Scuba Diving First Aid

title: Scuba
Diving First Aid

author:
publisher: Jones & Bartlett Publishers, Inc.
isbn10 | asin: 0867209445
print isbn13: 9780867209440
ebook isbn13: 9780585326900
language: English
Scuba diving injuries, First aid in illness and
subject
injury.
publication date: 1996
lcc: RC1220.D5S38 1996eb
ddc: 617.1/027
Scuba diving injuries, First aid in illness and
subject:
injury.
Over 60 national organizations have reviewed, contributed to and/or
endorsed the National Safety Council first aid and CPR programs.
These leading organizations include:
American Academy of Ophthalmology
American Academy of Safety Education
American Alliance for Health, Physical Education, Recreation, and
Dance
American Burn Association
American Camping Association
American Civil Defense Association
American College of Surgeons
American Dental Association
American Diabetes Association
American Medical Association
American Equine Association
American Trauma Association
Aquatic Exercise Association
Association for the Advancement of Automotive Medicine
Basic Trauma Life Support
Boy Scouts, USA
Canadian Association of Fire Chiefs
Centers for Disease Control
Ellis & Associates
Emergency Nurses Association
Emergency Response Institute
Epilepsy Foundation of America
Girl Souts, USA
International Association of Fire Fighters
International Society of Fire Service Instructors
Medic Alert Foundation
Mine Safety and Health Administration
National Academy of Emergency Medical Dispatch
National Association of EMS Physicians
National Athletic Trainers Association
National Center on Child Abuse and Neglect
National Cotton Ginner's Association
National Emergency Number Association
National Highway Traffic Safety Administration
National Institute of Burn Medicine
National Oceanic and Atmospheric Administration
National Recreation and Park Association
National Rescue Consultants
National Safety Council
National Ski Patrol
National Society to Prevent Blindness
Occupational Safety and Health Administration
U.S. Air Force
U.S. Army
U.S. Centers for Disease Control
U.S. Coast Guard
U.S. Consumer Product Safety Commission
U.S. Department of Health and Human Services
U.S. Public Health Service
Wilderness Medical Society

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Scuba Diving First Aid

Page ii

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Jones and Bartlett Publishers
One Exeter Plaza
Boston, MA 02116
617-859-3900
800-832-0034
Copyright © 1996 by Jones and Bartlett Publishers, Inc. All rights
reserved. No part of the material protected by this copyright notice
may be reproduced or utilized in any form, electronic or mechanical,
including photocopying, recording, or by any information storage and
retrieval system, without written permission from the copyright
owner.
Library of Congress Cataloging-in-Publication Data
Scuba diving first aid/National Safety Council.
p. cm.
Includes bibliographical references and index.
ISBN 0-86720-944-5
1. Scuba diving injuries. 2. First aid in illness and injury.
I. National Safety Council.
RC1220.D5S38 1995
617.1'027dc20 94-48302
CIP
Vice President and Publisher · Clayton E. Jones
Editorial Assistant · Deborah Haffner
Assistant Production Editor · Nadine Fitzwilliam
Manufacturing Buyer · Dana L. Cerrito
Illustrations · Pre-Press Company, Inc.
Photographs · Dennis K. Graver
Typesetting · Pre-Press Company, Inc.
Cover Design · Hannus Design Associates
Printing and Binding · Banta Company
Cover Printing · New England Book Components
Printed in the United States of America
99 98 97 96 95 10 9 8 7 6 5 4 3 2 1

Page v
Welcome Message
Dear Scuba Enthusiast:
Like you, I enjoy scuba diving. It is a great sport for exploring new
worlds, keeping fit, and having the companionship of people who
appreciate the skills necessary for great, fun diving experiences. I
know you will agree that diving is one of the best recreational
activities.
This is why I am so pleased to welcome you to the National Safety
Council's new first aid book designed just for scuba diving. As with all
National Safety Council programs, a team of experts who know the
divers' special needs collaborated to put together a comprehensive
"how-to" especially for scuba divers. We all need to know what to do
in an emergency. The training this book offers could make a real
difference in reducing pain, preventing further injury, or actually
saving a life.
Please study this material thoroughly and be ready to take action if
someone in a scuba dive needs help.
Sincerely,
GERARD F. SCANNELL, PRESIDENT

