a negative. If the diver fixates on something that’s
not the true cause of the problem, or on a solution that doesn’t
work, perceptual narrowing may reduce the ability to look for the
real problem or alternative solutions, or to perceive other problems

arising. In the panicked diver, perceptual narrowing may be so
extreme that the individual will not hear directions, will not recog-
nize attempts to help and will put all energy into a single, ineffec-
tive solution.
Let’s look at the effects stress can produce in a diver by look-
ing at the stress response cycle. As you know, when a problem or
perceived problem (threat) arises, the diver feels stress. The stress
evokes both physical and psychological responses. At this point,
the diver’s disposition will affect the cycle. If the diver reacts with
problem recognition and confidence that the problem can be man-
aged, the individual engages in solution thinking and takes steps to
remove the threat, or to be prepared if the threat manifests itself.
Anxiety falls. If the diver fails to react with solution thinking, or the
reaction fails to solve the problem, anxiety increases, and so does
stress. What happens next often depends on the diver’s training
and experience.
If the diver’s reaction doesn’t remove the threat, and the
diver feels unable to correct the problem (response unavailabil-
ity), the result is likely to be sudden, unreasoned instinctive panic.
Underwater, the diver’s breathing rate may lead to a feeling of air
starvation or suffocation. At the surface, the diver may spit out the
regulator, push off the mask and fail to establish buoyancy, result-
ing in a struggle to keep the face above water to breathe, leading
to more stress and more physical responses to heightened anxiety.
The result is a vicious cycle of psychological and physical stress
that continues to raise anxiety, perceptual narrowing and fear of
lost control and the inability to escape the mounting threats. This
will almost always lead to exhaustion and collapse unless a res-
cuer intervenes. Besides active panic, as just described, the diver
may experience (though rarely) passive panic, becoming frozen,
trancelike and unaware. Although the outward behavior differs, the
internal psychological cycle is the same.
If the diver’s reaction does not solve the problem, but the
diver remains confident that the problem can be solved, panic will
be avoided. If the diver stops, thinks, controls breathing and then
takes alternative corrective action, panic is not immediately likely. If
perceptual narrowing does not close the door on solution thinking,
the diver continues to stop, breathe, think, and search for alterna-
tives. The diver may attempt more than one solution before finding
one that works, yet not panic.
Whether an individual will panic depends upon how much
threat and how much personal control to remedy the situation the
Chapter One 23
diver perceives. The more threat perceived and the more helpless
someone feels, the more likely the person will panic. Air supply
disruption, for example, is highly threatening, sudden, and must be
solved quickly, making panic more likely if there’s no immediate
perceived solution.
The less threat and the more control a diver perceives, the
less likely panic and the more likely solution thinking. A broken fin
strap, on the other hand, is much less likely to lead to panic, at
least initially. Training, staying within experience limits and person-
al disposition are the major factors for avoiding panic. A common
example is flooded masks – many beginners abruptly stand up
when they flood their masks for the first time even though there is
no real threat – only discomfort that they perceive as a threat. The
same individuals, following training and practice, swim extended
distances with no mask and without panic because they’ve learned
the discomfort isn’t threatening, and that they can clear their
masks at will. They perceive minimal threat and high control.
Exercise 1-2
1. Diver stress is:
□ a. the physical and psychological responses to a
perceived threat
□ b. always negative and to be avoided
□ c. the same thing as panic
□ d. None of the above.
2. Causes of physical stress include (check all that apply):
□ a. cold and heat □ c. task loading
□ b. peer pressure □ d. fatigue
3. Causes of psychological stress include (check all that apply):
□ a. cold and heat □ c. task loading
□ b. peer pressure □ d. fatigue
4. Perceptual narrowing is the tendency under stress to be less
broadly aware and more focused on a perceived threat and/or
solutions to that threat.
□ True □ False
5. The effects of stress on a diver can include (check all that apply):
□ a. anxiety □ c. perceptual narrowing
□ b. increased breathing □ d. panic
How did you do?
1. a. 2. a, d. 3. b, c. 4. True. 5. a, b, c, d.

Being Prepared for
a Diver Emergency I
First Aid Kits
The further your diving takes you from access to
emergency medical care, the more important it
is to take a well stocked first aid kit. As a PADI
Highlight/underline the Rescue Diver, you’ll want to be sure that there’s
a suitable first aid kit on hand, whether you bring
read: it yourself (as when shore diving) or whether
someone else provides it (as when diving from a
1. What supplies belong
charter dive boat).
in a well stocked first
aid kit and how are The easiest way to be sure there’s a first aid
they used? kit on site is to bring it yourself. If you already
have a good first aid kit, you only need a few
2. What is a pocket
mask? more items to convert it into one
especially suited to diving. If you
3. What are four advan-
don’t have a first aid kit, it doesn’t
tages of a pocket
mask? cost much to put one together – as
you’ll see from the following list.
You can also buy preassembled
diver first aid kits, though you may want to add
some items, depending upon where you dive. A first
aid kit lasts for years (with periodic replenishing, of
course), and can come in handy for nondiving emer-
gencies as well as diving emergencies.
Since you may need to store or deploy your
first aid kit in sand, sea spray and weather, pack it in
a durable noncorrosive, water resistant case. Plastic
tackle boxes and tool boxes work well; several man-
ufacturers sell preassembled kits for divers in heavy
duty, water resistant fabric cases. It’s likely the kit
will get dropped or knocked around from time to
time, so avoid putting glass or anything fragile in it.
Label your first aid kit and inform other divers
Store your first aid kit (and emergency oxygen system)
where you store it. This ensures that your com- where it’s easily accessible but out of the way. Be sure
panions can find it even if you’re underwater or not to let other divers know where to find it.
immediately present for some reason. Keep your kit
Chapter One 25
in full readiness by replacing used supplies and outdated medi-
cines as soon as possible.
In setting up your kit, keep in mind that you’ll use it for
the most common diving and nondiving injuries you’re likely to
encounter. Its contents are meant to manage minor problems –
like a small cut – or to stabilize a major one – like profuse bleeding
– until reaching medical care.
The easiest way to set up your first aid kit is to start with a
premade one – you’ll find many on the market – and then add to it
as necessary. A first kit will seldom have (or need) all of the follow-
ing, but consider the appropriateness of each in your kit:
• Latex or vinyl gloves, pocket mask with one way valve for rescue
breathing, ventilation barriers, eyeglasses/eye protection, face
mask – as you learned in your EFR® course (or other first aid
training), you use these to reduce the risk of infectious diseases,
and to reduce contact with blood, body fluids, mucus membranes,
wounds or burns.
• The Emergency First Response Participant Manual for ready access to first
aid information for common injuries or conditions.
• The PADI Accident Management Workslate to provide dive
accident specific management flow instructions and emergency
contact information (more about contact information later).
• A pad of paper or blank slate for recording what you observe and
the steps you take to help an injured person to provide to emer-
gency medical personnel.
• Include reference materials with first aid specific to aquatic life
injuries.
• Coins or phone card – so you can make a telephone call at a pay
phone.
• Cell phone with power adapter – so you’re not limited by the
phone’s battery.
• Large absorbent dressings (various sizes) – used to help stop
bleeding.
• Sterile gauze pads (various sizes) – used to help stop bleeding
and dress wounds.
• Clinging rolled bandages (various sizes) – used to dress wounds.
• Adhesive bandages (various sizes) – used to dress wounds.
• Adhesive tape – used to dress wounds.
• Nonadherent, dry pads – used to dress burn wounds.
• Triangular bandages – used to immobilize dislocations and fractures.
• Sterile cotton – used to dress wounds.

• Cotton tipped swabs – used to clean wounds.
• Bandage scissors – used to cut bandages and dive apparel.
• Tongue depressors – to check vital signs during illness assess-
ment and can be used as splinting material for finger dislocations
and fractures.
• Tweezers – to assist in removing material.
• Needle – to assist in removing foreign material.
• Safety pins – to attach and secure bandages.
• Penlight – for light and to use as an examination tool.
• Oral thermometer – to measure temperature as a vital sign.
• Squeeze bottle of water – for hydration and divers with heat
stroke, for burns, eye or wound wash.
• Splints – to immobilize dislocations and fractures.
• Emergency blanket – for warmth and to cover divers with shock.
• Cold packs – for bruises, muscle injuries, strains, eye injuries,
stings and dislocation and fractures.
• Hot packs – for venomous bites and stings.
• Vinegar – to neutralize stinging cells of jellyfish.
• Plastic bags – used to dispose of gloves and medical waste and
may also be used in lieu of actual gloves as a barrier.
• Small paper cups – for drinking and to cover
eye injuries.
• Denatured alcohol – for disinfectant (not to be
used on wounds).
• Antibacterial soap – to clean wounds.
• Antiseptic solution or wipes – for wounds.
• Antibiotic ointment – for wounds.
• Hydrocortisone ointment – for stings/irritations.
• Aspirin and nonaspirin pain relievers – to
reduce swelling and diver discomfort.
• Antihistamine tablets – for allergic reactions.
• Sugar packs, candy or fruit juice – for low blood
sugar.
• Activated charcoal – for poisoning. In setting up your kit, keep in mind that you’ll use it for the
• Anti nausea drugs – for reducing seasickness. most common diving and nondiving injuries you’re likely to
encounter. Its contents are meant to manage minor problems
• Nasal decongestant spray with physician’s – like a small cut – or to stabilize a major one – like profuse
approval – useful for divers with equalization bleeding – until reaching medical care.
difficulty.
• Sunscreens – to prevent sunburn.
Chapter One 27
Pocket Mask. In your Emergency First Response – CPR
course, you learned to use ventilation barriers to reduce disease
transmission risk when providing rescue breaths. Although
there are many types that work well, as you’ll see, the PADI
Rescue Diver course emphasizes the use of the pocket mask,
also called a resuscitator mask or CPR mask.
A pocket mask is simply a mask
specifically designed to facilitate rescue
breathing. It has four advantages. First, it
simplifies getting an effective seal and head
positioning. Second, it reduces worries about
disease transmission. Third, as you’ll see
for yourself during rescue training exercises
A pocket mask is designed
later in the course, it is one of the most effective
to facilitate rescue breathing.
It has four advantages. It ways to provide inwater rescue breathing for a non-
simplifies getting an effective breathing diver. Fourth, you can connect a pocket
seal and head positioning. It
reduces worries about disease mask to emergency oxygen to provide oxygenated
transmission and is one the air with your rescue breaths. It is so effective a tool
most effective devices for You can tether a pocket mask case to
inwater rescue breathing. You that you’ll want to consider carrying one as a regu-
the inside of your BCD pocket to reduce
can connect a pocket mask to lar part of your dive kit. You can tether the mask loss risk while having ready access to the
emergency oxygen to provide mask in an emergency.
oxygenated air with your res- case to the inside of a pocket to reduce loss risk
cue breaths. while having ready access in an emergency.
Exercise 1-3
1. A well stocked first aid kit is intended to help manage small
problems, and to stabilize major problems until reaching emer-
gency medical care.
□ True □ False
2. A pocket mask is something a rescuer wears to prevent dis-
ease transmission.
□ True □ False
3. Advantages of a pocket mask include that (check all that apply):
□ a. it simplifies making an effective seal.
□ b. it reduces disease transmission risk.
□ c. you can use it for inwater rescue breathing.
□ d. you can provide oxygenated rescue breaths with it.
How did you do?
1. True. 2. False. A pocket mask is placed on the patient’s face.
3. a, b, c, d.

Emergency Oxygen
Delivery Systems
Mounting evidence in recent years points to administering
emergency oxygen as one of the single most important first
Highlight/underline the
aid steps for a diver suspected of suffering from decom-
pression sickness, lung overexpansion injury or near drowning questions as you
ing. Medical case histories show repeatedly that prompt read:
oxygen first aid can make a dramatic difference in the
1. Why is it important
diver’s immediate condition and in the effectiveness of sub- to have emergency
sequent treatment. You’ll learn more about these conditions oxygen available?
and oxygen administration later; for now let’s look at emer-
2. What are the three
gency oxygen equipment suitable for use by PADI Rescue primary types of
Divers. emergency oxygen
Emergency oxygen equipment falls into three primary systems?
categories: nonresuscitator demand valve units, continuous 3. How do the three
flow units, and positive pressure resuscitator units. Rescue primary types of
Divers may use the first two; the latter requires special emergency oxygen
paramedic level training because it can injure someone if systems differ?
used improperly. Nonresuscitator demand valve units and 4. Which two types of
continuous flow units adequately meet the needs of a dive emergency oxygen
emergency. systems are recom-
mended for use by
Nonresuscitator demand valve units operate much like
rescue divers?
your scuba regulator. Oxygen flows only when the diver
inhales, so these units minimize waste, and with a proper 5. How much oxygen
should be available?
mask it can deliver nearly 100 percent oxygen. In addition,
a rescuer can inhale from a nonresuscitator demand valve
unit and ventilate a nonbreathing patient with a high oxy-
gen concentration (the body only consumes a small fraction of the
oxygen in each breath). Dive accident first aid calls for delivering
the highest oxygen concentration possible for as long as possible,
making the nonresuscitator demand valve the best choice for
Rescue Divers.
Continuous flow units release oxygen continuously, so they’re
more wasteful than nonresuscitator demand valve units. Fixed
continuous flow units usually deliver six or 10 litres per minute;
adjustable units usually deliver up to 25 litres per minute. With
the proper flow (15 litres per minute recommended) and a nonre-
breather mask with reservoir bag, continuous flow units can deliver
more than 90 percent oxygen, but with low flow rates and/or an
improper mask, the concentration may remain below 60 percent.
Chapter One 29
By using a pocket mask, you can ventilate a
Positive Pressure nonbreathing diver with partially oxygenated air
Resuscitator using a continuous flow unit (more about pocket

masks and rescue breathing later). Continuous
Oxygen Systems flow is also used if the injured diver is very weak
Positive pressure resuscitator and unable to breath with the nonresuscita-
oxygen systems get their name tor demand valve system. Most nonresuscitator
because they use pressure from demand valve systems have multifunction regula-
the oxygen cylinder to provide tors that can be used for continuous flow so you
rescue breaths. While this sup- don’t sacrifice this benefit.
plies 100 percent oxygen and
Emergency oxygen comes in differing tank
is far less tiring for the rescuer,
sizes, and internationally, you may encounter dif-
oxygen cylinders have high pres-
ferent valve configurations, so it’s a good idea to
sure. Improper use could poten-
tially injure a patient by over- check the local standards when traveling. Ideally,
pressurizing the lungs. For this carry a big enough supply to keep an injured diver
reason, until recently these units on pure oxygen until in the hands of emergency
were used only by paramedics, medical care. However, some very remote dive
EMTs and other trained medical- destinations may make this impractical or impossi-
professionals. ble; carry as much oxygen as you reasonably can.
The manually triggered resus- Some oxygen is better than none at all. For gen-
citator valve is changing this. eral purposes, 637 litres of oxygen (22.5 cubic
Equipped with a special safety feet; even imperial system countries usually mea-
valve that prevents accidental sure medical oxygen in litres), can be expected to
injury to a patient, these devices last approximately 40 to 50 minutes, depending
are suitable for lay rescuer use, upon whether used with a nonresuscitator
and give you the ability to provide demand valve or continuous flow.
rescue breaths with positive pres-
Like your first aid kit, your oxygen equip-
sure. They do, however, require
ment needs a case that can withstand the rigors
some additional training for each
of diving, ideally one in which you can store your
specific model. In the PADI
Emergency Oxygen Provider equipment set up and ready to go. Most commer-
course, depending upon equip- cially available oxygen systems for divers come
ment availability, your instructor equipped with a suitable case. Most airlines won’t
may introduce you to manually let you bring a pressurized oxygen tank aboard
triggered resuscitator use, and the plane when you travel. If you frequent distant
you may have the option to quali- destinations that may not have
fy to use a specific model. oxygen on site (i.e., remote
locations that lack dive resorts)
you can also get systems that
Like your first aid kit, your oxygen equipment have everything except the oxy-
needs a case that can withstand the rigors of
diving, ideally one in which you can store your gen tank. Instead, you rent the
equipment set up and ready to go. This setup has oxygen tank at your destination
space for an extra oxygen cylinder.
and bring it to the dive site.

The PADI Rescue Diver course teaches what you need to
know and qualifies you to administer oxygen in a diving emer-
gency. The focus in this course is effective community standard
emergency oxygen first aid until emergency medical services per-
sonnel arrive, which you’ll practice beginning in Rescue Training
Exercise Nine. You can learn extra detail about emergency oxygen
equipment use in the PADI Emergency Oxygen Provider Course.
If your diving takes you into areas where you’re several hours or
more from emergency medical care, you’ll want additional training
in remote dive emergency management.
Can I Give Oxygen?

New PADI Rescue Divers often ask whether it is legal to
give an injured diver oxygen in an emergency, and whether
it might cause medical complications. These are valid con-
cerns, but within the scope of diving, administering oxygen in
an emergency isn’t really an issue.
In most areas, there are no laws prohibiting buying medi-
cal oxygen for emergency use, or administering oxygen
in an emergency. Some areas stipulate that the individual
be trained in oxygen administration (PADI Rescue Diver,
PADI Emergency Oxygen
Provider and/or other O OPTIONS
2
emergency oxygen diver
In a DCI emergency, if you run out of emer-
certifications qualify within
gency oxygen before you can get a breathing
the scope of dive emer-
patient into emergency medical care, have
gencies). As long as the
the patient breathe any enriched air avail-
diver consents, in most
able. While not as beneficial as 100% oxygen,
countries there’s nothing
enriched air has more oxygen than air and
illegal about providing oxy-
may help. It certainly won’t hurt. For a non
gen in a dive emergency (if
breathing patient, at least one manufacturer
the diver is unconscious,
makes a system that allows you to provide
consent is implied). Only
EANx from a scuba tank, much as you provide
a few countries prohibit
oxygen from an emergency oxygen system.
giving oxygen in an emer-
gency.
It has been thought that giving oxygen can make a few medi-
cal conditions worse, but there’s some doubt about this now.
Chapter One 31
Nonetheless, these conditions include emphysema and other lung
diseases that impair individuals significantly. People suffering from
these are not candidates for diving. Healthy individuals can suffer
lung irritation if they breathe high oxygen concentrations too long,
but this takes hours – more than likely, you’ll have the diver in pro-
Highlight/underline
fessional medical care, or run out of emergency oxygen first. answers to the follo
ing questions as yo
read:
1. What is an AED?
2. What is the bene
Exercise 1-4 of having an AED
1. It’s important to have emergency oxygen available because hand?
prompt oxygen first aid can make a difference in the case of
decompression sickness, lung overexpansion injury or near
drowning.
□ True □ False
2. The three primary types of emergency oxygen systems include
(check all that apply):
□ a. nonresuscitator demand valve systems
□ b. continuous flow systems
□ c. membrane extraction systems
□ d. positive pressure resuscitator systems
3. _______________ work much like a scuba regulator, supplying
100% oxygen when the diver inhales.
4. The emergency oxygen systems suitable for use by PADI
Rescue Divers include (check all that apply):
5. For general purposes in areas with ready access to emergency
medical services, an emergency oxygen supply of 40 to 50
minutes is normal.
□ True □ False
How did you do?
1. True. 2. a, b, d. 3. a. 4. a, b. 5. True

ther lung
Automated External
Defibrillators (AEDs)
ring from
an suffer
oo long, As you may recall from your Emergency First
er in pro- Response course, when someone’s heart stops,
rst. the sooner a shock can be delivered to attempt
ing questions as you to restart it – called defibrillation – the more likely
read: the heartbeat will return to normal. The purpose
of CPR is simply to extend the time between
1. What is an AED?
cardiac arrest and the start of defibrillation to
2. What is the benefit increase the probability that a normal heartbeat
of having an AED on
can be restored.
ause hand?
ase of Automated External Defibrillators (AEDs)
near were introduced to shorten the time to defibrilla-
tion by making it possible for laypersons with comparatively mini-
mal training to provide it. AEDs are electronic instruments that
include analyze an unresponsive div-
er’s heart rhythm, then guide
you through the steps of pro-
viding the shock, if necessary
(sometimes called “semiauto-
matic” AEDs). Some versions
deliver the shock automati-
upplying
cally if analysis determines
it’s required (sometimes
called “automatic” AEDs).
DI
AEDs (Automated External Defibrillators) are electronic instruments that analyze an unrespon-
sive diver’s heart rhythm, then guide you through the steps of providing the shock if necessary
(sometimes called “semiautomatic” AEDs). Some versions deliver the shock automatically if
analysis determines it’s required (sometimes called “automatic” AEDs).
ergency
o 50 An AED may, in some instances, increase the chances that
a diver with cardiac arrest will survive. Depending upon
availability, local restrictions and other factors, your instruc-
tor may include AED use as part of your rescue training.
Chapter One 33
Due to training requirements, costs and the relative newness
of the technology, as well as restriction in use by layperson in
some areas, currently AEDs are not considered standard first aid
equipment nor a community standard. However, if one is available,
the clear benefit is the ability to attempt to restart the heart in a
Highlight/underline
shorter interval than waiting for EMS personnel to arrive. As with answers to the follo
CPR and any rescue technique, an AED cannot guarantee that ing questions as yo
a diver with cardiac arrest will survive; it may, in some instances, read:
increase the chances of it. Depending upon availability, local 1. What is the differ
restrictions and other factors, your instructor may include AED use ence between a “
as part of your rescue training. tim” and a “patien
2. What are the two
possible roles a r
cue diver may ha
at a dive acciden
scene?
Exercise 1-5
3. What two forms o
1. An AED (check all that apply):
readiness prepar
□ a. is a device that delivers a shock in an attempt to restart you to manage a
the heart. emergency? Wha
are the elements
□ b. is part of the dive community standard first aid equip-
each?
ment.
□ c. eliminates the need for CPR training. 4. What are the six
basic steps for em
2. The primary benefit of an AED is that it shortens the interval gency manageme
between the loss of heartbeat and attempts to restart the
5. What consideratio
heart.
and procedures a
□ True □ False involved with form
How did you do? a local emergenc
1. a. 2. True. assistance plan?

newness
on in Accident
irst aid
available, Management I
Managing an
rt in a
As with
Emergency
e that ing questions as you
tances, read: When an emergency arises, your skills as a
cal 1. What is the differ- PADI Rescue Diver can contribute to a higher
AED use ence between a “vic- chance of a positive outcome. Your role in an
tim” and a “patient”? emergency situa-
2. What are the two tion can vary
possible roles a res- depending upon
cue diver may have the number and
at a dive accident training of others
scene?
available. Whether
3. What two forms of you’re alone or
readiness prepare one in a crowd
restart you to manage an
ready to help,
emergency? What
are the elements of emergency man-
quip-
each? agement is the
skill of using the
4. What are the six
basic steps for emer- human resources
terval gency management? available as effec-
he tively as possible.
5. What considerations
and procedures are In discussing diver emergencies, it’s
involved with forming important to distinguish between the con-
a local emergency cepts of “victim” and “patient.” A victim is a
assistance plan? diver in an accident situation who either has
yet to receive help, or who is receiving help,
but is not yet in a stable, safe environment. A patient is a diver
in an accident situation who is receiving emergency medical
care (such as your first aid) in a stable, relatively safe envi-
ronment. This means that the affected diver’s status changes
as a rescue progresses. For example, an unresponsive diver
A diver in the water who needs
floating face down is a victim. The diver remains a victim during
help is a victim.
your initial rescue and exit, and becomes a patient once aboard a The diver remains a
boat receiving rescue breaths and oxygen. victim during your initial res-
cue and exit, and becomes a
Your role as a rescuer will likely be one of two in the event patient
of an emergency. When there’s a more qualified person pres- once receiving rescue
breaths and oxygen in a rela-
ent, such as an instructor or divemaster, you will most likely be a tively safe, stable environment.
skilled rescue assistant under that person’s direction and
management.
Chapter One 35
On the other hand, if you are the most qualified diver present,
then you will likely coordinate the rescue as the emergency man-
ager, delegating tasks to others based on their abilities and qualifi-
cations. In this situation, take control in a firm but calm, direct
manner. Since you know what you’re doing there’s a tendency to
start giving orders, but a calm, reasoned approach more readily
inspires confidence and cooperation. For example, saying, “This
person needs oxygen immediately. Please get it from my car as
quickly as you can,” shows levelheadedness and thought.
Readiness. Since you may find yourself man-

aging an emergency, you want to attend to and
maintain two forms of readiness: personal readi-
ness and equipment readiness. Personal readi-
ness is your physical and mental preparedness
for an emergency, while equipment readiness is
being prepared with the tools that significantly
benefit your efforts in an emergency.
There are several elements to personal
readiness. The first is maintaining your physical
Personal readiness includes
maintaining your physi- fitness through regular, proper exercise, diet and rest. Adequate
cal fitness through regular, fitness gives you more strength and stamina to apply in an emer-
proper exercise, diet and rest.
Adequate gency, and also reduces the likelihood that you’ll become a victim
fitness gives you more strength yourself.
and stamina to apply in an
emergency, and also reduces Personal readiness also includes participating in regular
the training and practice to maintain your rescue and EFR skills. This
likelihood that you’ll become a
victim yourself. allows you to apply them more confidently and quickly in an emer-
gency. It’s fun to take a day with other PADI Rescue Divers and
higher level divers to run through some emergency drills and keep
fresh, but another way is to refresh and reapply those skill through
higher level training. This includes continuing on to the PADI
Divemaster course.
Proper attitude is a third aspect of personal readiness that
goes hand in hand with good judgment. As you learned earlier,
poor judgment is the primary reason divers get into trouble. As a
PADI Rescue Diver, you need to commit yourself to following safe
diving practices. By diving safely yourself and paying attention to
others, you’re better prepared for emergencies that may arise. Get
in the habit of mentally rehearsing what you would do by visualiz-
ing possible situations and your responses. This readies you to act
quickly and confidently.

Equipment readiness is having special rescue equipment,
either kept on hand in case it’s needed (like your first aid kit and
oxygen system), or being able to improvise it on the spot (like
using a table as a stretcher). Be resourceful!
Keeping a few of these items on hand, or noting where to
find them, can make helping a diver in trouble easier:
• Binoculars – for spotting divers at surface and for coordinating
missing diver search
• Clipboard with pen and paper – for recording what happened
to whom, where and when
• Surf/rescue board/torpedo float, rescue float, etc. – for swim-
ming assists
• Rope – to throw to divers at the surface, to lift victims from
water, to assist an underwater search and other uses
• Circular sweep anchor – to easily mark the center of a circular
search pattern
• Diver compass – for navigating an expanding square or U
search pattern
• Marker buoys – to mark location for missing diver search
• Flares – to signal help from boat to boat
• Whistle – to alert others at a distance
• Bullhorn – to coordinate a rescue effort over a large area
• Radio (CB/VHF) – for contacting emergency medical care
• Cellular telephone/public telephone – for contacting emergency
medical care
• UW recall system – if boat is so equipped, for recalling all div-
ers to the boat or shore in an emergency, or at the end of a
missing diver search
Besides having equipment, preparation includes knowing how to
use it, ensuring that it’s in working order, and stowing it where you
can get it easily if needed. If you’re unsure how to use something,
get trained for it. Special circumstances prompt special equipment;
for example, if you’re planning an ice dive, it makes sense to pack
blankets and warm liquids for treating slight hypothermia.
At the dive site, how you prepare your personal dive equipment
affects your readiness. Keep your mask, fins and snorkel arranged
together so you can pull them on quickly if necessary. Leaving them
scattered about the boat and piled in with other divers’ equipment
slows you down if you have to enter the water in a hurry.
Chapter One 37
Six Steps for Emergency Management. By being ready
personally and maintaining equipment readiness, you’re able to
anticipate what, where and when the most likely problems will occur.
This lets you plan, formally or informally, to handle those situations,
and to identify and avoid hazards likely to cause an emergency or
complicate a rescue.
Assess the Situation. When any emer-

Step One
gency arises, Stop. Breathe. Think. Act.
Assess the situation – who is involved, where is it happening, what
do you have available to assist you? Then, think about the best solu-
tion and get ready to act on your
plan. There’s no one “right” way to
handle a situation – every emergen-
cy is unique, so anything that gets
the job done without making things
worse works. Be flexible. Assessing
the situation and adapting the plan is
an ongoing process that continues
throughout the effort.
Act on
Step tWO
Your Plan.
If no one takes charge, step up to
the plate. Take charge and quickly
implement a plan of action by direct-
ing others in a calm, considered
When any emergency arises,
manner. If you are assisting a more qualified diver, carry out tasks as
Stop. Breathe. Think. Act.
Assess the appropriate. Keep that person updated on your efforts, but as a PADI
situation – who is involved, Rescue Diver, you will be able to carry out many tasks without bur-
where is it happening, what
do you have available to dening the manager with unnecessary details.
assist you? Then, think
about the best solution and
Step tHRee Delegate. By definition, a manager is
get ready to act
on your plan. someone who gets things done through other
people. Usually, you can make things happen more quickly if you
assign responsibilities quickly, clearly and concisely. Even bystand-
ers and inexperienced divers can help by contacting local emergency
services, fetching emergency equipment or performing tasks under
your direction. Given the resources, you may find a central loca-
tion where you can coordinate and direct the rescue, or, you may
dive in and effect the rescue first hand. What you delegate to whom
depends on how many people you have available, their qualifica-
tions, and the nature of the rescue, but you’ll want to consider sev-
eral options.

If you have enough qualified Rescue Divers available, it’s
usually more effective for two rescuers to go to the victim’s assis-
tance. However, you don’t want to endanger anyone by asking
untrained divers to do things beyond their training.
In delegating tasks, assign someone to get emergency assis-
tance, or to at least stand by for your signal to do so if you’re still
determining the victim’s condition. As appropriate, tell this person
who to call, where to find the contact information, and what to say.
Have the person call the local emergency medical system or
other similar local emergency personnel first. The person should
clearly establish that the call is about a diving accident and give
the exact location. If there’s a radio or cellular telephone on the
site, the person should give the call letters or telephone number so
medical personnel can regain contact. The caller should answer
all questions and stay on the line until the EMS call taker hangs
up. This assures that the EMS has all the information needed. If
necessary, assign the caller or others to meet emergency vehicles
and guide them to the accident site. Whether you’ll need to do this
will depend upon where you are, and what the EMS instructs the
caller to do.
After calling the local EMS, the caller should call the Divers
Alert Network (DAN) or other diver emergency service if in an area
served by them, and if you suspect decompression sickness or
lung overexpansion injury. The physician on call may not be imme-
diately available, so the caller will give contact information to the
service to call back. If there’s no way to contact you (such as if the
call’s made from a pay telephone far from the scene), the caller
should leave contact information for the hospital or local emergen-
cy service. If you’re outside a diver emergency service area, the
caller should call the local recompression chamber to alert them
and allow them to coordinate with the EMS.
Depending upon the people available, post observers to
watch the victim and the rescuers. In the water the rescuers may
have trouble seeing the victim, so the observers can help direct
them.
Other duties to consider include noting what happens,
accounting for all divers (especially those who may be underwater
and not involved in the rescue), securing the victim’s equipment,
and controlling bystanders.
Chapter One 39
Attend to Injuries. Once the victim is out
Step FOUR
of the water (now a patient), follow the proto-
cols you’ve already learned in your Emergency First Response
training. Begin with primary assessment and continue into second-
ary assessment if you discover no life threatening conditions. In
more serious accidents, you may need to provide Basic Life
Support (BLS – rescue breathing and CPR) and other primary
care until relieved by emergency medical personnel.
If the patient is responsive, try to calm and reassure the diver
by explaining what you’re doing to help. If you suspect that decom-
pression sickness or lung overexpansion injury may be involved,
keep the patient lying down (you’ll learn and practice the details for
pressure related accidents later in the course). If not done already,
contact local emergency medical care and the local diver emer-
gency service as appropriate. Remember that you can delegate
attending to injuries to qualified individuals present, leaving you to
handle other aspects of emergency management.
You may find it useful to ask a responsive patient about what
happened. The PADI Diving Accident Management Work Slate
prompts you to ask questions that may tell you more about the
patient’s condition. Your questions may go something like this:
You: My name is __________. I’m trained in emergency procedures. I can
help you. What’s your name?
Patient: Pat Smith.
You: What’s wrong, Pat? Do you hurt anywhere?
Patient: I think I’m bent. I can’t feel anything from the waist down.
You: What happened?
Patient: I’m not sure. I ran low on air and came up pretty fast. Maybe that was
it.
You: What were your depth and bottom time?
Patient: About 18 metres/60 feet for 35 minutes.
You: Did you make any other dives today?
Patient: Yeah, this morning. This was to about 30 metres/100 feet for 15 min-
utes.
You: When did you first notice . . .
Keep calm to reassure the patient. Cool, controlled and deliber-

ate action on your part goes a long way to encourage the patient.
Remember to tell the patient what you’re doing to help as you
proceed.

Control the Scene. Your ability to do this
Step FIVe
will depend on the number of people assist-
ing you and their qualifications. If you’re the only one with EFR
and rescue training, you may have to devote most of your atten-
tion to providing direct care for the patient. But, if there is sufficient
help available, your best role may be to coordinate activities and
administrate.
Coordination and administration may include providing
emergency personnel with appropriate information regarding
the injured diver and accident (The PADI Accident Management
Workslate was designed for this purpose), getting contact infor-
mation from those who witnessed the accident or helped with the
rescue, arranging to contact the patient’s family and if appropri-
ate (depending on the severity of the accident and local require-
ments), submitting a report to local authorities.
Avoid making any statements about causes, and avoid draw-
ing conclusions or assigning blame at this time. You likely don’t
have all the facts, and this is not the time. If the patient’s equip-
ment was recovered, turn it over to local authorities. Do not dis-
assemble it, but do have someone check the air pressure and
whether it seems to be functioning normally.
Arrange Evacuation to Medical Care.

Step SIX
In a serious dive accident, the patient must
reach the nearest medical facility; and a pressure related injury will
normally require recompression in a hyperbaric chamber. Even if
the first available medical facility doesn’t have a hyperbaric cham-
ber, the community standard is to get the patient there for medical
stabilization and support prior to and during chamber treatment.
Depending upon where you are, local emergency services
may or may not be familiar with treating diving injuries. If neces-
sary, provide information about dive accident care so that medical
personnel understand the nature of the injury/illness and require-
ments for care, and give them contact information for DAN or
other diver emergency service, emphasizing that these services
have specialized medical doctors on call for consultation and arranging
specialized treatment. Have the contact information listed on the
Accident Management Workslate you send with the patient, but
also find out where they’re taking the patient, then give that infor-
mation to DAN or other appropriate diver emergency service for
direct contact.
Chapter One 41
Helicopter evacuations from boats impose special procedures you
must follow for the safety of the patient, the helicopter and every-
one aboard the boat.
1. The boat and helicopter must communicate. Usually, they talk
directly by marine radio, but sometimes a third party relays
messages.
2. Normally, the helicopter pilot will prefer that the boat make way
into the wind at a slight angle, usually at approximately five
knots. The pilot directs the boat captain to the preferred course
and speed.
3. You need to prepare the boat for a helicopter pick up. Lower
all tall objects and secure loose objects so they don’t get
blown overboard, or worse, sucked into the helicopter engine.
Surprisingly heavy objects qualify as “loose” when you deal
with helicopters: helicopter blade wash can blow about dive
gear bags, partially filled coolers, wet suits, clothes’ bags and
similar objects. Secure these as well as smaller objects. If in
doubt about anything, stow it below or tie it down firmly.
4. Prepare the patient by putting a personal flotation device on

him. The helicopter will tell you whether there’s room for the
oxygen system. Send it along if possible.
5. When you have the boat and patient ready, signal the helicop-
ter by radio, or by hand signals or flashlight if you don’t have
direct communication. The helicopter will move in to lower a
basket stretcher. Let the helicopter come to you. Keep the boat
on a steady course; don’t try to maneuver toward the helicop-
ter unless so directed by the pilot.
6. Usually you’ll see a line dangling from the basket stretcher.