NATIONAL SAFETY COUNCIL

Page vii
Acknowledgments
Principal Author
Dennis K. Graver, D.M.T.
Camano Island, WA
Principal Reviewers
Jim Brown
NAUI's NSC Representative
Lakewood, CA
Christopher Dueker, M.D.
Stanford University
Atherton, CA
George Harpur, M.D.
Peninsula Medical Associates
Lion's Head, Ontario
CANADA
Edmond Kay, M.D.
Highline Medical Group
Seattle, WA
Jed Livingstone
NAUI's Training Department
Montclair, CA
Cliff Newell, C.H.T., D.M.T.
Member, U.H.M.S.
Seattle, WA
Donna Siegfried
First Aid Institute
Itasca, IL
Alton L. Thygerson, Ph.D.
Brigham Young University
Provo, UT

Page ix
Table of Contents
Chapter 1 1
Introduction
Course Prerequisites · Course Overview · Course
Requirements · Causes of Diving Accidents · The Need
for Specialized Training
Chapter 2 5
General First Aid Procedures for Injured Divers
Special Considerations · Handling Injured Divers ·
General Care · Precautions against Disease Transmission
· Summary
Chapter 3 19
Pressure-Related Injuries · Gas-Related Injuries ·
Environment-Related Injuries · Oxygen First Aid
Introduction Scuba Diving First Aid Supplies · Scuba
Diving First Aid Summary
Chapter 4 35
Scuba Diving Accident Management
Priorities · Dive Accident Tasks · Task Delegation ·
Emergency Services · Evacuation Procedures · Scuba
Diving Accident Management Summary
Appendix A 43
Scuba Diving First Aid Kit
Appendix B 45
Scuba Diving Emergency Action Plan
Appendix C 47
Scuba Diving Accident Information Form
Appendix D 49
Scuba Diving Accident Signs and Symptoms
References 51
Quick Emergency Index 54

Page 1
Chapter 1
Introduction
· Course Prerequisites · Course Overview · Course Requirements ·
· Causes of Diving Accidents · The Need for Specialized Training ·
Learning Objectives
By the end of this course you should be able to:
· Score 80% or higher on a comprehensive scuba diving first aid
written examination
· Demonstrate the techniques for handling, moving, and positioning
people who simulate injured scuba divers, including those with
suspected neck injuries
· Demonstrate the procedures for the secondary survey of an injured
scuba diver
· Demonstrate scuba diving accident management techniques,
including the delegation of at least ten emergency action tasks
Welcome to the National Safety Council (NSC) Scuba Diving First
Aid Course! Recreational scuba diving's safety record equals that of
swimming, but accidents do happen. Serious scuba diving accidents
for the last five years reported (19881991) average 685 per year for
approximately two million divers. Most divers never experience or
even witness a serious scuba emergency. Because diving takes place at
remote locations, however, it is essential for divers to have the first
aid knowledge and skills that enable them
First aid training for scuba divers is especially important
because diving often takes place at remote locations.
to sustain life and provide relief until casualties can receive
professional medical care.
This book provides supplementary information as part of a scuba
diving continuing education course. The book is not a substitute for
training. The information contained herein is the best available at the
time of publication. Some information may be controversial because
various diving medical experts have different opinions and
recommend different procedures.
Course Prerequisites
This course teaches scuba divers specialized first aid procedures for
diving injuries. You need to be a certified scuba diver because the
course assumes fundamental knowledge common to all entry-level
scuba courses.
You also need Standard First Aid and CPR knowledge and skills, or
the courses that teach these skills must be combined with this course.
The Scuba Diving First Aid Course deals primarily with exceptions to
standard first aid procedures.
Course Overview
In Chapter 2 you will learn general first aid procedures for the
handling and care of injured divers.