Do not touch or grab this line. Allow the line to touch the
boat first to discharge static electricity. If you touch the line
first, you may receive a severe, possibly life threat-
ening, static shock. If you don’t see a line dangling from
the basket stretcher, let the basket touch the deck before you
touch it for the same reason.
7. Once you have the basket down, load the patient as quickly as
possible. Do not tie the basket to the boat, or attach
anything from the boat to the helicopter. Keep the
helicopter free to move from the boat at any time.
If you need to move the basket, advise the helicopter and
disconnect it from the lifting cable. When you’ve readied the

patient (and reattached the cable), signal the helicopter. Have
everyone stand clear and use the basket trail line to steady it
as the helicopter rises away from the boat.
8. If appropriate, ask the helicopter to fly as low as possible with

the patient. Reduced pressure at altitude can worsen DCI by
making bubbles expand.
Land based helicopter evacuations also have considerations:

1. Mark off a landing area at least 18 metres by 18 metres/60
feet by 60 feet. It should be free of obstacles such as trees,
power lines and poles, or antennas.
2. Clear the area of litter and other loose objects that could be
blown about by blade wash.
3. Clear the area of all people, and station a guide on the wind-
ward corner of the landing zone to guide the pilot. As the heli-
copter lands, the guide should turn away so dirt and sand don’t
fly directly into his face.
4. Don’t let anyone approach the heli-

copter until signaled by the pilot.
Anyone approaching the helicopter
should note the blade height (which
lowers as they slow on landing),
maintain a low, crouched position and
keep eye contact with the pilot.
5. Keep everyone clear of the

helicopter tail. It’s nearly
impossible to see the rear rotor
in motion; people have been
killed accidentally stepping
into it. Never approach a heli-
copter from the rear.
Helicopter evacuations require
special procedures for your
Emergency Assistance Plans. In an emergency, you safety, patient safety and the
save a lot time if you already know who to call and where to go. It flight crew safety.
only takes a few minutes to jot down emergency contact informa-

tion relevant to the dive sites you visit and store them in your first
aid kit. When you go someplace new, add the information to the
list. You can note this on the Diving Accident Management Work
Slate for ready reference. Information readiness provides the basis
for your local Emergency Assistance Plan. This plan includes:
Chapter One 43
1. Contact information for local emergency medical systems. For
areas where Emergency Medical Services (EMS) are avail-
able, most people are familiar with emergency contact num- Exerc
bers – for example, 911. However, it’s still a good idea to write 1. A “p
this information down for easy access at the dive site. wher
reco
2. Contact information for the Divers Alert Network (DAN) office
□ T
serving the local area, or other diver emergency service pro-
2. As a
viding consultation for your area.
□ a
Areas with well-established emergency medical systems and dive
□ b
community may require only one or two contact telephone num-
bers. When you travel to remote dive destinations, however, you □ c
may need to have several telephone numbers as well as VHF □ d
radio frequencies and even multiple language considerations. To 3. Pers
be as useful as possible, try to include in your plan any contact (che
information you would need to get an injured diver to help. □ a
□ b
Calling DAN □ c
DAN America +1-919-684-9111 □ d

(incl. DAN Brasil and DAN World) Available 24/7 for diving and non-diving emergencies (including
DAN TravelAssist services); can be called collect
www.dan.org (DAN America) 4. In th
www.danbrasil.org (DAN Brasil) first
www.travelerems.com (DAN World)
□ a
DAN Europe +39-06-4211-8685
www.daneurope.org □ b
DAN Japan +81-3-3812-4999
□ c
www.danjapan.gr.jp
DAN Southern Africa □ d
(within South Africa) 0800-020-111 5. A loc
(outside South Africa) +27-10-209-8112 (accepts collect calls) mati
www.dansa.org
□ a
DAN Asia Pacific region www.danasiapacific.org
Diving Emergency Services (DES) □ b
DES Australia 1-800-088-200 □ c
(within Australia)
DES Australia +61-8-8212-9242 □ d
(from overseas)
DES New Zealand 0800-4DES111 How did
Singapore Naval Medicine & 6758-1733 1. Fals
Hyperbaric Center ment.
Philippines (02) 632-1077 safe s
3. a, b
Malaysia (05) 681-9485
invited
Korea (010) 4500-9113
China +852-3611-7326
Divers Alert Network (DAN)

ems. For
avail-
t num- Exercise 1-6
a to write 1. A “patient” is someone likely to recover from an accident,
whereas a “victim” is someone you help, but who is unlikely to
recover.
N) office
□ True □ False
ce pro-
2. As a PADI Rescue Diver, your role at a dive accident
□ a. never changes
and dive
□ b. may be to manage the emergency
e num-
er, you □ c. may be to assist a more qualified person
VHF □ d. Both b and c
ons. To 3. Personal readiness for managing an emergency includes
ontact (check all that apply):
p. □ a. staying physically fit
□ b. participating in regular training and practice
□ c. maintaining the proper attitude
□ d. establishing your authority with other divers before
it’s needed
4. In the six steps for basic emergency management, what is the
first thing you do when any emergency arises?
□ a. Stop, breathe, think and assess the situation.
□ b. Delegate someone to contact help.
□ c. Control the scene so the situation gets no worse.
□ d. Any of the above may be the appropriate first step.
5. A local emergency assistance plan should have contact infor-
mation for (check all that apply):
□ a. the US Navy surgeon diver
□ b. local emergency medical services
□ c. the diver emergency service for the area (if any)
□ d. any information you may need to get an injured
diver to help
How did you do?
1. False. A patient is someone receiving care in a relatively safe, stable environ-
ment. A victim is someone who needs or is receiving help but who is not yet in a
safe stable environment. 2. d.
3. a, b, c. d is not only incorrect, but a great way to stop being
invited to go diving. 4. a. 5. b, c, d.
Chapter One 45
Responding to Diver
Emergencies I
Self-Rescue –
Look After Yourself First
In a way, your diver training to this point has already taken you
into the rudimentary levels of rescue diver training. Your PADI
Open Water Diver course and Advanced Open Water Diver
or Adventure Diver course introduced and developed your
self-rescue skills by teaching you how to prevent and han-
dle problems you might come across while diving. At this
point, you’re ready to further develop these skills.
answers to the follow- Self-rescue means that you’re self-reliant, which every
ing questions as you diver should be, of course, but your confidence in your
read: self-reliance becomes crucial when dealing with an emer-
1. What three areas of gency. Before you can cope with another diver’s problem,
preparation increase you must believe that you won’t endanger yourself. If you
your self-rescue abili- don’t believe that, you probably won’t (and shouldn’t – more
ties? about this later) initiate a rescue. Furthermore, your ability
2. What three dive to calm and assist a victim may be affected by whether the
procedures help you victim trusts your capabilities as a diver. For discussion, we
anticipate and pre- can divide self-rescue into preparation, prevention and per-
vent problems while formance.
diving?
Physical preparation involves proper health, fitness and
3. What should you do diet. You already know that you should maintain good phys-
when you encounter ical fitness to be prepared to manage an emergency. Being
a problem while
fit physically also prepares you to better deal with any emer-
diving?
gency situations you find yourself in.
4. What are five skills Mental preparation involves confidence and a feeling of
that increase your
well being about the dive. This includes diving within the
self-rescue abilities?
limits of your training and experience. As you recall, you
need to have the right attitude to be prepared for accident man-
agement; again, this same attitude helps keep you out of trouble
and helps you handle a problem if one comes up.
Equipment preparation involves familiarity with the use of your
dive equipment and emergency equipment. It means keeping your
gear in working order and maintaining it properly, of course, and it
includes having emergency accessories at hand in case you
need them. These may include whistles, small emergency strobes,

flares, dye markers and inflatable signal tubes.
Inflatable tubes are especially helpful if you
find yourself drifting away from a boat. The
Equipment preparation
height of the inflated tube above the water sur- includes having emer-
face makes you much more visible. These gency accessories
at hand in case you
items can fit into a BCD pocket for easy need them. These may
access. You learned previously it includes include whistles, small
emergency strobes,
knowing what equipment you have on hand flares, dye markers
that could help handle an emergency. and inflatable signal
tubes.
Prevention can be divided into three proce-
dures as well. The first is to maintain your equip-
ment properly and have it serviced regularly as
recommended by the manufacturer. This,
along with a predive inspection, will head off
the vast majority of equipment related prob-
lems. Second, anticipate problems as part of your
dive plan and throughout the dive. Remember that
Inflatable tubes
dive planning involves risk assessment. Devise plans to
are especially
avoid those problems you anticipate. Third, don’t helpful if you
ignore small problems. Most major accidents start find yourself
drifting away
as small problems that snowball into a full blown from a boat.
chain of events that leads to disaster. If you can The height of
the inflated tube
recognize that a problem is occurring or is about to above the water
occur, you’ll be able to take early action and break surface makes
you much more
the event chain. This keeps a small problem from visible.
becoming a big one.
By not ignoring small problems and anticipat-
ing where they may lead, you can respond to things
like overexertion, hypothermia, vertigo, etc., soon
enough to head them off. For example,
if you were swimming hard against
surge, you may find yourself breathing
hard and becoming overexerted. By Don’t ignore small
stopping immediately and resting, you problems because they
often become big ones.
prevent the problem from growing into A small leak in a BCD
a serious situation that might require pressure relief valve
your buddy to assist you. You may also may become a big one
– resulting in the inability
realize you’re using your air far faster to control and maintain
than planned and modify your plan buoyancy with it.
when you turn and head for the exit to

avoid a long, difficult surface swim.
Chapter One 47
Performance is how you deal with a problem if, despite your
preparation and prevention, you find yourself in one. You do what
you’ve already learned when dealing with an emergency involving
another diver: Stop. Breathe. Think. Act. Stop what you’re
doing. Breathe to maintain or reestablish normal breathing.
Think about the problem, its cause and possible appropriate
actions. Act logically based on your plan, not based on a
thoughtless reaction. Assess the situation to avoid hazards
and consider resources available. Be prepared to reformu-
late a new solution if your first doesn’t work.
When anticipating problems, you plan to avoid them,
but you also visualize proper responses you would take if
problems happen anyway. This helps you make the right
choices quickly. And, the procedures you learn in this
Good buoyancy control course, plus practice to keep your skills sharp, prepares
helps you avoid struggling to
you with proper responses to help you deal with a problem.
maintain your position either
at the surface or underwater. There are five dive skills that you want to focus on to be bet-
Any problem is easier to deal ter prepared to deal with a problem. The first is good buoyancy control,
with if you’re not having to
deal with poor buoyancy at which helps you avoid struggling to maintain your position either
the same time. at the surface or underwater. It also helps you stay off the bottom,
reducing the risk of aquatic life injuries, while protecting aquatic life
from damage. Any problem is easier to deal with if you’re not hav-
ing to deal with poor buoyancy at the same time.
The second skill is proper airway control, which allows
you to breathe past small amounts of water in your regu-
lator or snorkel, thus avoiding choking. You probably do
this somewhat instinctively already, using your teeth and
tongue to block water as you let air gurgle past it. With
practice, you can breathe effectively with a surprising
amount of water in your snorkel or regulator.
You may not think of cramp removal as much of a skill
– until you need it. Practicing it helps cramp pain from
escalating into a bigger problem, like not being able to
swim back to the boat! The most common cramps are in
You may not think of cramp
the quadriceps, calf or hamstrings, all of which you can
removal as much of a skill –
until you need it. Practicing it help relieve by grasping your fin tip to give you something to pull
helps cramp pain from esca- against. When you get a new pair of fins, be sure to practice this
lating into a bigger problem,
like not being able to swim – you may find it easier or more difficult to get a hold of the tip like
back to the boat. you’re used to.
The fourth skill, handling air depletion, is something you learned
and practiced as an Open Water Diver. More than likely, you prac-
ticed sharing air with an alternate air source supplied by your

your buddy. You’ll refresh this skill during the Self
do what Rescue Review. However, as a PADI Rescue Diver,
nvolving you may want to consider an independent solution,
you’re such as a pony bottle or self-contained ascent bottle.
eathing. The fifth skill is responding to vertigo. Vertigo is losing
propriate your sense of balance and orientation, and can cause
d on a nausea as well as stress. Although it can happen on the
hazards bottom, you’re most likely to experience vertigo in mid-
eformu- water, especially if you can’t see the bottom and have
no visual reference for orientation. The easiest way to
d them, reestablish your sense of orientation is to make contact
take if with a fixed object. If that’s not possible, watch your
e right bubbles and consult your depth gauge for up and down
his orientation and whether you’re rising or descending.
pares Hugging yourself may also help. The easiest way to reestablish your sense of orien-
m. tation is to make contact with a fixed object.
o be bet-
ncy control,
n either
e bottom,
quatic life Exercise 1-7
not hav- 1. Three areas of self-rescue preparation include (check all that
apply):
allows □ a. physical preparation □ c. mental preparation
ur regu- □ b. contact preparation □ d. equipment preparation
ably do 2. Three procedures that help you anticipate and prevent prob-
eth and lems include (check all that apply):
With □ a. equipment maintenance
sing □ b. anticipating problems while planning the dive
□ c. not worrying too much about small problems
f a skill
from □ d. dive plans to avoid the problems you anticipate
ble to 3. If you encounter a problem while diving, you should first signal
s are in your buddy and then act immediately based on your gut instincts.
u can □ True □ False
g to pull 4. Which of the following is not a skill that can help you self-res-
ice this cue (check all that apply)?
he tip like □ a. good buoyancy control □ c. cramp removal
□ b. handling air depletion □ d. responding to vertigo
learned How did you do?
you prac- 1. a, c, d. 2. a, b, d. 3. False. You should stop, breathe, think, and then act based
your on a logical plan. 4. All are self-rescue related skills and you should not have
checked any boxes.
Chapter One 49
Recognizing Rescue
Situations – Responsive
Divers at the Surface
Highlight/underline the The majority of rescue situations involve a responsive diver
answers to the follow- at the surface, and range from a diver who simply needs
ing questions as you some assistance to those who’ve lost control and panicked.
read: The signs of a diver who needs help may be obvious, but
1. What signs and they can also be subtle. An exhausted diver at the surface
behaviors indicate may suddenly and quietly slip underwater for no appar-
a diver may have a ent reason. A diver with a problem may fail to ask for help,
problem at the sur- express anxiety or mention symptoms of injury or illness
face?
due to ego threat. Scuba equipment can conceal facial
2. What are the charac- expressions and other gestures that indicate stress or anxi-
teristics that indicate ety at the earliest stages, and it may reduce verbal commu-
a tired diver?
nication.
3. What are the charac- General signs and behaviors that indicate a diver may
teristics that indicate have a problem on the surface include:
a panicked diver?
• Giving distress signals –
raising one arm, whistling,
yelling for help, and so on.
• Struggling on or just below the
surface, especially with vigorous
arm swimming.
• High treading or finning with suf-
ficient vigor to lift a portion of the
body and equipment out of the
water.
• Rejecting equipment by pushing
off the mask and/or the regulator
mouth piece, or both.
• Clinging and clambering (pulling
the body toward the high point of
Tired divers generally need an assist more than a rescue. They
any object on the surface). usually respond to directions or questions, and can help you
• Not moving – apparent unre- with your efforts to
aid them.
sponsiveness.
During the first three Rescue Training Exercises, you’ll practice
rescuing responsive divers at the surface. You can classify the
rescues as a tired diver assist or as a panicked diver rescue. It’s
important to recognize the difference in the victim’s state of mind
because it affects how you handle the situation and the risk the
rescue poses for you.

Tired divers are divers with a problem, but are adequately man-
aging stress. Frequently the problem is fatigue, but it may also
be leg cramping or other difficulty. Generally, tired divers ask for
help and respond to directions or questions. They don’t reject their
gear, keeping their masks in place. They can usually assist with
your efforts to help, and often recover quickly, no longer needing
assistance.
Panicked divers are divers with a problem who have become
overwhelmed by stress and fear. They’ve abandoned rational
responses and react entirely through instinct and fear. Panicked
divers tend to reject their gear, pushing their masks off or onto
their foreheads and spitting out their regulator or snorkel. They fail
to establish buoyancy, and swim vigorously with arms and legs
until exhausted. Their eyes tend to be wide and unseeing due to
extreme perceptual narrowing, and they do not respond to com-
mands or questions. Panicked divers may fixate on a single, inef-
fective solution to the problem, and may attempt with great
strength to climb on anyone or anything to get out of the water.
They can do little to help themselves, and without a rescue will
usually exhaust themselves and lose con-
sciousness.
The panicked diver poses the most
risk because the victim can overpower
you if you don’t use techniques to main-
tain physical control. You’ll learn these
techniques during your training. It’s also
important to realize that a tired diver may
panic while you’re moving in to help, mak-
ing it important to constantly assess the
victim as you assist.
More rarely, a panicked diver will
panic passively, not splashing, climbing or
otherwise showing overt signs of panic.
Panicked divers tend to reject their gear, pushing their
However, the passive panicked diver will also masks off or onto their foreheads and spitting out their regulator
not respond to the emergency correctly, and or snorkel. They fail to establish buoyancy, and swim vigorously
with arms and legs until exhausted. Their eyes tend to be wide
may quietly slip below the surface and drown. and unseeing due to extreme perceptual narrowing, and they do
Therefore, if a diver who does not respond to not respond to commands or questions.
you, assume the person needs help until you
establish otherwise.
Chapter One 51
Exercise 1-8
1. Signs and behaviors of a diver with a problem at the surface
include (check all that apply):
□ a. giving distress signals
□ b. high treading or finning enough to lift a portion of the
body out of water
□ c. clinging and clambering
□ d. apparent unresponsiveness
2. Characteristics of a tired diver include (check all that apply):
□ a. asking for help □ c. failing to establish buoyancy
□ b. rejecting equipment □ d. responding to questions or
directions
3. Characteristics of a panicked diver include (check all that
apply):
□ a. asking for help □ c. failing to establish buoyancy
□ b. rejecting equipment □ d. responding to questions or
directions
How did you do?
1. a, b, c, d. 2. a, d. 3. b, c.
Nonswimming Assists
and Rescues
Emergency! You’ve just finished a dive, and while still in
answers to the follow- your exposure suit with mask, fins and snorkel in hand, you
ing questions as you see a responsive diver in trouble at the surface about 10
read: metres/yards behind the boat. What should you do? Stop,
1. Why does the res- breathe, think, and act. Your first thoughts should be to see
cuer’s safety take if you can provide assistance without getting in the water.
priority over the In any rescue situation, your first priority is to stay safe
distressed diver’s yourself. Rushing into the water to help another diver with-
safety in an emer- out any forethought may lead you to becoming a victim, too,
gency situation?
and in any case, poses more risk. Realize that maintaining
2. What are the four your own safety is for the victim’s sake as much as your own.
types of nonswim- You can’t help the victim if you’re in trouble. If you become a
ming rescues you
victim, it divides the remaining rescue resources between
can use to help a
diver at the surface? you and the original victim instead of concentrating them on
one. Yes, you may take on some more risk than you other-

wise might, but if you’re not reasonably confi-
dent you can stay safe, it is usually
a better strategy to not attempt a rescue and
instead summon additional help. Only after you
rface reasonably ensure your safety do you help the
victim. That gives the victim the best chances
for a positive outcome.
the The best way to minimize your risk while
helping someone is to do so without getting
into the water. It is generally faster and safer
to assist from a stable position on a boat
pply): or shore. These rescue techniques include
reaching, extension, and throwing assists from Reaching assists are
uoyancy
the pool deck, pier, boat deck or shore, as easy and effective ways
ons or to help someone within
well as wading assists in water no more than
arm’s length of a pool
chest deep. Failing all these, your next option deck, dock or swim step.
all that is a watercraft assist if you have a boat or Lie on the deck, dock or
platform, spread your legs
other watercraft available. Only after exhaust- to increase stability and
uoyancy reach out with only one
ing these possibilities do you want to consider
ons or arm and grab the victim’s
entering the water to help. You’ll practice the arm or piece of gear.
following nonswimming assists in Rescue
Training Exercise Three:
Reaching and Extension Assists. You can provide a reach

Reaching assists are easy and effective ways assist if you have a firm
to help someone within arm’s length of a pool grasp on a solid object,
like a boat ladder, dock or
deck, dock or swim step. The primary concern poolside. Extend one arm
is establishing a stable position that keeps or leg to the victim and
then pull to safety.
the victim from pulling you in. Lie on the deck,
still in dock or platform. Spread your legs to increase
and, you stability and keep your mass centered on the
out 10 deck over a wide area. Reach out with only one If the victim’s too far
away, you can use an
? Stop, arm and grab the victim’s arm or piece extension assist by
be to see of gear. reaching out with a pole,
boat paddle or even a
er. If you’re already in the water, you can towel or piece of clothing.
stay safe also provide a reach assist if you have a firm One advantage is that if
er with- the victim starts to pull
grasp on a solid object, like a boat ladder, you in, you can let go
ctim, too, dock or poolside. Extend one arm or leg to the easily.
ntaining victim and then pull to safety.
your own. If the victim’s too far away, you can use
become a an extension assist by reaching out with a
etween pole, boat paddle or even a towel or piece of
them on
ou other-
Chapter One 53
clothing. Use the same technique as with the reach to extend the
object. One advantage of an extension is that if the victim starts to
pull you in, you can let go easily.
Exerc
Throwing Assists. If you can’t reach 1. Your
or extend to the diver, your next choice is victim
a throwing assist. The ideal is to throw a □ T
rescue bag, or a tethered life ring, buoy or 2. Nons
personal flotation device. But, in a pinch,
□ a
anything with reasonable buoyancy tied to
□ b
a line will do. Throw the flotation past the
victim and then pull it in with the line – this □ c
is faster than attempting to throw to the □ d
victim because a short throw will require How did
you to retrieve the line and try again. If you 1. True
don’t have a line, throw flotation anyway.
Establishing buoyancy may stabilize the
situation, and it may come in handy if you
have to use an inwater assist.
Wading Assists. A wading assist is

more dangerous than other nonswimming
assists because you must enter the water.
Use a wading assist when the victim is too
far away for a reach or extension assist and
If you can’t reach or
extend to the diver, your you have nothing for a throwing assist, but the victim is reach-
next choice is a throwing able from water that allows you to go in no more than chest deep.
assist. The ideal is to
throw a rescue bag, or a
Wade in to water chest deep or shallower and get into a stable
tethered life ring, buoy or position with one foot forward and one back, weight on the foot
personal flotation device. away from the victim. Extend something to the victim and then
slowly walk to safety, reassuring the person as you go. In cold
water, remember your safety comes first, and you should not
attempt a wading assist unless you’re wearing adequate exposure
protection.
Watercraft Assists. If you can’t reach, extend, throw or wade,

your final option before attempting an inwater rescue is to use a
small boat or other watercraft if available. Use a stable craft that
can’t be capsized easily and approach from downwind so that the
boat doesn’t blow over the victim, then use a reach from the boat
side, if necessary, to help the victim. When possible, two rescuers in
the boat, one to drive and one to assist, simplifies the rescue.

end the
starts to
Exercise 1-9
’t reach 1. Your safety takes priority over the victim’s because it’s for the
oice is victim’s best interest as well as yours.
row a □ True □ False
buoy or 2. Nonswimming assists include (check all that apply):
pinch,
□ a. reach and extension assists
y tied to
□ b. watercraft assists
st the
e – this □ c. lifeguard tow assists
o the □ d. wading assists
equire How did you do?
n. If you 1. True. 2. a, b, d.
yway.
e the
y if you
Assisting the Responsive
Diver at the Surface
sist is As mentioned previously, you can broadly classify
mming responsive diver at the surface rescues as tired diver
e water. or panicked diver rescues. A tired diver rescue is gen-
m is too erally more of an assist, whereas the panicked diver
ssist and is a true rescue because the victim will likely lose
each- consciousness and drown if not helped. The pan-
est deep. icked diver rescue is also the most hazardous situa-
stable tion for the rescuer because the victim isn’t rational
e foot and may hang on or climb onto the rescuer in an
then attempt to remain afloat. Driven by fear, a panicked
cold diver can be incredibly strong and overpower small-
not er divers. This is why reaches, extensions, throws,
exposure wading and watercraft assists are your preferred
options over inwater rescues.
However, those options may not be avail-
w or wade,
able, or you may already be in the water near the
to use a
diver when the problem arises. Your and the diver’s
craft that
equipment provide adequate resources to handle If you must perform a rescue starting from shore or
o that the
the emergency. aboard boat, take your mask, fins and snorkel. Don
m the boat them with your eyes on the victim, or have someone
escuers in watch and point to the victim while you do so, and enter
Tired Diver Rescue. Let’s begin with the tired the water with your eyes on the victim.
cue. diver, which is perhaps the simplest rescue situation.
Chapter One 55
But, recall that a tired diver can lapse into panic during a
rescue (typically before you actually get close enough to
help), and a panicked diver may come out of panic (typically
after you make contact and establish buoyancy). You need
to continually assess the victim’s state of mind when assist-
answers to the following a responsive diver at the surface.
ing questions as you Approach – If you’re already in the water, you’ll be
read: fully equipped normally. But, if you must perform a rescue
1. What are the two starting from shore (which you’ll practice later in the course)
types of responsive or aboard a boat, take your mask, fins and snorkel. Don
diver at the surface them with your eyes on the victim, or have someone watch
rescues? and point to the victim while you do so. Enter the water (if
2. Why is rescuing a not already in) and swim with your head up, eye on the vic-
panicked diver the tim the entire time. Look for signs of panic and try to deter-
most hazardous mine the victim’s state of mind. Pace your swim so you
situation for the res- arrive with sufficient energy to complete the rescue and tow
cuer?
the diver to safety, if necessary. You want to hurry, but have
3. What are the proce- enough strength to do some good when you get there.
dures for rescuing Evaluate – Stop your approach near, but out of
a tired diver at the
reach of the victim. Assess whether the diver’s rational or
surface?
panicked. Try to spot the diver’s BCD inflator location and
4. What are the proce- type, and attempt to talk the person through the problem by
dures for rescuing
giving strong verbal
a panicked diver at
the surface? instruction to inflate
the BCD or drop
5. What are three
weights. If the victim
release techniques
for escaping from a complies or responds
panicked diver? coherently, then panic
has not set in.
Make Contact
– If you’re confident the
diver has not panicked,
establish ample positive
buoyancy and continue your
approach from the front.
Try to reassure the diver by
explaining what you’re going
to do or by giving further
directions. Make contact and
support the diver, assisting
Ideally, use a tow that keeps the victim’s face above the surface, with both
with establishing positive of you positively buoyant, swimming horizontally for minimum drag and easy
buoyancy, if necessary. kicking.

Reassure the Tired Diver – Make eye contact and talk
directly to the victim, which shows the diver
you’ve got the situation in control. Help the diver
relax and rest before resuming activity. If surface
conditions allow, the diver may remove the mask
and regulator/snorkel for more comfort.
Assists and Transport – As you assist
the tired diver to the boat or shore, allow the per-
son to self-assist as much as possible. Ideally,
use a tow that keeps the victim’s face above the
surface, with both of you positively buoyant, swim-
ming horizontally for minimum drag and easy
kicking. Obviously, you want to stay in control
of the situation and maintain eye to eye contact.
You’ll learn and practice several tows in Rescue
Training Exercise Three; for the first exercise,
your instructor will teach you one or two to use.
A “tired” diver may be a diver suffering from
a leg cramp. You can help the diver stretch the
cramp out by bracing the fin on the affected leg,
providing something to push and stretch against.
After relieving the cramp, you may tow the diver
a short ways while giving the leg a chance to
You can help the diver stretch the cramp out by bracing the
rest. Following some recovery, the diver can fin on the affected leg, providing something to push and
attempt to swim independently, though more slowly stretch against.
than before. Because mild activity stimulates blood
circulation, lightly swimming after stretching and resting typically
relieves cramping better than resting and not resuming activity.
Equipment Removal – A tired diver may not discard gear
due to impaired thinking under stress, but in most tired diver situ-
ations, other than dropping weights, ditching gear is a low priority.
In fact, it is typically unnecessary. You may want to help a very
tired diver remove the scuba unit (assuming adequate buoyancy
with the exposure suit) to reduce drag, and/or to lie on top of it
to rest. More likely, it may help to have the victim slip the scuba
unit off before trying to climb a boat ladder or trudge up a steep
shoreline. If you’re unsure of the victim’s mental condition as you
approach, one technique is to remove your scuba unit (assuming
you have adequate buoyancy without it), inflate the BCD and pass
it to the diver.
Chapter One 57
Panicked Diver Rescue.
Approach and Evaluation –Your approach and evalua-
tion are exactly the same for a panicked diver as with a tired diver:
Keep your eye on the victim the entire time, and stop out of reach
to determine the diver’s state of mind. Note the BCD inflator loca-
tion and type, and attempt to talk to the victim by giving instruc-
tions like “Inflate your BCD!” or “Drop your weights!” No matter
what behavior you see, assume that any diver who does not
respond rationally is panicked. Based on your size and strength
relative to the diver’s, determine whether you should make contact
on the surface or underwater.
Make Contact – You want to establish buoyancy for the
diver as quickly as possible. A surface approach is fastest, but
presents more risk to you. A flotation aid greatly simplifies a sur-
face approach (you’ll practice using flotation aids later in the
course), but if you’re already in the water, that’s not likely an
option. An underwater approach takes a little longer, but presents
less risk for you. It’s a good choice if you’re substantially smaller
or weaker than the victim.
If you elect to make surface contact, begin by
inflating your BCD and establishing ample buoy-
ancy, so that if the victim climbs on you, you’re less
likely to get pushed underwater. You want to estab-
lish buoyancy for the victim and yourself, and gain
control as quickly as possible. You can use several
methods.
The underarm lift method works well when you are
larger than or about the same size as the victim. As
you approach, the victim will usually reach toward
you. With one hand, grab the victim’s wrist so that
you grasp the diver’s right with your right, or left with
left, and pull him toward you, spinning him around so
he ends up facing away from you. Grasp the same,
upper arm with your other hand and lift, then inflate
the BCD. If necessary, you can easily go to the knee
cradle position for more control. The underarm lift
You can use the underarm lift when you are larger than allows you to support and reassure the victim quickly.
or about the same size as the victim. As you approach, Another method, is to swim around behind the
the victim will usually reach toward you. With one hand,
grab the victim’s opposite wrist and pull toward you, victim from beyond reach and approach from the
spinning the victium around to face away from you. rear. Grasp the tank valve and lock your legs onto
Grasp the same, upper arm with your other hand and
lift, then inflate the BCD.
the tank in the knee cradle position, which prevents a

struggling victim from being able to reach you. Inflate the victim’s
BCD. If possible, release the diver’s weights; this may be neces-
sary anyway if the BCD inflator doesn’t work, or if you’re not sure
the BCD will provide enough lift (overweighted vic-
tim). The cradle position gives you maximum con-
trol, though it takes time to swim behind the victim.
In some rare instances, the victim may turn with
you, making it hard to get behind him.
For an underwater approach, descend quickly
and approach the victim at knee level. If possible,
release the victim’s weights, then turn or swim
around the victim. Ascend hand over hand behind
the victim into the knee cradle position and inflate
both of your BCDs.
If you get into a panicked diver’s grasp, you’ll
need to use a release or escape to regain control
of the situation. The surest release is to breathe
from your regulator and descend. Underwater is
the last place the victim wants to go, and you can
continue your rescue with an underwater approach.
For an underwater approach, descend quickly and
Alternatively, you can attempt to escape by inflat- approach the victim at knee level. If possible, release
ing both of your BCDs, which tends to push you the victim’s weights, before turning or swimming around
the victim.
apart. Finally, you can push the victim up and away
from you, kicking to open the distance between you.
This tends to push you underwater, which is the last
place the victim wants to go. The best technique
may depend on your and the victim’s relative sizes
and the circumstances. You’ll have a chance to
practice different releases during Rescue Training
Exercise Two.
If you’re unable to maintain control of a victim
without unreasonable personal risk, your best option
may be to stay clear. The victim will reach exhaus-
tion, perhaps losing consciousness, after which
you provide aid using the techniques for rescuing
an unresponsive diver that you’ll learn later in the
course. Although this puts the victim in a more seri-
ous situation, it’s preferable to having you in trouble,
too, and unable to provide any rescue at all.
Reassure and Transport – After you’ve You can escape a panicked diver by pushing up and
away, which separates you and tends to drive you
established the victim’s buoyancy, the person will underwater – the last place the victim wants to go.
normally calm down and become more rational.
Chapter One 59
From this point, finish as you would with the tired diver by reassuring the person,
transporting to the boat or shore and encouraging rest. Equipment removal consid-
erations are the same, being a low priority based on the victim’s strength, surface
conditions and exit requirements.
As he grew
tired and
Exercise 1-10
gagged on sea-
1. The two types of responsive diver at the
surface rescues are assisted rescues and water, Thomas
unassisted rescues.
realized that
□ True □ False
2. Rescuing a panicked diver is the most haz-
he wouldn’t
ardous situation for the rescuer because make it to the
□ a. the rescuer is almost always injured. boat. It was
□ b. the victim may climb on and over- too far away, the current was too strong and he
power the rescuer.
was too exhausted. He also realized that the only
□ c. panicked divers usually don’t have
proper gear on. reason he was fighting a losing battle was to keep
□ d. None of the above. up with Jacques, who wasn’t having any diffi-
3. A tired diver is not panicked, so it is not culty – but that didn’t help him any.
necessary to stop outside the victim’s reach
when going to provide assistance. Thomas stopped, inflated his BCD and signaled
□ True □ False “I need assistance” to the divemaster. Without
4. When using surface contact to rescue a
panicked diver (choose all that apply)
hesitating, the divemaster jumped into the
□ a. establish ample buoyancy. small chase boat and picked up both Jacques
□ b. one option is the chin lift. and Thomas.
□ c. one option is the underarm lift.
Back aboard, Jacques mentioned that he didn’t
□ d. you may choose to swim around the
victim to the knee cradle position. even realize that Thomas had signaled for help,
5. Escaping a panicked diver by descending is much less that he needed help. Jacques apolo-
usually effective because underwater is the
last place a panicked diver wants to go.
gized to Thomas and thanked him for taking
□ True □ False steps to rescue himself by asking for assistance.
How did you do? As a result of the incident, Jacques learned that
1. False. The two types of responsive diver at the sur- checking on a buddy includes communicating
face rescues are tired diver rescues and panicked diver
rescues. 2. b. 3. False. You always stop to assess the with your buddy. Thomas learned that when
victim’s state of mind. 4. a, c, d. 5. True diving, stay within your own limits, not
your buddy’s.

Knowledge Review One
Check your understanding of Chapter One by completing the Knowledge Review.
You will answer 10 true/false, multiple choice/multiple response questions.
Please follow these steps:
• Before you begin, please ensure that you have internet access. You must have internet access to
complete the Knowledge Review.
• Tap on Take the Knowledge Review below to start. You’ll be required to log in to the assessment
area. Enter the same password and email address used to access the PADI Library.
• Read each question completely before selecting your answer. If you answer a question incorrectly,
read the explanation provided. Then, answer the question again.
• After you’ve answered all questions correctly, you’ll be asked to accept the Student Diver
Statement. This statement is your agreement that you either understand the questions you
missed, or that if you still don’t fully understand something, you will review the appropriate
sections and/or discuss the question with your instructor until you understand.
After successfully completing the Knowledge Review, you will be returned to this page. Please
continue to the next page, where you’ll find instructions on how to verify if your results have
been received and recorded on your online eRecord.
Take the Knowledge Review

Knowledge Review One
1. The most common cause of diver emergencies is
□ equipment failure.
□ running out of gas.
□ environmental conditions.
□ poor judgment.
Answer key: false, false, false, true
Response: Equipment failure, gas supply issues, the environment and other factors can contribute
to an emergency, but poor judgment is the most common underlying cause of most diver
emergencies.
2. You're on a boat and see a diver who needs help at the surface a short distance away. Before
entering the water to attempt a rescue, which of the following do you need to assess? (Choose all
that apply.)
□ Can the diver manage without assistance?
□ Do you need to enter the water at all?
□ Do you have the equipment and training needed for your and the victim's safety?
□ Can you reasonably accomplish the rescue without getting into trouble yourself?
□ Do you have emergency oxygen and a first aid kit?
Answer key: false, true, true, true, false
Response: Your first concern is to take care of yourself because you can't help someone if you're
in trouble, too. Don't get into the water if you don't have to. If you must, be confident that you have
the training and resources needed to accomplish the rescue without unreasonable risk to yourself.
3. Stress can cause: (Choose all that apply.)
□ temporary strength increase
□ faster thinking
□ pain tolerance
□ perceptual narrowing
□ panic
□ reduced thinking
Answer key: true, true, true, true, true, true
Response: Stress can cause all of these, depending upon the degree. Some stress improves
emergency response, but extreme stress can decrease broad awareness and reduce the ability to
look at the real problem or alternative solutions. Uncontrolled and unmanaged, stress can lead to
panic.
4. The only benefit of a pocket mask is that it reduces disease transmission risk.
□ True
□ False
Answer key: false
Response: The pocket mask reduces disease transmission risk, but it also simplifies getting an
effective seal and positioning the head of rescue breathing. It's one of the most effective tools for
inwater rescue breathing, and you can connect it to emergency oxygen to provide oxygenated air
with rescue breaths.
5. Put a “D” by the characteristics of nonresuscitator demand valve oxygen systems, and a “C” for
continuous flow systems
__ oxygen flows only when diver inhales
__ wastes more oxygen
__ may be used with nonbreathing patient
__ may be used with patient who has difficulty breathing
__ can deliver nearly 100% oxygen
__ used only with a breathing patient
Answer key: D, C, C, C, D, D
Response: If you had difficulty with this, review the discussion on oxygen systems. By successfully
completing the PADI Emergency Oxygen Provider specialty course, you may qualify to use
modern positive pressure oxygen units that combine some of the advantages of both systems.
6. Arrange the basics steps for emergency management into their proper order.
□ Assess the situation.
□ Act on your plan.
□ Delegate.
□ Attend to injuries.
□ Control the scene.
□ Arrange evacuation to medical care.
Answer key: 1, 2, 3, 4, 5, 6
Response: Assess the situation, act on your plan, delegate, attend to injuries, control the scene
and arrange evacuation to medical care. Review the section on emergency management if you
had difficulty with this question.
7. Which of the following skills increase your self-rescue abilities? (Choose all that apply.)
□ Underwater navigation
□ Good buoyancy control
□ Search and recovery
□ Airway control
□ Cramp removal
□ Handling air depletion
□ Responding to vertigo
Answer key: false, true, false, true, true, true, true
Response: All of these are useful skills, but underwater navigation and search and recovery are
not generally considered self-rescue skills.
8. While diving, you and your buddy suddenly start to get swept away in an unexpectedly strong
current. Your first response(s) should be to
□ ascend and surface.
□ set your compass.
□ stop, breathe, think and act.
□ swim into the current.
Answer key: false, false, true, false
Response: When faced with a problem, your first responses should be to maintain control and
respond rationally, based on your training. So stop, breathe, think and then act based on your
assessment of the situation.
9. Put a “T” by the characteristics of divers who are tired, but in control at the surface, and a “P” by
the characteristics of divers who are panicked at the surface
__ reject equipment
__ signal for help
__ respond to directions
__ high tread and excessive kicking
__ will climb on anything or anyone
__ usually assists with your efforts
Answer key: P, T, T, P, P, T
Response: Review the discussion on assisting divers at the surface if you had difficulty with this
question, paying particular attention to the differences between tired and panicked divers.
10. You see a diver who is floating on the surface, not moving. Until you determine otherwise, you
should assume that this diver needs help.
□ True
□ False
Answer key: True
Response: A diver floating on the surface who doesn't seem to be moving should be considered
unresponsive until you determine differently, especially if floating in an unusual position.
11. Your safety takes priority over a distressed diver's safety because it is in the victim's best
interest.
□ True
□ False
Answer key: True
Response: Taking care of yourself gives the victim the best chance because you can't help
someone if you get into trouble yourself. Furthermore, you divided any remaining rescue resources
because now two divers need help.
12. You're onshore by a lake and someone calls for help a short distance out in the water. Drag
and drop the following options to consider into their proper order.
□ Reach or extend something.
□ Throw something.
□ Wade into the water.
□ Use watercraft or boat.
□ Swim out to assist.
Answer key: 1, 2, 3, 4, 5
Response: Swimming out to help is your last choice. Provide assistance by reaching, throwing,
wading or taking a boat before getting fully into the water.
13. You're in the water at the surface and a diver signals for help. The diver has the mask on, has
inflated the BCD and responds to your directions. As you go to help, you
□ make immediate contact with the diver.
□ stop outside the diver's reach and assess whether the diver is panicked.
Answer key: false, true
Response: Although the diver doesn’t appear panicked (yet), that can change even as you provide
help. Always assess the diver's mental state, note the BCD inflator location and ask the diver to
establish buoyancy (if not already buoyant) before moving in to assist.
14. You're assisting a diver at the surface. The diver is high-treading, has no mask on and an
uninflated BCD. After assuring your own safety in handling the situation, you want to approach the
diver ___________________ and assist the diver in inflating the BCD and/or dropping weights.
□ on the surface
□ underwater
□ either on the surface or underwater
Answer key: false, false, true
Response: Whether you approach on the surface or underwater depends upon your relative size
and strength compared to the victim's. A surface approach is fastest, but an underwater approach
poses less risk of having the victim overwhelm a rescuer.
Student Diver Statement: I completed this Quiz to the best of my ability. For any questions I
answered incorrectly or incompletely, I reviewed the explanation provided and now
understand the material.In the case of anything about which I still have questions, I will
review the material again and, if necessary, discuss it with my instructor at our next
session.
□ I agree □ I disagree
Knowledge Review Complete
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Chapter One 63
Chapter Two
Barbara, a woman in her late thirties, and Gary, her 62-year-old father
were diving on a tropical shipwreck about 24 metres/80 feet deep. They
were wearing T-shirts and swimsuits, but no leg, arm or hand protec-
tion. The dive had been enjoyable, and, being low on air with no cur-
rent running, the pair decided to ascend
away from the boat. Careful to watch
their ascent rate, they kept a close eye on
their dive computers as they ascended.
Gary, in fact, watched his gauges the
entire time. They made no safety stop.
As they rose through the last 5 metres/15
feet, Barbara looked up and saw a
large Portuguese Man-o-war above.
She kicked to get out of the way, but
got stung on the legs. Gary ascended
directly into it, let out a yell and pushed
the Man-o-war away with his hands.
He managed to inflate his BCD, crying
out in pain. Barbara turned around,
found the boat and began yelling for
help. Gary’s cries stopped, and as far as
Barbara could tell, he was losing con-
sciousness.
Divemaster Wendy first heard Barbara’s calls of “Help! He’s been stung
by a jellyfish!” She quickly spotted the divers struggling about
18 metres/60 feet from the boat.
Chapter Two 65
C
hapter Two builds upon what you learned in Chapter
One and practiced in the first three Rescue Training
Exercises. You learned a bit about stress and this
chapter shows you more about recognizing it before
there’s an emergency, and what to do about it. Since equipment
problems can be a cause of diver emergencies, you’ll get some
detail on how scuba equipment works, common problems and
what to do about them. Then you’ll get into some of the specifics
about first aid for aquatic life injuries, followed by more about help-
ing responsive divers at the surface. In particular, you’ll learn more
about responding from shore, using flotation during an inwater res-
cue, different tows, and helping the victim out of the water. You’ll
also learn some important thoughts about how, after the emergency,
you interact with a diver you help.
The Psychology
of Rescue II
Highlight/underline the As a PADI Rescue Diver, you need to learn to recognize
answers to the follow- stress in yourself and other divers. You’ve already learned
ing questions as you that unmanaged stress leads to panic, and that stress can
read:
contribute to make an emergency worse by causing a diver
1. What two steps do to overbreathe the regulator and feel air-starved, therefore
you apply to recog- raising anxiety further.
nize stress in a
The first way to recognize stress is by your direct
diver?
observation. As you’ve already learned, once an emer-
2. What should you do gency’s underway, stress may be very obvious. However,
when you recognize
stress signs can be subtle, especially before an emergency
diver stress?
occurs. Yet this is the best time to catch it, because doing
so may avoid the accident and need for rescue in the first
place.
Look for behavorial changes, especially those that
appear inappropriate or abnormal, such as uncharacteristic
talkativeness, silence, irritability or hesitation. The normally
patient diver who snaps and complains about something
trivial, or a normally talkative diver who says little and
seems preoccupied, may be someone under stress.

Physical stress signs tend to be a bit more obvious, such as
a shivering diver. However, you may still need to look for behavior-
al changes. A mildly seasick diver may not be at the rail ready to
throw up, but instead become quiet and subdued managing the
nausea.
Since you probably won’t know every diver you’re
around, it’s not always obvious whether what you’re
seeing is a stress sign. A diver sitting quietly may sim-
ply be a shy, quiet person. The diver who’s talking a
mile-a-minute may do that all the time, or may have
had one too many cups of coffee. Therefore, the sec-
ond way to recognize stress in a diver is to simply ask.
That’s the best way to confirm whether you’re witness-
ing a sign of stress or are misreading the situation.
In talking to a diver who may be under stress,
the most important thing is to not pressure the diver.
Otherwise, you may get the answer the person thinks
you want to hear rather than what the person really
feels. It may even add stress by creating some peer
pressure. The best approach is to ask about your con-
cerns privately in an open, caring and nonjudgmental
manner. A sincere, “Hey, are you up for this dive?” or Behavioral changes may indicate
stress. The normally talkative diver who
“You seem really quiet today. Everything okay?” goes a says little and seems preoccupied,
long way. It may help to add or follow up with reassur- may be under stress.
ance that it’s not only acceptable, but smart to skip a dive
you’re not ready for, or to alter the dive plan. This reassurance
may remove any peer pressure so the diver feels more comfort-
able about being honest and open.
Once you identify stress, it’s important to break the cycle that
leads to anxiety and potentially, panic or other problems. Recalling
the Stress Response Cycle Chart, your goal is to lead the diver
to problem recognition and solution thinking, and away from anxi-
ety and worry. It’s not that the diver should disregard potential
concerns, but that the diver’s concerns should be realistic, and
the diver should feel that they’re adequately addressed and man-
aged. The diver should feel capable of making the dive, confident
that the risks will either be avoided, or should a particular problem
occur, that there’s an immediately workable and reliable solution
response that can reasonably be expected to resolve the situation.
Chapter Two 67
If someone enters the water feeling differently, anxiety lingers and
arguably, the dive plan’s inadequate at least with respect to that
person.
You can encourage solution thinking by guiding the diver
through four steps. The first is problem recognition. Often the diver
knows exactly what the worry is, but not always. It may help to ask
questions and help the person specifically identify the cause or
causes of stress. The second step is a plan of action formulated
by encouraging the diver to think of ways to handle the concern.
The third step is to have the plan successfully
implemented, which should lead to the fourth step
of the problem minimized or eliminated.
A source of stress may be a problem that
already exists or a problem that could exist,
but the process is the same. For example,
suppose you identify that a diver is stressed
because the dive site is going to be far
deeper than the diver’s experience and
training level. After discussing it, the
diver admits that it’s probably best not
to make the dive, but the cost and
time of getting there is an issue. At
your suggestion, you and the diver go
discuss it with the boat’s divemaster.
The divemaster agrees to put the boat
on a mooring in shallow water near the
deep site, allowing the experienced divers to make the deep dive,
but giving the less experienced divers a shallow reef to explore.
The problem’s eliminated and the diver can now make the dive
safely and without undue stress or anxiety.
Now suppose you’re about to make a boat dive and notice an
apparently stressful diver. Your conversation uncovers the concern
is with the current – the diver has little current experience and
fears getting swept away from the boat. Your conversation identi-
fies that more familiarity with current diving procedures would help,
so you and the diver go to the divemaster. The divemaster pro-
vides thorough briefing on using swim lines, the mooring line and
staying ahead of the boat to prevent getting behind the boat. Next
the divemaster explains how to use the current line if swept past
the boat, and finally, makes sure everyone has an inflatable signal
tube and points out the ready-to-go chase boat in case someone
misses the current line. With this information, the diver feels com-

fortable making the dive. The diver now realizes that getting swept
away from the boat is much less likely with the proper techniques,
and even if it should happen, the boat’s set up for it and it would
be no big deal. The problem has been practically eliminated, and
minmized if it happens anyway.
In going through this process, it’s important that you avoid
sounding judgmental or applying peer pressure. Empathy goes a
long way – statements like, “I feel (or, have felt) the same way,”
help someone recognize that there’s nothing wrong with having a
concern. If it appears the diver isn’t forthcoming about concerns,
the best course may be to take it on yourself by saying, “You
know, I’ve got some concerns about this dive. Maybe we should…”
You may be surprised how many people will come up to you after
and say, “Boy, I’m glad you spoke up because I was worried about
that, too.”
Exercise 2-1
1. What two steps do you apply to recognize stress in a diver?