Chapter 3 introduces the first aid procedures for pressure-related, gas-related, and
environment-related injuries. Scuba diving accident management procedures
comprise the final chapter. You test your knowledge at the end of each chapter by
answering self-check questions. Your instructor will test various skills you develo
during the course.
This course includes a brief introduction to oxygen first aid, which is an importan
first aid measure for injured scuba divers. We encourage participants to obtain
more extensive training in scuba diving first aid with oxygen. The knowledge and
skills required to be an effective oxygen provider are too extensive to include in
this course. If your instructor is an oxygen first aid instructor, he or she may offer
an oxygen first aid class in conjunction with your diving first aid training.
There are several diving-
related first aid skills you will learn during the NSC Scuba Diving First Aid cours
A. Management of aquatic neck and spinal injuries

B. Moving casualties of a scuba diving accident
C. Doing a secondary (field neurological) survey

D. Delegation of tasks for accident management

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Scuba diving first aiders should complete an oxygen first

aid provider course.
Course Requirements
Provided you pass the final written examination and satisfactorily
demonstrate all required skills, you will receive an NSC Scuba Diving
First Aid certificate. Anyone not successful during an initial attempt
to qualify for certification may qualify either by passing a written
exam that tests the same subject matter and/or further developing the
required skills to an acceptable proficiency level.
To qualify for NSC certification, you need to pass a written
exam and demonstrate several required skills
Causes of Diving Accidents

Environmental problemssuch as high surf, rough water, or strong
currentscause diving accidents when divers lack the wisdom to abort
dives. Other environmental factorssuch as ice, caves, caverns, and
penetrable wreckscause accidents when untrained and inadequately
equipped divers enter areas that restrict direct access to the surface.
Entanglements are an occasional accident-causing hazard. Venomous
aquatic animals can inflict painful wounds.
Health problemsasthma, diabetes, and cardiovascular diseaseare key
contributing factors to scuba diving accidents. A diving injury
combined with a preexisting medical condition may present a
challenging situation to a first aider. The same problem applies to
injured divers who are under the influence of alcohol or drugs; such
altered states also cause diving accidents.
Stress and panic leading to an incorrect reaction or the repetition of an
ineffective action are frequent accident-initiating causes that lead to
decompression illness and near drownings. The most frequent cause
of panic is an out-of-air situation or an interrupted air supply.
Diving equipment is reliable. Operational failure rarely causes an
accident. Diving with unfamiliar, incomplete, poorly adjusted, or
poorly maintained equipment does cause accidents. Contaminated air
can cause carbon monoxide poisoning. Overweighting, a frequent
problem that initiates accidents, is a user problem more than an
equipment difficulty.
Dives to depths greater than 80 feet (24 m) often contribute to
accident statistics. Nitrogen narcosis, increased air consumption, and
rapid ascents all contribute to accidents. A good way to prevent scuba
diving accidents is to discourage inexperienced divers from deeper
diving, especially in cold water.
Hazardous environmental conditions can cause diving

accidents when divers fail to avoid these situations.

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Diving accidents are more likely to occur when the water

depth exceeds 80 feet (24m).
Typical scuba dives are relaxed, slow-paced activities, but diving can
be strenuous. Unexpected currents, assisting others, and attempting to
work underwater while using recreational scuba equipment can
rapidly cause physiological stress. People who develop cardiovascular
disease may first experience related distress while scuba diving. Loss
of consciousness from heart arrest can lead to near drowning.
Unexplained sudden scuba diving accidents, which often occur at the
surface, usually indicate a cardiovascular event.
Often scuba accidents are the result of combined multiple factors. One
problem precipitates a sequence of inappropriate reactions that
complicate the situation and lead to injury or death. High air
consumption from excessive activity can shorten air supply duration.
A diver, surprised at being out of air so soon, may attempt to obtain
air from a buddy diver. Two divers who may not have practiced air-
sharing skills for years can wind up competing for air while
ascending. One may break away and bolt for the surface, and suffer an
embolism during the ascent. The resulting injury is an arterial gas
embolism, but overexertion precipitated the event.
Common Scuba Diving Accident Causes
· Stress and panic
· Poor judgment
· Overexertion/poor physical condition
· Inadequate skills
· Running out of air
· Rapid ascents
· Poor health
· Minor equipment problems (not failure)
· Hazardous environmental conditions
· Entanglement
· Separation from buddy diver
· Diving under the influence of alcohol, drugs
· Contaminated air
· Nitrogen narcosis
· Loss of consciousness
· Multiple factors in combination
From a first aid perspective, it is important to recognize that an
injured scuba diver presents a special, unique challenge. A diving
casualty may suffer a combination of injuries and problems. For
example, a cold, exhausted diver may panic, over-pressurize a lung
during a breath-hold ascent, lose consciousness, and nearly drown.
The combined physiological insults compound first aid procedures.
Thankfully, the vast majority of scuba diving accidents are less
serious than the foregoing scenario.
The Need for Specialized Training
You need to recognize the signs and symptoms of diving
maladiesillnesses that people do not experience on land. You also
need to provide correct first aid for injuries unique to scuba diving.
Finally, you need to be able to manage accidents at various types of
dive sites. The knowledge and skills you will develop during this
course are beyond the scope of standard first aid courses. All scuba
divers and anyone associated with scuba diving activities should
complete the NSC Scuba Diving First Aid course.
Scuba diving first aid requires specialized training.

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Chapter 2
General First Aid Procedures for Injured Divers
· Special Considerations · Handling Injured Divers · General Care ·
· Precautions Against Disease Transmission · Summary ·
Learning Objectives
By the end of this chapter, you should be able to:
· Explain the casualty monitoring rules for scuba diving first aid
· List ten of twelve special considerations for scuba diving first aid
· Describe three ways to remove an injured diver from the water
· Describe how to manage an aquatic neck or spine injury
· State three rules that pertain to diver casualty positioning
· Explain how to remove an exposure suit from an injured diver
· Describe three ways to move an injured scuba diver
· List three diving first aid procedures for shock
· Demonstrate a secondary survey of an injured scuba diver
· Correctly answer the self-check questions
Nearly all standard first aid procedures apply to injured scuba divers.
The exceptions are especially important, however, and ignorance of
them may contribute to residual symptoms. You need to learn the
special considerations pertaining to diving casualties, how to handle
and move injured divers, and the general care for scuba diving
casualties.
Special Considerations
Checking, calling, and caring for an injured personstandard first aid
proceduresdo not always apply to scuba diving accidents. At remote
locations you may be the only person available. Do not leave a
seriously injured scuba diver unattended. Monitor an injured scuba
diver continuously. When medical help cannot arrive quickly and you
are the first responder, do all you can for the casualty. Whenever
possible, send someone to summon medical assistance. If you cannot
send anyone, remain with the casualty and provide the best first aid
you can while trying to attract someone's attention.
You may need to provide in-water first aid. Rescue is a separate
subject beyond the scope of this course. A rescue is the prompt,
vigorous action taken to release a person from imminent danger. First
aid is the temporary care provided to
The person giving first aid must remain with a casualty

at remote sites.