□ a. direct observation
□ b. ask the diver
□ c. Both a and b
□ d. None of the above
2. When you recognize diver stress, you should alert the divemas-
ter to cancel the dive.
□ True □ False
How did you do?
1. c. 2. False. You should attempt to guide the diver through
solution thinking. Cancelling the dive may be the solution sometimes,
but not normally.
Chapter Two 69
Being Prepared
for a Diver
Highlight/underline
the answers to the
Emergency II
following questions
as you read:
Equipment Function and
1. How do cylinders,
Function-Related Problems
valves and regula- Dive equipment familiarity allows you to go beyond recog-
tors function? nizing problems to understanding their possible causes on
2. What functional an operational level. This enables you to recognize a de-
problems can occur cline in performance before it reaches the problem stage.
with cylinders, To understand how scuba operates, let’s look at a typi-
valves, regulators, cal scuba unit – cylinder; regulator with submersible pressure
SPGs and BCDs?
gauge (SPG), alternate air source and low pressure hose; and
3. What are the two BCD with low pressure inflator – one piece at a time.
basic types of alter-
nate air sources? Cylinders and Cylinder Valves
4. What three points As you know, a scuba cylinder is simply a steel or aluminum
does the dive com-
cylinder capable of holding gas compressed to between
munity generally
agree upon regard- 150 bar/2250 psi and 280 bar/4200 psi. The cylinder valve
ing alternate air controls airflow into the cylinder (when filling) and out to the
sources? regulator (when in use).
The K-valve operates as a simple
on-off valve. The J-valve has a spring
loaded reserve valve that shuts off your air
when the pressure drops to approximately 20
bar/300 psi. This alerts you that you’re almost
out of air; you pull the lever on the valve to
release your remaining air. The J-valve simply
alerts the diver; there’s no more or less air
than without one. The J-valve has become
increasingly less popular since the introduction
of the SPG.
Both valves may also have (varies inter-
nationally) a burst disk, which blows out if tank
pressure rises too high. This prevents cylinder
rupture in case of accidental exposure to high
heat or gross overfilling.
The “K”-valve operates as a
simple on-off valve.

The most serious problem involving cylinders is debris inside
them. This usually develops if someone acci-
dentally pumps moist air or water into the tank,
causing it to corrode inside. You can also get
moisture in the tank by draining it rapidly,
causing condensation, or by storing it com-
pletely depressurized (keep about 7 bar/
100 psi in a cylinder when storing).
In the short term, corrosion can flake off
and clog the valve or regulator. Over the long
term, corrosion weakens the cylinder. Annual
visual inspections keep this problem in check,
but if you hear anything in a cylinder when
you turn it over, or if you suspect you may
have had moisture pumped in, have it visually
inspected at a PADI Dive Center or Resort
immediately.
Getting a bad fill with contaminated air
has become almost unheard of, but the pos-
sibility exists and you should be alert for it. If
air smells bad or has a funny taste, don’t use it. You can see if air The “J” -valve has a
spring loaded reserve
discolors a white handkerchief when you blow the air through it. If
valve that shuts off your
so, don’t use it. Alert the dive operation where you got the fill that air when the pressure
there may be a problem. drops to approximately
20 bar/300 psi to alert
You’ll find that the most common cylinder problem arises you that you’re almost
when a diver doesn’t properly secure it in the BCD. The cylinder out of air. The J-valve
has become increasingly
may slip out, or it may be too high and bang against the diver’s less common since the
head. Watch for cylinders that sink slowly when the diver stands, invention of the SPG.
especially when the diver is walking to or from the water; keep an
eye on where the valve ends up relative to the diver’s head with
the unit on.
The most common valve problem tends to be a worn O-ring.
Slight leakage during a dive doesn’t pose a concern, but advise
the diver to replace the O-ring as soon as possible. Major leaks,
on the other hand, call for aborting the dive due to rapid air loss.
Major leaks develop due to wear, but also when an O-ring dislodg-
es from its seat so the regulator doesn’t seat properly. You can
prevent major leaks by replacing O-rings frequently, before they
show wear, and by making sure they seat properly when setting
up your equipment. Note that with DIN equipment you’ll find the
O-ring on the regulator, not the valve.
Chapter Two 71
Human error leads to another common valve problem: it
being turned off or only partially turned on. This can happen if after
setting up gear to check the air supply and regulator function, a
diver turns the air off, but doesn’t purge the pressure. The SPG
still reads “full,” and the hoses hold enough pressure for a couple
of breaths. The diver may think the air is on and enter the water,
only to “run out” of air after two or three breaths. You can prevent
this by depressurizing the regulator after making a system check.
Similarly, a diver may open the valve only partially, usually to
check the pressure, then forget and begin the dive with the valve
barely open. Or, a stiff valve that needs servicing may feel like it’s
all the way open when only partly open. At the surface this usu-
ally makes no difference, but at depth this may restrict airflow suf-
ficiently to affect breathing. Look at the SPG if you think this may
have happened; the pressure will usually fall and rise sharply as
the diver inhales and exhales. To prevent this, as well as the pre-
vious problem, divers should confirm open cylinder valves during
the predive safety check.
Regulators
Air exiting the cylinder valves flows into the first stage of the regulator.
The first stage reduces the cylinder pressure to an intermediate pres-
sure, which it delivers to the second stage, the alternate air source
second stage and the low pressure inflator hose. The first stage also
feeds high pressure air directly from the cylinder to the SPG.
When you inhale from the second stage, you
draw the diaphragm (see illustration) inward, which
opens the downstream valve and releases the air
you breathe. When you exhale, the diaphragm
returns to its normal position, allowing the
valve to close. Your exhaled breath exits
through the one-way exhaust valves.
Simplified schematic of a second stage. When you inhale,

the diaphragm opens the downstream valve and releases
cylinder air. When you stop inhaling, the valve and dia-
phragm return to their closed positions.

em: it
ppen if after Piston first stage (top) and
nction, a diaphragm first stage (bottom).
he SPG
r a couple
As air flows when you inhale,
he water,
the pressure drops in the first
an prevent
stage intermediate pressure cham-
em check.
ber. In a piston first stage, the
usually to
piston moves toward the interme-
the valve
diate pressure chamber, opening
eel like it’s
the valve and permitting air to flow
his usu-
from the cylinder. In a diaphragm first
airflow suf-
stage, the diaphragm flexes toward the
this may
intermediate pressure chamber, pushing
harply as
the valve seat open to permit air to flow
s the pre-
from the cylinder (see illustrations). The
es during
same thing happens when you put air in
your BCD with your low pressure inflator.
When you stop inhaling (or inflating
your BCD), air from the cylinder accu-
e regulator.
mulates, raising the pressure until the
ediate pres-
piston/diaphragm return to their normal
r source
closed position. Note that water reaches
stage also
the piston or diaphragm, so that as you
G.
descend, rising water pressure also
ge, you
actuates the first stage, so its intermedi-
ard, which
ate pressure remains constant above the ambient pressure. Most
ases the air
regulators maintain an intermediate pressure of about 10 bar/150 psi.
diaphragm
To make breathing as effortless as possible, scuba regula-
wing the
tor valves usually close against the airflow (called downstream
ath exits
valves), with the springs set to just barely close. This means that
valves.
only slight effort overcomes the springs holding the valves shut,
allowing air to flow. It also means that if a downstream valve
fails, it virtually always fails open, allowing air to flow continuously
instead of cutting it off.
Most problems involving regulators begin with inadequate
maintenance or failure to have them serviced annually. A regulator
that doesn’t get properly rinsed accumulates salt and minerals
(even when used in most freshwater sites). As these build up,
parts that used to move against each other freely begin to resist,
especially if the diver hasn’t had the regulator serviced regularly so
it lacks lubrication. This not only increases breathing resistance,
Chapter Two 73
but may also cause unnecessary wear. A regulator that breathes
stiff should be professionally serviced, even if it’s not due for
service yet.
Because downstream valves open with the airflow, misadjust-
ment plus salt/mineral build up and sand can keep the valve from
completely seating, resulting in an annoying constant hiss from the
second stage. Although it’s the second stage that makes the noise,
the problem may be in the first stage. If the first stage valve doesn’t
seat completely, high pressure air from the cylinder flows down to
the second stage where it pushes open the valve. This action pre-
vents the second stage hoses, which weren’t designed to handle
high cylinder pressures, from rupturing. Ironically, a regulator that
won’t stop free flowing can also breathe hard. A
regulator that won’t stop free flowing needs pro-
fessional servicing.
Second stage exhaust valves can also have
problems by sticking or failing to seal. Either
means the regulator needs servicing. You can
often free stuck valves by soaking the second
stage for a few minutes, then blocking the mouth-
piece with your fingers (not in your mouth!) and
pressing the purge button. Nonetheless, have the
regulator serviced as soon as possible.
The mouthpiece deserves attention apart
from rinsing and servicing. Divers sometimes bite
through the bite tabs, and the mouthpiece can
tear, allowing water to drizzle in during use. If
the plastic tie that secures it to the second stage
breaks, the mouthpiece can separate from the
second stage. Inspect the mouthpiece and the
plastic tie before each dive; they’re simple to
replace if you carry spares.
Divers sometimes overlook hose wear.
Inspect the mouthpiece and the plastic tie Inspect the hoses frequently, especially where
before each dive; they’re simple to replace if you
carry spares. they meet the regulator. Hose protectors reduce
wear, but they can also hide it. Slide hose pro-
tectors back periodically and check for damage underneath. Have
your PADI Dive Center or Resort replace damaged hoses before
diving with the regulator.
Diving in freezing climates can cause a temporary “malfunc-
tion” when a regulator freezes, usually causing an uncontrolled free
flow. This happens because the temperature lowers the regulator

to near-freezing temperature. Air flowing and expanding through
the regulator drops the temperature below freezing, causing water
inside and in contact with the regulator to freeze. This jams every-
thing in place, including the open piston or diaphragm. Turn off the
air and take the regulator some place where it can rewarm. You
may need to remove ice from both stages.
To prevent regulator freeze, some divers use special regula-
tors that enclose the first stage in a special fluid that won’t freeze.
The fluid transmits water pressure to the first stage so it operates
normally, but keeps water out of contact with the piston or dia-
phragm. Cold water diving, especially ice diving, requires special
considerations, so it’s recommended you receive training in it from
a PADI Instructor.
Some final thoughts regarding regulators: Don’t use a regula-
tor that leaks water until it receives professional servicing, unless
a torn mouthpiece caused the leakage and you’ve
replaced the mouthpiece. Never spray lubricants
into your regulator – it won’t help, and may damage
the regulator by attracting grit, deteriorating parts or
dislodging the second stage diaphragm. Also, some
lubricants are toxic.
Alternate Air Source

There are two basic types of alternate air source:
alternate air sources that allow buddies to share air
from the same cylinder, and alternate air sources
that are entirely independent air supplies that permit
self-rescue. Because divers have individual pref-
erences, and different alternate air sources have
differing set up requirements, alternate air source
configuration hasn’t become standardized. However,
the dive community has standardized three points
with respect to alternate air sources. First, the sec-
ond stage the out-of-air diver should use should be
clearly identified. Second, it should not be allowed
to dangle, and third, it should be secured in the tri-
Secure your alternate air source in the
angle formed by your chin and the corners of your triangle formed by your chin and the corners
rib cage. of your rib cage.
Allowing an alternate air source to dangle may
damage it, fill it with sand or mud and render it unusable, and
make it hard to find in an emergency. Also, it may snag, bang
Chapter Two 75
and destroy aquatic life, or snag during your entry and snap off.
Securing it and making it conspicuous makes it readily available
and ready to use.
The most common problem, then, arises when divers in a
buddy team don’t familiarize each other with their alternate air
source configurations. This can lead to problems in a low or out-
of-air situation. As a Rescue Diver, it’s recommended that you
become familiar with the options available, and their advantages
and disadvantages.
Most divers use an extra second stage as their alternate air
source, although many divers use alternate inflator regulators,
pony bottles and self-contained ascent bottles. An alternate inflator
regulator consists of an extra second stage combined with a BCD
low pressure inflator; a pony bottle consists of a miniature tank
and a separate regulator; self-contained ascent bottles consist
of very compact, miniature tanks with a built-in regulator. Since Alternate inflator regulators alw
the left because they integrate
they’re all variations of scuba regulators, what you’ve already inflator. With an alternate inflato
learned covers their operation and potential mechanical problems. the donor always gives away th
switches to the alternate inflato
The extra second stage alternate seems to have the most
configuration and use options, and perhaps the most confusion
potential. It can be mounted coming off the diver’s right shoulder
or left shoulder, and it can have a standard length hose or an extra
long hose.
Those who favor a right shoulder configuration note that this
allows the donor as well as the receiver to use the second stage
if necessary. Because this is consistent with the primary second
stage, divers are used to looking for a second stage on the right.
Also, with the low pressure inflator and SPG already on the left,
right shoulder routing reduces clutter and hose confusion on the
left. With a right shoulder routing, the hose must have an “S” bend
when used, so most divers prefer an extra long hose.
Those who favor a left shoulder configuration note that this
positioning orients the second stage so it faces the receiver with-
out an “S” bend in the hose. The primary drawback to the left
configuration is that the donor cannot use the alternate without
severely bending the hose – not a preferred option in an emer-
gency situation.
Divers also differ on which second stage to give the receiver.
Some divers advocate giving the primary to the receiver and
switching to the alternate. The advantages are that there’s no
question that the primary works, and the donor can find it quickly.
Also, panicked out-of-air divers may snatch the primary out of the

snap off. donor’s mouth in the first place. Two
available drawbacks seem to be that both divers
momentarily have no air during the
ers in a switch, and that a longer hose becomes
ate air inconvenient. Because the donor gives
w or out- away the primary, it must have the lon-
hat you ger hose (if a longer hose is used); in
vantages use an extra long hose protrudes and
may snag more easily than a
ernate air standard hose.
ulators, Divers who advocate giv-
nate inflator ing the alternate to the receiv-
with a BCD er cite better control because
re tank the donor always retains the
consist primary air source. Giving
r. Since Alternate inflator regulators always mount on away the alternate allows the
the left because they integrate with the BCD
ready inflator. With an alternate inflator regulator,
donor to route a longer hose
problems. the donor always gives away the primary and out of the way until needed.
switches to the alternate inflator regulator.
he most The primary drawback seems
nfusion to be delay in locating the
shoulder alternate if the diver doesn’t secure it where he or the
or an extra receiver can find it easily. Note that tec divers use extra
long hoses (2.5 metres/7 feet) on their primaries and
e that this always give the primary. They’re trained to route the
nd stage hose to control its length and for use in more complex
y second gas-supply emergency procedures.
the right. Alternate inflator regulators always
the left, mount on the left because they integrate The pony bottle’s
n on the with the BCD inflator. With an alternate advantages consist of a
n “S” bend inflator regulator, the donor always gives system that allows easier
self rescue, additional
away the primary and switches to the air, and, in a malfunction
that this alternate inflator regulator. Those who use situation, a completely
independent scuba
eiver with- this system like getting rid of the additional system.
he left hose, plus the other advantages listed for
Self contained ascent
without giving the primary second stage to the bottles share many of
n emer- receiver. The drawbacks listed apply, too, the pony bottle’s advan-
tages without the bulk
of course. and expense. However,
e receiver. Because pony bottles permit a diver they hold a very limited
r and to self-rescue in a low or out-of-air situ- air supply – just enough
to reach the surface from
e’s no ation, they’re nearly always set up with a moderate to shallow
it quickly. a right shoulder hose configuration for depth, without making a
safety stop.
out of the use by the donor as well as an out-of-air
Chapter Two 77
buddy. The pony bottle’s advantages consist of a system that
allows easier self-rescue, additional air, and, in a malfunction situ-
ation, a completely independent scuba system. The cost and bulk
comprise the main drawbacks. Many divers who use pony bottles
also keep an extra second stage on their primary regulators.
Self-contained ascent bottles share many of the pony bottle’s
advantages without the bulk and expense. Those who use these
point to the fact they’re completely independent air sources in a
compact unit. Also, you can hand an out-of-air buddy a self-con-
tained ascent bottle for an unassisted ascent. However, self-con-
tained ascent bottles hold a very limited air supply – just enough to
reach the surface from a moderate to shallow depth, without mak-
ing a safety stop. Most divers who carry self-contained ascent bot-
tles also keep an extra second stage on their primary regulators.
As a Rescue Diver, try to note what type alternate air sources
the people you dive with use. During your predive safety check,
agree with your buddy which second stage you’ll donate and
which you’ll receive, and vice versa, should the need arise.
Submersible Pressure Gauge

In the past few years, the submersible pressure
gauge has evolved significantly, so that you’ll find
divers using conventional mechanical SPGs,
SPGs integrated with computers, and
most recently, hoseless SPGs.
The hose leading to your SPG
routes high pressure air directly
from your tank to the gauge.
In a conventional SPG, the air
enters a flexible metal tube,
In a conventional SPG, the air enters a flexible either in a spiral, C-shape
metal tube, which tries to straighten much like or similar design, called a
party toys uncurl when you blow into them.
Bourdon tube. The pressure tries to straighten the
The tube flexes, rotating the gauge
needle in response. Bourdon tube, much like party toys uncurl when you
blow into them. The tube flexes, rotating the gauge
needle in response. The more pressure, the more the tube flexes,
showing a higher reading on the gauge.
Most of the newer electronic SPGs are actually part of an
integrated computer. These computers not only read your tank
pressure, but also estimate your air consumption and air time
remaining at depth, plus your no decompression status. The SPG

portion uses a pressure transducer instead of a Bourdon tube.
Changes in pressure produce a change in electronic resistance in
the transducer, which the computer measures to determine and
display your pressure. Computer integrated
SPGs provide high accuracy and convenience,
with the drawback that if your computer fails,
you lose the ability to read your air supply at
the same time.
The latest version of SPG eliminates the
hose by attaching a transducer/transmitter to
the regulator where the SPG hose normally
goes. The transducer reads the pressure and
transmits a signal to your computer on your
wrist, which displays your pressure and uses
Some integrated computers read air pressure
the data for consumption calculations. transmitted from the regulator by a transducer,
The most common SPG problems result eliminating the SPG hose.
from letting the gauge dangle instead of secur-
ing it. A dangling SPG can snag during an
entry, damaging or destroying the gauge,
snapping the hose or causing the diver to
lose his balance. Underwater, dangling SPGs
receive blow after blow against the bottom and
other obstacles, which can cause premature
hose failure, loss of accuracy, or entangle-
ment, destroying aquatic life in the process.
An entire console or computer dangling aggra-
vates the problem with added mass, damaging
several instruments at once while affecting the
environment that much more. As a Rescue
Diver, you can make an important safety and
ecological contribution through the simple step
of properly securing your SPG/console and
diplomatically encouraging other divers to do
the same.
Most SPG mechanical failures involve the
SPG hose and hose connections. Watch for Underwater, dangling
SPGs receive blow
hose wear and replace SPG hoses at the first signs of damage. after blow against
The connection between the hose and the gauge has several tiny the bottom and other
obstacles, which can
O-rings that leak if not replaced regularly.
cause premature hose
A tiny bubble trail from that connection doesn’t usually require failure, loss of
cancelling a dive, but you should have the gauge serviced as soon accuracy, or entangle-
ment, destroying
aquatic life in the pro-
cess.
Chapter Two 79
as possible. When you have your regulator serviced annually, ask
the service technician to service the SPG connections, too.
With high pressure cylinder air feeding it, major SPG hose
or connection failure looks impressive, with a monstrous bubble
cloud and tremendous noise. Although it may appear the diver’s
cylinder will take only moments to drain, unless it’s nearly empty
already there’s usually ample time to make a safe ascent. This is
because manufacturers, recognizing the potential for accidental
gas loss, intentionally restrict flow to the SPG by making all ports
and hose openings to it pin-hole sized. Nonetheless, if someone’s
SPG hose or connection fails, a buddy at hand with an alternate
air source ready adds a margin of reassurance and safety. Note
that the hoseless SPG systems eliminate dangling SPGs and limit
major air leakage to the O-ring port where the transducer/transmit-
ter connects.
Also, with a mechanical SPG, look at the needle during your
predive safety check before you turn the air on. If it reads above
zero with the air off, realize that you can empty your cylinder with
the SPG still showing air left. If you notice this, have your SPG
serviced to correct its accuracy
BCDs and Low

Pressure Inflators
Compared with your regulator, the BCD and low pressure inflator
enjoy mechanical simplicity and few problems. The BCD consists
of little more than a highly spe-
Morn BCDs usually have two or three cialized airtight bladder made
exhaust valves, including an over pressure of incredibly durable material,
relief valve (1), a quick dump exhaust valve
(2) and the exhaust valve integrated with shaped so you can wear it,
the low pressure inflator hose (3). and with straps for adjust-
ment and holding a tank.
Because they’re
simple and sturdy, prop-
erly maintained BCDs
seldom have blad-
der related problems
such as leakage. The
most common problem
involving the BCD blad-
der is simply a BCD that’s
too large or too small for the diver.
One that’s too large may not hold

the diver comfortably at the surface, and one that’s too small can
restrict breathing (especially when fully inflated), making the diver
feel air starved during exercise.
The BCD inflation system takes low pressure air from your
regulator and injects it into the BCD when you press the inflator
button. The inflator valves have a much simpler design than regu-
lator valves. Most aren’t particularly temperamental and function
reliably for years with normal maintenance. In some areas, BCDs
with integrated pony bottles have become popular; these systems
require care and maintenance comparable to your regulator.
Most of today’s popular BCDs have two or three exhaust
valves. The exhaust control that you also use for oral inflation
employs a simple open-close valve that opens when you depress
it. At the base, where the corrugated hose attaches to the BCD,
you may find a “quick dump” exhaust valve that lets you deflate
quickly without raising the BCD hose. This valve opens when you
pull the inflator mechanism, thanks to a cable running through the
BCD hose. When rinsing a BCD with a quick dump, be sure to let
fresh water exit this valve, too. Finally, BCDs have an over pres-
sure relief valve (which may have a quick dump integrated into
it). A spring holds these valves shut until pressure inside the BCD
rises too high. The pressure forces the valve open, relieving pres-
sure rather than bursting the BCD. Rinse this valve carefully and
check it periodically for leakage when the BCD’s inflated normally.
Older BCDs may have CO2 inflators. These devices
employed single-use carbon dioxide cartridges to inflate the BCD
in an emergency. However, low pressure inflators have proved
themselves reliable, while CO2 inflators have been associated with
problems including accidental firing, failure to fire when triggered
and maintenance difficulties, so that few modern BCDs have them.
Divers with older models frequently replace the CO2 cartridge with
a plug.
As you may imagine, most BCD problems involve the inflation
and exhaust valves. Most inflation system problems result in con-
tinuous inflation rather than noninflation. Generally, this begins as
a slow leak that continuously fills the BCD, sometimes so slowly
the diver doesn’t even know it’s happening. If you find your BCD
fully inflates itself when left alone with the cylinder on, have your
inflator checked and overhauled if necessary.
Inflators can also stick in the open position, usually as
a result of not being serviced and maintained properly. Salt
and debris cause the inflator to leak or jam when activated,
Chapter Two 81
inflating the BCD rapidly. This can cause a runaway ascent.
You can stop the airflow by disconnecting the low pressure hose.
Slow the ascent by using your quick dump and by flaring out your
arms and legs to create drag. Inflate orally to finish the dive and
have the inflator serviced before using the BCD again.
Other common inflator problems include leaks at the inflator
connection and disconnected inflators. A leak where the inflator
hose connects to the inflator seldom poses a hazard, because the
released air goes into the water instead of the BCD, but have it
serviced before leakage becomes significant. Divers sometimes
forget to connect the inflator hose when setting up their equip-
ment; you can avoid this problem by checking BCD operation dur-
ing your predive safety check.
Exhaust valves also tend to leak slowly, not fail completely,
when they need service. You may not notice a quick dump valve
or over pressure valve leaking because they may be out of sight
with your mask on. If you find yourself adding air to your BCD fre-
quently without changing depth, have your buddy check them for
bubbles. You’ll probably see leaks in the exhaust valve on the
BCD hose.
If an exhaust
valve sticks open,
Exercise 2-2 how you respond
depends on the
1. A regulator’s intermediate pressure ________________the valve. If it’s the
ambient pressure.
hose deflator valve
□ a. remains constant below □ c. varies above or below
or an overpressure
□ b. remains constant above □ d. None of the above.
valve located low
2. You can classify alternate air sources into those you can use on the BCD, the
independently, and those that require a buddy’s assistance.
BCD will still hold
□ True □ False air if you remain
3. The dive community agrees that an alternate air source should upright and hold
be conspicuous to the diver needing air, not allowed to dangle, the hose deflator
and secured in the area formed by a diver’s chin and lower rib
cage corners. (if that’s the failed
□ True □ False valve) as low as
possible. A failed
4. Salt or debris jamming a low pressure inflator can cause a run-
away ascent.
quick dump may
be more difficult;
□ True □ False
you may have to
How did you do?
swim to the sur-
1. b. 2. True. 3. True. 4. True.
face and dump

your weights to remain afloat. If you’re too heavy to swim to
the surface, you may need to abandon some or all of your
weight underwater.
Common Highlight/underline the
Equipment answers to the follow-

Problems read:
1. What are six general
causes of equipment-
Although function-related problems can occur as you just
related problems?
learned, when a diver encounters an equipment problem, it
usually has one of these six general causes: 2. What are the causes,
effects and preven-
1
The diver uses unfamiliar or specialized equipment with- tion of problems with
out learning to use it properly first. For example, dry suit masks, snorkels, fins,
diving requires some techniques you don’t need when exposure suits, BCDs,
wet suit diving that relate to buoyancy control, valve weight systems and
scuba units?
use, proper zipper maintenance and other consider-
ations. Preferably, the diver learns specialized equip-
ment use from a qualified instructor. Even standard
equipment, such as the BCD, can be misused by
failing to inflate or deflate as needed.
2
The diver uses equipment that doesn’t fit properly.
This can be a simple adjustment problem, such
as a proper sized BCD that needs its straps tight-
ened, or it can be a size selection problem, such
as a wet suit that’s too big or too small.
3
The diver substitutes makeshift, homemade or
obsolete equipment for accepted standard equip-
ment. An example might be a diver who makes a
weight belt from an old automobile seat belt.
4
The diver lacks essential equipment for the dive
environment, or uses the wrong equipment. For
instance, a diver might show up for a cool water
dive with a shorty wet suit. The suit may be in
good shape and fit properly, but if the dive calls
for full wet suits with hoods, problems may result. One common cause of equipment related
problems results from a diver using
5
The diver severely modifies the equipment. equipment that doesn’t fit properly. A wet
suit that’s too small, for example, can
Simple, proper modifications and adjustments restrict breathing leading to a feeling of
don’t usually cause problems; in fact, they usually air starvation.
Chapter Two 83
reduce problems by adapting the equipment to the diver bet-
ter. Nonetheless, be wary when you see extreme or excessive
modifications.
6
The diver doesn’t properly maintain and inspect the equipment.
Like any equipment, dive equipment wears out. Without proper
care, it wears even faster. A diver who doesn’t regularly check
fin straps, for instance, may eventually have one break during
a dive. A diver who doesn’t have his regulator serviced annu-
ally may find it won’t deliver as much air as he demands during
a hard swim.
Predive equipment checks and proper

maintenance play primary roles in preventing
accidents, and should not be neglected.
Obviously, your responsibilities as a Rescue Diver do not include

taking care of every diver’s equipment. All divers have to take care
of their own equipment. Still, by learning to look at other divers’
equipment, you may spot possible problems before they happen.
Exercise 2-3
1. Causes of common equipment problems include (check all

that apply):
□ a. using unfamiliar, specialized gear without learning to
use it properly.
□ b. substituting makeshift gear for accepted standard
equipment.
□ c. failing to inspect and maintain equipment.
□ d. severely modifying equipment.
2. Equipment-related causes of breathing difficulty may include a
□ a. weight system under BCD.
□ b. cylinder valve only partially open.
□ c. exposure suit is too tight.
□ d. loose or damaged mouthpiece.
How did you do?
1. a, b, c, d. 2. b, c, d.

Common Equipment Problems
Equipment Problem Cause Effect Prevention
MASK Water in mask Skirt torn, improper fit, Preoccupies diver Visual inspection,
leaky purge valve, hood, and causes stress. inhaling to test before
hair, etc. under skirt. Obstructs vision. dive.
Lost mask Strap broken, dislodged, Eliminates effective Check strap for cracks,
dropped. underwater vision. aging, adjustment.
Surface swimming Wear correctly.
difficulty.
SNORKEL Unable to Leaky self-drain. Breathing difficulty. Check before and after
clear Incorrectly positioned Water inhalation. entering the water.
on head or in mouth.
Lost snorkel Lost mask, snorkel not Unable to snorkel at Check snorkel security.
attached to mask. at surface. High Wear securely attached
Broken snorkel keeper. energy expenditure to mask.
to swim at surface.
FINS Lost fin(s) Fins too large. Strap Loss of effective Check straps and
slippage. Broken or propulsion and adjustment before dive.
loose strap. Dislodged direction control. Secure straps to
in surf. prevent movement.
Cramp Fins too stiff or large. Ineffective swim- Check fins for fit, com-
Foot pocket too small. ming. Stress. fort and adjustment
Strap or bootie too tight. prior to dive.
EXPOSURE Chilling Suit fits improperly. Shivering, anxiety, Recommend proper

SUIT rapid air use, cramps. insulation. Check fit.
Breathing Suit too tight. Air starvation, Check fit of suit.

difficulty anxiety.
Flooded Torn or punctured suit, Cold water shock. Proper maintenance.

dry suit zipper failure, damaged Negative buoyancy. Examine before dive.
seals.
Overly New suit, salt water, Struggling descents. Check buoyancy;

buoyant air in suit, not enough Overexertion, lung in- add weight if needed.
weight. jury, runaway ascents.
BCD Air leakage Hole in bladder, slow Loss of buoyancy. Check BCD before dive.
leak, hose pulled out, Overexertion. Store BCD partially
missing/defective valve. inflated.
Excessive Stuck or leaking inflator Runaway ascent. Know and maintain

buoyancy valve. Lost deflator hose, Possible air expansion equipment. Test
trapped hose. injury or decompres- before dive.
sion illness.
Chapter Two 85
Common Equipment Problems continued
Equipment Problem Cause Effect Prevention
WEIGHT Difficult to Strap too long; excess Difficulty in establish- Check weight system
SYSTEM remove tucked or tied. Rotated ing buoyancy in an carefully before dive.
weights next to buckle. emergency.
Nonstandard belt. Belt
under BCD harness. Re-
lease mechanism frozen.
Unintentional Belt not buckled securely. Runaway ascent. Check weight system
loss Buckle caught. Attempted Possible decompres- carefully before dive
adjustment. Improper sion illness. and adjust after entry.
position or adjustment.
Weight system release
mechanism snagged and
opened.
SCUBA Little or no air Poor maintenance. Respiratory distress. Proper routine mainten-
upon demand No pressure gauge. ance and service.
Inaccurate gauge. Valve Monitor cylinder pressure.
only partially open. Check air supply before
Reserve not activated. dive.
Dive started with nearly
empty cylinder.
Air loss Free-flowing primary Early termination of Call attention to air

or secondary second dive leading to buddy losses. Encourage
stage. Ruptured hose or separation. Unexpec- correction before dive.
burst disk. Leaky pres- ted depletion of air Adequate predive
sure gauge, leaky O-ring supply. check.
or leaky connections.
Free-flowing Regulator needs service. Distress and possible Proper routine mainten-
Dented cover. Foreign air expansion injury. ance and service.
matter in regulator. Proper use. Anitfreeze
Freezing. provision in very cold
water. Keep second
stages clear inside.
Inhalation Loose or damaged Respiratory distress, Proper maintenance.

of water mouthpiece. Stuck coughing, choking. Check regulator before
exhaust valve. Hole dive.
in regulator diaphragm.
Cylinder out of Backpack improperly Awkward situation. Check cylinder security

backpack adjusted. Incorrect cylinder Possible loss of air before dive.
band. Releasing of cylinder supply.
bank.
There’s always the possibility that a diver will dive with equipment that has a problem despite your
advice against it. If this happens, you can’t do much more than hope for the best and be ready to
help if necessary. The diver, not you, bears the responsibility for the consequences.

Diplomatically discussing what you see may prevent a rescue,
especially if you can correct a problem, such as by offering to
replace a worn fin strap with one from your spare parts kit. Look for
the problems identified in the Common Equipment Problems chart.
Release Function
and Problems
Rescue commonly requires removing and disconnecting Highlight/underline the
equipment, so as a Rescue Diver, you’ll want to recognize answers to the follow-
the most common releases used in scuba equipment, how ing question as you
to operate them and possible difficulties you may encoun- read:
ter with each. Also, releases can create rescue situations 1. What are six types of
if they let go unexpectedly. You can avoid many release releases commonly
problems simply by inspecting them during your predive found in scuba sys-
tems and what prob-
safety check, making sure you’ve secured them properly
lems may they have?
and that you and your buddy know how to operate each
other’s releases. During an emergency, you’ll want to work
each release without having to stop and figure it out.
Quick Release Buckle. You’ll find the familiar quick release

buckle on most weight belts and used as a waist strap on some
BCD jackets. Made from plastic or metal, the majority of these
work simply by biting into the nylon webbing,
although wire quick release buckles lock into a
matching wire loop.
The quick release buckle releases simply by
flipping open the buckle, though it’s usually wise to
pull a weight belt clear of other equipment before
dropping it. The most common problems involve
the buckle not holding, so that the weight belt or
other equipment comes loose unexpectedly. This
can happen due to a broken buckle, or if the diver
accidentally misaligns the webbing so the buckle
doesn’t close all the way.
Sudden weight belt loss can create a haz-
ardous uncontrolled ascent, so never dive with a
broken weight belt buckle, and be sure to close it You’ll find the familiar quick release buckle
on most weight belts and used as a waist
properly. Check the buckle and webbing alignment strap on some BCD jackets. Made from plastic
for your buckles and your buddy’s during your pre- or metal, the majority of these work simply by
“biting” into the nylon webbing.
dive safety check. Many divers carry a spare buckle
so they don’t have to miss a dive if they accidentally
break one.
Chapter Two 87
The dive community has standardized the weight belt release
as a right hand release, preferably with all other releases being
left handed. This makes it easier for a rescuer to locate the proper
release by touch in an emergency.
Quick Disconnect Fasteners. You’ll usually find quick

disconnect fasteners used for BCD chest and shoulder straps, for
attaching accessories to weight belts
or BCDs, and sometimes to attach fin
straps. Occasionally a diver may use
a large one as a weight belt buckle.
Quick disconnect fasteners
release easily by squeezing them,
even under strain. They may become
less reliable with heavy wear, howev-
er, so that they pull free unexpectedly
under strain. Also, putting too much
You’ll usually find quick disconnect fasteners used for BCD chest
and shoulder straps, for attaching accessories to weight belts or
BCDs, and sometimes to attach fin straps.
strain on one may cause it

to pop free (though this has
become less of a problem
with improvements in the
quick disconnect designs).
To prevent these problems,
inspect quick disconnect fas- Known commonly as “Velcro™” after the most popular brand,
touch fasteners join fabric to fabric. You’ll find touch fasteners
teners for wear, and use one used on BCD cummerbunds, and to take up slack when you
large enough for the load. adjust nylon webbing.
Touch Fasteners. Known commonly as “Velcro™” after the

most popular brand, touch fasteners join fabric to fabric. You’ll
find touch fasteners used on BCD cummerbunds, and to take up
slack when you adjust nylon webbing. Nylon cylinder bands, for
example, usually have touch fasteners to hold the web end after
you cinch the buckle down.
Touch fasteners wear out, and they can get clogged with
sand and lint, making them less reliable. Therefore, they’re not

commonly used for weight belts or to hold significant loads.
Inspect the material for wear and replace it as necessary.
Cylinder Band Releases. Several cylinder band release

designs have debuted over the years, but the one shown has
become the most common by
far. Used properly, this release
snugs the nylon cylinder band
firmly, so the cylinder stays put
even with a long walk to and
from the water.
Divers commonly encoun-
ter problems with this release if
they don’t thread it properly, or
if they don’t adjust it properly.
To prevent threading problems,
the manufacturer usually prints
a threading diagram on the
buckle or strap; consult the
Several cylinder band release designs have debuted over the diagram.
years, but this type has become the most common by far. Most adjustment prob-
lems result from securing the
band while it’s dry. Nylon stretches when wet, so
the band loosens after the diver enters the water.
The cylinder may slip free during the dive, or more
commonly, soon after exiting the water. Prevent
this by wetting the band first, and by snugging the
band tightly before swinging the release closed for
a tight grip.
Inflator Quick Disconnect. The com-

mon low pressure inflator quick disconnect hose
has rapidly become the dive community stan-
dard. You’ll most commonly find this connection
on BCD low pressure inflators, dry suit inflators,
and used on many air powered accessories. As
you probably know, you simply pull back on the
knurled ring, though it may take two hands.
Alternate inflator regulators often employ a
larger connection to provide the alternate with
adequate airflow for breathing, and a few high-
volume low pressure inflators use the same con- The common low pressure inflator quick discon-
nect hose has rapidly become the dive commu-
nity standard. You’ll find this connection on BCD
low pressure inflators, dry suit inflators, and on
many air powered accessories.
Chapter Two 89
nector. However, these connect and disconnect exactly
like the standard quick disconnect; they’re just larger.
A common problem with the inflator quick discon-
nect is failure to connect it before the dive. As you’ve
already learned, another problem is that the inflator can
leak and inflate the BCD, but this is a malfunction of the
inflator mechanism rather than the quick disconnect.
Integrated Weight Releases. Weight integrated

BCDs continue to grow in popularity. These systems use
distinct weight quick releases, though they’re generally
similar. Most have a right-handed grip or T-handle that
when pulled, opens the system’s weight pockets. A few
use touch fastener (Velcro™) releases, and some may
have a right and a left release, each of which ditches
half the weight.
These systems function well; the most common
problem is a diver who doesn’t know how to work a
Weight integrated BCDs continue to buddy’s. Because different systems may operate slightly
grow in popularity. These systems
use distinct weight quick releases, differently, divers using such weight systems should be
though they’re generally similar. Most sure their buddies know how to release their weights.
have a right-handed grip or T-handle
that when pulled, opens the system’s
weight pockets.
Exercise 2-4
1. Put the letter of the problem or
characteristic next to the matching release.
a. works by biting into webbing
b. most common problem: not knowing how to work buddy’s system
c. most common problem: failure to connect
d. used to take up slack and on BCD cummerbunds
____ integrated weight release
____ touch fastener
____ quick release buckle
____ inflator disconnect
How did you do?
1. b – integrated weight release, d – touch fastener,
a – quick release buckle, c – inflator disconnect