Page 6
an injured person prior to professional medical treatment. At times
rescues and first aid may overlap. If you can recognize an injury or
sudden illness while diving and provide in-water first aid, you may be
able to prevent further injury or death.
You may provide temporary in-water care to an injured diver suffering
vertigo (dizziness), nitrogen narcosis, or seizures. You may also help a
diver remove a cramp, control bleeding, or cope with a puncture
wound or an impaled object, such as a spear. For serious injuries, you
may need to do in-water rescue breathing, a skill developed during a
course on diving rescue techniques. Although a rare event, you might
have to manage a neck or spine injury for a scuba diver tumbled in
heavy surf.
Positioning a casualty is a particularly important first aid
consideration for injured scuba divers. Casualties may have bubbles
blocking their circulatory systems and causing strokelike symptoms or
may have bubbles in their spinal columns causing loss of motor
control. Incorrect positioning or changing the position of casualties
may cause bubbles to shift and worsen the injured divers' conditions.
The manner in which you extricate injured divers from the water,
position, and transport them may be a critical factor affecting their
recovery.
The human body considers bubbles to be invaders when the bubbles
occur in inappropriate locations and amounts. Immune system
reactions can worsen a diving illness when the body's defenses work
to its detriment. It is important to keep injured divers well hydrated to
minimize the effects of blood sludging resulting from injury reactions.
The normal first aid procedure withholds fluids from casualties, but
you should encourage injured divers to drink water provided
Although rescue and first aid are different skills, you may
need to provide in-water first aid to an injured diver.
Although some diving injures require treatment in a

recompression chamber, you should take an injured diver
to the nearest medical facility.
they can do so safely. Keep in mind there are dangers when victims
drink fluids when they are not fully conscious or if their injuries may
require surgery. Divers usually breathe pure, dry, compressed air. The
dry air dehydrates the body, which is another reason to give fully
conscious scuba diving casualties water to drink.
Exposure suits reduce heat loss in water, but do not
eliminate it. Divers in exposure suits can overheat out
of the water and become chilled in the water.

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Recompression in a large, pressurized vessela recompression
chamberis the medical treatment for bubble injuries. Some well-
intentioned divers think seriously injured scuba divers should be taken
directly to a recompression chamber for treatment. However, the
chamber may not be operational or there may not be personnel
available to operate it. Correct first aid procedures specify that you
take injured divers to the nearest medical facility where the casualties
can receive professional medical care while arrangements are made, if
necessary, to transfer the patients to a recompression chamber.
Bubbles affecting the brain and spinal column can cause nerve
damage. You need to be able to conduct a simple neurological survey
to assess a casualty's condition. Secondary survey procedures appear
later in this chapter.
The air in divers' tanks may be contaminated with carbon monoxide
and cause toxicity that can be life threatening or lethal. Carbon
monoxide inhaled at depth increases in toxicity in proportion to the
ambient (surrounding) pressure. It is important to recognize the signs
and symptoms of carbon monoxide poisoning and provide appropriate
first aid.
Heat-and cold-related injuries occur in scuba diving. Water absorbs
heat from divers and can cause hypothermia (subnormal body core
temperature). Exposure suits that divers wear to reduce heat loss in
water insulate them on land and can cause hyperthermia (overheating)
and syncope (fainting). You need to be able to recognize signals of
heat-and cold-related illnesses and provide proper first aid for them.
In addition to heat and cold, two other environmental conditions
prompt special first aid considerationswater and the animals that live
in water. The danger of drowning exists for all
Defensive actions by venomous aquatic animals can inflict
severe wounds that require special first aid measures.
aquatic activities. Divers, especially when incapacitated, can aspirate
water. Marine creatures and other aquatic animals, some of which are
venomous, may inflict serious wounds. A few beautiful animals of the
underwater world pose a risk to adventure seekers and may create
severe first aid problems. Many divers like to eat seafood. Several
types of seafood poisoning pose first aid challenges that you should be
able to recognize and manage temporarily.
Finally, keep in mind that divers usually dive in pairs. When you give
first aid to a diver, it is essential to account for the injured diver's
buddy immediately. If you delay locating the casualty's buddy, the
second diver might not survive. Diving's buddy system also implies
that you may have to give first aid to two injured divers
simultaneously.
Handling Injured Divers
You may have to remove or help remove injured divers from the
water, position them on the shore or in boats, remove their exposure
suits, provide first aid, and move the casualties for evacuation. You
need to acquire the handling skills that prevent further injury to scuba
diving casualties.
Removing Injured Divers from the Water
It is not difficult to assist conscious divers from the water, but the task
is quite difficult with unconscious casualties. The two criteria for an
optimum egress are handling scuba casualties gently and keeping
them as horizontal as possible. Avoid rough handling because injured
divers may be cold and suffering from shock. Gentle handling
minimizes the risk of cardiac arrest that rough handling might trigger.
Water pressure may increase blood pressure during immersion. If you
pull injured people from the water in an upright position, they
experience sudden drops in blood pressure. The consequences can be
significant, especially if there are bubbles in the casualties' circulatory
systems. Whenever possible, avoid moving injured divers from
horizontal to vertical positions. If you combine movement to vertical
with a rapid decrease in blood pressure during extrication, the results
could be fatal.
There are several ways to remove casualties from the water while
maintaining them in a horizontal position. The following photographs
depict various methods you may use in different situations. Use any
extrication method, even vertical, if arranging horizontal removal
causes a serious