Accident
Management II
Common Aquatic Life
Injury First Aid
Although few aquatic animals naturally attack divers, many Highlight/underline
have natural defenses that can injure a diver who inadver- the answers to the
tently touches, steps on or blunders into them. Aquatic life following questions
as you read:
injuries fall into three primary types: bites, cuts/abrasions/
punctures and stings (venomations). 1. What are the three
Aquatic animals – even those capable of it – don’t types of aquatic life
injuries?
commonly bite divers. Most bites involve feeding behavior,
though they may also be defensive, such as if a diver sticks 2. What first aid step
a hand into a moray eel’s hole. You give first aid for bites do all aquatic life
injuries have in com-
the same way you would a similar sized wound caused by
mon?
something else. Although very rare, sharks sometimes bite
divers. With a shark bite, your primary concern will be blood 3. What are the first
aid for bites, and for
loss from a massive wound, and your first aid will focus on
cuts, abrasions and
controlling bleeding, managing shock and basic life support. punctures?
Abrasions, cuts and punctures result from falling
4. What five signs and
against barnacle covered surfaces, scrapping bare skin
symptoms indicate
across coral, stepping on sea urchins or similar misfortunes. venomous aquatic
Again, first aid for these is the same as for similar wounds life injuries?
caused by anything else. Give particular attention to sea
5. What is the basic
urchin injuries, however. You may find it difficult to remove first aid for venom-
a fully imbedded spine, and punctures may be prone to ous injuries?
infection. It’s
Cone Shell always wise to
have a physician exam-
ine and treat even minor
injuries.
Venomous wounds
may arise from con-
tact with a wide variety
of aquatic organisms,
including jellyfish, sting-
rays, cone shells, fire
coral, scorpionfish and
others. Fortunately, seri-
ous injuries don’t happen
Chapter Two 91
Urchin Moray Eel Fire Coral
Shark Lionfish
Stone Fish Stingray

often. However, when diving in an unfamiliar area, always check
to see what local aquatic life can sting or produce venomous
wounds.
Venomous wounds vary in severity from minor local pain to
life threatening cardiac arrest. The signs and symptoms tend to be
species specific, though the exact reaction will depend on individu-
al susceptibility to the venom, the individual’s size, age and health,
how much venom entered the injury, where the individual received
the injury, and whether the individual has been exposed to the
same toxin before. Divers with a venomous wound may: 1) suffer
excruciating pain, 2) have local swelling, inflammation and tenta-
cles or welts on the affected area. More serious signs and symp-
toms include 3) weakness, nausea, shock, unconsciousness and
confusion. The diver may have 4) a spreading numbness or paral-
ysis, or convulsions. In the most severe cases, the diver may 5)
suffer respiratory and cardiac arrest.
Treat venomous wounds beginning with primary assessment.
Remove spines (scorpionfish, urchin, stingray, etc.) or stingers
with forceps or other tools, or by irrigating (running water over) the
wound. Don’t touch these with your hands. Soak the affected area
with hot water (43°C to 49°C/ 110°F to 120°F) for
30 to 90 minutes. If the injury occurred to a limb,
keep the limb below heart level. Treat the patient
for shock, maintain the ABCD’S and get the patient
to emergency medical care as soon as possible.
Jellyfish, Portuguese man-o-war and similar
organism tentacles often stick to the wound. Do
not use unprotected hands to remove tentacle
pieces or other stingers – they can still sting even
detached from the animal. Use forceps or other
tools to gently lift the pieces off or irrigate the
wound with seawater (do not use fresh water), and
five percent solution acetic acid. Vinegar, which
contains acetic acid, neutralizes jellyfish stinging
cells. If acetic acid (vinegar) isn’t available, use
household ammonia diluted three parts water to
one part ammonia. After you’ve removed the ten- Aquatic life injuries are typically scrapes or
stings, and can be both painful and serious.
tacles and neutralized the cells, if possible, apply
shaving cream to the affected area and shave it clean. Resoak the
affected area with the acetic or ammonia solution, then clean the
wound with soap and apply an antihistamine or mild corticosteroid
Chapter Two 93
ointment for pain relief. Ice packs, or ice in a dry bag (no leaks or
condensation) and anesthetic sprays may also reduce pain. If the
patient has signs or symptoms more serious than mild pain at the
wound, get the diver to emergency medical care while monitoring
the patient’s lifeline.
Immerse injuries caused by spines or barbs in hot water
50°C/122°F until the pain subsides (using fresh water is not an
issue here). Use hot packs if you can’t immerse the wound. After
the patient feels relief, allow the injury to cool; the patient will prob-
ably feel pain again. Repeat the heat treatment and cooling until
the patient doesn’t feel pain when the injury cools.
Some marine life injuries may benefit from pressure immobi-
lization to reduce the spread of venom until reaching professional
medical care. You can use this with sea snake bites, cone shell
stings, sea wasp (box jellyfish) stings and blue ringed octopus
bites, but don’t use it with stonefish, stingray or other fish-spine
injuries. Apply pressure to the injury with a gauze bandage (or
something similar), wrapping over the bite/sting first, and then
above and below. Wrap joints as well and use a splint if avail-
able, with tension comparable to bandaging a sprain – don’t cut
off circulation. The injured areas must be kept as still as possible
because movement aids venom spread and absorption.
Severe injuries, such as sea snake bites, stonefish and South
Pacific sea wasp stings usually require professional medical care
and antivenom treatment.
Marine Injury First Aid Summary

Pressure Sprays, Ointments, Ice
Immobilization • jellyfish
• sea snake bites
Antivenom
• cone shell
• sea snake
• blue ringed octopus
• sea wasp (box jellyfish)
• sea wasp (box jellyfish)
• stonefish
Hot water
Basic Life Support
• stonefish/scorpionfish
and CPR
• stingray
• may be required by any
• fish spines severe marine injury
Vinegar
• jellyfish

Don’t Underestimate Their Power
Stings from marine animals vary from annoying to life threaten-
ing. Cone shells, sea wasps, Portuguese man-o-war, sea snakes,
and other venomous creatures have killed swimmers and divers.
Whether a sting can be lethal depends on the organism, the sever-
ity of the wound and the victim’s individual reaction.
As a Rescue Diver, this means:
1. Wear appropriate exposure suits and other
protection.
2. Watch where you put your hands and feet,
and watch where you swim.
3. If you don’t recognize something, don’t touch
it, no matter how harmless it looks.
Scorpionfish
4. Heed posted warnings.
Exercise 2-5
1. The three forms of aquatic life injuries include (check all that apply):
□ a. bites □ c. venomous stings
□ b. cuts, abrasions and punctures □ d. impact injuries
2. The first aid step that applies to all aquatic life injuries is
□ a. pressure immobilization. □ c. immerse the wound in hot water.
□ b. begin with primary assessment □ d. apply ice packs.
and the ABCD’S.
3. If it is not a venomous wound, the first aid for aquatic life bites, cut, abrasions and punc-
tures is the same as for a similar wound caused by something else.
□ True □ False
4. The signs and symptoms of venomous aquatic life injuries include (check all that apply):
□ a. severe pain □ c. nausea
□ b. inflammation □ d. paralysis and cardiac arrest
5. The basic first aid for jellyfish stings includes (check all that apply):
□ a. rinsing the injury with fresh water. □ c. applying acetic acid (vinegar) or
□ b. rubbing the affected area with sand. diluted ammonia
□ d. applying a tourniquet
How did you do?
1. a, b, c. 2. b. 3. True. 4. a, b, c, d. 5. c.
Chapter Two 95
Responding
to Diver
Emergencies II
read:
More on Responding
1. What are the tech-
to Responsive Divers
niques and consider- at the Surface
ations for responding In the first two Rescue Training Exercises, you practiced
to a responsive diver
the basic procedures for rescuing responsive divers at
at the surface from a
distance? the surface when you’re already in the water. In Rescue
Training Exercise Three, you’ll practice responding as
2. What is the advan-
though you were ashore or on a boat, and you’ll also prac-
tage of using emer-
gency flotation when tice exiting the water with the victim. In the last chapter you
assisting a responsive learned that you should always opt for a rescue by reach-
diver at the surface? ing, throwing, wading or small vessel before an inwater
3. What are the proce- rescue, if possible. You’ll practice some of those types of
dures for approach- rescues in Rescue Training Exercise Three as well.
ing, evaluating and
helping more than Entry and Approach Considerations. Imagine
one responsive diver you’re relaxing after a dive with a buddy and suddenly a
in the water? diver out in the water starts calling for help. You have your
scuba gear, but there’s no way to reach, throw or wade to
assist, and you have no
small boat or vessel, meaning
you’re going to need to make
an inwater rescue. What
equipment do you take with
you? What’s the most effec-
tive way to enter the water?
The equipment you
should take will depend on the
circumstances, but you almost
always want your mask, fins,
snorkel and some form of flo-
tation. The added advantages
these give you more than
offset the time it may take to
grab them. Other equipment

racticed
ers at
Rescue When an emergency
requires an inwater res-
ng as cue from boat or shore,
also prac- the equipment you
hapter you take will depend on the
circumstances, but you
by reach- almost always want your
nwater mask, fins, snorkel and
some form of flotation if
types of available.
ell.
. Imagine
denly a
have your
r wade to
may depend on the circumstances, how long it will take to reach
the victim and so forth. For example, if you’re wearing a buoyant
exposure suit you may need your weight belt in case you need
to free dive down to a sinking victim (you can ditch the belt after
bringing the victim up). Or, if you see the victim going under imme-
diately and you know the water is deep, you may want to don your
scuba gear. With more than one rescuer, someone can move to
the victim’s aid quickly just snorkeling, while another rescuer pre-
pares for the worst case by getting kitted up in scuba.
Put your mask, fins and snorkel on as close as possible to
the water, but without losing sight of the victim. You want to keep
your eyes on the victim constantly so you don’t lose track. If you
have a long shallow distance to cross, you may want to wade to
chest deep water before donning your fins, again keeping the vic-
tim in sight.
Chapter Two 97
Enter the water as close as possible without losing sight of
the victim. Enter in a manner that keeps the victim in view – wad-
ing in or easing in is usually best. If possible, have spotters watch
and point to the diver. Ask them to not look away for any reason –
that way, if you lose track of the victim in waves or while navigat-
ing around an object, you can look back at the spotters to see
where they’re pointing. If you must step into deep waters, wear
your fins and snap your legs together as
you go in to keep your face above water
and your eyes on the victim.
As you’ve already learned, swim
with your head up and eyes on the vic-
tim. You may have farther to go than if
you were in the water already, so pace
yourself. Swim as fast as possible, but
save enough energy to perform the res-
cue and tow the diver to safety. This will
depend on your physical condition, the
distance, the victim’s relative size, envi-
ronmental conditions and other factors.
You may find that a crawl stroke
using your arms as well as your legs
allows you to approach quickly while
leaving your legs more rested. But
again, you need to conserve enough
upper body strength to handle the
rescue.
Quick Reverse – As you
learned, you stop to evaluate the vic-
Stop to evaluate the victim’s mental state, note the BCD tim’s mental state, note the BCD inflator
inflator location, being prepared for a quick reverse. Lean location, make sure you have ample
backward in the water with your legs towards the victim.
If the victim reaches and struggles toward you, you’re buoyancy and tell the victim to drop
positioned to swim away from the diver’s grasp. weights or inflate the BCD. As you do
this, be prepared for a quick reverse,
which is simply being ready to back away from a panicked diver.
As you stop, lean backward in the water with your legs towards
the victim. If the victim reaches and struggles toward you – threat-
ening to climb on you and (depending on your relative sizes and
strengths) overpower you – you’re already positioned to swim
away from the diver’s grasp.

Using Emergency Flotation. While responding from a
boat or shore likely means a longer swim than if you were in the
water near the victim, the up side is that you’re more likely to have
emergency flotation you can take
with you. The advantage of a flota-
tion device is that it simplifies the
rescue by providing immediate buoy-
ancy and allows you to avoid con-
tact with a potentially panicked diver.
After stabilizing the situation, it’s
often easier to tow the diver to safe-
ty by a flotation device than by tow-
ing the diver directly.
Anything with adequate buoy-
ancy that you can tow or push
with you as you respond will work.
Sometimes you’ll have available flo-
tation that was thrown to the victim,
but fell short; you pick up the device
on your way to the victim. PFDs With emergency flotation available, put it between you and the
victim as you approach. Extend if from a safe distance and tell the
(personal flotation devices) are obvi- diver to hold on to it.
ous rescue aids, but a spare BCD,
a gear bag stuffed with wet suits, a boat fender or even a sealed
cooler may work. All that matters is that it floats enough to support
a diver, and you can swim or tow it.
With emergency flotation available, put it between you and
the victim as you approach. Extend if from a safe distance and tell
the diver to hold on to it. A panicked diver may grab and climb on
to it before you can say anything, or (less commonly) fail to recog-
nize it and disregard it.
If you don’t have emergency flotation available, or the victim
doesn’t take it, you’ll make contact and assist like you’ve already
learned, using tired diver or panicked diver rescue techniques, as
appropriate for the situation.
More than One Responsive Diver. It’s rare, but pos-

sible, that two or more divers may need help at the surface. This is
more complex than a single victim, obviously, but often even a sin-
gle rescuer can assist several victims if the right resources exist.
But, you can only do so much. Remember that your safety comes
first because you can’t help anyone if you get into trouble.
Chapter Two 99
When rescuing more than one responsive divers at the surface, give flotation to the diver
who appears to be in the worst trouble first, confirm that it solves the immediate threat and
stabilizes the situation, then go assist the next diver.
With two or more responsive divers in trouble at the surface,

your first response to consider is the same as with a single victim:
look for ways to reach, throw, wade or use watercraft. If there are
other qualified Rescue Divers present, immediately agree who will
help whom, effectively turning the situation into multiple single
diver rescues going on at the same time.
If you have no choice but to attempt an inwater rescue of
multiple victims yourself, emergency flotation may be almost
essential. Find something, however improvised, and take it
with you.
As you enter and approach, try to determine which diver
needs the most help. Commonly that will be the one who initiated
the situation. Give flotation to that diver first, confirm that it solves
the immediate threat and stabilizes the situation, then go assist the
next diver. Tell the first victim to hang tight and that you’ll be right
back. Approach and evaluate each diver just as you would a single
diver.
In rare circumstances, you may need to separate two pan-
icked divers. Your best bet is usually to approach from underwater

or behind, inflate the divers’ BCDs and/or drop their weights. The
expanding BCDs tend to push them apart, just as when you use
the technique for a release like you practiced in Rescue Training
Exercise Two.
If handling more than one panicked diver presents unac-
ceptable risk, stay clear until one or more exhaust themselves.
This may mean you have to follow up with an unresponsive diver
rescue, but that’s better than getting into trouble yourself. Stop,
breathe, think, and act, do the best you can and keep yourself
safe so you can continue to help.
Exercise 2-6
1. When responding to a responsive diver at the surface from a distance
□ a. take your mask, fins and snorkel.
□ b. don’t waste time looking for flotation devices.
□ c. keep your eyes on the victim continuously.
□ d. be prepared to make a quick reverse.
2. The advantage of emergency flotation in responding to a responsive
diver at the surface is that it provides immediate buoyancy and may
eliminate the need for direct contact.
□ True □ False
3. When assisting more than one responsive diver at the surface (check
all that apply):
□ a. your safety comes first.
□ b. emergency flotation may be almost essential for inwater
rescues.
□ c. never attempt the rescue from in the water.
□ d. remember to rescue by reach, throw, wade or watercraft
first if possible.
How did you do?
1. a, c, d. 2. True. 3. a, b, d.
Chapter Two 101

Exits with a
Responsive Diver
Equipment Removal. After you’ve handled the immediate
emergency by establishing buoyancy for yourself and the victim
and given the situation a chance to calm down, you’ll usual-
ly assist the diver to the boat or shore. In some situations,
getting rid of some equipment may be advantageous by
making a swim less tiring or simplifying an exit. In other situ-
ations, it may be better to keep all equipment in place, and
Highlight/underline the in yet others, it may make little difference. Think about the
following:
read: How far do you have to go? If you have a short
swim to safety or help, the additional weight and drag from
1. What factors should
equipment probably won’t make much difference. If you
you consider when
removing equipment have a long
from a distressed swim, eliminat-
diver? ing the drag
2. What are the general may help you
criteria for tows used save both
to transport a dis- strength and
tressed diver in the energy. Even
water? with a long
3. What should you con- swim, a diver
sider when helping a may be perfectly
distressed diver exit capable of rest-
the water?
ing adequately
to avoid the
expense of tossing
equipment.
What is the In some situations, getting rid of some equipment may be advanta-
environment like? geous by making a swim less tiring or simplifying an exit.
You can remove
almost any equipment that doesn’t provide buoyancy or help you
swim in flat, warm water with an exit on a calm shore or aboard a
boat. On the other hand, you and the victim probably need your
masks and snorkels in choppy seas. If you have to exit through
heavy surf, both you and the distressed diver may need to keep

all your equipment, but through mild surf an exhausted diver might
be best off with mask and snorkel, but no heavy scuba unit or
weights.
What’s the victim’s condition? If the diver recovers
completely, there may be no need to remove any equipment. With
tired, injured or distressed divers who have trouble recovering and
appear weak, it may be best to eliminate equipment to reduce
drag and make it easier for them to exit the water.
There are no hard rules when it comes to equipment remov-
al. Think about the situation and do what’s necessary to give the
best chances for you and the victim to reach safety.
Tows. In Rescue Training Exercise One you practiced towing

distressed divers, and in Rescue Training Exercise Three, you’ll
practice several specific tows. The
ideal tow meets the following general
criteria:
• The tow keeps the diver’s face out
of the water.
• The tow reduces drag by letting you
and the tired diver move through
the water horizontally.
• The tow gives you control.
• The tow doesn’t restrict your
swimming.
• The tow allows you to communicate
with the tired diver, preferably with
eye-to-eye contact, so you can
continue to reassure the diver as
you swim.
Unfortunately, no single tow really
meets all of these criteria, which is why
you learn several tows. That way, you
can choose the tow that best meets The underarm tow is a good tow for a short swim,
and is especially useful for maintaining eye-to-eye
the needs of the situation.
contact and reassuring the victim.
Underarm Tow – Grasp the tired diver
under the arm and continue to swim to safety
while your face remains close to the diver’s. This is a good tow for
a short swim, and is especially useful for maintaining eye-to-eye
contact and reassuring the victim.
Chapter Two 103

Modified Tired Swimmer’s Carry – With the diver float-
ing face up in the water, put the diver’s feet on your shoulders with
the fins out of the water, and
grasp at or above the knees
while you swim, pushing the
diver to safety. This has
some eye-to-eye contact and
is a good position for a long
swim. If you’re a second res-
cuer arriving to help, it’s also
a good way to assist with
transport while the first res-
cuer remains close to the vic- The modified tired swimmer’s carry is a
tim’s face. good position for a long swim.
Cylinder Valve Tow –
Grab the diver’s cylinder valve and swim the face up diver to the
shore or boat. This tow does little to reassure and
provides no eye-to-eye contact, but is an effective
tow for speed over a short distance. You can also
use it over a longer distance once a victim settles
down and trusts that all will be okay, making the
eye contact less important.
Exit Considerations. Circumstances affect

how you’ll exit the water with an responsive diver.
Variables to consider include the exit terrain, sur-
face conditions, whether the victim needs medical
assistance and where that assistance may be,
and how tired you and the diver are.
For a shore exit, you may need to assist a
weak distressed diver to safety. Stand at the div-
er’s side with the near arm across your shoulder,
secured by grabbing the wrist with your far hand.
Support with your free arm around the waist or
tank. You should be able to walk the tired diver to
safety.
You may decide the diver is too weak to walk
ashore or climb aboard a boat with equipment on.
In this case, and if environmental conditions allow,
remove the victim’s equipment before exiting. With
For a cylinder valve tow, grab the diver’s cylinder
valve and swim the face up diver to the shore a difficult shore exit, or one where it’s best to wear
or boat. This tow is effective for speed over a gear due to conditions, you may opt to have the
short distance.
diver crawl out.

diver float- In many instances, a seemingly difficult
ulders with exit with a weak, tired diver may be simplified
by allowing adequate time for the victim to rest
and recover enough to manage the exit with
relatively little assistance from you (though you
should stay at hand in case needed). If time and
conditions allow, this is often the best solution
because it is often beneficial to the diver psycho-
logically by helping restore self-confidence.
For a shore exit, you may need to assist a

weak distressed diver to safety. Stand at
the diver’s side with the near arm across
rry is a your shoulder, secured by grabbing the
wrist with your far hand.
ver to the
assure and
an effective
ou can also
ctim settles
Exercise 2-7
aking the
1. When deciding whether to remove equipment from a distressed diver
□ a. remember that you always remove all gear.
nces affect
□ b. how far you have to go to reach safety is not important.
nsive diver.
□ c. a victim who recovers adequately may not need to
errain, sur-
remove anything.
ds medical
□ d. None of the above.
may be,
2. The ideal tow meets which of the following criteria? (Check all that apply.)
assist a □ a. It keeps the diver’s face out of the water.
at the div- □ b. It reduces drag.
shoulder, □ c. It avoids eye contact.
r far hand. □ d. It gives you control.
waist or 3. Things that may affect how you exit the water with a tired diver may
ed diver to include (check all that apply):
□ a. the exit terrain.
eak to walk □ b. the need for medical assistance.
uipment on. □ c. how tired you and the victim are.
tions allow, □ d. surface conditions.
exiting. With
How did you do?
best to wear
1. c. 2. a, b, d. 3. a, b, c, d.
have the
Chapter Two 105

Post Attendance
Once out of the water, you have three primary concerns with a
responsive diver. First, assess the diver for injury or illness that
needs your attention, based on your Emergency First
Response training. Second, if your assessment finds a seri-
ous medical condition, contact emergency medical care.
Third, be sensitive to the diver’s feelings. Many respon-
sive diver at the surface rescues end up with little or no
Highlight/underline physical injury, but the potential for emotional injury. It’s
the answer to the important to not play hero. Instead, downplay any remarks
following question as
made along those lines, even with good intentions. A good
you read:
response to such comments is something like, “I only did
1. What three concerns what that person would have done for me.”
do you need to han-
Realize that the diver you helped may experience self-
dle with a respon-
sive diver once you esteem loss, especially if that person panicked. Residual
get on the boat or fear may be significant, and your actions at this point may
shore? influence whether that person continues to enjoy diving, or
even ever dives again at all.
Try to reassure and praise the
diver’s correct actions, but don’t minimize the
situation – especially a panicked diver. Realize
that in panic, the person faced an overwhelming
fear, and to be told the cause was “really noth-
Exercise 2-8
ing” is insensitive. To the diver at the moment, it
1. Three concerns
wasn’t “nothing” and it was frightening. But, you regarding a respon-
can show the diver how a simple, different set of sive diver once
responses would easily prevent an emergency if you’re safely on
the boat or shore
the situation were to arise again.
include (check all
Following panic, the most important thing that apply):
for the diver to do is to go diving – which is □ a. assessing for
probably the last thing the person wants to illness or injury.
do. Encourage – but don’t push – the person □ b. contacting
to buddy up with an instructor or divemaster emergency
and go diving again as soon as possible in a medical care if
nonchallenging environment. The sooner the required.
person goes diving again, the sooner that diver □ c. being sensitive
can get past the fear, learn from the incident to the diver
and move on. If you can encourage the diver to regarding the
accomplish that, you will have not only helped incident.
the person when the incident occurred, but you How did you do?
will have helped the person to become a better 1. a, b, c.
diver because of it.

Assessing the situation, Wendy noted that Barbara and Gary were the
first divers up; with other divers in the water and due up soon, she
couldn’t have the captain start up the boat. Eighteen metres/60 feet was
just beyond what she could throw a rescue line effectively. Calling for
Captain Nicolas to assist, she grabbed her mask, snorkel and fins, then
quickly retrieved the trail line, which no one was using because there
was no current anyway. With a full body suit on, she felt she could make
a direct assist with only minimal chance of getting stung herself if she
watched where she went.
She reached the divers quickly; Gary was breathing but didn’t respond
to her. She grabbed him with one arm, and suspecting Barbara may also
have trouble swimming, had her hang on to her same arm. With her
other arm, Wendy held onto the line while Nicolas
pulled them to the boat, making sure no water
splashed into Gary’s airway. The calm conditions
made this easier.
Nicolas and Wendy pulled Gary aboard. Wendy
began her primary assessment, finding Gary’s
breathing shallow and his pulse rapid and weak.
Wendy maintained the lifeline while Nicolas sum-
moned the coast guard by radio. At the same time,
Wendy kept watch on Barbara, who was experi-
encing much pain, in case she began to react more
severely to the stings.
The coast guard advised them to head for port where
they would have an ambulance waiting, which
would be the fastest way they could get medical
care based on their location. Nicolas recalled all the
divers. Several Rescue Divers were among the first
aboard, so Wendy had them get the first aid kit and help Barbara take
care of her stings. At this point, Wendy noticed that her unprotected
hands were burning, having been stung by tentacles still on Gary.
At her request, one of the Rescue Divers helped carefully remove remain-
Chapter Two 107

ing tentacles from Gary and apply first aid for stings while Wendy
maintained the lifeline.
All the divers came aboard quickly. About 10 minutes after the boat
pulled away, Gary stopped breathing and his pulse stopped. Wendy
began CPR with a pocket mask. Five minutes later, Gary resumed
breathing and had a weak pulse. The boat reached the dock about 15
minutes later.
Paramedics took both Gary and Barbara to the local emergency unit.
Wendy remained behind and Nicolas helped her apply first aid to the
stings on her hands for the first time since they occurred. The next day
Barbara was released and Gary was in serious but stable condition.
Eventually he recovered, but the medical opinion was that had medical
care been delayed, due to his age, he probably would not have survived
the accident despite Wendy’s efforts.
Gary and Barbara resumed diving again within a year. They had
learned that some of the simplest rules from their training – such as to
look up while ascending – can have dramatic importance. They also
switched to full length skin suits for better exposure protection. Although
Portuguese Man-o-war were not common to the area, that didn’t mean
they would never encounter one, or another stinging organism. They also
learned that in clear water, a safety stop, besides helping prevent DCI,
provides an opportunity to stop and thoroughly check what’s overhead
before finishing the ascent.
Wendy and Nicolas had responded well to the incident, but they learned
a few things. Most importantly, Wendy realized that she jeopardized
her own safety and her ability to help Barbara and Gary by not fully
protecting herself. In this case, latex or even reef gloves would have
prevented the stings to her hands. Had she reacted to the stings like
Gary, Nicolas may have had to handle her rescue as well as Gary and
Barabara’s. She also realized that as a matter of practice, she should
wear latex gloves when providing any first aid to reduce concerns of dis-
ease transmission.

Knowledge Review Two
Check your understanding of Chapter Two by completing the Knowledge Review.

Knowledge Review Two
1. Preparing for a dive in challenging conditions, someone in another buddy team with whom
you're familiar seems more withdrawn and quieter than usual. To determine whether your
observation indicates stress about the dive, the best approach is to
□ tell the divemaster you have a genuine concern.
□ talk to the diver privately in an open, caring manner.
□ stay close to the buddy team during the dive.
Answer key: false, true, false
Response: Ask about your concerns privately in an open, caring and nonjudgmental manner that
avoids pressuring the person. Break the cycle that leads to anxiety and, potentially, panic or other
problems. Encourage solution thinking.
2. Setting up your equipment following what the dive community agrees on, your alternate air
source is
□ tucked in your right side BCD pocket.
□ tucked in your left side BCD pocket.
□ hanging free on the right cylinder side.
□ hanging free on the left cylinder side.
□ secured in the triangle formed by your chin and rib cage corners.
□ secured on the lower outside right side of your BCD.
Answer key: false, false, false, false, true, false
Response: Your alternate air source should be clearly identified and secured in the triangle formed
by your chin and rib cage corners so that it frees easily with a tug. Don't allow it to dangle and don't
put it in a pocket where it's difficult to see.
3. Which of the following are causes of equipment-related problems? (Choose all that apply.)
□ Not using top-of-the-line equipment.
□ Using unfamiliar equipment.
□ Using equipment that doesn't fit properly.
□ Using makeshift or obsolete equipment.
□ Failing to use equipment essential for the environment.
□ Using equipment with unauthorized modifications.
□ Failing to properly inspect/maintain equipment
Answer key: false, true, true, true, true, true, true
Response: All of these are common causes of equipment-related problems except not using top-
of-the-line gear. Top-of-the-line equipment offers the best performance and is generally worth the
investment, but all equipment produced by reputable manufacturers meets the requirements of
recreational diving.
4. Select the appropriate possible problem for the release it may be related to
a. Less reliable with wear
b. Clogs with sand/lint
c. Strap threaded improperly
d. Not connected
e. Unfamiliar with use
f. Not holding
__ Quick release buckle
__ Quick disconnect ("Fastex™") fastener
__ “Velcro™” fastener
__ Cylinder band release
__ Inflator quick disconnect
__ Integrated weight release
Answer key: f, a, b, c, d, e
Response: Dive equipment releases are highly reliable when you use and care for them properly.
Review the discussion on release problems if you don't understand the possible problems.
5. You can classify aquatic life injuries as what forms? (Choose three.)
□ Bites
□ Maliciousnesses
□ Stings
□ Attacks
□ aggressives
□ Cuts, abrasions & punctures
□ Whiplashes
□ Ambushes
Answer key: bites, stings and cuts, abrasions and punctures
Response: Aquatic life injuries are classified as bites, stings and cuts, abrasions and punctures.
Aquatic injuries generally result from defensive mechanisms and behavior, not from attacks, malice
or aggression.
6. Treatment for all aquatic life injuries begins with
□ removing spines/stingers.
□ treating for shock.
□ soaking the affected area.
□ primary assessment.
Response: Begin all treatment and first aid for any aquatic life injury with primary assessment.
Maintain the ABCD’s before worrying about more specific first aid, and for serious injuries get the
patient to emergency medical care as soon as possible.
7. Surfacing from a dive, your buddy accidentally brushes an exposed arm against jellyfish
tentacles. Which of the following first aid steps may apply? (Choose all that apply.)
□ Rinse with fresh water.
□ Rub the area vigorously.
□ Remove tentacles with forceps or other tool.
□ Rinse with acetic acid (vinegar) or ammonia solution.
□ Apply heat packs.
□ Follow local emergency protocols.
Answer key: false, false, true, true, false, true
Response: After primary assessment and monitoring the ABCD'S, remove the tentacles by rinsing
with seawater or acetic acid solution, and/or with forceps or other tool. Don't use fresh water or rub
the area because this will trigger further stinging cells. After removing the tentacles, shave the area
if possible and reapply acetic acid or ammonia solution to neutralize remaining toxin. Clean the
wound and apply antihistamine or corticosteroid ointment. An ice pack may help reduce pain. Get
emergency medical care if the injury area is extensive, for very serious stingers like sea wasps,
and/or if the diver has a serious reaction to even a mild sting
8. You're on a boat when a diver surfaces and signals for help, too far to throw to and there are no
watercraft available. When you enter the water, you would get in
□ as close to the diver as possible, keeping sight on the diver all times.
□ where you are when sighted, using a head-first racing dive.
Answer key: true, false
Response: Keep your eyes on the victim at all times. Enter the water as close as possible to the
victim using a technique that lets you keep the diver in sight.
9. As you swim to help the diver in Question 8, you swim
□ as quickly as you can.
□ paced to conserve energy.
□ as slowly as you can.
Answer key: false, true, false
Response: You want to get there quickly, but with enough strength to handle the rescue, so pace
yourself. Don't waste all your energy swimming to the victim.
10. When you approach the victim in Question 8, you stop outside of the diver's reach to evaluate,
prepared for a quick reverse. This means you
□ have your feet angled toward the victim.
□ will swim back to the boat for more equipment.
□ may decide to abandon the victim.
Answer key: true, false, false
Response: By having your feet angled toward the victim, you can quickly reverse away should the
diver become panicked and attempt to climb on to you.
11. In the scenario in Question 8, as you go to the entry area to quickly put on your mask, fins and
snorkel, you pass a PFD (personal flotation device). You should take the PFD with you.
□ True
□ False
Answer key: True
Response: Providing a source of immediate buoyancy allows you to avoid contact with a panicked
diver and usually solves the immediate problem. Once the diver is buoyant and calm, it may be
easier to tow the diver with the PFD.
12. When towing the diver in Question 8, you would choose a tow that allows you to communicate
with the diver.
□ True
□ False
Answer key: True
Response: Communicating is important because it helps further reassure the diver. The diver may
also be able to assist your efforts by following your directions.
13. After getting the diver from Question 8 back aboard the boat, the immediate concerns are:
(Choose all that apply.)
□ assess the diver for injuries or illnesses
□ find out what happened
□ contact EMS if the diver has a serious medical condition
□ be sensitive to the diver's feelings
□ check that the diver's gear is stowed properly
Answer key: true, false, true, true, false
Response: The immediate concerns are checking for medical conditions and contacting EMS if
you suspect anything serious, and being sensitive to the diver's feelings. Divers who need a
rescue may be embarrassed. Being sensitive can help the person learn, feel reassured and
continue to enjoy diving.
session.
□ I agree
□ I disagree
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Chapter Two 111

Chapter Three
Blake and Émile arrived at one of their favorite dive sites, a shallow reef
just offshore, which they reached by swimming from a steep rocky beach.
Normally the beach had a steady flow of sunbathers and anglers, but
this day was overcast and windy, and in the middle of the week. When
they arrived, they were alone.
The pair entered from shore through moderately heavy surf – normal
for this steep beach. Because the water and the air were cool, they had
chosen dry suits. This would make their entry and surface swim to the
reef more tiring, but they reasoned that it would allow a longer dive in
comfort. The high surf at this site called for breathing from their scuba
units during both their entry and exit. Although it wasn’t likely they’d
encounter boats under the conditions, they towed a float with dive flag
as required by local law.
Both divers were experienced
and dived often. Both stayed
physically fit, but Blake had
recently recovered from knee
surgery, and had been away
from his regular schedule of
physical activity. He found the
entry and swim out much more
tiring than usual, and used far
more air than normal swim-
ming through the surf.
The pair reached the dive site
and after resting, descended.
The dive progressed normally,
but unknown to Émile and
Chapter Three 113

Blake, pushed by the growing wind, the swell and surf rose considerably
while they were underwater. When they surfaced, three metre/nine foot
waves were breaking. Also, because Blake had used more air than usual
on the entry, he had little air remaining.
They timed their exit for a lull in the waves, but in these conditions, the
“lull” still had two metre/six and a half foot waves breaking. They swam
toward the surf zone, switched to their regulators and descended, with
Blake holding Émile’s forearm to maintain contact while Émile towed
the float, planning to swim in under the waves as far as possible, then
crawl out on their hands and knees.
It was hard work pulling against the surge. They had hardly entered the
surf zone when Blake ran out of air.
Blake’s tug alerted Émile to a problem. Émile was turning back to deep
water when Blake let go. Émile surfaced immediately, and found Blake
a short distance away, choking and coughing, but in control. A few
waves nearly broke on them, but they were still on the ocean side of the
surf zone. Blake orally inflated his BCD and they swam a safe distance
from the surf.
“I’m nearly out of air,” said Blake, who appeared to Émile to be
exhausted. “And I don’t think I can make it through on the surface. I’m
too weak.”
Émile looked toward shore to see who he could call for help, but they
were alone.

C
hapter Three shifts to new areas and aspects of
managing diver emergencies. You’ll start by looking
at making an emergency action plan – which is a
way to think as much as a way to prepare yourself.
From there you’ll learn specifics about how your CPR and first aid
skills apply to the unique concerns of diving, including how dive
scenarios affect Basic Life Support considerations, and specific
first aid situations that diving can present.
To this point, most of your rescue training has focused on
handling problems at the surface. In this section, you’ll start to look
at rescue situations that take place underwater.
The Psychology
of Rescue III
Emergency Action Plans Highlight/underline
the answers to the
You might think that the topic of emergency action plans
following questions
fits more appropriately under “Being Prepared for an as you read:
Emergency III.” Certainly it wouldn’t be out of place there,
1. What is an emer-
but it appears under “The Psychology of Rescue III”
gency action plan?
because this topic involves a way to think as much as it
involves writing a plan. 2. What five areas of
information may an
The most effective emergency responses result from
emergency action
teamwork and preparation. By thinking about what may plan include?
happen and how you and others would have to respond,
3. What are the ben-
you mentally prepare a list of answers to likely questions.
efits of practic-
When trouble arises, you draw upon this preparation. ing emergency
Actually practicing emergency scenarios takes this a step procedures regu-
farther. Preparation increases the speed and efficiency larly based on your
with which you handle an emergency, so as a PADI emergency action
Rescue Diver, make it a habit to constantly prepare for plan?
an emergency.
Chapter Three 115

At the most basic level, an emergency action plan is simply
an extension of the emergency assistance plan you learned about
in Chapter One. It is the information you will need, at a particular
dive site, in the event of a dive accident. This can be a short list in
a well-developed areas with sophisticated diver medical services,
or it can be extensive in a remote area with little coordinated pub-
lic emergency support. It may be something you just know – like
“dial 911” – or you may need a formal, written detailed plan.
Regardless, you want
to have an emergency action
plan for the sites you visit,
and ideally, practice using
the plan with other Rescue
Divers and higher level div-
ers. Practice with the plan
helps identify hazardous
areas where problems are
The most effective emergency responses

result from teamwork and preparation.
When trouble arises, you draw upon this
preparation.
most likely, additional infor-

mation the plan may need,
ways to refine your respons-
es and so on.
Your emergency action
plan should consider your
team: yourself, other div-
ers, the local emergency
response team (EMS or
local fire department), and
appropriate local medical
services. To the degree fea-
sible, involving these in form-
ing emergency action plans
makes them more efficient and more effective. In some areas, you
may be able to arrange for your group to practice procedures with
outside emergency personnel.

In putting your emergency action plan together, consider what
you’re likely to have to do. Most plans include some or all of the
following:
• the sequence of steps to follow that may be affected by the
local environment
• a list of emergency phone numbers (see Chapter Two)
• a script for what to say when calling emergency services –
especially helpful when delegating untrained bystanders to
make call for you
• the procedures for responding to, moving and transporting
an injured diver out of the area to within reach of emergency
medical care.
• procedures for completing any
required accident and incident
reports.
Although it’s not always feasible or practi-
cal, when you can, there are three ben-
efits to practicing emergency procedures
regularly based on your emergency plan:
The first is that it refines your response
skills. Second, it makes a real emergency
less stressful because you and other div-
ers are familiar with your roles, you know
what to do and you’re more confident
because you’ve done it. Third, after prac-
ticing you can evaluate your performance
and refine the plan based on areas you
could improve.
A practice run does not have to
be an all day event. A good time to run
Practicing emergency procedures regularly refines your
through a scenario may be at the end of response skills, makes a real emergency less stressful and
a day of diving, and simply take 15 to 20 allows you to evaluate your performance.
minutes. Even when you can’t do a full-blown simulated accident

scenario, there’s tremendous benefit if you and those whom you
dive with regularly walk through the steps, discussing what you
would do, when, where, why and how.
Emergency action plans are not necessarily complex or diffi-
cult to complete. As mentioned, when diving in an urban area with
emergency medical services, your contact information may be a
single local number and the local diver emergency service num-
ber. Transport and evacuation may be as simple as carrying the
Chapter Three 117

diver up the stairs or meeting emergency medical personnel at the
dock. Likewise, one of the benefits of going out with professional
dive operators is that they maintain an emergency action plan for
their operation and area. As a PADI Rescue Diver, your role would
most likely be part of a team carrying out their plan as delegated
to you – which can include being asked to stay clear unless asked
to assist.
On the other hand, the more remote your dive site and away
from a dive operation, the more thought and information your plan
requires. You may need to have separate contact information for
emergency medical services – you may even need multiple ser-
vice contacts, each for a different type of emergency. Your plan
may need to consider first aid and Basic Life Support for many
hours. If you’ll be diving in this type situation, you may want to
consider further training in remote area first aid and emergency
management.
Exercise 3-1
1. Basically, an emergency action plan is the information you

would need in the event of an emergency in a particular loca-
tion or at a particular site.
h True h False
2. Areas of information an emergency action plan may include
h a. steps to follow
h b. emergency phone numbers
h c. a script for what to say when calling emergency services
h d. information about any required accident reports
3. Benefits of practicing emergency procedures regularly based
on your emergency action plan include that (check all that
apply):
h a. it eliminates need to brush up on rescue skills
periodically.
h b. it reduces stress in the event of a real emergency.
h c. it refines your response skills.
h d. it allows you to evaluate your performance and refine
your plan.
How did you do?
1. True. 2. a, b, c, d. 3. b, c, d.

Being Prepared
for a Diver
Emergency III Highlight/underline
the answers to the
Basic Life Support for following questions
as you read:
Dive Emergencies 1. What is meant
As you know from your Emergency First Response training by “Basic Life
in CPR and first aid, Basic Life Support (BLS) includes moni- Support”?
toring and enacting emergency procedures for patient respi- 2. What types of
ratory and/or cardiovascular system failure, which cuts off dive accidents can
oxygen to the body, making death imminent. In following require BLS?
the ABCD’S (Airway, Breathing, Circulation-Chest 3. How does time
Compressions, Defibrillation, Serious Bleeding, Spinal and affect Basic Life
Shock Management) Support?
of the patient’s life-
line, you provide BLS.
As you know from your Emergency

First Response training in CPR and first
aid, Basic Life Support (BLS) includes
monitoring and enacting emergency
procedures for patient respiratory and/or
cardiovascular system failure.
Many circumstances
that cause medical emer-
gencies in day-to-day life
can cause the same emer-
gencies in diving circum-
stances, but dive accidents
have unique emergencies
that can also require BLS.
Dive accidents involving
drowning, decompression
sickness and lung overex-
pansion injuries can cause
respiratory and/or cardiac
Chapter Three 119

arrest. Heavy exposure suits in hot weather can cause heat stroke
and heat exhaustion. Prolonged exposure to cold water can cause
hypothermia. Diving is a physical activity with physical stress.
Predisposed individuals exerting beyond their physical limits can
suffer heart attack or stroke. These are not dive accidents per se,
but the activity of diving can be the trigger just like any other sport,
and complicate rescue efforts if they occur underwater or in the
water.
BLS in dive accidents may require rescue breaths for a non-
breathing diver using mouth-to-pocket mask, mouth-to-mouth or
other ventilation methods. You’ll practice rescue breathing in the
water. For a diver with no heartbeat, BLS requires CPR chest
compressions, but because you need the person on a firm sur
face, you can’t begin compressions until you remove the victim
from the water. You’ll also practice managing emergencies for div-
ers who aren’t breathing
and have no pulse.
As you recall,
time affects Basic Life
Support. You want to
begin BLS as soon as
you recognize the need
because without oxygen,
brain damage can occur
in four to six minutes. Time is critical. After six minutes, brain
damage is likely and after 10 minutes it is almost certain.
In diving circumstances, one challenge is that it’s harder
to recognize the need for BLS as quickly. For example, it is often
You want to begin BLS impossible to tell if an unresponsive, nonbreathing diver has a
as soon as you recognize heartbeat or not. Even if you can tell, as just discussed with CPR,
the need because without
oxygen, brain damage you may not be able to begin BLS until you exit the water – and
can occur in four to six exiting the water may present difficulties and delays due to envi-
minutes.
ronment and conditions.
Any emergency situation – diving or nondiving – will have
conditions beyond your control. That’s just how it is. The realities
of diving can keep you from beginning BLS as soon as you’d like,
but whatever circumstances you face as a rescuer, keep time in
mind as you formulate plans for helping a diver who needs, or
who may need, BLS. Do whatever you can to shorten the time to
beginning BLS.