Page 8
Learn several rescue exit techniques that maintain an

injured diver in a horizontal position.
delay. First aid following egress is your primary concern. Maintaining
a horizontal position during egress is a secondary priority.
Managing Aquatic Neck and Spine Injuries
The author surveyed thousands of scuba diving instructors to
determine the frequency of scuba diving neck and spine accidents, but
was unable to find a single incident. Scuba divers do not dive into
water head first, so cervical injuries are not likely. A diver tumbled in
heavy surf could suffer a neck injury. A diver who fell into shallow
water from a great height while trying to enter the water could have a
back and/or neck injury. Although it is a complicated procedure that
you may never need to use, you should be able to manage an aquatic
neck or spine injury so you can preserve an injured diver's quality of
life. You may also have occasion to assist a swimmer or surfer who
has a neck injury.
To be effective in an emergency, you must learn, plan, and practice
aquatic neck and spinal exits for various situations. There is more than
one acceptable technique. You should learn a method that requires
only two people because you may have only one person to call upon
for assistance at a dive site.
Your first step is to recognize a possible cervical or spinal injury. With
your basic understanding of the injury mechanism, you should know
when to suspect a neck or back injury. Check the responsiveness of
any diver who is motionless in shallow water. Keep in mind that slips
and falls on wet decks and rocks can cause neck and back injuries. Be
aware of a potential neck injury if an exiting diver complains about
pain in the neck.
The second step for managing an in-water neck or back injury is to
summon help while approaching the injured diver and stabilizing him
or her. Approach as quickly as possible without creating waves in the
process. The casualty may be face down in the water and need air
desperately. Your goal is to stabilize the person's head in relationship
to the body. Avoid moving the head to its normal position; stabilize
the head in the relative position in which you find it.
If the casualty is face down, place your chest next to the injured
diver's side. Bend sideways toward the person's head and center your
lower forearm beneath the casualty and along the sternum. Seal the
casualty's mouth and nose with the palm and fingers of the hand
beneath the casualty. Place your upper forearm along the injured
diver's spine and grasp the person's head (not neck). If the diver is
wearing scuba equipment, you may need to quickly and carefully
loosen or remove the equipment before you can stabilize the neck and
back.
With your arms positioned correctly, press your forearms and hands
together to stabilize the casualty's neck and spine. Move forward
slowly in the water. Movement keeps the injured person more
horizontal than a stationary position. While moving forward and
squeezing the casualty between your hands and elbows, duck beneath
the injured diver, roll him or her to an upright position, and uncover
the person's mouth and nose. As you remove your hand from the
casualty's mouth and nose, slide it to form an arch with your fingers
grasping one cheekbone and your thumb grasping the other
cheekbone.