Focus on beginning rescue breaths and/or CPR as soon as
possible, without compromising your own safety. Part of BLS pro-
cedures includes contacting the local Emergency Medical Service
(EMS) system as soon as possible. In a diving context, you may
have a delay before you can begin CPR, but not in contacting
EMS. For example, you may be a ten minute swim from shore with
a victim, but able to yell for someone to contact EMS. This brings
emergency medical care to the site ten minutes faster.
Exercise 3-2
1. Basic Life Support is (check all that apply):

h a. the emergency care found only in a trauma center.
h b. monitoring and enacting emergency procedures for
respiratory and/or cardiovascular system failure.
h c. not ever applicable to a dive accident.
h d. None of the above.
2. Dive accidents that may require BLS include (check all that
apply):
h a. drowning
h b. decompression sickness
h c. heart attack
h d. heat stroke
3. Time affects BLS because the longer the brain goes without
oxygen, the more likely it becomes that brain damage will
occur.
h True h False
How did you do?
1. b. 2. a, b, c, d. 3. True
Chapter Three 121

Accident
Management III
Highlight/underline
the answers to the
Emergency Care
following questions In your Emergency First Response training, you learned
as you read: that a primary assessment is the process of assessing a
1. What are the rec- victim/patient’s situation and condition. In dive accidents,
ommended steps, you follow the same steps you’ve already learned, but the
in order of priority, environment may affect your assessment. Here are the
for conducting a pri- steps of primary assessment in order of priority, with a look
mary assessment? at how diving circumstances can affect them:
2. How do diving cir-
1. Assess the situation – Look for hazards that may
cumstances affect
primary assess- cause further harm to you or the injured diver. In diving,
ment? watch out for things like stinging organisms, boat traffic,
waves or current. Water can conceal potential dangers,
3. What are the nine
signs and symp- so especially if you’re entering the water from boat or
toms of shock? shore, beware of submerged objects or other hazards.
4. How may shock 2. Establish responsiveness. Shake and tap on an

occur in a dive acci- apparently unresponsive diver, and turn a diver who is
dent? face down in the water face up.
5. What is the pro-
3. Upon discovering unresponsiveness or other
cedure for treating
serious medical emergency, call for help as
shock, and how may
dive accident circum- soon as possible. In nondiving circumstances, this
stances affect it? has become increasingly easier thanks to modern com-
munications like cell phones. But when you’re diving,
6. What are the proce-
dures for conducting you may not be able to contact help as quickly, such
a secondary as if you’re underwater or a long way from boat or
assessment of a shore. But, as you’ve learned, summon help as soon
responsive ill or as possible.
injured patient?
4. Establish an airway if the diver is unrespon-
sive. You’ve learned to do this out of the water, but
doing so in the water requires special techniques that
you’ll learn and practice later. Diving circumstances
also require protecting the victim’s airway from water,
which is part of those techniques.
5. Check for breathing. If the victim isn’t breathing,
begin giving rescue breaths, again using techniques for
doing so in the water.

6. Check for circulation (heartbeat). If the diver has no cir-
culation, you need to begin CPR, but you can only do this after
getting the person out of the water onto a hard surface.
Further, it’s so difficult as
to border on impossible to
determine whether a vic-
tim has a heartbeat in the
water, so the protocol is
that you don’t waste time
trying. If the diver isn’t
breathing, you begin res-
cue breaths and tow the
victim to boat or shore as
quickly as possible for fur-
ther assessment, and
begin CPR as necessary.
You’ll learn more about
the procedure details later
in the course. When there’s bleeding from
a leg, it may be most effec-
7. Check for bleeding. If the victim is breathing (which tive for the victim to apply
pressure (if responsive and
means there’s a heartbeat, too), determine if there’s any seri- possible) while you tow.
ous bleeding that you must control. In dive contexts, a
responsive victim will usually know if there’s a substantial
injury (bite or wound) to check. Direct pressure will
work in water, but it may be difficult or impossible
to use pressure points through an exposure suit.
Elevating an arm above the surface may be effec-
tive for short periods. When there’s bleeding from
a leg, it may be most effective for the victim to
apply pressure (if responsive and possible) while
you tow, or for one rescuer to apply pressure
while another tows. The body’s clotting mecha-
nism may be slowed by water, so getting the diver
out of the water is a priority.
Managing Shock. The previous steps are all part Elevating an arm above the
surface may be effective
of shock management. Out of the water, you continue shock
to help control bleeding for
management as you learned in the EFR course, while following short periods.
the priorities for rescue breathing, CPR and first aid.
As you recall, shock is a state in which profound depression
of vital body processes occurs. Severe, sustained shock is a criti-
cal condition that can have permanent effects, even death. There
Chapter Three 123

are nine signs and symptoms of shock (remember, a sign is some-
thing you observe and a symptom is something the injured diver
describes to you):
1. Rapid, weak pulse 5. Altered consciousness

2. Pale or bluish tissue color 6. Nausea and perhaps vomiting
3. Moist, clammy skin – 7. Thirst
possibly with shivering 8. Lackluster eyes, dazed look
4. Mental confusion, anxiety, 9. Shallow, but rapid, labored
restlessness or irritability breathing
Many dive accidents can cause shock, including decompression
sickness, lung overexpansion injury, aquatic life injuries, heat
stroke or exhaustion, hypothermia and near drowning. Anything
that causes a serious wound or trauma can cause shock.
Once out of the water, shock management procedures begin
with primary assessment and monitoring the patient’s ABCD’S
until a medical professional takes over. Maintain the patient’s
body temperature. In dive circumstances, this may mean remov-
ing a wet exposure suit – cutting it away if necessary with a weak
patient. It
can also mean protecting the patient from heat, by providing shade
and sun exposure protection, and removing a hot exposure suit.
Keep the patient lying down. This is important in shock treat-
ment, but as you’ll learn more about later, is also a specific first
aid step for treating decompression sickness and lung overexpan-
sion injuries. Elevate the legs, (except for head or chest injury,
heart problem, stroke or if the leg may be broken). Generally avoid
giving the patient anything to eat or drink, though a diver with sus-
pected decompression sickness or lung overexpansion injury may
drink water to maintain hydration. But, do this with the patient tak-
ing small sips lying down – not by sitting or standing.
Secondary Assessment. Just as you learned for general
first aid, in dive accidents you perform a secondary assessment
on a responsive diver only after a primary assessment determines
that no life-threatening conditions exist. You do this exactly as you
learn in your EFR training, with the patient in the position found
if possible. In diving, this situation is most often in circumstances
such as a hard fall while wearing dive gear, or getting injured by
waves while entering or exiting the water.

Examine the diver from head to toe as you’ve learned, check-
ing for sensitive areas, looking for deformities, fluid, swelling or
reaction to pain. Exposure suits may interfere with injury assess-
ment, but don’t try to remove it if you suspect spinal injury. If you
suspect spinal injury and you need to get the patient out of the suit
to prevent overheating while waiting for EMS, cut the suit off care-
fully, while keeping the patient immobile.
Begin first aid for any injuries you discover during injury
assessment, again following the protocols you learn in EFR.
Monitor the diver’s ABCD’S until medical personnel arrive.
Exercise 3-3
1. The first two steps for primary assessment are establishing respon-
siveness and checking for a heartbeat.
h True h False
2. When rescuing an unresponsive diver in the water, it is important to
check for a heartbeat.
h True h False
3. Signs and symptoms of shock include (check all that apply):
h a. shallow breathing h c. nausea
h b. moist, clammy skin h d. restlessness
4. Shock almost never occurs in dive accidents.
h True h False
5. Treating shock in diving circumstances may require keeping a
patient warm, or keeping a patient cool.
h True h False
6. The procedures for a secondary assessment in diving are the same
as those you learn in EFR secondary assessment.
h True h False
How did you do?
1. False. Primary assessment begins with assessing the situation and
establishing responsiveness. 2. False. It’s almost impossible to deter-
mine heartbeat in the water, so the protocol is that you don’t waste time
trying. 3. a, b, c, d. 4. False. Dive accidents can produce shock due to
injury, decompression sickness, lung overexpansion injury and other con-
ditions. 5. True. 6. True.
Chapter Three 125

Thermal Problems
With heavy exposure suits, cool water and hot climates,
diving presents the potential for heat-related emergencies,
including too much heat and too little. The body maintains
Highlight/underline its core (internal) temperature at approximately 37ºC/98ºF
the answers to the via different physiological mechanisms that promote heat
following questions
loss or cooling as needed. As a PADI Rescue Diver, you’re
as you read:
concerned with heat exhaustion, heat stroke and hypother-
1. What are the differ- mia, which can occur if exposure to heat or cold exceeds
ences between heat
the body’s ability to maintain its core temperature.
exhaustion and heat
stroke, and how do Heat Exhaustion and Heat Stroke. Heat exhaus-
you treat each? tion and heat stroke are forms of hyperthermia (too much
2. What are seven heat) that generally occur before a dive, when a diver
signs and symptoms wears a heavy exposure suit in a hot climate. Exercise,
of hypothermia? which generates body heat, makes the situation worse. Two
3. What is the proper of the body’s chief methods for cooling are perspiration,
procedure for which cools by evaporation, and dilat-
rewarming a patient ing capillaries to promote blood flow
with hypothermia?
and cooling through the skin. An expo-
sure suit effectively negates both of
these mechanisms.
Heat exhaustion occurs when the body’s
ability to cool becomes taxed. Symptoms
and signs include profuse sweating, nau-
sea, dizziness, weakness and faintness. The
body temperature will be near normal, with
cool clammy skin. To handle suspected heat
exhaustion, begin with primary assessment
and move the patient to a cool, shaded area.
Have the patient remove the exposure suit
and drink water. Up to a litre/quart is accept-
able, because heat exhaustion often causes
dehydration. If symptoms don’t subside within
Heat exhaustion and heat stroke
approximately 30 minutes, contact emergency generally occur before a dive, when a
medical care. diver wears a heavy exposure suit in a
hot climate.
Heat stroke is a far more serious condi-
tion, and occurs when rising temperatures
exceed the body’s cooling mechanisms. These mechanisms fail,
and the core temperature begins to rise, which like a high fever, can
destroy tissue and cause permanent disability. You should consider
heat stroke to be immediately life threatening.

Symptoms include hot, dry flushed skin. The patient is hot
to the touch and does not perspire. Begin with primary assess-
ment. Get the patient into a cool area, remove the exposure suit
and immerse the patient in cool water or apply cool wet towels.
Contact emergency medical care while monitoring the patient’s
lifeline.
Hypothermia. Hypothermia occurs when the body cannot
maintain its internal temperature and begins to cool. It usually
results from diving a cool water, but can occur from failing to wear
adequate protection before or after a dive in cold climates.
As a PADI Rescue Diver, it’s important to recognize that
“adequate exposure protection” varies to some degree. In all but
the warmest water, even with a wet suit or dry suit, a diver loses
heat faster than the body can generate it. This is because without
protection, water absorbs heat about 25 times faster than air does.
Furthermore, the diver loses some heat to each breath as the
body warms the cool gas.
An exposure suit slows the heat loss down significantly com-
pared to diving without one, but given enough time, the body may
lose too much heat. A diver may be adequately protected and
comfortable with a given amount of protection at a certain temper-
ature for 30 minutes, for example, but become uncomfortable in an
hour. If a diver encountered circumstances that prevented exiting
the water for three hours, hypothermia could be a substantial
concern.
Likewise, in many multiple dive circumstances, divers partially
rewarm between dives, but don’t have time to entirely rewarm. In
these instances, hypothermia may be even more of a concern.
Hypothermia can also occur or become worse when a diver
leaves the cold environment. This phenomenon is believed to be
caused by cool blood from the extremities returning to the core and
cooling it as normal circulation restores in the warm environment.
Short of causing immediately life threatening symptoms,
hypothermia affects divers in three concerning ways. First, the cold
exposure is a distraction that takes the diver’s focus away from the
dive. Second, with extremity numbness, especially in the fingers,
the diver loses manual dexterity and strength, making it difficult
or even impossible to operate dive gear. Third, as hypothermia
becomes more severe, it impairs mental processes, slowing emer-
gency responses and altering good judgment.
Chapter Three 127

Signs and symptoms begin with shivering, numbness and
blueness in fingers, lips and toes (may be difficult to see underwa-
ter). Shivering is the body’s attempt to generate heat by muscle
contraction and internal friction. Numbness and blueness result
from the body reducing blood flow to the extremities, which radiate
too much heat.
As hypothermia worsens, the diver loses coordination, and
becomes weak and confused. In severe cases, body systems fail,
and shivering stops. At this point, the diver may feel “warm,” with
the next step loss of consciousness, followed by death.
First aid begins with primary assessment. 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. Keep the patient lying down
and not exercising, both of which can lead to heart beat irregulari-
ties in hypothermia.
For severe hypothermia, contact emergency medical care
and protect the patient from further cooling, but leave rewarm-
ing to EMS because doing so is medically complicated. Improper
rewarming can further injure the patient and cause cardiac distur-
bances.
Exercise 3-4
1. Heat ______________ causes profuse sweating, whereas with

heat ___________________, the patient does not perspire.
Treat heat _______________ as immediately life threatening.
h a. stroke, exhaustion, exhaustion
h b. stroke, exhaustion, stroke
h c. exhaustion, stroke, exhaustion
h d. exhaustion, stroke, stroke
2. If the patient isn’t shivering, then hypothermia is not a concern.
h True h False
3. For severe hypothermia, you should protect the patient from
further cooling but leaving rewarming to medical professionals.
h True h False
How did you do?
1. d. 2. False. At the most severe stages of hypothermia, shivering
stops. 3. True

Responding to Diver
Emergencies III
Managing an Emergency
Underwater
Underwater trouble signs tend to be more subtle, but as
you’ve already learned, you can often spot them by being
alert. Watch for rapid breathing, awkward kicking, or other Highlight/underline
signs indicating exhaustion and tiring. A panicked or near- the answers to the
following questions
panicked diver underwater may have wide eyes, breathe
as you read:
rapidly and tend to maintain a vertical posture. Jerky move-
ments, using arms to swim, and sinking while swimming 1. What signs indicate
a diver may have a
upward all point to imminent panic. Panicked divers may
problem underwater?
reject their masks and regulators and bolt for the surface,
forgetting to exhale; this poses a serious danger of lung 2. What do you do to
help a diver with
overexpansion injury. A similar situation may arise from an
these underwater
uncontrolled ascent caused by ineffective buoyancy con- problems: overexer-
trol, a sticking low pressure inflator, or accidentally losing tion, uncontrolled
weights. descent, excessive
Nonetheless, you can help another diver effectively in buoyancy, cramps,
many situations, including the following common problems. entanglement,
entrapment, pas-
Overexertion. As you’ve already learned, overexertion sive panic and active
can be closely linked to stress and panic. Rapid shallow panic?
breathing, whether initiated by fear or trying to swim too
hard, can cause the diver to feel air starved, setting up a
stress cycle that leads to more rapid breathing, increased
air starvation and eventually panic.
Watch for overexertion when you see a diver swimming hard or
doing anything strenuous underwater. Also look for more bubbles than
usual; if you’ve been monitoring the diver’s air supply and can get a look
at the SPG, check for a sharp increase in air use.
Have an overexerting diver stop everything and rest.
Preferably, make contact and have the diver hold on to something
stationary, such as a rock or anchor line, except in heavy surge
where this may require even more effort. When doing this, how-
ever, make sure there’s nothing that could sting or cut the diver
on the stationary object. Encourage the diver to relax and resume
breathing normally by signaling or writing on your slate. After the
Chapter Three 129

diver recovers, it’s a good idea to keep watching to avoid acciden-
tal overexertion again.
Uncontrolled Descent. While you might expect uncontrolled
descents from only overweighted divers, any diver can have this
problem. Uncontrolled descents result from improper buoyancy
control, and can happen if a diver fails to compensate for lost
exposure suit buoyancy by putting air in the BCD during descent,
causing the descent to accelerate with depth. Uncontrolled
descents can also result from carrying something heavy, BCD or
dry suit seal failure, inflator or valve fail-
ure, and in some instances, strong down
currents. A diver sinking out of control ini-
tially faces a high risk of ear and sinus
squeeze, with greater hazard as the diver
reaches extreme depths where nitrogen
narcosis, rapid air use and short no
decompression limits complicate the
problem.
You may need to make contact with the diver to

arrest an uncontrolled descent.
You can often stop an uncontrolled

descent by signaling the diver to add air to
the BCD and level off. If this doesn’t work,
make contact with the diver to arrest the
descent. Use caution and avoid descend-
ing below safe depths as you swim after
the diver. When you reach the diver, grasp
the BCD or tank valve, then add air to the
BCD. If the victim’s BCD doesn’t work,
then use your BCD. Keep in mind that this
will make you excessively buoyant if you let go, so be ready to pre-
vent a runaway ascent, if necessary.
If a diver has extreme negative buoyancy, such as with dry suit
flooding, you may need to drop the diver’s weights. Generally, don’t
do this unless you have no alternative because dropping weights
can cause excessive buoyancy, turning an uncontrolled descent
into an uncontrolled ascent. Also, divers sometimes kick hard when
fighting an uncontrolled descent, so watch for over-exertion.

Excessive Buoyancy. A sticking low pressure inflator or
accidentally dropping weights can cause excessive buoyancy,
but you usually see it in a diver who starts the dive with insuffi-
cient weight. The diver swims in a head-down attitude, kicking to
fight the buoyancy and consequently using air rapidly. Rapid air
consumption aggravates the problem because the tank becomes
lighter.
Escort an underweighted diver to the surface and get the
right amount of weight. Sometimes an underweighted diver can
kick down deep enough to compress the exposure suit or carry
rocks, but these practices can lead to rapid ascents and make it
difficult to maintain safety stops.
Divers sometimes find themselves with excess buoyancy
when they ascend over something without releasing expanding air
from their BCDs. The increased buoyancy lifts them, causing more
expansion and more buoyancy. If they don’t react quickly, they
may find themselves in a runaway ascent.
If you’re close to someone as a runaway ascent begins, you
need to make contact and correct the problem quickly. Use the
quick dump on the diver’s BCD if possible, and reduce your own
buoyancy by dumping your BCD. If the diver’s inflator has stuck,
disconnect the low pressure hose.
If you can’t stop the ascent or reach the diver in time, let go.
You won’t help the victim by making a rapid ascent, too. Try to sig-
nal the victim to flare arms and legs to create drag and slow the
ascent. Ascend at a normal, safe rate and check that the victim
hasn’t been injured.
Cramps. You practiced cramp
relief in the Self Rescue Review, and
you’ve practiced relieving your own
and another diver’s cramps. Before
helping the diver stretch and massage
a cramp, point to the muscle you sus-
pect has cramps and confirm with the
“cramp” signal. You can use the same
signal to tell your buddy you have a
cramp, of course.
After relieving the cramp, encour-
age a slower pace and stay close, just
in case the diver needs a tow back to
the boat or shore. Rapidly clenching your fist is
the signal for “cramp.”
Chapter Three 131

What Causes Cramps?
A cramp is a sudden, involuntary muscle contraction involving
a single muscle or a series of muscles. This happens when
the body temporarily loses its ability to control the muscle.
The most common reasons for cramps are low potassium
(which the body uses for muscle control), dehydration (which
alters the availability of potassium and other minerals) and
lack of fitness in the affected muscle group for the exercise
it’s doing. All of these can contribute simultaneously.
Prevent cramps by staying well hydrated (which also reduces
DCI risk) and eating a properly balanced diet. Bananas sup-
ply high potassium if you believe you need to boost your
potassium levels. If you frequently experience cramps in a
particular muscle group, exercise to develop those muscles.
Entanglement. Divers seldom swim into something that

causes severe entanglement, but by far, fishing line is the most
common cause. Divers sometimes have problems with nets in low
visibility when wreck diving. Severe entanglement more commonly
results when a diver becomes slightly tangled behind his back and
turns to try to extricate himself. Turning wraps more of the rope,
kelp, fishing line, etc., around the diver, making the situation much
worse.
Therefore, your first priority when dealing with entanglement
is to have the victim hold still. Signal “stop,” and get the victim to
hold still while you disentangle him. Reassure the diver as you
progress to discourage turning to see how you’re doing and caus-
ing more tangles.
Usually you can free an entangled diver without cutting. If
you must cut the diver free, use caution. You may find that large,
heavy duty dive knives don’t always have the sharpness you want
for cutting, so you may prefer to carry a second, smaller dive knife
kept very sharp and reserved exclusively for emergencies.
Entrapment. Entrapment situations, such as getting a limb
stuck under something, or wedged into a gap are very rare in
recreational diving. If a diver becomes entrapped, your first con-
cern will be ensuring 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, it may be best to ascend and get more while you still
have ample time. If you decide to do this, mark the site in any way
possible so you can return easily with additional tanks. You may
also consider leaving your scuba unit with the victim and making
an assisted or emergency ascent.
Entrapment can also occur when an improperly trained and
improperly equipped diver enters an overhead environment and
loses his way back out. Unless you’re both properly trained and
properly equipped for the particular overhead environment, do
not attempt to rescue a diver believed lost in it. The chances are
that you’ll become a victim, too, rather than rescue the lost diver.
You can do the most for the lost diver by seeking qualified help as
quickly as possible.
Passive Panic. As discussed earlier, panic may not manifest
itself with wild struggling. In some instances,
the victim freezes into a trance-like state
unaware of the surroundings or anything
happening.
Approach the diver from the front and
signal, “Okay?” If you get no response, go
behind the diver and, holding the regula-
tor in place, take the diver to the surface.
It’s important to help the diver from behind
because passive panic may change to
active panic without warning; by remaining
behind the victim, you’ll be out of the diver’s
immediate grasp.
Once you reach the surface, establish
buoyancy for the victim and yourself, and
help the victim out of the water.
Active Panic. Assisting a diver with
active panic underwater poses a serious
situation for both you and the victim. The
victim may go from stress to total panic in
seconds, sometimes as you’re approach-
ing to help. As with panic on the surface,
the victim may claw, grab and struggle with
tremendous strength, possibly yanking out a
You probably can’t stop a panicked diver from ascend-
rescuer’s second stage or knocking off the ing, but you don’t need to. You want to prevent a rapid,
mask. The panicked diver may fight to reach breath-held ascent.
Chapter Three 133

the surface, instinctively holding his breath and creating a serious
risk of lung overexpansion injury.
Often a panicked diver will bolt for the surface ahead of you,
forcing you to grab a foot or leg to restore control to prevent an
uncontrolled ascent. You probably can’t stop a panicked diver from
ascending, but you don’t need to. You want to prevent a rapid,
breath-held ascent. If the victim has the regulator in the mouth,
simply hanging on and flaring out will usually suffice to control the
ascent rate. If the victim is breath holding, delay is your best bet
at getting the diver to resume breathing before ascending too far.
If without air, your delay may get the diver to signal for your alter-
nate air source or reach for the second stage in your mouth.
If the diver has dropped the regulator and breath-holding, the
victim probably ran out of air. Slow the ascent as much as pos-
sible while providing your alternate air source. Since a panicked
person doesn’t usually respond rationally, you may have to force
the mouthpiece into the mouth while depressing the purge button
lightly to keep it clear. Even if the diver refuses it, the diver must
begin breathing eventually; you want to slow or arrest the ascent
until the victim at least begins exhaling. Once you get the diver
breathing from it, even though possibly coughing and choking in
the process, finish the ascent.
Once you reach the surface with a panicked diver, establish
positive buoyancy for the victim, and exercise control using the
procedures for rescuing a panicked diver at the surface.
Exercise 3-5
1. Signs that a diver may have a problem underwater may include

h a. rapid breathing h c. swimming with arms
h b. horizontal posture h d. jerky movements
2. In the case of a panicked ascent you want to
h a. stop the ascent entirely.
h b. let the diver go.
h c. prevent a rapid, breath-held ascent.
How did you do?
1. a, c, d. 2. c.

Missing Diver Procedures
Missing diver situations can arise suddenly, without warn-
ing. You may be in a group aboard a charter dive boat
or ashore after a dive, when a diver surfaces alone and
announces he can’t find his buddy. Or, you may simply be Highlight/underline
near water when someone nearby calls for help – in this the answers to the fol-
lowing questions as
case, the missing “diver” may not be a diver, but a swim-
you read:
mer, water-skier, angler or other person (Note: for brevity,
the term “missing diver” or “victim” will be used from here 1. Why is time critical in
a missing diver situa-
on.) Regardless of who the victim is, time is precious. You
tion?
need to get things going quickly. Remember, if the victim
isn’t breathing, permanent brain damage is likely after six 2. What steps should
you take if you dis-
minutes. How you respond will depend on the resources
cover that a diver is
you have, but put the following steps in motion as practical: missing?
1. Have someone call for emergency help (EMS, coast 3. What four search pat-
guard, etc. as appropriate for the area) while you find terns may be useful
out where anyone last saw the missing diver. for finding a missing
diver?
2. Assign spotters to look in that area for bubbles and to
4. What considerations
direct rescuers to the area. Tell them where to get bin-
should you take into
oculars if you have them. account when imple-
menting a search for
3. Try to determine if the missing diver may have left with-
a missing diver?
out telling anyone. Have someone look for the diver’s
clothes, gear bag, automobile, etc.
4. Immediately assign qualified divers to don scuba equip-

ment and head to the area where the diver was seen last to
begin an underwater search.
5. If immediately available, send two or more skin divers to mark

the search area with buoys. If they don’t have commercially
made marker buoys, they may be able to improvise with dive
floats, empty bottles and twine, etc. Don’t waste time doing this
– delegate this and stay focused on getting the rescue moving.
The skin divers should save you time, or begin the rescue if
they find the victim in water shallow enough to locate and
surface the person by free diving. However, don’t waste time
with this step if it won’t do anything to make the rescue more
efficient.
Chapter Three 135

A missing diver search calls for executing a search pattern; random
searches may, perhaps, be better than nothing, but provide less
chance of finding the missing diver. Since you’re in a time-critical
situation, your best bet will generally be a simple pattern requiring
little or no special equipment. The most effective search pattern
depends on environmental conditions, but you’ll usually find one of
these four patterns appropriate:
U-Pattern. The U-pattern works well for covering a large

area using minimal equipment. It’s a good choice when you
have several search teams, each conducting a U-pattern in a
different direction away from where the victim was seen last.
Expanding Square. The expanding

square works well when you have only
moderate visibility and you believe the
missing diver hasn’t gone far. It’s a good
choice when you have only a single
search team. The pattern begins where
the diver was seen last and expands
outward.
Circular Search.
The circular search allows
you to search effectively
in poor visibility. However,
because it requires a line, it
takes longer to set up than
the U-pattern or the expand-
ing square. Also, you can only
make the search over a rela-
tively unobstructed bottom.

Surface Led Search. If you need to cover a large complex
area, a surface led search allows the divers to look for the victim
while a skin diver or small boat controls the pattern from the sur-
face. You can search a large area relatively quickly with this meth-
od, so it’s a good choice for most situations and relatively shallow
water.
When searching for a missing diver, keep the following consider-

ations in mind:
1. Have a way to recall searchers to save time when someone
finds the victim. Electronic recalls work well, but you can
improvise by banging on a boat ladder or holding a tank under-
water and rapping on it.
2. Permit searches in buddy teams only. This helps increase

safety for the searchers, and it puts two rescuers on the scene
when they find the missing diver. Also, make sure searchers
have ample air and no decompression time to perform the
search. Rescuer safety takes priority; don’t permit search div-
ers to jeopardize themselves.
3. Currents don’t usually move an unresponsive diver very much

on the bottom, so begin searches where someone last saw
the diver. If you think the victim lost consciousness on the sur-
face and sank, have rescuers descend from that point without
swimming so their descent simulates a sinking unresponsive
diver. Keep in mind that strong currents, tidal currents and
surge may affect where an unresponsive diver ends up.
4. If you don’t have qualified divers present for the search, you
may need to choose a buddy and begin the search yourself.
5. 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, or until relieved by professional assistance.
6. If unsuccessful to this point, turn the search over to

professionals.
Chapter Three 137

Exercise 3-6
1. If you discover a diver is missing (check all that apply):

h a. determine where anyone last saw the diver.
h b. check to see if the diver may have left the area.
h c. request a helicopter from local authorities.
h d. assign spotters to look for bubbles.
2. Time is critical in a missing diver scenario because you don’t
want the diver to get too cold.
h True h False
3. In moderate visibility with a single buddy team, no equipment
and it’s not likely the missing diver is too far from the last
known spot, the most appropriate search pattern would prob-
ably be
h a. the U pattern.
h b. the expanding square.
h c. the circular search.
h d. the surface led search.
4. When implementing a search for a missing diver
h a. start at the furthest point the diver’s likely to be and
work inward.
h b. start at the point where the diver was last seen.
h c. it really doesn’t matter where you start.
How did you do?
1. a, b, d. 2. False. Cooling may be an issue in some instances,
but the primary concern is that if the diver isn’t breathing, brain
damage can occur in six minutes. 3. b. 4. b.

Émile assessed the situation and his options. He could leave Blake on the
float while he went ashore for help. If Blake dropped his weights, there’d
be little chance he’d go under in his dry suit, plus the dry suit ensured
little chance of hypothermia for a while yet. However, the waves were
growing and Émile didn’t know how long it would take to get help.
Blake could be carried out to sea if he took too long.
They could also abandon their scuba units and go in through the surf
with Blake hanging on to the float. The problem was that this could be
just as tiring as going under the waves, and without scuba, there wasn’t
any guarantee that Blake
would handle it any better.
Émile checked his air. Because
Blake had used air fastest and
ended the dive, Émile had 61
bar/900 psi left.
“If we rest a few minutes
and you use my alternate air
source, do you think you can
make it in if you hang on to
me while I pull us ashore?” he
asked Blake.
“Yes, I think so.”
Émile’s plan was to have Blake
use his alternate second stage
and hang on to him while he pulled and swam along the bottom. If they
were separated, Blake still had enough of his own air supply to make it
to the surface safely.
Chapter Three 139

When Blake felt ready, they again descended, this time with Émile doing
most of the kicking and pulling while Blake hung on to him. Shortly,
they crawled safely out of the surf, having only lost their float, which
Émile abandoned due to drag during the exit.
From this incident, Blake and Émile learned several lessons. Because
they had had to manage alone, they realized that it’s much easier to
manage an emergency with more than one rescuer present. Therefore, the
more challenging the conditions, the more important it is to have several
people at the dive site, just in case. Second, they learned the importance
of checking weather reports and erring on the conservative side when
assessing conditions. Third, they learned that a lengthy period of inac-
tivity is likely to affect diving fitness and skills, and that you need to
account for that when planning a dive. Finally, they learned they should
never be afraid to abort a dive when problems start to develop.
Émile handled the situation through excellent emergency management.
He assessed the situation and, despite very limited resources, he came up
with a workable plan by analyzing the rescuer’s condition and thinking
through his options. In this case, he took advantage of the fact that Blake
wasn’t panicked and could assist with his own rescue. With a panicked
victim or a more seriously tired or injured victim, he would have needed
a different approach.

Knowledge Review Three
Check your understanding of Chapter Three by completing the Knowledge Review.

Knowledge Review Three
1. An emergency action plan is
□ a comprehensive manual detailing diver emergencies.
□ a brief discussion on where to get help in a given local area.
□ the information you would need to manage an accident at a particular site.
Answer key: false, false, true
Response: An emergency action plan is the information you would need in the event of an accident
at a particular site. What you need varies with the site, but may include steps to follow, local
emergency phone numbers, protocols for interacting with emergency services, procedures you
may need for moving/transporting a patient, and any details you may need regarding
accident/incident reports.
2. What is BLS (Basic Life Support)?
□ Monitoring heartbeat and breathing
□ Providing emergency oxygen
□ Another term for your regulator
Answer key: true, true, false
Response: BLS (Basic Life Support) means monitoring a patient's heartbeat and breathing, and
providing CPR if needed. Providing emergency oxygen is often an important first aid step in diving,
but is not considered part of BLS. Your regulator is part of your underwater life support system, but
is not termed “BLS”.
3. Which of the following require BLS? (Choose all that apply.)
□ going underwater
□ decompression illness (DCI)
□ heart attack
□ heat stroke
□ hypothermia
□ drowning
□ stroke
Answer key: false, true, true, true, true, true, true
Response: Any condition that can cause respiratory or cardiac arrest requires BLS. If the patient
stops breathing and/or loses a heartbeat, you may need to provide CPR and defibrillation with an
AED. Going underwater may require a life support system, but that isn't termed BLS.
4. Timely BLS is important because it attempts to keep the brain supplied with oxygen. After 2 / 4 /
6 / 8 / 10 / 12 / 14 / 16 minutes without oxygen brain damage is likely, and after 2 / 4 / 6 / 8 / 10 / 12
/ 14 / 16 minutes it is almost certain.
Answer key: 6, 10
Response: Monitoring breathing and heartbeat is a priority because the longer a patient goes
without oxygen to the brain, the more likely brain damage and nonreversible death. Note, however,
that in some circumstances such as drowning in cold water, automatic body responses may supply
the brain with oxygen for durations longer than 10 minutes. Therefore, even if the patient has not
been breathing or had a heartbeat for a long interval, provide BLS and CPR (as needed) until
emergency medical care arrives.
5. Select the steps for a primary assessment in their proper order
__ Open airway if unresponsive
__ Call for help if unresponsive
__ Check for bleeding
__ Assess the situation
__ Manage shock
__ Establish responsiveness
__ Check for circulation
__ Check for breathing
Answer key: 4, 3, 7, 1, 8, 2, 6, 5
Response: If you had difficulty with this, review the Emergency First Response Primary and
Secondary Care Participant Manual as well as the discussion in this chapter.
6. Match the primary assessment steps to how diving can affect each.
__ Establish responsiveness
__ Manage shock
__ Assess the situation
__ Check for circulation
__ Check for bleeding
__ Open airway and check for breathing
a. Turn the diver face up
b. Must get diver out of water
c. Water may conceal dangers
d. Skip this step
e. Pressure points difficult through suit
f. Use inwater techniques
Answer key: a, b, c, d, e, f
Response: You may need to turn a diver face up at the surface to establish responsiveness. A
diver must be out of the water to manage shock. Underwater, it may be harder to assess the
situation for potential hazards. It's almost impossible to check for a heartbeat in the water, so don't
waste time on this step. If you find severe bleeding, applying pressure to the wound may help, but
it is difficult or impossible to use a pressure point through a wet suit or dry suit. It's important to
protect the victim's airway from water, so you need to use techniques you learn in this course
when opening the air way, checking for breathing and providing rescue breaths if needed.
7. A diver has had an accident in a cool climate. You and your buddies have gotten the diver
ashore and are providing BLS and emergency oxygen. EMS is on the way. The diver is lying down,
responsive and breathing, but in pain. You've gotten the wet suit off and put a blanket over the
patient to help maintain body temperature. By enacting these steps, you've followed the
procedures for treating shock in a diving emergency.
□ True □ False
Answer key: True
Response: This is an example of appropriately treating shock in a diving emergency. You may also
slightly elevate the patient's legs to help favor blood flow to the heart, but this isn't mandatory. You
would not elevate the legs if you suspect leg injury or if it causes patient discomfort.
8. We need to change to copy to match drop down
a. Heat Exhaustion
b. Heat Stroke
__ Profuse sweating
__ Hot, dry skin
__ No perspiration
__ Patient hot to touch
__ Cool, clammy skin
__ Patient temperature near normal
Answer key: a, b, b, b, a, a
Response: With heat exhaustion, the body's cooling ability is taxed. The patient will be sweating
profusely and may be nauseous, dizzy, weak or faint, with cool, clammy skin that's nearly normal
temperature. Heat stroke results when the body's cooling systems fail. The patient's core
temperature rises, like a serious fever, and can cause brain injury, tissue damage and permanent
disability. A patient with heat stroke has hot, dry, flushed skin, feels hot to the touch, and no longer
perspires.
9. After too long in the hot sun wearing a dry suit, a diver is feeling very poorly. Once out of the
suit, the diver isn't sweating and feels hot to the touch. You should call EMS and get the patient
into cool water or apply cool wet towels.
□ True □ False
Answer key: True
Response: The diver is showing signs of heat stroke, which is a medical emergency. Take
immediate steps to drop the patient's temperature and contact emergency medical care.
10. You and your buddy have surfaced after a long dive in cool water. You wore a dry suit, but your
buddy was in a thin wet suit. The air temperature is brisk, and your buddy was standing around in
the wet suit rather than changing into warm dry clothes. Your buddy is now shivering
uncontrollably, and complains of numb fingertips and no grip strength. Your buddy's lips, fingers
and toes appear bluish. You should begin first aid for
□ decompression sickness.
□ decompression illness.
□ gas narcosis.
□ hypothermia.
Response: Your buddy is showing the signs/symptoms of hypothermia, meaning the body core
temperature has fallen below normal. As hypothermia becomes severe, shivering stops, and the
patient becomes more confused, eventually losing consciousness.
11. A diver bolts for the surface. Assisting the diver requires you to stop the person's ascent.
□ True □ False
Answer key: False
Response: You probably can't stop a panicked diver's ascent, but you usually don't need to. If the
diver's breathing from the regulator, hanging on and slowing the ascent will usually suffice. If the
diver is breath-holding, this is also your best bet to getting the diver to resume breathing. If the
diver has dropped the regulator and/or appears out of gas, provide your alternate air source while
slowing the ascent.
12. Fighting a current, your buddy seems to be breathing very hard and appears over exerted. You
should signal your buddy to ________ and restore normal breathing.
□ stop, hold onto a stationary object, rest
□ ascend, make a safety stop
□ slow down, press the regulator purge
Answer key: true, false, false
Response: If you or your buddy suffers overexertion, stop and rest. Relax and restore normal
breathing. If possible, hang onto a stationary, insensitive object.
13. While diving on a wreck, your buddy gets some monofilament fishing line wrapped around the
cylinder valve and can't get to it. Your first step would be to have your buddy turn to see if that
releases it.
□ True □ False
Answer key: False
Response: When entangled, turning usually makes the situation worse. Signal "stop" and have the
diver hold still while you untangle everything. Carefully use your cutting tool if you don't think you
can free your buddy in a reasonable period.
14. A diver is missing after a boat dive. Which of the following steps might you put into action?
□ Try to determine where the diver was last seen.
□ Assign a spotter to look for bubbles.
□ Call for emergency help.
□ Assign qualified divers to begin an underwater search on scuba.
□ If immediately available, have skin divers mark the search area.
Answer key: true, true, true, true, true
Response: These are all steps to enact if a diver is missing. When diving from shore, you may also
have someone try to determine if the diver may have surfaced and left without telling anyone.
15. When implementing a search for missing diver, permit searches only by buddy teams within
safe gas supply, no stop time and exposure limits. Have a way to recall searchers.
□ True □ False
Answer key: True
Response: These are all important considerations in implementing a search. If there are no
qualified divers present, you may have to conduct the search. Search for 30 minutes, until you find
the victim, until you reach a gas supply/no stop/exposure limit or until you're relieved by
professionals.
session.
Congratulations, you have completed the Chapter Three Knowledge Review!

After completing the Chapter Three Knowledge Review, you should receive an email from padilibrary@
ppor t
Your Su
Show Off
Select the Project AWARE version of your PADI certification or
replacement card to support underwater conservation.
Project AWARE Foundation receives 100 percent of your donation to

conserve underwater environments through projects like:
 $10 involves 10 children in conservation activities with AWARE Kids
 $25 supports one underwater cleanup project and provides data for marine debris solutions
 $50 activates a team of 10 dive volunteers to monitor coral reefs for stress and bleaching
 $100 helps protect threatened sharks and sustain global ecosystems
Every dollar counts!
Ask your PADI Instructor for details.
Divers Conserving Underwater EnvironmentsSM
projectaware.org
Chapter Three 143

© Project AWARE 2010
Chapter Four
Kimihito, Hiroki and Kenichi were at a dive site aboard their favorite
charter dive boat. The boat was full, but not over crowded, and many
of their other diver friends were aboard. There were also several divers
they didn’t know. The sea conditions were calm, the water warm and
there was no current running. The divemaster had just briefed everyone
for the first dive, which would be a 30 metre/100 foot deep dive along a
drop off.
As Kenichi finished assembling his
scuba gear, he overheard a diver he
didn’t know tell his buddy, “My
regulator’s breathing really stiff, but
it’ll be okay because this first dive
will be short.”
Believing what he’d heard might
be a safety problem, Kenichi told
Kimihito and Hiroki what he had
heard. All three agreed it wouldn’t
be wise to ignore the problem.
Chapter Four 145

I
n Chapter Four, you begin looking at the possible psychologi-
cal consequences that follow a dive accident, then move into
the specific first aid for pressure-related injuries and near
drowning. Following that, this chapter discusses managing
accidents that involve the unresponsive diver at the surface, which
you’ll practice in Rescue Training Exercise Seven.
The Psychology of
Rescue IV
Highlight/underline
Critical Incident Stress
the answers to the A critical incident is an emergency involving a serious injury
following questions or death – and as you know, dive accidents can involve
as you read: both. The acute stress such an incident causes may over-
1. What is critical come or impair a person’s ability to cope emotionally. This
incident stress? acute stress is called critical incident stress.
2. What are 12 signs Critical incident stress effects may appear almost imme-
and symptoms of diately, or not manifest themselves until after days, weeks
critical incident or even months have passed. It’s important to recognize
stress? that after being involved with a dive emergency, you and
3. What actions others involved may experience critical incident stress. It is
should be taken to most likely if the affected diver died or became disabled as
reduce critical inci- a result. The signs and symptoms of critical incident stress
dent stress?
include:
• confusion • changes in interactions with
• lowered attention span; others
restlessness • increased or decreased eating
• denial (weight gain or weight loss)
• guilt or depression • uncharacteristic, excessive
• anger humor or silence
• anxiety • sleeplessness
• unusual behavior • nightmares

While some of these are immediate, short-
term reactions to an unpleasant incident are nor-
mal, if they persist or worsen, then it’s likely to be
critical incident stress. Don’t leave it untreated.
Critical incident stress requires professional help
to prevent post-traumatic stress disorder. A pro-
cess called critical incident stress debriefing
brings together those with critical incident stress
with some of their peers and a trained mental
health professional. This process helps those
with critical incident stress share and understand
their feelings while learning to cope with them.
The acute stress following an emergency situation may

overcome or impair a person’s ability to cope emotionally.
This is called critical incident stress.
Exercise 4-1
1. Critical incident stress is the stress you feel while handling a

rescue situation.
h True h False
2. Signs and symptoms of critical incident stress include (check
all that apply):
h a. confusion
h b. anger
h c. guilt or depression
h d. excessive humor
3. To reduce critical incident stress
h a. do nothing; it will pass on its own.
h b. enlist professional help.
How did you do?
1. False. Critical incident stress is acute stress following an incident.
2. a, b, c, d. 3. b.
Chapter Four 147

Being Prepared
for a Diver
Highlight/underline
the answers to the
Emergency IV
following questions
as you read: Pressure Related Injuries
1. What is meant Up to this point in your diver training, you’ve learned about
by decompression two serious pressure-related injuries that divers can suffer:
illness? lung overexpansion injuries and decompression sickness
2. What are the signs (DCS).
and symptoms of As a PADI Rescue Diver, you should be familiar with
decompression the different types of injuries lung overexpansion can
illness? cause, and be able to contrast those injuries with decom-
3. What is the most pression sickness. However, in the field, lung overexpan-
common cause of sion injuries and DCS can be difficult to distinguish because
lung overexpansion the symptoms over-
injuries? lap. Also, you apply
4. What are the causes the same first aid for
of and signs/symp- both. Therefore, in
toms of air embo- the field you’ll usual-
lism, pneumothorax,
ly use and hear the
sub-cutaneous
emphysema and term decompression
mediastinal emphy- illness (DCI), which
sema? combines both lung
5. What are the dif- overexpansion inju-
ferences between ries and DCS. At an
air embolism and accident scene,
decompression sick- there’s no benefit
ness?
from trying to distin-
guish between the
two. Signs/symp-
toms of decompression ill-
ness include:
• pain in the joints, fatigue • unconsciousness
• dizziness • cardiac arrest
• extreme fatigue • nausea
• paralysis

Lung Overexpansion Injuries – As you probably recall
from your PADI Open Water Diver course, lung overexpansion inju-
ries result when a diver holds his breath and ascends, or when a
physiological condition (like diving with a chest cold) traps air in the
lung during ascent. In either case, the expanding air can rupture the
lung, releasing bubbles into body tissues, leading to four distinct
possible injuries: air embolism, mediastinal emphysema, subcuta-
neous emphysema and pneumothorax. These four can occur inde-
pendently, or more than one can occur
at once. Subcutaneous
The most serious, and unfortu- Emphysema Blood
Pneumothorax
Vessel
nately, the most common of these is Alveolus
air embolism, also called “arterial gas
embolism” or (AGE). Air embolism arises Air
when expanding air forces through the

alveoli (lung air sacs) into the pulmonary
capillaries (blood vessels surround- Air Embolism
ing the alveoli). This air forms bubbles
that travel in the blood stream through
the heart into the arterial blood supply, Mediastinal
then to the body tissues where they Emphysema
lodge themselves, blocking blood flow.

Lung overexpansion can lead
The symptoms of air embolism, then, vary to four distinct injuries, the most
depending upon where the bubbles end up. serious of which is air embolism.
The most serious (and

again, unfortunately the The Most Common Cause of
most common) symptoms
Lung Overexpansion Injuries
from air embolism result
The most important rule in scuba diving is “Breathe
from bubbles traveling
continuously; never hold your breath.” The inference
through the carotid arteries
might be, “Make sure you always have something to
to the brain. The bubbles
breathe, so you won’t be tempted to hold your breath.”
block blood flow, depriving
The most common cause of AGE and other over-
the brain tissue of oxygen.
expansion injuries is running out of air. Sometimes
These symptoms occur
a diver runs out of air and, instead of responding
swiftly – usually within five
according to his training, panics and rushes to the
minutes – and are similar surface without exhaling continuously.
to stroke. The diver may
So, one of the easiest ways divers can reduce the
experience blurred vision,
possibility of lung overexpansion injuries is to check
dizziness, sudden uncon-
their air often and encourage their fellow divers to do
sciousness and loss of the same.
coordination. The signs
Chapter Four 149

include a bloody froth from the mouth, breathlessness, coughing,
personality changes and respiratory/cardiac arrest.
Mediastinal emphysema occurs when the expanding air
becomes lodged in the chest cavity between the lungs (the medi-
astinum). As the diver continues to ascend, this air expands, con-
stricting the heart and lungs. Signs and symptoms include pain
under the breastbone, shortness of breath and other breathing
difficulties, fainting, shock and cyanosis. Mediastinal emphysema
isn’t as serious as air embolism, but it is serious.
Subcutaneous emphysema occurs when the expanding air
accumulates under the skin around the neck and collar bone
(subcutaneous means “under the skin”). The signs and symptoms
include fullness in the neck area, voice changes, neck swelling,
difficulty swallowing and a crackling sensation when the skin is
moved.
If the air from an overexpansion injury forces its way into the
space between the lung and the chest wall (called the pleural cav-
ity), it can totally or partially collapse the lung, which is called a
pneumothorax. Signs and symptoms include severe chest pain,
extreme difficulty breathing and irregular pulse.
Clearly, all the lung overexpansion injuries are serious. What
is more important, if you assist a diver with mediastinal emphyse-
ma, subcutaneous emphysema or pneumothorax, always assume
that an air embolism is present and give first aid accordingly, even
if you don’t see signs immediately.
Comparison of Symptoms
Decompression
embolism sickness
Onset of Usually within five Tend to be delayed
Symptoms minutes of surfacing

Most Common Sudden Pain in joints, fatigue
Symptoms unconsciousness
Location of One side of the Both sides of the body

Symptoms body (usually upper or lower)

Change of May improve as Usually no change or
Symptoms result of first aid worsening condition
Decompression Sickness – Decompression sickness

also results from gas bubbles in the body, but the mechanism that
causes them differs. As you probably realize, DCS arises when

excess dissolved nitrogen comes out of solution forming bubbles in
the body after a dive. The bubbles block circulation, much like air
embolism. This most commonly happens due to diver error – fail-
ure to properly use dive tables or a dive computer, or failure to
adhere to safe diving practices relating to decompression.
However, though it’s improbable, DCS can also occur even when
you do everything right. Because people
differ in their susceptibility to decom-
pression sickness, no dive table (or dive
computer) can guarantee that DCS will
never occur, even when you dive within
table (or dive computer) limits.
Because bubbles can come out of
solution almost anywhere in the body,
DCS symptoms tend to be variable and
range in seriousness. The most com-
mon symptom is pain, usually but not
necessarily in the joints. More serious
cases affect the nervous system, caus-
ing unusual fatigue, inability to urinate,
blurred vision, vertigo, hearing or speech impairment, paralysis,
loss of sensation and unconsciousness. Bubbles can form in the
veins of the lungs causing breathing difficulties, chest pain and
uncontrollable coughing. Divers commonly call this form of DCS
“the chokes.”
Typically, DCS symptoms manifest themselves more slowly
than air embolism symptoms. In over half of DCS cases, symptoms
appear after one half hour after the dive. Symptoms appear within
three hours in about 95 percent of cases. See the accompanying
table for a comparison between air embolism and DCS symptoms.
Use the Computer Between Your Ears

Although it’s possible to experience DCI even when you correctly use
dive tables or a dive computer, the most common cause of DCI is diver
error. Accident statistics show that DCI problems arise from failure to
use dive tables or a computer, or even more commonly, disregarding
basic guidelines and safety principles while using them.
So, when planning your dives, always use a computer – the one in your
head – as well as your dive tables or dive computer.
Chapter Four 151

Exercise 4-2
1. Decompression illness refers to:

h a. the condition that results from inert gas coming out
of solution in the body.
h b. the conditions that result from lung overexpansion releasing air into
the bloodstream.
h c. Both a and b together.
2. Signs and symptoms of decompression illness include (check all that apply):
h a. pain in the joints. h c. blue lips.
h b. foolish behavior at depth. h d. paralysis and unconsciousness.
3. Air embolism results from air overexpanding the lungs escaping into the bloodstream,
whereas decompression sickness results from inert dissolved nitrogen coming out of
solution following a dive.
h True h False
4. The most common cause of lung overexpansion injury is:
h a. simply forgetting to never hold the breath.
h b. running out of air.
h c. runaway low pressure inflator.
5. Fill in the appropriate lung overexpansion injury:
a. _____________________ air under the skin at the base of the neck.
b. _____________________ air in the chest cavity that collapses the lung.
c. _____________________ air in the tissues blocking circulation.
d. _____________________ air in the center of the chest.
How did you do?
1. c. 2. a, d. 3. True. 4. b 5. a. subcutaneous emphysema, b. pneumothorax,
c. air embolism, d. mediastinal emphysema.
Squeezes – A Reminder
Squeezes occur when the pressure outside an air space exceeds the pressure
inside. A squeeze injury is a barotrauma (pressure injury).
Ear squeeze is the most common squeeze and, without treatment, it can cause
infection and permanent hearing impairment.
Ears and Sinuses

Middle Ear Squeeze occurs when divers descend and can’t equalize caus-
ing sharp ear pain. Continued descent causes fluid to fill the ear spaces making

them feel full with diminished hearing. If this occurs, the diver should
discontinue diving and seek medical treatment.
Eardrum Rupture occurs when a diver descends rapidly without
equalizing. Symptoms are the same as ear squeeze except the diver
gets relief as water enters the air space through the ruptured eardrum.
It can cause vertigo. If this occurs, the diver should discontinue diving
and seek medical treatment.
Inner Ear Round-Window Rupture occurs if a diver delays equal-
ization and then attempts a forceful or lengthy equalization. Symptoms
include full or blocked ears, hearing reduction, deafness, vertigo and
ringing sounds. This serious injury needs medical treatment.
Reverse Block results when expanding air cannot escape the ear’s
air space on ascent. It causes pain similar to a middle ear squeeze. If
this occurs, the diver should ascend slowly. Sometimes reverse equal-
ization (inhaling against a pinched nose) may relieve the block. Severe
cases can rupture eardrums.
Sinus – Rapid descents with blocked sinuses can cause pain between
eyes, over teeth or in cheekbones. Fluids enter sinuses to equalize the
pressure. On ascent, expanding air forces these fluids out, often leav-
ing blood in the mask. If this occurs, the diver may relieve discomfort by
ascending and attempting to equalize. Sinus squeezes typically heal,
but if the pain is severe or extended, the diver should seek medical
advice.
Relieving Ear and Sinus Squeezes

Encourage divers showing signs of equalization trouble (very slow
descent, pointing to ears, repeated or exaggerated attempts at equal-
ization) to ascend or surface before continuing to descend. Divers with
colds or congestion shouldn’t dive.
Other Squeezes
Mask – An unequalized mask can cause eye capillary rupture and skin
bruising. Mask squeezes look dramatic and painful, but divers may not
feel them or realize it’s happening. To correct this, a diver must exhale
through the nose. Capillary rupture or bruising typically clears without
medical treatment, but divers may want to consult a physician as a pre-
caution.
Suit – Dry suit divers can experience suit squeeze if they don’t add air
to equalize the suit. Suit squeeze can cause skin bruising and blisters
or, if unchecked, welts and further injury.
Chapter Four 153

Accident
Management IV
First Aid for
Decompression Illness
At an accident scene, it doesn’t really matter whether the diver suf-
fers from air embolism or DCS. First aid for suspected decompres-
sion illness remains the same no matter what the cause; in fact, you
may not be able to determine which cause affects the diver. More
than one form of DCI can be present at once.
Begin with a primary assessment.
With an unresponsive patient, maintain
the ABCD’S, providing rescue breath-
ing and CPR if necessary. Encourage a
responsive patient to lie down and relax.
Ask the patient (or the patient’s
buddy if the patient is uncon-
scious) these questions, noting
the answers on the PADI Diving
Accident Management Work
Highlight/underline Slate:
the answers to the
1. Were you scuba diving today
following questions
as you read: or breathing compressed air?
2. Did you make a forced or rapid
1. What first aid steps
ascent?
should you take for a
diver with suspected 3. How deep did you go?
decompression ill- 4. What was your bottom time?
ness? 5. Do you feel excessively tired?
6. Where do you hurt? At an accident scene, it doesn’t really matter
2. Why should a diver whether the diver suffers from air embolism or
with suspected 7. Do you feel dizzy? DCS, the first aid is the same.
decompression ill- 8. Does any part of you feel numb
ness remain lying or tingle?
down?
9. Are you having trouble breathing?
Give a breathing patient oxygen, ideally 100 percent con-

centration supplied by a nonresuscitator demand valve unit. (You’ll
learn the specifics for oxygen administration in the next knowledge
development and rescue training exercises).

In all cases, maintain the patient’s lifeline. Be ready to switch
to the pocket mask and provide rescue breathing and CPR if nec-
essary. Protect the patient from excess heat or cold, and arrange
for emergency evacuation and medical care, which will usually
include recompression in a hyperbaric chamber. Keep the patient
as comfortable as possible, but lying down because some have
experienced significantly worsened symptoms when they sit up.
(Don’t use the formerly recommended Trendelenburg position in
which you slant the patient head down. This position hasn’t proved
helpful, has several drawbacks and is no
longer recommended.)
Provide oxygen until you get the
patient 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 patient more than
trying to extend the oxygen by reducing
the flow rate or switching it on and off.
If you run out of oxygen, but have
enriched air nitrox available, you can
give that to a responsive patient with a
scuba regulator.
Never attempt to recompress
a diver suspected of DCI by put-
ting the patient back underwater.
If you run out of oxygen, but have enriched air nitrox avail-
Recompression therapy takes hours; able, you can give that to a responsive patient with a scuba
even if you had sufficient air supply to regulator.
do this, you wouldn’t be able to keep

the diver adequately warm, or to administer necessary drugs and
fluids. Without the proper equipment and training, attempts to
recompress a patient in the water invariably lead to worsening
symptoms and delays in proper treatment. Inwater recompression
is only used in very remote areas with long intervals to a hyper-
baric chamber. It requires specialized equipment and training, and
may only be attempted with patients with specific symptoms. If
your diving takes you to situations where inwater recompression
may be called for, have the training and equipment required before
attempting it.
Chapter Four 155

Exercise 4-3
1. First aid steps for a patient with suspected decompression ill-

ness include (check all that apply):
h a. providing emergency oxygen
h b. maintaining the patient’s lifeline
h c. arranging for emergency evacuation and medical care
h d. putting the patient in a slanted head-down, feet high
position
2. The ideal position for a patient with suspected decompression
illness is sitting or standing.
h True h False
How did you do?
1. a, b, c. 2. False. The patient should be kept lying down.
Near Drowning
Although a variety of causes may initiate fatal dive acci-
dents, in most instances drowning ultimately causes death.
You can define drowning as death caused by asphyxiation
Highlight/underline
(suffocation) in water. When a diver suffers asphyxiation
the answers to the
following questions in water but gets revived, you define the accident as near
as you read: drowning.
In more than 80 percent of cases, near drowning
1. What is the dif-
ference between causes water to enter the patient’s lungs. This interferes
“drowning” and “near with the body’s ability to transport oxygen even if the
drowning”? patient’s breathing, resulting in hypoxia – insufficient oxy-
2. What is the primary gen reaching the tissues.
first aid for a serious With near drowning, the most common immediate
near drowning acci- symptom will be that the patient isn’t breathing. Therefore,
dent? regardless of how long the person was submerged, the
primary first aid for near drowning is immediate rescue
breathing, with CPR if the patient has no heartbeat. Be
alert for vomiting, especially as the patient resumes breathing on
his own. Be prepared to turn the patient and keep the airway clear.
Symptoms also include coughing, shortness of breath, blueness of
lips (cyanosis), frothy sputum, vomiting and cardiac arrest. Give a
breathing patient emergency oxygen, keep the patient lying down

and treat for shock. Contact the local EMS. Near drowning can
also involve decompression illness, so contact DAN or other
appropriate local diver emergency service to begin preparations
for recompression until DCI has been ruled out by appropriate
medical personnel.
Although in most instances brain
damage occurs in as little as four to six
minutes without oxygen, for reasons
not completely understood, immersion
(especially in cold water) can make
revival possible even after fairly long
periods. Therefore, begin emergency
care immediately, even if the victim has
been submerged longer than four to six
minutes.
A revived near drowning patient
may quickly seem fully recovered.
Nonetheless, the patient should always
go to a hospital as soon as possible. When a diver suffers asphyxiation in water but
Physiological complications caused by inhaled gets revived, you define the accident as near
drowning.
water, which occurs in about 85 percent of near
drowning incidents, can occur five to six hours
after the accident; untreated these complications
can be fatal. Proper medical care can prevent this.
Exercise 4-4
1. The difference between drowning and near drowning is that in

near drowning, the patient revives.
h True h False
2. The primary first aid for near drowning is
h a. oxygen.
h b. keeping the patient lying down.
h c. recompression.
h d. rescue breathing.
How did you do?
1. True. 2. d.
Chapter Four 157

Responding
to Diver
Highlight/underline
the answers to the
Emergencies IV
following questions
as you read: Managing an Unresponsive
1. What are proce- Diver at the Surface
dures to follow If you spot an apparently unresponsive diver at the surface,
when rescuing an you need to act quickly. If the diver isn’t breathing, as you’ve
unresponsive diver
learned, time is critical.
at the surface?
As you approach, call out, splash and so on to get the
2. Why do you give person’s attention. If the diver is actually responsive, this helps
rescue breaths to
you determine so. If not, make contact and confirm unrespon-
an unresponsive
diver with no appar- siveness, while turning the diver face up (if face down). One
ent heartbeat? way to do this is from above the diver’s head. Cross your arms
with your stronger arm on top, grasp the diver’s wrists and
then uncross your arms. This spins the diver face up.
One way to turn a diver

face up is from above the
diver’s head. Cross your
arms with your stronger
arm on top, grasp the
diver’s wrists and then
uncross your arms.

Establish buoyancy for you and the victim. You may do this
by inflating your BCDs and dropping weights, though you may
want to keep your weights if wearing a substantially buoyant expo-
sure suit (dry suit or heavy wet suit) to help
position yourself in the water for the rescue.
Call for help if there’s someone within hearing
distance.
Remove the victim’s mask and regula-
tor, open the airway by lifting the chin and tilt-
ing the head, and check for breathing. If you
suspect spine or neck injury may be involved,
open the airway by lifting the chin only (also
called jaw thrust), tilting the head only if it’s
the only way to get the airway open. You
may need to remove your mask, too, so that
you can get close enough for the check, and
depending upon the rescue breathing you will
use if needed (you’ll learn about the specif-
ics for inwater rescue breathing techniques
shortly).
Look, listen and feel for breathing for 10
seconds.
If the victim is breathing, hold the airway
open and protect it from splashes and water
while towing to safety. Be careful to not turn
the diver’s face into the water or push the
diver’s face under the surface. Recheck for
breathing every couple of minutes as you tow.
After opening the victim’s airway, look, listen and
If you establish the diver isn’t breathing, feel for breathing for 10 seconds.
you’ll begin inwater rescue breathing. Start with
two slow rescue breaths. If your rescue breaths
cause the diver to begin breathing, proceed as above for a breath-
ing victim.
If there is no response to your two rescue breaths, assess
your situation. If there is a boat nearby and you can attract the
attention of those on board then do so since they may be able to
come to your aid or send others to help you in the water.
If a boat is coming to you, stay where you are and support
the victim with further rescue breaths. If not, then how you proceed
will depend on how far you are from surface support (a stationary
boat or the shore). If you are less than about 5 minutes from sur-
Chapter Four 159

face support, tow the diver there while continuing to provide rescue
breaths. Get the diver out of the water, continuing rescue breaths
and perform a circulation check. Begin CPR if necessary and con-
tinue with the ABCDs as you learned in your EFR training.
If you are more than 5 minutes from surface support give res-
cue breaths for 1 – 2 minutes whilst watching the victim for signs
of movement or other response to the ventilations. If there is a
response, but continued absence of spontaneous breathing by the
victim continue providing rescue breaths whilst towing the diver to
the surface support. If there is no response to this period of rescue
breathing then cardiac arrest is likely. Rescue breaths don’t benefit
someone in cardiac arrest without chest compressions, so it’s nec-
essary to get the victim out of the water as quickly as possible to
start CPR. Discontinue rescue breaths in favor of speed. Tow the
victim to safety as quickly as possible, exit the water, perform a cir-
culation check and begin CPR and rescue breathing as appropriate
according to your Emergency First Response training.
Others factors to consider with inwater rescue breathing are the
environmental conditions, your condition and the victim’s condition.
In some rare situations, attempting to give rescue breaths in the
water could present additional hazard to you and/or the victim. Just
as you learned in EFR, you assess the scene, and if necessary, rap-
idly tow the victim to a safe area before beginning rescue breathing.
Why Give Rescue Breaths? Earlier you learned that in the

water, it’s difficult to determine whether a diver has a heartbeat. If
there’s no heartbeat, rescue breaths don’t do any good, so you may
wonder why you would give them.
The reason is that while you can’t easily detect a heartbeat
in the water, one may be present. Especially in water-related acci-
dents, respiratory arrest often precedes cardiac arrest. If you correct
respiratory arrest quickly with rescue breaths, cardiac arrest may not
occur. The survival rate for respiratory arrest is much higher than
survival for full cardiac arrest.
In dive scenarios, if the victim has only respiratory arrest,
without inwater rescue breaths the interval before exiting the water
would likely be long enough to trigger cardiac arrest. Providing in-
water rescue breaths reduces this risk. The potential disadvantage
is that if the diver is already in cardiac arrest a prolonged period of
in-water rescue breathing may delay removal from the water and
administration of CPR. There is limited research that suggests the

advantage of inwater rescue breathing outweighs this potential
disadvantage. This will be most true of a situation where a skilled
rescuer can provide rescue breaths while towing the victim toward
surface support at a similar speed to that would be achieved with-
out rescue breaths.
Exercise 4-5
1. Procedures for rescuing an unresponsive diver at the surface

include (check all that apply):
h a. opening the airway.
h b. checking for breathing.
h c. giving rescue breaths if breathing is absent.
h d. inwater oxygen therapy.
2. You give rescue breaths in the water because waiting until
exiting the water would likely cause a victim who is only in
respiratory arrest to go into cardiac arrest.
h True h False
How did you do?
1. a, b, c. 2. True.
Inwater Rescue Breathing Highlight/underline

the answers to the
Techniques following questions
For inwater rescue breathing, you’ll follow the same steps as you read:
as for rescue breathing on land, but with some modifica- 1. What are the tech-
tions to account for being in the water. You give priority to niques for mouth-
providing regular ventilations every five seconds, keeping to-pocket mask,
the airway open and free of water, and pacing yourself so mouth-to-mouth
and mouth
you have sufficient energy to get the diver out of the water
to snorkel inwater
when you reach the exit. rescue breathing?
Positive buoyancy saves your energy because you
2. What should you
don’t have to struggle to stay at the surface. As mentioned,
do if you think a
though, you may want to keep your weights, if they help victim has no pulse
you attain a vertical orientation for giving rescue breaths. while in the water?
Whether this will be a factor depends on the exposure suit
Chapter Four 161

you’re wearing and the in water rescue breath technique you use.
If you decide to keep your weights, inflate your BCD just enough
to keep you comfortably at the surface. You’ll get a feel for what
works best for you as you experiment and practice in Rescue
Training Exercise Seven.
You’ll give rescue breaths using one of three methods. In
order of recommended preference, these are mouth-to-pocket
mask, mouth-to-mouth (or nose) and mouth to snorkel. Watch the
PADI Rescue Diver Video for demonstrations of each of these.
Remember that the techniques you use may vary depending upon
the situation and local protocols. The main priority is to activate
the emergency medical system and if the victim isn’t breathing, to
maintain regular rescue breaths while towing the victim to the boat
or shore.
Mouth-to-Pocket Mask. As you approach an unresponsive

diver, retrieve your pocket mask from your BCD pocket (or wher-
ever you store it) and prepare it for use. Move above the victim
and place the mask on his face,
thumbs on the mask and fingers on
the bony part of the jaw. You may
find it fastest to administer the two
initial breaths, then secure the
mask strap, but in rough water you
may want to put the strap on initial-
ly so you don’t lose it.
Leave the mask on while you
look, listen and feel for breathing. If
You’ll find the pocket mask makes it easy to give rescue

breaths, maintain the airway and tow at the same time.
In rough water, seal the pocket mask to keep the airway dry
between breaths by putting your thumb over the opening
while applying pressure.

e you use. the victim doesn’t breathe, give rescue breaths
t enough every five seconds as you tow the diver to safety.
for what You’ll find the pocket mask makes it easy to give
escue rescue breaths, maintain the airway and tow at
the same time. In rough water, seal the pocket
ods. In mask to keep the airway dry between breaths by
pocket putting your thumb over the opening while apply-
Watch the ing pressure.
f these. Once you begin rescue breathing, maintain
nding upon the open airway with one hand, even between
activate breaths. This ensures that the victim can begin
eathing, to breathing independently. Give regular, rhythmic
to the boat rescue breaths priority over other rescue proce-
dures such as removing equipment. If you must
interrupt breaths (to get the victim out of the
esponsive water, for example), precede the interruption with
(or wher- two slow, full breaths, interrupt no longer than 30
e victim seconds, and resume regular ventilations with two
his face, slow, full breaths.
d fingers on
You may Mouth-to-Mouth. If you lose your pocket
er the two mask or don’t have one, mouth-to-mouth rescue
re the breathing is the next option. You can use the do-
water you si-do or head cradle methods.
p on initial- For the do-si-do method, face the victim’s
For the do-si-do method, slide your arm closest
side. Take your arm closest to the victim’s feet, to the victim’s feet behind the victim’s arm and
while you slide it behind the victim’s arm and reach up to reach up to grab the victim’s hair, hood, or
BCD. Place your other hand on the victim’s
breathing. If grab the victim’s hair, hood, or BCD. Place your forehead to tilt the head and open the airway,
other hand on the victim’s forehead to tilt the head while pinching the nose.
and open the airway, while pinching the nose.
Roll the victim toward you (this is easier than
climbing over the victim) so you can provide res-
cue breaths – two initially and one every five sec-
onds as described earlier. You may find that plac-
ing a flotation aid under you helps you get higher
out of the water, over the victim, making it easier
to give rescue breaths. When practicing mouth-to-
mouth during training, it’s recommended that you
To perform the head cradle method, put your hand

closest to the victim’s feet under the neck. Put your
other hand on the victim’s forehead and pinch the nose.
Chapter Four 163

seal your mouth on the victim’s
chin, which better simulates the
height and position you need than
sealing on a cheek.
To perform the head cradle
method, put your hand closest to
the victim’s feet under the neck.
Put your other hand on the victim’s
forehead and pinch the nose as
before. Because you don’t have
the leverage that you have with
the do-si-do, you may have to rise
over the victim to give breaths
rather than roll the diver toward
you. However, this position may
work better if you’re a lot smaller
than the victim, or if the victim
is wearing a bulky exposure suit
that prohibits an effective do-si-do
position.
In some circumstances, you
may find mouth-to-nose rescue
breathing effective, which is a
variation of the head cradle posi-
tion. For mouth-to-nose, put your
hand furthest from the victim’s feet
Mouth to nose rescue breathing is a variation of the head cradle under the neck, and use the other
position. Put your hand furthest from the victim’s feet under the neck, hand to simultaneously hold the
and use the other hand to simultaneously hold the mouth closed and
tilt the head. Give rescue breaths through the nose just as you mouth closed and tilt the head.
would through the mouth. Give rescue breaths through the
nose just as you would through
the mouth. Mouth-to-nose works well when choppy conditions or
equipment configurations make mouth-to-mouth ineffective, or if
you can’t get the victim’s mouth open. If a common technique in
your area, your instructor may have you practice mouth-to-nose
rescue breathing.
When giving mouth-to-mouth rescue breaths in cold climates
that require neoprene gloves, keep in mind that your gloves may
hold considerable water. By shaking them quickly out of the water
before sealing the victim’s nose, you’ll reduce the amount of water
that flows from your gloves onto the victim’s face and possibly into
the airway.

Mouth to Snorkel. At one time, most divers considered
mouth to snorkel rescue breathing the best method for giving ven-
tilations while towing the victim a long way. However, the pocket
mask has largely replaced mouth-to-snorkel,
because it’s so much easier for most divers, it
reduces communicable disease risk out of the
water as well as in it, and because so many divers
now use self-drain snorkels. Mouth to snorkel res-
cue breathing requires a snorkel without self-drain.
Today it is not as widely used; your instructor will
have you practice it if it is still common in your area
for some reason, such as if pocket masks aren’t
readily available.
You begin mouth to snorkel rescue breath-
ing with mouth-to-mouth for the initial two breaths,
look, listen and feel. If you decide to remove any
equipment, you also do that while using mouth-
to-mouth rescue breathing (equipment removal
discussed shortly). When ready to begin the tow,
move above the victim and hold the snorkel up to
drain it. Put the mouthpiece in or on the victim’s
mouth and hold there between your middle and The pocket mask has largely replaced
mouth- to-snorkel, because it’s so much
ring finger. Use your index finger to block the nos- easier for most divers, it reduces communi-
trils, while your other fingers seal the mouthpiece cable disease risk out of the water as well
as in it, and because so many divers now
and keep the head tilted. Keep the snorkel tip out use self drain snorkels.
of the water while you do this.
Keep the snorkel tip out of the water by
clamping it along the side of the victim’s head, or by simply hold-
ing it. Give rescue breaths every five seconds through the snorkel.
Note that ideally, you should get into the mouth to snorkel position
without interrupting regular ventilations. If it takes longer than five
seconds, resume ventilations with two slow rescue breaths. Allow
the victim to exhale through the snorkel, which you can check by
feeling the breath on your cheek.
No matter which technique you use, remember that you do
not check for a pulse or attempt CPR in the water (although there
have been attempts to create inwater CPR techniques, none have
proved practical and effective). If you think the victim doesn’t have
a pulse (heartbeat), you nonetheless follow the inwater rescue
breathing protocols because a heartbeat may be present.
Chapter Four 165

Exercise 4-6
1. Mouth-to-pocket mask is the least preferred inwater rescue
breathing technique.
h True h False
2. If you suspect a victim does not have a pulse
h a. do not give rescue breaths.
h b. follow the rescue breaths protocols.
How did you do?
1. False. Mouth-to-pocket mask is the most preferred inwater rescue
breathing technique. 2. b.
Unresponsive Diver
Underwater
When you find an unresponsive diver underwater, getting
Highlight/underline
the diver to the surface takes priority over everything except
the answers to the
following question your personal safety. With a nonbreathing victim, you can
as you read: only begin rescue breathing at the surface; with a breath-
ing victim, only at the surface can you take steps to protect
1. What are the pro-
cedures for bring- the airway and try to prevent drowning. Circumstance will
ing an unrespon- dictate the most effective steps in bringing up the victim, but
sive diver the following procedures generally apply:
to the surface?
1.Upon finding the victim, quickly note the diver’s posi-
tion, whether the regulator is in the mouth, whether the
mask is on and any other clues about the accident. Don’t
waste any time doing this, but make a conscious effort to
remember these details.

2. If you find the regulator in the victim’s
mouth, hold it in place even if the
victim isn’t breathing. This may help
keep water out of the victim’s lungs,
and it provides air if the victim
resumes breathing during ascent.
The second stage won’t interfere
with expanding air escaping from
the victim during ascent. If you find
the regulator out of the victim’s
mouth, don’t waste time trying to put
it back; expanding air may prevent
water from entering his lungs.
3. You’ll probably want to hold the

victim from behind so that you can
keep the regulator in the mouth (if
it’s still in) and hold the head in a
normal position. Holding the victim
from behind also allows you to vent
the victim’s BCD.
4. For the best control, you’ll usually During ascent, keep the victim’s head in a neutral position.
use your own BCD to ascend with Expanding air will vent by itself.
the victim. Begin your ascent, vent-
ing air from your BCD as necessary
to maintain a safe rate. If releasing air from your BCD doesn’t
control the ascent, you may need to release air from the vic-
tim’s BCD. You can also flare out to reduce ascent speed. If
you can’t keep the ascent under control, allow the victim to
ascend separately. Ascend at a safe rate and regain contact
with the victim at the surface.
If possible, don’t drop the victim’s weights or inflate the victim’s

BCD until you reach the surface. This makes it easier to con-
trol the ascent. However, in some instances, you could find the
victim too heavy to bring up using your BCD. You may need to
use the victim’s BCD or drop the victim’s weights, but this may
make it hard to control the ascent. However, with the exception
of your personal safety, getting a nonbreathing diver to the sur-
face is the top priority.
Chapter Four 167

5. During the ascent, keep the victim’s head in a normal position.
Expanding air will vent by itself, so you don’t need to squeeze
the victim’s chest to expel air.
6. As you ascend, think about the steps you’ll take when you
reach the surface. This mental rehearsal will help you prog-
ress through the rescue more effectively.
7. If you didn’t have to ditch the victim’s weights on the bottom,

you may want to drop them just below the surface. This
assures positive buoyancy for the victim, making it easier to
move into your surface rescue procedures as you just learned.
However, you may want to retain your own weights if they
make it easier to perform in water rescue breathing. Note:
During training, practice dropping weights over sand or anoth-
er insensitive area that falling weights won’t damage. For
training in a pool, your instructor may put a mat or other pro-
tection on the bottom.
During Rescue Training Exercise Six, your instruc-

tor will have you practice controlled buoyant ascents
before practicing with a simulated victim.
Exercise 4-7
1. You should attempt to replace the regulator of an unresponsive

diver underwater if the victim has dropped it.
h True h False
How did you do?
1. False. Do not attempt to replace the regulator.

Equipment Removal
During the rescue of an unresponsive diver (and a responsive
diver too, for that matter), equipment removal takes a very
low priority. The exception is discarding weights to establish
buoyancy, of course, but aside from that the priorities are answers to the follow-
providing an open airway, providing rescue breaths if needed, ing questions as you
and getting the victim to safety as quickly as possible. read:
Learning equipment removal with an unresponsive diver 1. Where does equip-
at the surface is a complex motor skill on which you’ll spend ment removal fit as a
a lot of time in training. This is necessary for learning, but priority in a rescue?
keep equipment removal in perspective. Even though you’ll 2. What are the sug-
spend a fair amount of time mastering the techniques, in gested procedures
and techniques for
most rescue situations you wouldn’t need to do it. It’s a tech-
removing equipment
nique to apply intelligently. Stop, breathe, think, and then act. from an unresponsive
Equipment removal is only a means to an end, and diver?
that end is to get the victim to safety and out of the water 3. What should you con-
in the fastest way possible. Equipment removal takes time, sider when removing
so it only makes sense to do it if doing so more than offsets equipment from your-
the time required. Typically, this would be a situation requir- self while dealing with
an unresponsive diver
ing a long tow, so that by reducing the equipment’s drag, at the surface?
you speed up the swim enough to cancel out the equipment
4. What circumstances
removal time. For a short tow, on the other hand, it makes lit-
would limit the remov-
tle sense to remove gear. Open the airway, check for breath- al of equipment from
ing and give rescue breaths if needed, while towing to safety. an unresponsive diver
Think “What’s the fastest way out of the water?” rather than “I or yourself at the sur-
face?
need to take this gear off.”
If you need to remove equipment to get the diver out
of the water, again, think about what’s fastest. The gear has to
go, but it’s usually easier to get it off when you can stand in waist
deep water, or if there’s a boat ladder or swim step you can use
for leverage. It’s faster still if there are other rescuers there who
can help. So, the fastest way out of the water may be to tow to
shallow water or up to the boat before worrying about the gear.
Removal Techniques. If in your best judgment the fast-

est way out of the water is to get rid of the gear for a faster swim,
how and what equipment to ditch will depend upon circumstances.
Apply the following procedures and techniques:
Chapter Four 169

1
First, think buoyancy. Don’t dump anything you need to maintain
adequate buoyancy. In warm water, the victim may not have an
adequately buoyant expo-
sure suit to allow getting
rid of the BCD, though you
might quick release the cyl-
inder to reduce drag. In
cooler water that requires
full wet suits or dry suits,
once the weight’s gone
there’s more than enough
buoyancy without the BCD.
2
Second, do things in a logi-
cal order, always keeping
one hand on the airway to
ensure it stays open. The
exact order isn’t important,
With help available, the fastest way out of the water
provided you think about may be to tow to shallow water or up to the boat before
what you’re doing. To be worrying about gear removal.
obvious, you want to ditch

weights before a BCD. You want to disconnect a dry suit inflator
before attempting to remove the scuba unit.
3
Third, keep a rhythm. When giving rescue breaths, remove equip-
ment between breaths. Breaths have priority, so don’t try to do
too much at each step. Removing a single piece of gear may take
several small steps between breaths. For example: breath, unlatch
BCD waist buckle, breath, disconnect BCD center strap, breath,
deflate BCD, breath, push BCD off right shoulder, breath… etc.
4
Fourth, keep moving! Remember, what you’re concerned with is
getting to safety as fast as possible. Swim and tow while ditching
the gear.
In deciding what, how and when to remove equipment, don’t
assume that you have to remove from yourself everything you
remove from the victim. As previously mentioned, in a buoyant
exposure suit, assuming you still have adequate buoyancy, you
may want to retain your weights for better positioning when giving
rescue breaths – but you’ll almost certainly remove the victim’s
weights. Think about what gear you may need to complete the exit
with the victim.

Environmental circumstances can limit or affect the equip-
ment you remove and when. In calm conditions, you probably
wouldn’t worry about keeping your mask and snorkel, but you’d
probably keep them for an exit through surf. Rough conditions may
make it necessary to keep the victim’s BCD to hold the airway
high above the chop, yet you may remove yours to reduce drag.
Obviously you need your fins to help you swim, but you may need
to ditch them in shallow water so you can wade ashore with the
victim. Exiting into a boat may require you to keep your fins so you
can kick yourself up onto the swim step. At the same time, the vic-
tim’s fins aren’t doing anything, but neither are they in the way, so
it’s not likely you’d pay any attention to them until well after you’re
ashore and have completed primary assessment.
Exercise 4-8
1. The priority of equipment removal during a rescue is

h a. very high.
h b. moderate.
h c. very low.
h d. not something easily determined.
2. When removing equipment from an unresponsive diver
h a. disregard rescue breaths if necessary when getting the
gear off.
h b. keep moving.
h c. take things off in a logical order.
h d. keep a rhythm.
3. Just because you remove something from the victim doesn’t
mean you have to remove it from yourself.
h True h False
4. Environmental conditions can affect what gear you remove
from yourself or an unresponsive diver.
h True h False
How did you do?
1. c. 2. b, c, d. 3. True. 4. True..
Chapter Four 171

Kimihito, Hiroki and Kenichi privately told the divemaster what
Kenichi had overheard. Further, Hiroki volunteered that he had a
spare regulator that had just been overhauled that the diver could use
if he wished. The divemaster thanked them for their consideration and
explained that the boat
carried a couple of regulators for just such situations.
The divemaster spoke privately with the diver. Shortly after, the diver
put a different regulator on his scuba tank. Later, after the dive,
Kimihito overheard the diver thank the divemaster for the regulator.
From this incident, the diver in question learned
to inspect his equipment well in advance of
going diving and to have it serviced regularly.
He also learned that it’s a good idea to have
spare equipment when feasible. Kimihito,
Hiroki and Kenichi observed that by being
observant and tactful, a rescue diver can perform
a “rescue” before an accident ever happens.

Knowledge Review Four
Check your understanding of Chapter Four by completing the Knowledge Review.

Knowledge Review Four
1. A friend of yours was involved in an incident that resulted in a serious injury of another person.
Now your friend seems restless and depressed, and expresses feeling guilty about what
happened. Your friend (choose all that apply):
□ may have critical incident stress
□ is reacting normally to the incident
□ has signs likely unrelated to the incident
□ will definitely get through this without help
Answer key: true, false, false, false
Response: Your friend is showing signs of critical incident stress, which has signs and symptoms
including 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 or nightmares. Your friend may require
professional help to prevent post-traumatic stress disorder.
2. Decompression illness is term that means
□ decompression sickness.
□ lung overexpansion injuries.
□ decompression sickness and lung overexpansion injuries.
□ decompression sickness, lung overexpansion injuries and gas narcosis.
Answer key: false, false, true, false
Response: Decompression illness is a term that combines decompression sickness and lung
overexpansion injuries. Although the underlying causes differ, in the field they can appear similar
and require the same first aid, so it's not important determine which it is. So, you refer to \
3. The most common cause of lung overexpansion injuries is prevented by properly planning and
managing your gas supply.
□ True
□ False
Answer key: True
Response: The most common cause of lung overexpansion injuries is running out of gas, followed
by a panicked breath-held ascent. You prevent this by properly planning and managing your gas. If
you do have a gas supply problem underwater, remember your training and do not hold your
breath as you ascend.
4. Match the characteristics to the appropriate lung overexpansion injury.
a. Air embolism
b. Pneumothorax
c. Subcutaneous emphysema
d. Mediastinal emphysema
__ gas forced into bloodstream
__ gas collapses lung
__ gas accumulates under skin at neck/collar bone
__ gas lodges in chest cavity between lungs
Answer key: a, b, c, d
Response: All four types of lung overexpansion injury are caused by holding the breath while
ascending, with different results depending upon the damage caused by expanding gas in the
lungs. All are serious and more than one can be present at the same time. Air embolism can be
the most immediately life threatening if bubbles forced into the bloodstream block blood flow to the
brain, causing stroke-like symptoms.
5. A diver is suspected of having DCI. The diver is breathing and responsive, and you have
contacted emergency care. Which of the following actions are also appropriate? (Choose all that
apply.)
□ Have the diver breathe emergency oxygen.
□ Keep the diver lying down.
□ Treat the diver for shock.
□ Monitor the diver's breathing and heartbeat.
Answer key: true, true, true, true
Response: All of these are appropriate parts of DCI first aid. If you don't understand some of these
steps, review the discussion about first aid for decompression illness.
6. While diving from shore, you're involved in an emergency involving a man (nondiver) who has
experienced near-drowning. He was retrieved from underwater and wasn't breathing, but resumed
breathing and regained consciousness after two or three rescue breaths. He now claims he feels
fine and there's no reason to go to the hospital. You should respond
□ that this is normal in near-drowning cases, but he should monitor himself for anything unusual.
□ that he should get medical attention because dangerous secondary symptoms can develop
hours after near-drowning.
Answer key: false, true
Response: Physiological complications occur in about 85% of near-drowning cases and are often
delayed by several hours. These complications are serious and can be fatal, so a near-drowning
patient should receive medical attention in all cases.
7. You're rescuing an unresponsive diver who isn't breathing. You're in the water at the surface
giving rescue breaths and estimate that you're about a 15-minute swim to shore. After a minute of
giving breaths, the victim shows no signs of response. The best action would be to tow the diver to
shore giving rescue breaths.
□ True □ False
Answer key: False
Response: In this situation, the victim likely has no heartbeat, so rescue breaths don't provide any
benefit without CPR compressions. Discontinue the breaths in favor of speed and tow the victim to
shore where you can exit and begin CPR. If the diver showed signs of responsiveness, or if you
were less than five minutes from safety, you would continue to provide breaths while towing the
victim.
8. It's difficult to detect a heartbeat in the water, so you provide rescue breaths (at least initially)
because one may be present.
□ True □ False
Answer key: True
Response: If you correct respiratory arrest quickly, you may prevent cardiac arrest. The survival
rate for respiratory arrest is much higher than for cardiac arrest. As discussed in the previous
questions, you would discontinue inwater rescue breathing only if you are a long way from safety,
after determining that cardiac arrest has likely already occurred.
9. Which of the following steps apply to giving mouth-to-pocket mask rescue breaths? (Choose all
that apply.)
□ Give breaths every two seconds.
□ Secure the mask strap.
□ Hold the mask with your thumbs, fingers on bony part of jaw.
□ Remove the mask to check for breathing.
Answer key: false, true, true, false
Response: Give breaths every five seconds. You want to secure the mask with the strap to help
prevent loss as you use one hand between breaths to remove equipment, etc. Form a good seal
by pressing the mask firmly with your thumbs on it, pushing against the face held firmly by your
fingers on the jaw. Keep the mask on while checking for breathing; doing so helps protect the
airway and doesn't interfere with looking, listening and feeling for breathing.
10. While returning to the boat, you and your buddy come upon a diver, unresponsive, lying on the
bottom. The diver's regulator is out of the mouth. You should replace it before taking the victim to
the surface.
□ True □ False
Answer key: False
Response: When rescuing an unresponsive diver underwater, if the regulator is in the mouth, hold
it there. But, if it is out, don't waste time trying to put it back. The priority is getting the victim to the
surface.
11. During ascent with the victim in the previous question, keep the victim's head in a normal
position. Expanding air will vent from the victim by itself.
□ True □ False
Answer key: True
Response: Holding the head in the normal position will allow expanding air to escape from the
diver's lungs. There's no need to tilt the head back or take any other unusual step to accomplish
this.
12. You're providing rescue breaths for an unresponsive diver at the surface, and are about 6
metres/20 feet from the boat's swim step where the divemaster and other divers stand ready to
help. You should continue / discontinue rescue breaths and remove equipment / leave equipment
in place as you swim to the boat.
Answer key: continue, leave equipment in place
Response: The priorities with an unresponsive diver are basic life support -- doing whatever most
quickly provides rescue breath and/or CPR as needed -- and getting the diver into emergency
medical care. This means doing whatever gets the victim out of the water as quickly as possible. If
you're a short distance from safety and help, there's little benefit in removing gear. Tow the victim
to where you will have help getting equipment off and exiting. If you have a long swim, then
removing gear while continuing to monitor breathing/provide rescue breaths may get the victim to
safety faster by reducing drag and speeding up the swim.
session.
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Chapter Five
“Okay, that’s it for the day,” Eliel told the group.. They had just fin-
ished a 24 metre/80 foot shore dive on the wreck of a large paddleboat.
Although it had been in the lake for years, it was well preserved with
most of its structure intact.
Eliel, with his fellow divemasters Olle and Max, had been particularly
adamant to the group that no one was to enter the wreck unless prop-
erly trained and equipped for wreck penetration diving. Eliel, who was
thoroughly familiar with wreck penetration diving and this wreck in
particular, having made more than 100 dives on it, took this seriously.
All in the group said they’d stay outside the wreck.
With everyone getting out of the water, Eliel, Olle and Max left their
equipment by the shore and, still
in their exposure suits, walked up
to their cars to discuss the plans
for the evening and the next day.
This took about ten minutes, then
they went back to where the divers
were getting out. Immediately,
Eliel noticed that two of the group
were missing. He asked the others
where they went.
“They said they had some air left
and decided to go back to the wreck,” one diver told him. “They said
something about going inside. They took a light.”
“How long ago?” Eliel asked.
“They swam out right after you went up to your car.”
Eliel recognized immediately that the situation was probably very serious.
Chapter Five 177

C
hapter Five marks the end of your knowledge devel-
opment in the PADI Rescue Diver course. By now
you’ve learned a great deal, and this chapter pro-
vides the final touches you’ll need to complete the
course. You’ll start by learning a bit about completing accident
reports, which may be required in some areas and circumstances.
Next, you’ll learn the procedures and techniques for providing
emergency oxygen, which you’ll practice and apply during Rescue
Training Exercise Nine. Finally, you’ll look at managing an acci-
dent scene while waiting for emergency medical care, and tech-
niques and considerations for exiting the water with an unrespon-
sive diver.
The Psychology of
Rescue V
Highlight/underline the Post Accident Reports
In some areas, a dive accident will require you and others
read: involved to write a report. Obviously, you don’t write acci-
dent reports for trivial incidents, such as a minor scrape on
1. When should you
a rock that you adequately treat with antiseptic and a ban-
write up a report?
dage. Nor would you normally write a report for an incident
2. What are eleven such as successfully helping a buddy to the surface with
questions to answer,
your alternate second stage in a low air situation.
if you can, when
completing a report? However, following an accident that requires first aid
and summoning emergency medical care or other emergen-
3. What statement can
cy personnel, you may be asked by authorities to complete
you make regarding
the incident that will or file an accident report. Or, emergency personnel may
allow you to avoid interview you to complete such a report. By gathering and
questions from the providing as much factual information as possible, accident
media? reports help investigators determine what happened. This is
4. What should you done partly to prevent and reduce such accidents in the
avoid doing on future, if possible, and to help emergency systems better
a report or when respond when they do occur.
answering questions? Be aware that accident reports are usually considered
legal documents that could be used in litigation as well as
investigation. For this reason, it’s important to report only

dge devel- facts that you personally witnessed to the
By now best of your ability. Nothing else belongs in
ter pro- an accident report because guesses and
plete the speculations can confuse the facts and
ccident interfere with determining what happened.
umstances. Try to answer the following questions on a
viding report, but again, do not guess or speculate.
ng Rescue
• How did you become aware of the
an acci- problem?
nd tech-
unrespon- • Where was the victim (depth, location, etc.)?
• Was any of the victim’s equipment out

of place or unusual (regulator out of
y of mouth, etc.)?
• How soon were you able to respond to

the emergency?
• What did you do when you responded

to the emergency situation?
nd others
rite acci- • Were you able to identify the person
scrape on you helped?
nd a ban- • What did you personally see happen? In some areas, a dive accident will
require you and others involved
n incident
to write a report.
ce with • What first aid was administered?
• Was emergency oxygen necessary?

first aid Was the individual responsive or unresponsive? Was the person
r emergen- breathing or not breathing?
complete
• Was EMS called? At what time? When did they respond? What
el may
action did you see EMS take?
ering and
e, accident • Was the victim’s gear recovered? If so, and you personally
ned. This is checked it, was it functioning properly, and how much air was in
s in the the cylinder?
s better
It’s not unusual for news media to show up following an incident that
required contacting emergency personnel. In many countries report-
onsidered
ers have the right to try to interview you and others involved and ask
s well as
questions.
port only
Chapter Five 179

While reporters probably wish you no intentional ill will,
there’s sometimes a tendency for reporting to sensationalize or
speculate. Reporters may push those they’re interviewing for opin-
ions and speculations, which, unfortunately, may be used out of
context and reappear in legal circumstances. Well meant thoughts
may seem insensitive and cause further hurt to the patient and
patient’s loved ones.
Although the media may have the right to report and ask
questions, you do not have to answer their questions, especially
those that would require you to guess or speculate. Immediately
after an accident you seldom have all the facts, and you’re usu-
ally emotionally stressed. Feeling guilty or bad may lead you to
make statements that lay the blame on you, when in fact you did
nothing blameworthy and have nothing to feel guilty or bad about.
Therefore, your best action after an incident is to only answer
questions asked by police or other government authorities.
Refer reporters and other media personnel to the proper
authorities to get their questions answered. Since “no comment,”
is often interpreted as being noncooperative and possibly hiding
something, say something like, “An accident investigation is under-
way and I’m not in a position to answer questions. Please get a
statement from the authorities when they have completed their
investigation.”
Not to belabor the point too much, but remember that follow-
ing an accident, you may feel considerable emotional stress and
you may believe you know what happened. Be very careful to
think about what you really know because you witnessed it, and
what you only think happened. When answering questions and
making statements, again, avoid speculation and don’t guess.
Don’t give your opinion about what caused an accident, but
instead only say what you know because you observed it. This
may mean you answer some or many questions, “I don’t know –
I didn’t see,” but being honest makes the authorities’ jobs easier,
not harder.

will,
nalize or
ng for opin-
Exercise 5-1
ed out of
nt thoughts 1. You should write a report following any dive incident, no matter how
ent and trivial.
h True h False
nd ask 2. Questions you might answer, if you know because you personally
specially witnessed it, may include (check all that apply):
mediately h a. how you became aware of the problem.
u’re usu- h b. what you did in response to the emergency situation.
d you to h c. what first aid was administered.
ct you did h d. your best guess at what might have happened.
bad about. 3. The best approach with media after a dive accident is to politely
nswer refer them to authorities for information.
es. h True h False
proper 4. When writing a report or answering questions (check all that apply):
omment,”
h a. try to be helpful with your opinions and ideas.
ly hiding
h b. never guess or speculate.
on is under-
h c. state only facts you personally witnessed.
se get a
ed their
How did you do?
1. False. You write up a report when asked to by authorities.
hat follow-
2. a, b, c 3. True. 4. b, c.
ress and
eful to
Highlight/underline
d it, and the answers to the
ons and
guess.
Being Prepared following questions
as you read:
but
it. This
for a Diver 1. Why is administering
emergency oxygen
’t know –
bs easier,
Emergency V to a diver with sus-
pected decompres-
sion illness crucial?
Use of Emergency Oxygen
2. What are six proce-
When comparing the first aid you learn in the PADI Rescue
dures to follow when
Diver course with your Emergency First Response training handling oxygen?
for more general medical emergencies, perhaps the most
3. How do you admin-
significant difference is the emphasis on oxygen use in diver
ister oxygen to a
emergencies. Administering emergency oxygen to a patient breathing injured
with suspected decompression illness is the dive com- diver and to a non-
munity standard of care. You also provide oxygen for near breathing injured
drowning patients, you may recall.Administering emergency diver?
Chapter Five 181

oxygen is crucial because field experience shows that emergency
oxygen provides significant benefit in many (but not all) cases of
decompression illness. Medical case histories show that prompt
oxygen first aid can improve the effectiveness of recompression
treatment, and the probability of a complete recovery.
It’s important to realize that while oxygen may be beneficial, it
isn’t a cure by itself, and there are types of decompression illness
that do not respond well to oxygen. However, in those instances, it
does no harm, so there’s never a reason to not give oxygen.
As you’ve already learned, the preferred oxygen system for
Rescue Divers is the nonresuscitator demand valve type, with con-
tinuous flow capability. During Rescue Training Exercise Nine,
you’ll practice using oxygen systems so that you’re capable and
qualified to provide emergency oxygen in diver emergencies. You
can also further your training through the PADI Emergency
Oxygen Provider course.
The preferred oxygen system for

Rescue Divers is the nonresuscitator
demand valve type, with continuous
flow capability. You’ll practice using
oxygen systems so that you’re capable
and qualified to provide emergency oxy-
gen in diver emergencies.
Handling Oxygen.
During Rescue Training
Exercise Nine, you’ll get a
chance to assemble and
disassemble an oxygen unit.
You’ll find that it’s pretty much like your scuba gear and shares
many characteristics, so working with it is pretty simple. However,
some materials that would not normally be flammable in air at
surface pressures can become combustible or even explosive in
pure oxygen. This tendency increases with elevated pressure.
Therefore, you have some handling concerns that differ from
regular scuba. With proper handling and common sense, oxygen
systems are safe to have around, though. Follow these six proce-
dures when handling oxygen and oxygen systems:
• 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.

• Never attempt to lubricate oxygen equipment or use standard
scuba parts in it. Pure oxygen requires that only special lubri-
cants and materials come in contact with the system.
• 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 con-
taminated the equipment.
• Keep your unit assembled to minimize the possibility of con-
taminants getting into it, as well as to save time in an emer-
gency. 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).
• 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 re-
quired by the manufacturer, just as you would scuba equipment.
• 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, pref-
erably in a ventilated area.
Administering Oxygen. There are three basic ways to pro-

vide oxygen with a nonresuscitator demand valve system. Which
one you use will depend upon the patient’s condition. In an emer-
gency, you may need to change the delivery method based on
changes in the patient’s condition.
Breathing Injured Diver. In all cases, you want to provide the
highest oxygen concentration possible. With a breathing patient,
this normally means using the demand valve on the oxygen 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 (for sanitation
reasons).
3. Secure the tank and protect it from being knocked over or roll-
ing loose. The best place for it is cradled in its box.
Chapter Five 183

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, you may 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.
Weakly Breathing Injured Diver. In

some instances, a diver may be breathing,
but very weakly. In this case, the patient may
be too weak to activate the demand valve,
which like a scuba regulator, has some
breathing resistance. In this case, you will
use the continuous flow outlet and a nonre-
breather mask. This is also how you would
set up the unit to supply oxygen to a second
patient from a single unit, or older oxygen
systems that lack the demand valve system.
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 min-
ute.
3. Using a nonrebreather mask, hold your

thumb over the inlet inside the mask and
allow the reservoir bag to inflate.
With a breathing patient, you’ll normally use the

demand valve, which provides the highest oxygen
concentration while conserving gas.

you. May I 4. Say to the injured diver, “This is oxygen.
It will help you. May I give it to you?”
face and 5. Assuming agreement, place the mask on
diver can the diver’s face and instruct the person to
more in breath normally. Use the head strap and
be sure the mask fits snugly. You may
assume implied consent with an unre-
assume
sponsive diver.
ed implied
. 6. If the reservoir bag collapses completely
when the diver inhales, increase the flow
it run
rate to 25 litres per minute.
7. Monitor the oxygen pressure gauge. Don’t

ver. In
let the unit run empty with the mask still
eathing,
on the diver.
patient may
d valve, Nonbreathing Diver. If your patient is not
some breathing, you can still provide oxygen while
you will giving rescue breaths by using a pocket mask
a nonre- with an oxygen inlet valve. The valve
ou would accepts oxygen from the system’s continu- For a weakly breathing patient, you’ll use the
continuous flow setting with a nonrebreather mask.
a second ous flow outlet. Follow these steps:
oxygen
1. Have someone open the kit while you
ve system.
continue rescue breaths and attach the
oxygen tube from the continuous flow
be from the outlet to the pocket mask (if not already
ntinuous done). Don’t let this interfere with rescue
this is not breathing or CPR procedures.
2. Slowly turn open the valve and set the

d set the flow rate at 15 litres per minute.
s per min-
3. Give rescue breaths through the pocket
mask as usual. Each rescue breath will
hold your carry in extra oxygen from the continuous
mask and flow.
te.
4. If the diver begins to breathe, switch to
the demand or nonrebreather masks as
e above.
en
You can use the continuous flow setting with a

pocket mask to provide oxygenated rescue breaths
for a nonbreathing patient.
Chapter Five 185

Exercise 5-2
1. Administering emergency oxygen to a diver with suspected

decompression illness is crucial because
h a. it will cure the diver.
h b. it may improve the effectiveness of recompression and
the chances of a complete recovery.
h c. It is not actually crucial, though desirable.
2. When handling oxygen (check all that apply):
h a. keep the unit thoroughly lubricated with silicone grease.
h b. keep the unit disassembled for easy cleaning.
h c. open the valves rapidly to purge the hoses of
contaminants.
h d. extinguish any sources of flames to reduce fire hazard.
3. Which method of oxygen administration would you normally
use for a breathing diver?
h a. nonresuscitator demand valve
h b. continuous flow with nonrebreather mask
h c. continuous flow with pocket mask
How did you do?

1. b. 2. d. 3. a.

Accident
Management V
Managing the Scene Highlight/underline
the answers to the
Until Help Arrives following questions
In a serious diver emergency, you may often reach a point as you read:
where you have the patient out of the water and under first 1. After beginning
aid care, but emergency medical care has not yet arrived. primary care, sec-
During this interval, you need to manage the scene until ondary care, oxygen
and other first aid as
help arrives.
needed for a patient,
After beginning primary care, secondary care, oxygen what do you do for
and other first aid as needed, your priority is to monitor the the diver while
patient’s lifeline and the ABCD’S. Following a serious injury, waiting for emergen-
a diver’s condition can change from breathing to nonbreath- cy care to arrive?
ing or responsive to unresponsive. 2. What information
Protect the patient from excess heat or cold (shock should you collect to
management), and as necessary, control bystanders to send with the injured
keep the areas open and unconfusing for arriving emergen- diver upon the arrival
of emergency medi-
cy medical personnel. Pressure related injuries usually
cal services?
require recompression in a hyperbaric chamber, so maintain
contact with the local diver emergency service. Keep a
responsive patient comfortable, but lying down.
For a diver with suspected decompression

illness, you will provide oxygen until
emergency care arrives. If you won’t have
enough oxygen, give the highest concentra-
tion possible for as long as it lasts.
Chapter Five 187

For a diver with suspected decompression illness, you will
provide oxygen until emergency care arrives. If you find yourself
in a situation where you won’t have enough oxygen, give the high-
est 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.
Generally, you try to collect the following information and
write it down to send with the injured diver (use the PADI Accident
Management Slate):
• 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.
Exercise 5-3
1. After beginning primary care, secondary care, oxygen and

other first aid as needed for a patient (check all that apply):
h a. monitor the patient’s lifeline.
h b. protect the patient from excess heat or cold.
h c. control bystanders.
h d. maintain contact with the local diver emergency service.
2. Information that is typically sent with the injured diver includes
h a. diver’s name and contact information.
h b. significant medical history.
h c. dive profile information.
h d. first aid procedures initiated.
How did you do?
1. a, b, c, d. 2. a, b, c, d.

you will
yourself Responding to Diver
e the high-
enefits the Emergencies V
xtend the
off. If the
Exiting with the
at the Unresponsive Diver
ulator. This In Rescue Training Exercises Six and Seven, you practiced
enefit than tows, providing rescue breaths and equipment removal Highlight/underline
the answers to the
for unresponsive divers at the surface. In Rescue Training
following questions
n and Exercise Eight, you’ll get to practice some methods for as you read:
DI Accident exiting the water with an unresponsive diver. Here are six
1. What are six tech-
techniques you can use, though the method you use will
niques for exiting
depend on where you’re diving, your strength, whether you the water with an
have help and other factors. Your instructor may have you unresponsive diver?
practice some of these, but some may not be appropriate
2. How can circum-
to practice depending upon your physical characteristics, stances affect your
equipment available, etc. exit with an unre-
sponsive diver?
Saddleback Carry – For this carry, the injured diver is
m and
stretched across the rescuer’s back. It is normally an exit
over a sloping shore. The hard part is holding the victim in
and
pply):
service.
includes
Saddleback carry.
Chapter Five 189

place during the carry, but it is easier to lower the victim gently to
the ground without help.
Fireman’s Carry – In this

carry, the injured diver is
swung across the rescuer’s
shoulders. This is normally
used as a shore exit. It is an
easier carry than the saddle-
back because the victim is
held in place by weight on
your shoulders, but it may be
harder to lower the victim gen-
tly to the ground without help
once out of the water.
Fireman’s carry.
Packstrap Carry – The injured

diver is draped over the rescuer’s
back and arms are pulled over the
rescuer’s shoulders. This is the
preferred method of exiting with an
injured diver because the victim’s
weight assists with the carry, yet it
is not too difficult to lower the per-
son gently to the ground.
Lifeguard Exit – One of the

most useful exits to learn, this tech-
nique works well when alone at a
low dock or swim step. The rescuer
places the injured diver’s hands on
the deck. The rescuer pushes out Packstrap carry.
of the water keeping one hand on the victim’s hands so the
victim doesn’t slide back in. Holding the diver by the wrists and
standing, the rescuer lifts the victim’s waist to dock level, then low-

Sequence showing lifeguard exit.
2
3
Chapter Five 191

Roll up technique.
Ladder exit.
ers the diver face down on the deck. From there the rescuer rolls
the victim over, and may drag the person rest of the way from the
water if necessary.
Roll Up Technique – This is a multirescuer technique used

to lift the victim up a considerable height. It requires a net or tarp
that can be lowered from a pier or boat deck to roll up an injured
diver. One end is secured to pier/boat deck, with the other end
lowered and placed under the victim, who lies in the tarp parallel
to the deck. Rescuers roll the victim up by pulling up the far end of
the tarp (ropes may be secured to the lower end if necessary for
length).
Ladder Exit – This technique is used to bring a victim up

alone. It requires that the rescuer’s pretty strong and the victim is
not too large in relation to the rescuer. The ladder also has to be
strong enough for the weight of both – don’t attempt this technique
if there’s an unreasonable chance of getting hurt.
The injured diver is straddled over the rescuer’s high thigh
and shoulder, cradled between the arms during the climb. The
rescuer steps up one rung with high thigh (with victim), then bring
other foot to same rung and continues up ladder.

Environmental conditions and other circumstances will affect
what you have to do when you exit the water, including the tech-
nique you use – you obviously can’t use the packstrap carry to
climb a ladder.
Remember that maintaining rescue breaths takes priority. For
shore exits without help, give two slow, full 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, full breaths within 30 seconds.
When you exit through surf, do your best to protect the vic-
tim’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. 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.
If you expect help shortly, consider staying in the water, main-
taining the airway and/or giving rescue breaths until help arrives.
This may be more effective than attempting a difficult exit alone.
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, though this is difficult alone. This raises the point that a sec-
ond 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 they may provide
the strength of two people to lift a victim ashore. Even bystand-
ers make a big difference because they can help based on your
instructions. Always ask for help if it’s available.
The priorities are maintaining rescue breathing and contacting
emergency medical care (if you’ve not been able to do so already).
But you have to balance even these variables amid the demands
of the situation. For example, it may be impossible to exit the
water without interrupting rescue breaths more than 30 seconds,
such as if you’re alone and have to carry the victim up a tall lad-
der. There could be circumstances in which it may be impossible
for you to get the victim out of the water at all, there’s no one there
to help, yet you know that you must exit the water to get help.
Chapter Five 193

In such extreme circumstances, there aren’t easy answers.
You can only do the best you can. Do that, and resume rescue
breathing/start CPR as soon as possible. The victim generally has
a better chance out of the water than in it, and with emergency
medical care on the way rather than delayed.
Exercise 5-4
1. The technique for exiting the water with a victim onto a low
dock or swim step alone is:
h a. packstrap carry
h b. lifeguard exit
h c. fireman’s carry
2. There is never a time when you would let environmental condi-
tions affect regular rescue breaths.
h True h False
How did you do?
1. b. 2. False. Rescue breaths are a priority, but in some circum-
stances a brief interruption may be necessary to get the victim out of
the water.
Some Important
Closing Thoughts
When you successfully complete the PADI Rescue Diver course,
you can take pride in your accomplishment. You’ll have grown as
a diver, and become better prepared to deal with an emergency if
you ever face one.
Of course, rescue skills and knowledge erode with time, so
refresh your rescue and Emergency First Response abilities peri-
odically. You can do this by taking part in rescue workshops and
refresher programs, as well as the EFR refresher program, at least
every two years. In addition, read dive magazines and other peri-
odicals to keep your knowledge fresh and up to date.
Finally, it’s important that you understand that one day you
may help someone in a serious emergency, the result of which

the victim/patient dies or has a permanent serious disability for the rest
of his life, despite everything you do. Realize that your training doesn’t
guarantee happy endings. You often can’t control what caused the
accident, the severity of an injury, the victim’s physical condition before
the accident or any of hundreds of other influences that determine the
emergency’s outcome.
As a rescuer, all you can expect is to do the best you can with the
resources you have under the circumstances. All you can do is give the
victim/patient more of a chance – not certainty – for a more favorable
ending. Realize that even if your efforts, in the end, made no difference
to the outcome, they still made a difference in that they improved what
chances the victim/patient had.
So if you’re ever involved in a rescue situation that doesn’t have
a happy ending, when it’s all over, don’t tell yourself you “failed” and
second guess yourself. Don’t play “If only I’d . . .” with yourself because
the fact is, you don’t know and can never know whether anything would
have made a difference. Usually, the reality is nothing would have.
You did something wonderful – you reached out and did the best
you could to help another person. That’s not failure. It’s compassion.
“We need to get out there right away,” Eliel told Olle and Max. He assigned
one of the group to watch for the missing divers and make notes about the res-
cue, then took Olle and Max up to the car for fresh tanks and to get his wreck
penetration equipment.
Olle was also penetration trained, so Eliel asked him to assist with the rescue.
He had Max help them get set, then told him to contact help on his cellular
telephone. Olle and Eliel returned to the water’s edge, made a quick but thor-
ough safety check and began swimming out on the surface to the buoy that
marked the wreck.
The pair descended as quickly as they could. There were several places to enter
the wreck, but figuring the divers wouldn’t have gone far with partially empty
tanks, Eliel and Olle tied off their penetration line and entered the closest
entry, a large deck hatch. Almost immediately they encountered thick silt,
Chapter Five 195

which indicated someone had been there. Fortunately, the silt was set-
tling, so they could see.
Turning a bend, Eliel spotted the missing divers lying inert, one in a
passage and the other partially in a cabin. Neither was breathing. Eliel
took the penetration line past both victims, locked the reel and secured
it. He signalled Olle to take the closest to the exit, and watched to be
sure Olle could handle the diver by himself.
Eliel took the second diver, following Olle and the line out. He ascended
as quickly as he could safely. At the surface, he found Olle already giving
inwater rescue breaths and towing the victim toward shore. He did the
same with his victim.
Max was waiting when Olle came ashore first. He helped pull the vic-
tim out and began CPR while Olle took off his equipment. Olle took
over CPR so Max could help Eliel with his victim. Paramedics
arrived shortly.
The two divers never regained a pulse or resumed breathing, and were
pronounced dead on arrival at the local emergency room.
The victims had willfully broken multiple safe diving practices that they
had learned as entry-level divers and that Eliel had reiterated that same
day, including making a deep repetitive dive without full tanks and
entering an overhead environment without the proper equipment. They
had even disregarded Eliel’s statement that diving was through for the day.
The rescue wasn’t a failure – it was an example of doing everything cor-
rectly, including taking reasonable steps to assure rescuer safety while res-
cuing the victims from an overhead environment. They had the proper
training, planning and equipment to respond quickly and effectively to
an emergency. Eliel, Olle and Max could not have done anything else.
They did the best they could, which is as much as anyone can do.

Knowledge Review Five
Check your understanding of Chapter Five by completing the Knowledge Review.

Knowledge Review Five
1. After a dive incident that required summoning emergency medical care, an official asks you
questions for a formal accident report. Which of the following would be appropriate for you to
provide when answering? (Choose all that apply.)
□ Events/facts that you personally witnessed
□ Events/facts that someone told you about
□ Your opinion/guess about what happened
□ Whose fault the incident was
Answer key: true, false, false, false
Response: Only provide facts that you personally witnessed. If you don't know, say so. Don't offer
guesses, opinions or speculations because they can interfere with determining the true cause or
causes of the incident. Avoid suggesting fault. Due to the emotions following a serious incident,
these suggestions are often inaccurate and mislead investigators.
2. Administering emergency oxygen promptly is crucial for suspected decompression illness
because it has been shown to improve the effectiveness of recompression in many, but not all
cases.
□ True □ False
Answer key: True
Response: Emergency oxygen has shown to be beneficial in many DCI cases. There are some
types of DCI that don't seem to benefit from oxygen, but providing it does no harm. Oxygen is only
first aid, however. Recompression is still needed for treatment of the vast majority of DCI cases.
3. You've just invested in an emergency oxygen system to have with you when diving. Which of the
following are true? (Choose all that apply.)
□ Keep the valve lubricated with standard silicone grease.
□ Always put out any flame before deploying oxygen.
□ When using oxygen, always open the valve quickly.
□ Keep the unit assembled even when not in use.
Answer key: false, true, false, true
Response: Equipment used with pure oxygen requires special lubricants; never use standard scuba
lubricants. Have oxygen equipment serviced by the manufacturer. Put out any flames before using
oxygen, and pressurize the unit slowly by opening the valve slowly. This reduces the risk of heat
caused by pressurization. When not in use, keep the unit assembled (but not pressurized) to reduce
the risk of contaminant entering the system.
Answer key:
4. Match the oxygen system with the type of patient with whom you would use it.
a. Nonresuscitator demand valve
b. Continuous flow, nonrebreather mask
c. Continuous flow, pocket mask
__ Breathing
__ Breathing weakly
__ Not breathing
Answer key: a, b, c
Response: All Matched
5. When using a continuous flow oxygen system, initially set the flow rate at 5 / 10 /15 / 20 / 25 / 30 /
35 / 40 litres per minute. If the reservoir bag collapses completely when the patient inhales, change
it to 5 / 10 /15 / 20 / 25 / 30 / 35 / 40.
Answer key: 15, 25
Response: When providing oxygen with a continuous flow unit, set the flow at 15 litres per minute.
This is the same whether you're helping a breathing patient with a nonrebreather mask, or providing
oxygenated rescue breaths with a pocket mask. If a breathing patient collapses the reservoir bag
completely on inhalation, increase the flow to 25 litres per minute.
6. The advantage(s) of a nonresuscitator demand valve oxygen system is(are) (choose all that
apply):
□ less expensive
□ delivers nearly 100% oxygen
□ suitable for nonbreathing patients
□ accepts standard scuba regulator
□ wastes less oxygen
Answer key: false, true, false, false, true
Response: The nonresuscitator demand valve oxygen system delivers nearly 100% oxygen and
wastes less because it only flows when the diver inhales. You need to switch to continuous flow for
nonbreathing/weakly breathing patients. Most oxygen systems intended for dive emergencies have
both nonresuscitator demand and continuous flow ability. The manually triggered resuscitator valve
is a system that allows you to provide 100% oxygen to nonbreathing patients, and also works as a
demand or continuous flow unit. You may be able qualify to use these units by completing the PADI
Emergency Oxygen Provider course. Ask your PADI Instructor for more information.
7. You're managing a dive accident scene. You've completed primary and secondary care and
summoned EMS. The patient is breathing emergency oxygen. While waiting for EMS you (choose
all that apply):
□ manage shock.
□ keep the area open for EMS access.
□ monitor the ABCD'S.
□ allow the patient to sit up (if more comfortable).
□ contact local diver emergency service.
Answer key: true, true, true, false, true
Response: These are all appropriate steps following primary and secondary care, summoning EMS
and providing oxygen, except for allowing the patient to sit up. Keep the patient comfortable, but
lying down.
8. What information should you collect (as available) to send with the injured diver and EMS?
□ Diver's name and contact information
□ Dive profile information
□ Significant medical history
□ Emergency care provided
□ Local diver emergency system number & contact name
□ Best guesses to any of the above
Answer key: true, true, true, true, true, false
Response: Provide all the information listed, but as with incident/accident reports, provide only
facts. Guesses and speculation can make things more difficult, so don't guess.
9. Drag the steps for a lifeguard exit into their proper sequence.
□ Place victim's hands on deck.
□ Push out of water with one hand holding victim's hands.
□ Grasp victim's wrists.
□ Stand and lift victim's waist to deck level.
□ Lower victim face down on deck.
□ Roll/drag victim clear of water.
Answer key: 1, 2, 3, 4, 5, 6
Response: The lifeguard exit is useful if you have to get someone onto a low boat swimstep or dock
without help. Review the discussion on exiting with an unresponsive diver and talk with your
instructor if you don't understand this and/or other exit procedures.
10. You're exiting the water onto shore through mild surf with an unresponsive victim who isn't
breathing. It will take more than five seconds to pull the person ashore. The protocol for interrupting
rescue breaths is to begin the interval with 2 / 4 / 6 / 8 breaths, then resume with 2 / 4 / 6 / 8 breaths
after no more than 10 / 15 / 30 / 45 / 60 / 120 seconds.
Answer key: 2, 2, 30
Response: The environment, your personal characteristics, whether you have help and other
circumstances will affect what you have to do when you exit the water, including the techniques. In
all cases, protect the victim's airway and continue providing rescue breaths if required. If you must
interrupt rescue breathing for an exit, give two quick breaths, stop for no more than 30 seconds,
then resume with two quick breaths. Review the discussion on exiting with an unresponsive diver
and talk with your instructor if you don't understand these and/or other exit procedures.
review the material again and, if necessary, discuss it with my instructor at our next session.
Congratulations, you have completed the Chapter Five Knowledge Review!

After completing the Chapter Five Knowledge Review, you should receive an email from padilibrary@
PADI Rescue Diver Final Exam
1. The most common cause of diver emergencies is
A. bad weather.
B. malfunctioning gear.
C. unexpected illness.
D. poor judgment.
2. Perceptual narrowing is
A. caused by the dive mask.
B. a normal part of every dive.
C. lost in an emergency situation.
D. a decrease in broad awareness caused by focus on a problem.
3. You would include ______________________ in a first-aid kit to reduce disease transmission
risk.
A. cotton swabs
B. latex gloves
C. antibacterial soap
D. denatured (toxic) alcohol
4. It is important to have ____________________ available for divers suspected of having
decompression sickness, lung overexpansion injuries or near drowning.
A. fluids
B. pocket masks
C. emergency oxygen
D. acetic acid
5. The two types of oxygen equipment recommended for use by rescue divers are
A. nonresuscitator demand valve and continuous flow.
B. nonresuscitator demand valve and positive pressure resuscitator.
C. positive pressure resuscitator and continuous flow.
D. None of the above.
6. As a PADI Rescue Diver, in a dive accident situation your role
A. will be to manage the rescue.
B. will be that of a skilled assistant helping someone else who’s managing the rescue.
C. a or b, depending upon the qualifications of the divers present.
7. Personal readiness for a diver emergency includes
A. maintaining adequate fitness.
B. a proper attitude toward safety.
C. keeping your rescue skills fresh.
D. All of the above.
8. The first step in managing any emergency is to
A. throw emergency flotation to the victim.
B. stop, breathe, think and act.
C. swim to the victim with your head up.
D. Any of the above may be correct, depending on the situation.
9. An emergency assistance plan for a dive site or area lists
A. contact information for local EMS.
B. contact information for the local diver emergency service.
C. any other contact information needed to get in touch with emergency services.
10. To help anticipate and prevent problems, you should
A. maintain your equipment properly and inspect it before diving.
B. try to think ahead and plan for unexpected situations.
C. not ignore small problems.
11. A diver who struggles at the surface, does not signal for help, fails to respond to directions
and/or rejects the mask and regulator is probably a(n)
A. panicked diver.
B. tired diver.
C. unresponsive diver.
12. In an emergency, _____________takes priority over_____________
A. the victim’s safety, your safety
B. calling for help, your safety
C. your safety, the victim’s safety
D. emergency oxygen, CPR
13. You’re on a boat and a tired diver needs help at the surface approximately 6 metres/ 20 feet
from the boat. Assuming you have the available equipment, your first choice of rescue would
probably be
A. a throwing assist.
B. a reaching assist.
C. a swimming assist with flotation.
D. a watercraft assist.
14. When helping a responsive diver at the surface
A. swim to the diver as fast as you possibly can.
B. keep your head down for streamlining.
C. watch the diver for signs of panic.
D. do not waste time getting your mask or fins if you do not have them.
15. _____________to maintain control of a panicked diver at the surface.
A. Grasp across the victim’s chest
B. Cradle the victim’s tank with your knees
C. Restrict the victim’s kicking
16. While at the surface, an effective escape from a panicked diver who is climbing on you is to
A. switch to your regulator and descend.
B. calm the victim by talking.
C. overwhelm the victim with your strength.
17. If you recognize stress in a diver before a dive, your goal is to
A. keep the person from diving.
B. become the person’s “body guard” for the dive.
C. alert the divemaster to cancel the dive.
D. encourage the diver to apply solution thinking.
18. With respect to your alternate air source, the dive community generally agrees that
A. it should be in a pocket for protection.
B. it should be clearly identified.
C. it should be secured outside the triangle formed by your chin and the corners of your rib cage.
19. The primary hazard of a sticking BCD inflator is
A. a BCD rupture.
B. a runaway ascent.
C. severe negative buoyancy.
D. an exhausted air supply.
20. Equipment-related problems can result from
A. using specialized or unfamiliar equipment without training.
B. using equipment that does not fit correctly.
C. making or extensively modifying equipment.
21. The most common cause of weight belt loss is
A. using plastic buckles instead of metal.
B. tying the belt in place.
C. misaligning the webbing (strap of the belt) so the buckle does not close properly.
D. wearing the belt upside down.
22. You should rinse a jellyfish wound with freshwater to remove the tentacles.
□ True
□ False
23. When responding from a boat or the shore to a responsive diver needing help on the surface,
A. swim with your head up and keep your eyes on the victim.
B. never take flotation devices because they slow you down.
C. never use your arms for swimming.
24. You can more easily stay out of a panicked diver’s grasp if
A. you are positioned for a quick reverse.
B. you have a flotation device to extend to the diver.
C. you stop at a safe distance to evaluate the diver’s state of mind.
25. Whenever performing an inwater rescue for a responsive diver at the surface, always take
emergency flotation if it is immediately available.
□ True
□ False
26. When responding from a boat or the shore to more than one responsive diver needing help at
the surface, the first response you should consider is
A. swim to the victim who needs help the most.
B. swim to the victim who is farthest away.
C. swim to the victim who is closest.
D. whether you can reach, extend, throw, wade or use a watercraft to assist.
27. Whether or not to remove equipment from a distressed diver may depend upon
A. the victim’s condition.
B. environmental factors.
C. the cost of the gear.
D. both a and b, but not c.
28. While wearing scuba gear, the best tow for going fast over a short distance would be
A. the underarm tow.
B. the tank valve tow.
C. the modified swimmer’s carry.
29. A difficult exit with a weak and tired diver may be simplified by
A. letting the diver rest and recover before exiting.
B. carrying the diver out on your back.
C. leaving the diver to handle it alone.
30. After you are out of the water following a responsive diver rescue, and after assuring the
diver does not have a condition that requires emergency medical attention, you should
A. pretend nothing happened.
B. be sensitive to possible self-esteem issues the diver may have.
C. minimize the situation by citing the diver’s incorrect actions.
31. An emergency action plan
A. is necessarily detailed and complex.
B. lists the information and steps for handling a diver emergency.
C. eliminates the need to practice rescue skills regularly.
32. BLS
A. stands for Basic life Support.
B. applies to emergencies involving respiratory and/or cardiovascular system failure.
C. may be needed for patients with decompression illness or near drowning.
33. When rescuing an unresponsive diver in the water, you never attempt to get help until you
reach the boat or shore.
□ True
□ False
34. Following an accident, a patient has a weak, rapid heartbeat, pale tissue color, nausea,
vomiting and thirst. These symptoms probably indicate
A. the patient is too hot.
B. the patient is recovering.
C. the patient is seasick.
D. the patient is in shock.
35. If you suspect shock
A. keep the patient slightly chilled.
B. give the patient something to eat.
C. keep the patient lying down.
36. If you suspect a spinal injury, do not attempt to remove the patient’s exposure suit, except to
carefully cut it off if necessary to prevent overheating.
□ True
□ False
37. Dry flushed skin that is hot to the touch and has a lack of perspiration are symptoms of
A. heat exhaustion
B. heat stroke
C. hypothermia
D. None of the above
38. Treat suspected heat stroke as a life threatening emergency. Contact emergency medical care,
cool the patient and monitor the patient’s lifeline.
□ True
□ False
39. In advanced hypothermia, shivering stops.
□ True
□ False
40.If a panicked diver attempts to bolt for the surface, you want to
A. stop the ascent entirely.
B. keep clear of the diver.
C. take the diver deeper to compress bubbles.
D. prevent a rapid, breath-held ascent.
41. You are looking for a missing diver who you do not believe has gone far from where the diver
was seen last. Only you and your buddy are available to search, and you do not have a line and
reel. Most likely you would use a(n)___________ search pattern.
A. u-pattern
B. expanding square
C. circular
D. surface-led
42. For a diver with suspected decompression illness, provide oxygen
A. for no more than 30 minutes.
B. until emergency help arrives.
C. until the diver experiences symptom relief.
D. even if the diver refuses it.
43. You are rescuing an unresponsive, non-breathing diver at the surface. You estimate you can
reach the boat in three minutes or less. You should
A. tow the victim to the boat while providing rescue breaths.
B. discontinue rescue breaths and tow the victim to the boat as fast as possible.
C. leave the diver and go for help.
44. You are rescuing an unresponsive, non-breathing diver at the surface. You estimate it will take
10 minutes to reach the boat. After another minute of rescue breaths, there is no sign of response
from the victim. You should
A. tow the victim to the boat while providing rescue breaths
B. discontinue rescue breaths and tow the victim to the boat as fast as possible.
C. leave the diver and go for help.
45. If you find an unresponsive diver underwater
A. hold the regulator in the victim’s mouth (if it is in) during ascent.
B. remove the regulator from the victim’s mouth and ascend.
C. you may disregard a safe ascent rate due to the emergency.
D. squeeze the victim’s chest during ascent to force out air.
46. When deciding when and where to remove equipment from the victim and/or yourself, keep in
mind that
A. it is always better to get rid of everything as soon as possible.
B. it is always easier to leave everything on.
C. the goal is to do what gets the victim to safety and out of the water fastest.
D. you should stop swimming while removing gear.
47. If your emergency oxygen system requires lubrication, use the same silicone grease lubricants
that you use on your regular scuba gear.
□ True
□ False
48. For a breathing, injured diver, you would normally provide oxygen using a
A. nonresuscitator demand valve system.
B. continuous flow with nonrebreather mask system.
C. positive pressure resuscitator system.
D. pocket mask with free flow oxygen system.
49. For a weakly breathing diver, you would normally provide oxygen using a
A. nonresuscitator demand valve system.
B. continuous flow with nonrebreather mask system.
C. positive pressure resuscitator system.
D. pocket mask with free flow oxygen system.
50. If a diver is unresponsive, you may assume the diver would want oxygen. This is called implied
consent.
□ True
□ False
.
session.
Answers
1. D. Response: The most common cause of diver emergencies is poor judgment. The
majority of diver accidents are actually preventable; you can trace most of them back to a
poor decision that begins a series of events that culminates in trouble.
2. D. Response: Perceptual narrowing is a decrease in broad awareness through close focus
on a perceived threat or the solution to that threat. To a degree this is a good thing, giving
the individual intense concentration in dealing with a problem. However beyond a point, it
becomes a negative.
3. B. Response: Latex or vinyl gloves, along with ventilation barriers and eye/face protection,
reduce the risk of infectious diseases by reducing contact with blood, body fluids, mucus
membranes, wounds or burns.
4. C. Response: Mounting evidence points to administering emergency oxygen as one of the
single most important first-aid steps for a diver suspected of suffering from decompression
sickness, lung overexpansion injury or near drowning.
5. A. Response: Emergency oxygen equipment falls into three primary categories:
nonresuscitator demand valve units, continuous flow units, and positive pressure
resuscitator units. Rescue Divers may use the first two; the latter requires special paramedic
level training.
6. C. Response: Your role in an emergency situation can vary depending upon the number
and training of others available. Emergency management is the skill of using the human
resources available as effectively as possible.
7. D. Response: There are several elements to personal readiness. The first is maintaining
your physical fitness through regular, proper exercise, diet and rest. The second is
participating in regular training and practice to maintain your rescue and EFR skills. The
third is proper attitude, which goes hand in hand with good judgment.
8. B. Response: The first step when any emergency arises is to: Stop. Breathe. Think. Act.
Assess the situation – who is involved, where is it happening, what do you have available to
assist you? Then, think about the best solution and get ready to act on your plan.
9. D. Response: Areas with well-established emergency medical systems may require only
one or two contact telephone numbers (for the local emergency medical systems and for the
Divers Alert Network (DAN) office, or other diver emergency service, serving the local area).
In remote dive destinations, however, you may need several telephone numbers as well as
VHF radio frequencies.
10. D. Response: Three procedures help anticipate and prevent problems: The first is to
maintain your equipment properly, have it serviced regularly and perform a predive
inspection, will prevent most equipment problems. Second, anticipate problems as before
and throughout the dive. Plan to avoid these problems. Third, don’t ignore small problems,
which can snowball into a chain of events that leads to disaster.
11. A. Response: Panicked divers, overwhelmed by stress and fear, have abandoned rational
responses and react entirely through instinct and fear. They tend to reject their gear,
pushing their masks off and spitting out their regulator or snorkel. They fail to establish
buoyancy, and swim vigorously with arms and legs until exhausted. Their eyes tend to be
wide and unseeing due to extreme perceptual narrowing, and they do not respond to
directions.
12. C. Response: In any rescue situation, your first priority is to stay safe yourself. Realize that
maintaining your own safety is for the victim’s sake as much as your own. You can’t help the
victim if you’re in trouble. You may take on more risk than you otherwise might, but only
after you reasonably ensure your safety do you help the victim.
13. A. Response: If you can’t reach or extend to the diver, your next choice is a throwing assist.
The ideal is to throw a rescue bag, or a tethered life ring, buoy or personal flotation device.
But, in a pinch, anything with reasonable buoyancy tied to a line will do.
14. C. Response: A tired diver can lapse into panic during a rescue (typically before you
actually get close enough to help). You need to continually assess the victim’s state of mind
when assisting a responsive diver at the surface. Take your mask, fins and snorkel; swim
with your head up, eye on the victim the entire time and pace your swim so you arrive with
sufficient energy to complete the rescue.
15. B. Response: To control a panicked diver at the surface, swim around behind the victim
from beyond reach, approach from the rear, grasp the tank valve and lock your legs onto
the tank in the knee cradle position, which prevents a struggling victim from being able to
reach you.
16. A. Response: If you get into a panicked diver’s grasp, you’ll need to use a release or escape
to regain control of the situation. The surest release is to breathe from your regulator and
descend. Underwater is the last place the victim wants to go, and you can continue your
rescue with an underwater approach.
17. D. Response: Once you identify stress, it’s important to break the cycle that leads to anxiety
and potentially, panic or other problems. Your goal is to lead the diver to problem
recognition and solution thinking, and away from anxiety and worry. It’s not that the diver
should disregard potential concerns, but that the concerns should be realistic, and the diver
should feel that they’re adequately addressed and managed.
18. B. Response: The dive community has standardized three points with respect to alternate
air sources. First, the second stage the out-of-air diver should use should be clearly
identified. Second, it should not be allowed to dangle, and third, it should be secured in the
triangle formed by your chin and the corners of your rib cage.
19. B. Response: Inflators can stick in the open position, usually as a result of not being
serviced properly, inflating the BCD rapidly. This can cause a runaway ascent. Stop the
airflow by disconnecting the low-pressure hose. Slow the ascent by using your quick dump
and by flaring out your arms and legs to create drag.
20. D. Response: There are six main causes of equipment-related problems: using unfamiliar or
specialized equipment without learning to use it properly; using equipment that doesn’t fit
properly; using substitute, makeshift, homemade or obsolete equipment; lacking essential
equipment for the dive environment, or using the wrong equipment; severely modifying the
equipment; or failing to properly maintain and inspect the equipment.
21. C. Response: If the diver accidentally misaligns the webbing, the buckle doesn’t close all
the way. Sudden weight belt loss. Check the buckle and webbing alignment for your buckles
and your buddy’s during your predive safety check.
22. False. Response: Use forceps or other tools to gently lift the pieces off. Irrigate the wound
with seawater (do not use fresh water), and five percent solution acetic acid. Vinegar, which
contains acetic acid, neutralizes jellyfish stinging cells.
23. A. Response: When responding from boat or shore, you almost always want your mask,
fins, snorkel and some form of flotation. You also want to keep your eyes on the victim
constantly so you don’t lose track.
24. D. Response: First, stop outside the victim’s reach to evaluate the diver’s mental state, note
the BCD inflator location, make sure you have ample buoyancy and tell the victim to drop
weights or inflate the BCD. Be prepared for a quick reverse, which is simply being ready to
back away from a panicked diver. A flotation device simplifies the rescue by providing
immediate buoyancy and allows you to avoid contact with the panicked diver.
25. True. Response: A flotation device simplifies the rescue by providing immediate buoyancy
and allowing you to avoid contact with a potentially panicked diver. After stabilizing the
situation, it’s often easier to tow the diver to safety by a flotation device than by towing the
diver directly.
26. D. Response: With two or more responsive divers in trouble at the surface, your first
response to consider is the same as with a single victim: look for ways to reach, throw,
wade or use watercraft.
27. D. Response: Consider the victim’s condition, environmental factors and how far you have
to go to the exit when deciding what gear, if any, to remove. For example, if the diver
recovers completely, there may be no need to remove any equipment and if conditions are
choppy, it may be wise to retain masks and snorkels. Cost is never an issue when deciding
to remove equipment.
28. B. Response: While the tank valve tow does little to reassure the victim and provides no
eye-to-eye contact, it is an effective tow for speed over a short distance. You can also use it
over a longer distance once a victim settles down and trusts that all will be okay.
29. A. Response: A difficult exit with a weak, tired diver may be simplified by allowing adequate
time for the victim to rest and recover enough to manage the exit with relatively little
assistance (though you should stay at hand). If time and conditions allow, this is often the
best solution because it helps restore the diver’s self-confidence.
30. B. Response: Many responsive diver at the surface rescues end up with little or no physical
injury, but the potential for emotional injury. Realize that the diver you helped may
experience self esteem loss, especially if that person panicked. It’s important to not play
hero and be sensitive to the diver’s feelings.
31. B. Response: An emergency action plan is the information you will need, at a particular dive
site, in the event of a dive accident. This can be a short list in a well-developed areas with
sophisticated diver medical services, or it can be extensive in a remote area with little
coordinated public emergency support.
32. D. Response: Basic Life Support (BLS) includes monitoring and enacting emergency
procedures for patient respiratory and/or cardiovascular system failure, which cuts off
oxygen to the body, making death imminent. Dive accidents involving drowning,
decompression sickness and lung overexpansion injuries can cause respiratory and/or
cardiac and may require BLS.
33. False. Response: Part of BLS procedures includes contacting the local Emergency Medical
Service (EMS) system as soon as possible. In a diving context, you may have a delay
before you can begin CPR, but not in contacting EMS. For example, you may be a ten
minute swim from shore with a victim, but able to yell for someone to contact EMS.
34. D. Response: Many dive accidents can cause shock. There are nine signs and symptoms of
shock: 1. Rapid, weak pulse 2. Pale or bluish tissue color 3. Moist, clammy skin, possibly
with shivering 4. Mental confusion, anxiety, restlessness or irritability 5. Altered
consciousness 6. Nausea and perhaps vomiting 7. Thirst 8. Lackluster eyes, dazed look 9.
Shallow, but rapid, labored breathing.
35. C. Response: Shock management begins with primary assessment and monitoring the
patient’s ABCD’S until a medical professional takes over. Maintain the patient’s body
temperature by protecting the patient from heat with shade and sun exposure protection,
and removing a hot exposure suit. Keep the patient lying down.
36. True. Response: Exposure suits may interfere with injury assessment, but don’t try to
remove it if you suspect spinal injury. If you suspect spinal injury and you need to get the
patient out of the suit to prevent overheating while waiting for EMS, cut the suit off carefully,
while keeping the patient immobile.
37. B. Response: Heat stroke occurs when rising temperatures exceed the body’s cooling
mechanisms. These mechanisms fail, and the core temperature begins to rise, which like a
high fever, can destroy tissue and cause permanent disability. Symptoms include hot, dry
flushed skin. The patient is hot to the touch and does not perspire.
38. True. Response: You should consider heat stroke to be immediately life threatening. Begin
with primary assessment. Get the patient into a cool area, remove the exposure suit and
immerse the patient in cool water or apply cool wet towels. Contact emergency medical care
while monitoring the patient’s lifeline.
39. True. Response: As hypothermia worsens, the diver loses coordination, and becomes weak
and confused. In severe cases, body systems fail, and shivering stops. At this point, the
diver may feel “warm,” with the next step loss of consciousness, followed by death.
40. D. Response: You don’t need to stop a panicked diver from ascending. You want to prevent
a rapid, breath-held ascent. If the victim has the regulator in the mouth, simply hanging on
and flaring out will usually suffice to control the ascent rate. If the victim is breath holding,
delay is your best bet at getting the diver to resume breathing before ascending too far.
41. B. Response: The expanding square works well when you have only moderate visibility and
you believe the missing diver hasn’t gone far. It’s a good choice when you have only a
single search team. The pattern begins where the diver was seen last and expands
outward.
42. B. Response: Provide oxygen until you get the patient 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 patient more than trying to extend the
oxygen by reducing the flow rate or switching it on and off.
43. A. Response: How you proceed will depend on how far you are from surface support (a
stationary boat or the shore). If you are less than about 5 minutes from surface support, tow
the diver there while continuing to provide rescue breaths. Get the diver out of the water,
continuing rescue breaths and perform a circulation check.
44. B. Response: If you are more than 5 minutes from surface support give rescue breaths for 1
– 2 minutes whilst watching the victim for signs of movement or other response to the
ventilations. If there is no response to this rescue breathing then cardiac arrest is likely.
Rescue breaths don’t benefit someone in cardiac arrest without chest compressions, so it’s
necessary to get the victim out of the water quickly. Discontinue rescue breaths in favor of
speed. Tow the victim to safety as quickly as possible.
45. A. Response: Upon finding the victim, quickly note the diver’s position, whether the
regulator is in the mouth, whether the mask is on and any other clues. If you find the
regulator in the victim’s mouth, hold it in place even if the victim isn’t breathing. This may
help keep water out of the victim’s lungs, and it provides air if the victim resumes breathing
during ascent.
46. C. Response: During a rescue, equipment removal takes a very low priority. The exception
is discarding weights to establish buoyancy, of course, but aside from that the priorities are
providing an open airway, providing rescue breaths if needed, and getting the victim to
safety as quickly as possible.
47. False. Response: Keep an oxygen unit clean and protected it in its box until needed.
Particularly avoid putting the system in contact with greases, oils or even silicone grease.
Pure oxygen requires that only special lubricants and materials come in contact with the
system.
48. A. Response: In all cases, you want to provide the highest oxygen concentration possible.
With a breathing patient, this normally means using the demand valve on the oxygen unit.
49. B. Response: In some instances, a diver may be breathing, but very weakly. In this case,
the patient may be too weak to activate the demand valve, which like a scuba regulator, has
some breathing resistance. In this case, you will use the continuous flow outlet and a
nonrebreather mask.
50. True. Response: If the diver is unresponsive and breathing, you may assume that the diver
would want oxygen, and supply it (called implied consent) with the nonresuscitator demand
valve unit
Appendix
A ppendix
PADI Standard Safe Diving Practices 202
Dive Planning Checklist 203
PADI Open Water Equipment Checklist 204
PADI Boat Diving Information Sheet 205
PADI Diving Accident Management Flowchart 206
PADI Accident Management Work Slate 207
Get Academic Credit for Your PADI Education 208
English-Metric Conversions 209
Index 211
Appendix 201
STANDARD SAFE DIVING PRACTICES
When diving, you will be expected to abide by standard diving practices. These practices have been compiled
to reinforce what you have learned and are intended to increase your comfort and safety in diving.
As a certified PADI diver, you should:
1. Maintain good mental and physical fitness for diving. Avoid being under the influence of alcohol or dangerous
drugs when diving. Keep proficient in diving skills, striving to increase them through continuing education and
reviewing them in controlled conditions after a period of diving inactivity, and refer to my course materials to
stay current and refresh myself on important information.
2. Be familiar with my dive sites. If not, obtain a formal diving orientation from a knowledgeable, local source.
If diving conditions are worse than those in which I am experienced, postpone diving or select an alternate
site with better conditions. Engage only in diving activities consistent with my training and experience. Do not
engage in cave or technical diving unless specifically trained to do so.
3. Use complete, well-maintained, reliable equipment with which I am familiar; and inspect it for correct fit and
function prior to each dive. Have a buoyancy control device, low-pressure buoyancy control inflation system,
submersible pressure gauge and alternate air source and dive planning/monitoring device (dive computer, RDP/
dive tables – whichever you are trained to use) when scuba diving. Deny use of my equipment to uncertified
divers.
4. Listen carefully to dive briefings and directions and respect the advice of those supervising my diving activities.
Recognize that additional training is recommended for participation in specialty diving activities, in other geo-
graphic areas, and after periods of inactivity that exceed six months.
5. Adhere to the buddy system throughout every dive. Plan dives – including communications, procedures for
reuniting in case of separation, and emergency procedures – with my buddy.
6. Be proficient in dive planning (dive computer or dive table use). Make all dives no decompression dives and
allow a margin of safety. Have a means to monitor depth and time underwater. Limit maximum depth to my
level of training and experience. Ascend at a rate of not more than 18 metres/60 feet per minute. Be a SAFE
diver – Slowly Ascend From Every dive. Make a safety stop as an added precaution, usually at 5 metres/15
feet for three minutes or longer.
7. Maintain proper buoyancy. Adjust weighting at the surface for neutral buoyancy with no air in my buoyancy con-
trol device. Maintain neutral buoyancy while underwater. Be buoyant for surface swim ming and resting. Have
weights clear for easy removal, and establish buoyancy when in distress while diving. Carry at least one sur-
face signaling device (such as signal tube, whistle, mirror).
8. Breathe properly for diving. Never breath-hold or skip-breathe when breathing compressed air, and avoid
excessive hyperventilation when breath-hold diving. Avoid overexertion while in and underwater and dive within
my limitations.
9. Use a boat, float, or other surface support station whenever feasible.
10. Know and obey local diving laws and regulations, including fish and game and dive flag laws.

DIVE PLANNING CHECKLIST
Advance Planning
h Dive buddy(s) _____________________________________________________________
h Date and time (check tide tables) ______________________________________________
h Dive objective _____________________________________________________________
h Location __________________________________________________________________
h Alternate location(s) ________________________________________________________
h Directions _________________________________________________________________
_________________________________________________________________________
h Meeting place and time ______________________________________________________
h Any special or extra gear needed ______________________________________________
h Precheck of weather and water conditions _______________________________________
Preparation
h Tank(s) filled h Equipment packed
h Equipment inspected h Transportation arranged
h Equipment marked (ID) h Obtain information on new location
h Spare parts inventoried h Get local emergency contact information
h Weights adjusted
Last Minute
h Make sure you are healthy, rested and nourished.
h Have a good, confident feeling about the dive.
h Check weather and water conditions.
h Pack food, snacks, drinks.
h Leave dive plan information with someone not going.
(dive site, expected return time, what to do if you do not report back by agreed time, etc.)
h Be sure you have
h Tickets h Money h Medications h Directions
h Swimsuit h Towel h Jacket h Sunglasses
h Other ________________________________________________________________
Pre-Dive Planning
h Evaluate conditions decide whether or not to dive.
h Locate and check nearest communications (telephone, radio).
h Select entry/exit points, alternates, methods.
h Discuss buddy system techniques.
h Agree on
h Pattern or course for the dive
h Limits for the dive (depth, time, minimum air)
h Emergency procedures
Problems? Call ____________________________ or _____________________________
Appendix 203
OPEN WATER EqUIPMENT CHECKLIST
Basic Equipment Spare Equipment
h Gear Bag h Tanks (filled)

h Fins, Mask, Snorkel h Weights
h Exposure Suit h Straps
h Hood h O-ring
h Boots h Tools
h Gloves h Regulator HP Plug
h Weight Belt h Bulbs and Batteries
h BCD (Buoyancy Control Device) h Nylon Line
h Tank (filled)
h Regulator (with SPG and
Personal Items
alternate air source)
h Swimsuit
h Dive Planning System
h Towel
h RDP
h Jacket
h eRDPml tm
h Extra Clothes
h Dive Computer
h Money
h Depth Gauge
h Tickets
h Knife / Cutting Device
h Certification Card
h Watch / Bottom Timer
h Log Book
h Surface Signaling Devices (2)
h Audible h Dive Tables
h Sunglasses
h Visible
h Suntan Lotion
Accessory Equipment
h Medications
h Float and Flag h Toilet Articles
h Thermometer
h Lunch, Thermos
h Dive Light
h Eating Utensils
h Slate and Pencil
h Ice Chest
h Marker Buoy
h Sleeping Bag
h Buddy Line
h Camera
h Lift Bag

BOAT DIVING INFORMATION SHEET
Date of Trip _____________ Name of Vessel ______________________________________
Landing ____________________________ City _____________________________________
Directions _____________________________________________________ ________________
Destination _____________________________________ Cost ________________________
Departure Time ______________________ Estimated Return Time _____________________
Items Needed
______ Diving Equipment ______ Warm Clothes ______ Suntan lotion ______ Money
______ Gear Bag ______ Jacket ______ Medication ______ Ticket
______ Extra Tank ______ Towel ______ Lunch, snacks ______ Drinks
Terminology
Bow: Front end of the boat Leeward: The downwind side; sheltered side
Stern: Rear end of the boat Windward: Side facing into the wind; windy side
Bridge: Wheelhouse, vessel control area Port: Left side of the boat when facing bow
Galley: Kitchen Starboard: Right side of the boat when facing bow
Head: Restroom
Instructions
1. Double-check to be sure you have all required equipment and needed items
2. Board vessel at least one half hour prior to departure time.
3. Ask crew where and how to stow your gear.
4. Place clothes, cameras, lunch, and all items to be kept dry, inside and all diving equipment
outside on the deck.
5. Wait in the stern area for pre-departure briefing.
6. Keep dockside rail clear during docking operations.
7. If susceptible to seasickness, take medication prior to departure.
8. If seasick, use the leeward rail, not the head.
9. Learn toilet operation and rules before using head.
10. Stay off the bow during anchoring operations.
11. Work out of your gear bag. No loose gear on deck.
12. Check out and check in with the divemaster for all dives.
13. Pack and stow all gear before return trip.
14. Be available for visual roll call before boat is moved.
15. Check to be sure nothing is left behind when disembarking.
RULES
1. No trash or litter overboard. Use trash cans.
2. Bridge and engine room are off-limits.
3. Do not sit on the rails when underway.
4. Follow the instructions of the crew.
Appendix 205
DIVING ACCIDENT MANAGEMENT FLOWCHART
IF AN ACCIDENT OCCURS: Make only factual statements; do NOT make value judgments or
1. Locate patient’s I.D., and recent diving history. express opinions.
2. Use reverse side of this slate to record information as indicated. 5. Write accident report as soon as possible while events are fresh.
3. Secure patient’s gear. Rinse and hold. Do NOT disassemble. 6. Send this slate and other appropriate information with evacuation

4. Upon proper identifi cation, cooperate with authorities. personnel.
Has the individual taken a breath Mild Symptoms Serious Symptoms

under water from a compressed YES NO
Fatigue Skin Rash Unusual weakness
air source? Itching Pain (particularly joint, abdominal,
Printed in USA
© PADI 2010
and lower back)

YES Dizziness, vision or speech diffi culty
NO 1. Administer oxygen (100% ideal). Paralysis, numbness/tingling
Not a diving accident. 2. Have patient lie level on left side, head Breathing diffi culty
Go to nearest hospital. supported. Severe cough
3. Administer nonalcoholic fl uids, such as Bloody, frothy mouth
fruit juices, orally. Decrease or loss of consciousness
4. Observe for more serious symptoms. Convulsions
Keep patient under
observation and consult RELIEF WITHIN 30 MINUTES?
diving physician as soon NO
as possible.
1. Maintain open airway – prevent aspiration of vomitus.
2. Initiate CPR if necessary.
3. If conscious/breathing independently, administer oxygen (100% ideal).
4. Have patient lie level on left side, head supported.
5. Advise patient not to sit up during fi rst aid or transport.
6. If convulsion occurs, do not restrain – support head/neck.
7. Protect injured diver from excessive heat, cold, wetness, noxious fumes.
8. If conscious, administer nonalcoholic fl uids, such as fruit juices, orally.
9. Arrange immediate evacuation to appropriate medical facility.
NOTE: DO NOT DISCONTINUE THESE FIRST AID PROCEDURES
EVEN IF PATIENT SHOULD SHOW SIGNS OF IMPROVEMENT.
Product No. 79103 Ver 1.01 (Rev. 8/10) 101PDH10
Ambulance/Medical _____________________ Diving Physician ______________________ Police ______________________

EMERGENCY
CONTACT Medical Facility ________________________ Chamber ____________________________ Other ______________________
INFORMATION United States: DAN +1 919 684-8111 USCG VHF Channel 16
ACCIDENT MANAGEMENT WORKSLATE
ATTENTION: Physicians and Emergency Medical Personnel
The individual identifi ed on this slate has been involved in scuba diving activities and may
have suffered a pressure-related injury resulting from decompression sickness or lung over
expansion. You have no reason to be familiar with all the pathological details of the various
rare disorders which may occur. It is, however, imperative that you follow the guidelines
outlined in the red box on the reverse side of this slate until arrival at a medical facility.
In addition, the Divers Alert Network (DAN) at Duke University Medical Center (U.S.) is
prepared to assist you in patient treatment. DAN may be contacted at +1 919 684-8111. A
physician experienced in the management of diving accidents is available for consultation.
Patient’s Name ____________________________________ Age _____________

Address ____________________________________________________________
___________________________________________________________________
Contact ________________________________ Phone (______) ____________
 Relative  Friend
SIGNIFICANT MEDICAL HISTORY: (allergies, medications, diseases, injuries, etc.)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
SIGNS/SYMPTOMS: (note time)

:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
FIRST AID PROCEDURES INITIATED: (note time)

:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
:
__________ ____________________________ :
_________ ___________________________
DIVE PROFILE:
First Dive Second Dive Third Dive
:
Time In ___________ :
Time In ___________ :
Time In ___________
:
Time Out ___________ :
Time Out ___________ :
Time Out ___________
Depth :
___________ Depth :
___________ Depth :
___________
COMMENTS: ______________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Appendix 207
Get Academic Credit for your PADI Education
©
PADI courses have the unique distinction of meeting academic excellence criteria as established
by university and vocational accreditation bodies. Find out how you can get credit for your
PADI education!
Australia
PADI Divers may receive credit toward various certificates and diplomas for several PADI courses within the Australian national training
system. The following training providers recognise certain PADI and Emergency First Response® (EFR) courses — Technical and Further
Education, South Australia; Australia Fisheries Academy, South Australia; Victorian Tertiary Admissions Center, Victoria; and the Western
Australia Curriculum Council. For more information, go to: www.padi.com/scuba/scuba-diving-guide/start-scuba-diving/scuba-lessons-
for-college-credit/default.aspx
Canada
The British Columbia Ministry of Education (External Credentials Program for Industrial and Occupational Courses) has approved the
PADI Open Water Diver (2 credits), PADI Advanced Open Water or Adventures in Diving Program (4 credits) and PADI Rescue Diver
(4 credits) courses for school credit. Grade 10, 11 and 12 students who have been certified in these PADI courses simply present
their PADI certification card to the school administration to apply for credit. For information on receiving credit contact your school’s
administration. On an individual, merit-base case, divers in Canada may also receive credit for PADI courses through the USA-based
American Council on Education’s College Credit Recommendation Service as noted under “United States.”
England, Wales and Northern Ireland

PADI Open Water Scuba Instructors can apply to PADI for the Certificate in Scuba Instruction, a Vocationally Related Qualification
(VRQ) accredited at Level 3 on the National Qualifications Framework in England, Wales and Northern Ireland, by the Qualifications
and Curriculum Authority (QCA) for England, Department for Education, Lifelong Learning and Skills (DELLS) for Wales and the Council
for the Curriculum, Examinations and Assessment (CCEA) for Northern Ireland. The certificate may be accepted by Further Education
institutions as proof of eligibility for attendance at higher level courses. Contact ie@padi.co.uk for an application form.
Europe
Divers have received credit for PADI courses in mainland Europe academic institutions and through the military; but since there is no
formal recognition process, these have been individual cases. For more information or for a specific request, contact PADI Europe at
training@padi.ch
Japan
Those who want to teach diving in Japanese school systems (colleges, universities, vocational schools, etc.) undergo general and
specialized course work and testing to become authorized by the Japan Sports Association (JASA), under the jurisdiction of the
Ministry of Education, Culture, Sports, Science and Technology. PADI Open Water Scuba Instructors are exempt from this specialized
course and test, and can attain JASA authorization by taking a general course and certification test. For more information go to
www.japan-sports.or.jp/english
New Zealand
PADI Divers may qualify to receive recognition through a New Zealand Qualification Authority accredited provider. Open Water Diver,
Advanced Open Water Diver and Rescue Diver qualify for the National Certificate of Diving: Foundational Skills; Divemasters and
Open Water Scuba Instructors qualify for the National Certificate of Diving: Leadership; and Specialty Instructors qualify for the National
Certificate of Diving: Instruction. For more information, go to www.padi.com/scuba/scuba-diving-guide/start-scuba-diving/scuba-lessons-
for-college-credit/default.aspx
United States
The American Council on Education’s College Credit Recommendation Service (ACE CREDIT) has evaluated and recommended college
credit for 16 PADI courses, and the EFR Instructor course. The American Council on Education, the major coordinating body for all the
nation’s higher education institutions, seeks to provide leadership and a unifying voice on key higher education issues and to influence
public policy through advocacy, research, and program initiatives. For more information on ACE CREDIT recommendations, and to order
an official PADI transcript, go to www.padi.com/scuba/scuba-diving-guide/start-scuba-diving/scuba-lessons-for-college-credit/default.
aspx or contact PADI Americas at training@padi.com
DT405 (Rev. 5/10) Version 1.05 © PADI 2010

ENGLISH-METRIC-CONVERSIONS
Length
1 inch = 2.54 centimetres 1 centimetre = 0.39 inches
iteria as established 1 foot = 0.30 metres 1 metre = 3.28 feet
et credit for your 1 yard = 0.91 metres 1 metre = 1.09 yards
1 fathom = 1.83 metres/6 feet 1 metre = 0.55 fathoms
1 statute mile = 1.61 kilometres/5280 feet 1 kilometre = 0.62 statute mile
e Australian national training
1 nautical mile = 1.85 kilometres/6080 feet 1 kilometre = 0.54 nautical mile
ses — Technical and Further
nter, Victoria; and the Western Capacity
art-scuba-diving/scuba-lessons- 1 cubic inch = 16.38 cubic centimetres 1 cubic centimetre = .06 cubic feet
1 cubic foot = .03 cubic metres 1 cubic metre = 35.31 cubic feet
1 cubic foot = 28.32 litres 1 cubic metre = 1.31 cubic yards
Courses) has approved the 1 cubic yard = 0.76 cubic metres 1 litre (1000cc) = .04 cubic yards
dits) and PADI Rescue Diver 1 pint = .57 litres 1 litre = .22 gallons
DI courses simply present 1 gallon = 4.55 litres 1 litre = 1.76 pints
edit contact your school’s
ses through the USA-based
”
Weight
1 ounce = 28.35 grams 1 cubic ft. fresh = 62.4 pounds
1 pound = .45 kilogram 1 cubic ft. salt = 64 pounds
lly Related Qualification 1 kilogram = 2.21 pounds 1 litre fresh = 1 kilogram
reland, by the Qualifications
1 litre salt = 1.03 kilograms
S) for Wales and the Council
epted by Further Education Pressure
ication form. 1 pound per square inch = 0.07 kilograms per square centimetre
1 kilogram per square centimetre = 14.22 pounds per square inch
1 atmosphere = 14.7 pounds per square inch
itary; but since there is no
1 atmosphere = 1.03 kilograms per square centimetre
est, contact PADI Europe at
Temperature
To convert degrees Fahrenheit to Centigrade, deduct 32 and multiply by 5/9.
.) undergo general and To convert degrees Centigrade to Fahrenheit, multiply by 9/5 and add 32.
the jurisdiction of the
exempt from this specialized
ore information go to
Conversions (approximate)
Miles to kilometres multiply by 8/5
Kilometres to miles multiply by 5/8
Statute miles to nautical miles deduct 1/8
ovider. Open Water Diver, Nautical miles to statute miles add 1/7
Skills; Divemasters and
ctors qualify for the National Pounds per square inch (psi) to atmospheres divide by 14.7
art-scuba-diving/scuba-lessons- Water depth (feet) to bars absolute divide by 33, add 1 bar
Water depth (metres) to bars absolute divide by 10, add 1 bar
Bars absolute to feet of water depth subtract 1 bar, multiply by 33
Bars absolute to metres of water depth subtract 1 bar, multiply by 10
and recommended college
ordinating body for all the
on issues and to influence Wind Direction, Speed and Measurement
ommendations, and to order Direction is specified always as the direction from which the wind blows.
s-for-college-credit/default. (For example, a westerly wind blows west to east.)
Speed is in knots by mariners/airmen, in mph by landsmen/coastal navigators.
© PADI 2010 Measurement: 1 knot = 1.7 feet/.51 metres per second 1 mph = 1.61 kph
1 foot per second = .3 metres per second 1 kph = 5/8 mph
Appendix 209
Index
A
contaminated air, 71
CPR, 33-34, 40, 119-121, 156, 159-160,
165, 185
Accident Management Workslate, 41, cramps, 48, 131-132
43, 154, 188, 206-207 critical incident stress, 146-147
active panic, 23, 133-134 cylinder band releases, 89
administering oxygen, 183-185 cylinder valve tow, 104
adrenaline, 22 cylinders, 70-72
AEDs, 33-34
D
AGE, see “air embolism”
air depletion, see “out of air”
air embolism, 149-151
airway control, 48 DAN, 39, 41, 44, 157
alternate air source, 75-78 DCI, see “decompression illness”
alternate inflator regulator, 76 decompression illness 148, 152, 154-
assessment, risk, 17-18 155, 181
assessment, situation, 38 decompression sickness, 39, 124, 148,
Automated External Defibrillators, 150-151
see “AEDs” defibrillation, 33, 160
diaphragm first stage, 73
B
diver emergencies, causes, 16
diver medical emergency contact
information, 44
Basic Life Support, see “BLS” Divers Alert Network, see “DAN”
BCD, 80-83, 90, 130, 131, 167, 170 do-si-do position, 163-164
BCD, problems with, 85 downstream valve, 73
behavior, abnormal, 66-69 dry suit squeeze, 153
bleeding, 123
E
BLS, 40, 118-121
Bourdon tube, 78
buoyancy compensator, see “BCD”
buoyancy control, 48, 167 eardrum rupture, 152-153
EFR, 40, 119, 122, 160
C
emergency action plan, 115-118
emergency assistant plans, 43-44
Emergency First Response, 28, 36
circular search, 136 emergency management, 35-44
circulation check, 123 Emergency Medical System, see “EMS”
CO2 inflator, 81 emergency oxygen, 29-31, 154-155,
cone shells, 91, 95 179, 181-185
Index 211
I
EMS, 39, 44, 116, 121, 125, 128, 135,
157, 179
entanglement, 132
entrapment, 132-133 inflator quick disconnect, 89
entry, rescue, 98 integrated weight system, 90
epinephrine, 22
equipment maintenance, 47
equipment maintenance and problems,
70-90
J
jaw thrust, 159
equipment removal, 57, 102-103, 169- jellyfish, 91-94
171 judgment, 16
excessive buoyancy, 131 J-valve, 70
exits, 102-105, 170-171, 189-194
K
expanding square search, 136
exposure suit, 126-127
exposure suit, problems with, 85
knee cradle position, 58-59
F
K-valve, 70
fins, problems with, 85

fireman’s carry, 190
first aid, 118, 119
L
ladder exit, 192
lifeguard exit, 190-191
first aid kit, 25-28
low pressure inflator, 80-83
first aid, for common aquatic life injuries,
lung overexpansion injuries, 148-151
91-95
lung overexpansion injury, 40, 124
first aid, for decompression illness,
M
154-155
flotation, 99
flow rates, for emergency oxygen, 29,
184-185 marine injury first aid summary, 94
mask squeeze, 153
H
head cradle position, 163-164
mask, problems with, 85
mediastinal emphysema, 149-150
middle ear squeeze, 152-153
missing diver, 135-137
heat exhaustion, 124, 126-127
modified tired swimmer’s carry, 104
heat stroke, 124, 126-127
moray eel, 91-92
helicopter evacuations, 42-43
mouthpiece, regulator, 74
hyperbaric chamber, 41
mouth-to-mouth rescue breathing,
hypothermia, 124, 127-128
163-164
hypoxia, 156
mouth-to-nose rescue breathing, 164
mouth-to-pocket mask rescue breathing,
162-163

R
mouth-to-snorkel rescue breathing, 165
multiple victim rescues, 99-101
N
reaching assists, 53-54
recompression chamber, see “hyperbaric
chamber”
near drowning, 124, 156-157 recompression, inwater, 155
news media, 179-180 regulator, 72-75
nonswimming assists and rescues, regulator freezing, 75
52-54 release, from panicked diver, 59
releases, function and problems, 87-90
O
out of air, 48
rescue breathing, 120, 156, 159-165,
185
Rescue Diver Video, 10, 11, 12, 162
overexertion, 129 rescue equipment, 37, 46, 97
rescue scenarios, 11
P
reverse block, 153
roll up technique, 192
round-window rupture, 153
packstrap carry, 190 runaway ascent, 82
panic, 23, 51, 133-134
S
panicked diver, 51, 55, 58-60, 98,
100-101, 106, 129, 133-134
passive panic, 23, 51, 133
patient, definition of, 35 saddleback carry, 189-190
peer pressure, 21-22, 69 scorpionfish, 91
perceptual narrowing, 22 scuba system, problems with, 86
physical stress, 20-21 sea snakes, 95
piston first stage, 73 sea urchin, 91
pneumothorax, 149-150 sea wasp, 94-95
pocket mask, 28, 30, 162-163, 185 second stage, diagram of, 72
pony bottle, 76-78 secondary assessment, 124-125
Portuguese man-o-war, 93, 95 self-contained ascent bottle, 76-78
post accident report, 178-181 self-rescue, 46-49
post attendance, 106 sharks, 91-92
problem recognition, 68 shock, 123-124
psychological stress, 21-22 sinus squeeze, 153
snorkel, problems with, 85
Q
solution thinking, 68
SPG, 78-80
squeezes, 152-153
quick dump exhaust valve, 81 stingray, 91-94
quick release buckle, 87-88 stress, 16, 19-24, 66-69, 146-147
quick reverse, 98 stress response cycle, 22
Index 213
V
subcutaneous emphysema, 149-150
submersible pressure gauge, see “SPG”
surface led search, 137
surface problems, 50-52, 96-101, valve, 70-72
158-160 venomous wounds, 91-94
vertigo, 49
T
victim, definition of, 35
tank band releases, see cylinder band

releases
tank valve tow, see cylinder valve tow
W
wading assist, 54
tanks, scuba, see cylinders, scuba watercraft assist, 54
throwing assists, 54 weight system, 130, 131, 168
tired diver, 50, 55-57 weight system, problems with, 86
transducer, for SPG, 78-79 weight systems, 87, 90
wet suit, problems with, 85
U
uncontrolled descent, 130
underarm lift, 58
underarm tow, 103
underwater problems, 129-134, 166-168
U-pattern search, 136

RESCUE DIVER Manual
The Way the World Learns to Dive®
PADI’s Rescue Diver program will build As you master rescue techniques,
your confidence as a diver, give you valuable adapting your new-found skills to suit a
experience in emergency management and variety of different situations both in and out
prevention and heighten your awareness of of the water, your confidence level will soar.
the surrounding environment. In addition, the “tool box” of techniques,
skills and knowledge you have accumulated
Your home-study materials cover principles throughout the Rescue Diver program will give
and information necessary for preventing and you the expertise and confidence to handle
handling dive emergencies. Sections on self- almost any emergency situation.
rescue, diver stress, diving first aid, emergency
management, equipment problems and other
topics prepare you to handle almost any
emergency whether on the shoreline
or in the water.
Product No. 79102 (Rev. 02/13) Version 3.07 © PADI 2011 307PDE13
Printed in Canada

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RESCUE DIVER Manual

Product No. 79102 (Rev. 02/13) Version 3.07

Instructional Design, Development, Consultation and Review

International Review and Consultation

Design and Production

Introduction 7 Chapter Three 113

Course Overview 10 The Psychology of Rescue III 115

Course Philosophy 11 Being Prepared for a Diver Emergency III 119

How to Use This Manual 13 Accident Management III 122

Emergency Oxygen Delivery Systems 29 The Psychology of Rescue IV 146

Automated External Defibrillators (AEDs) 33 Being Prepared for a Diver 148

Unresponsive Diver Underwater 166

Being Prepared for a Diver Emergency II 70 Chapter Five 177

Common Equipment Problems 83 The Psychology of Rescue V 178

Accident Management II 91 Accident Management V 187

Responding to Diver Emergencies II 96 Responding to Diver Emergencies V 189

Exits with a Responsive Diver 102

Post Attendance 106 Appendix / Index 201

It’s been a great, long,

8 PADI Rescue Diver Manual

10 PADI Rescue Diver Manual

Chapter Rescue have not yet enrolled in a PADI Rescue

PROVIDE COURSE FEEDBACK

12 PADI Rescue Diver Manual

“Low on air,” Thomas signaled his buddy, Jacques. “Okay,” Jacques

16 PADI Rescue Diver Manual

Three Considerations Before

2. Assuming inwater rescue is required, in the context of the situ-

3. Assuming inwater rescue is required, can you reasonably

1. The most common cause of diver emergencies is:

18 PADI Rescue Diver Manual

Physical Stress. Physical stressors are those that affect

20 PADI Rescue Diver Manual

Handling Peer Pressure

22 PADI Rescue Diver Manual

24 PADI Rescue Diver Manual

immediately present for some reason. Keep your kit

26 PADI Rescue Diver Manual

28 PADI Rescue Diver Manual

Resuscitator using a continuous flow unit (more about pocket

30 PADI Rescue Diver Manual

Can I Give Oxygen?

32 PADI Rescue Diver Manual

34 PADI Rescue Diver Manual

Readiness. Since you may find yourself man-

36 PADI Rescue Diver Manual

Assess the Situation. When any emer-

38 PADI Rescue Diver Manual

Keep calm to reassure the patient. Cool, controlled and deliber-

40 PADI Rescue Diver Manual

Arrange Evacuation to Medical Care.

4. Prepare the patient by putting a personal flotation device on

6. Usually you’ll see a line dangling from the basket stretcher.

42 PADI Rescue Diver Manual

8. If appropriate, ask the helicopter to fly as low as possible with

Land based helicopter evacuations also have considerations:

4. Don’t let anyone approach the heli-

5. Keep everyone clear of the

only takes a few minutes to jot down emergency contact informa-

DAN America +1-919-684-9111 □ d

Divers Alert Network (DAN)

46 PADI Rescue Diver Manual

when you turn and head for the exit to