Page 9
A. Sandwich the casualty between your elbows, forearms,

and hands and seal the airway.
B. Move forward and roll the casualty while stabilizing

the neck and back between your elbows, forearms, and
hands.
C. Release the mouth and nose, grasp the cheekbones, and

check for breathing.
When you regain your footing, check to determine if the casualty is
breathing. You should be able to feel breathing on the hand that you
have on the person's face. If the casualty is not breathing, you need a
second person to begin rescue breathing via the jaw thrust airway
method. The second rescuer may move the head slightly, but only if
unable to open the airway using the jaw thrust maneuver. Moving the
head risks permanent injury, but the casualty will die without air.
After getting the casualty upright and stabilized, all you can do is wait
for professional assistance unless you have a backboard available and
know how to use it. When you do have a board and can secure the
casualty to it, you should be able to carry the person from the water
and pro-
Proficiency Checklist: Aquatic Neck and Spine Injury
1. Call for response.
2. Approach casualty without making waves.
3. Check responsiveness of casualty.
4. Have someone call EMS.
5. Bend to one side and center your lower forearm along
face-down casualty's sternum.
6. Seal casualty's mouth and nose with your lower hand.
7. Center your upper forearm along casualty's spine.
8. Grasp casualty's head (not neck) between your hands.
9. Press your forearms and hands together and move the
casualty forward slowly.
10. Duck beneath the casualty and roll the person to an
upright position.
11. Uncover the casualty's mouth and nose.
12. Check for breathing.
13. Turn the casualty as a unit if vomiting occurs.
14. Position a backboard beneath the casualty.
15. Have a second rescuer stabilize the casualty's head
between the arms.
16. Place padding beneath the casualty's head to
maintain a neutral spinal column position (no extension).
17. Secure the casualty to the backboard.
18. Carry the casualty from the water.
19. Provide first aid for shock.
20. Monitor and reassure the casualty until EMS arrives.

Page 10
A. Position a backboard beneath the casualty.
B. Have a second rescuer grasp the top of the casualty's

armpits (using the first two fingers only) and stabilize
the head between his or her arms.
C. Position and secure the casualty to the board.

vide further care. If you do not have a backboard, keep moving
forward while holding the casualty and giving reassurance. Do your
best to minimize neck and back movement while summoning
assistance. If the casualty vomits, roll the person to the side as a unit
and drain the airway, then return the casualty to a face-up position.
Positioning Diving Casualties
A modified Trendelenburg (Durant) position is traditional first aid for
air embolism casualties who can breathe without difficulty. The
Durant position places casualties head-down at a 30° angle (head 19
inches lower than the feet) on the back or the left side. The intent of
the position is to increase the cerebral arterial blood pressure and
force bubbles into the venous system so the lungs can trap and
eliminate them.
It is difficult to keep casualties in the modified Trendelenburg
position. The head-down position may cause respiratory discomfort,
regurgitation, ear congestion, and cerebral edema. The current
recommendation concerning the Durant position is not to use it.
Rationale for the position is not well documented. You must have a
backboard with straps to maintain the correct positioning. Strapping
may increase intrathoracic pressure and force bubbles through the
circulation. More reasonable positions are flat on the back or on the
left side.
Place unconscious casualties who can breathe on their left sides to
minimize the possibility of aspiration if regurgitation, a common
event, occurs. Breathing casualties can receive oxygen while lying on
their sides, even when unconscious.
An alternative position to laying breathing casualties on their left sides
is the semiprone (Sims') recovery position. Lay casualties on their left
sides with the right knee and thigh flexed and the left arm supporting
their heads. A semiprone position may provide more stability aboard a
rocking boat than a left-side position.
Place unconscious casualties who require resuscitation (CPR) flat on
the back (supine position) on a firm surface. You must maintain a
clear, open airway in unconscious casualties. To prevent aspiration of
vomitus when nonbreathing casualties regurgitate, roll them to one
side temporarily and clear their airways, then resume artificial res-
To maintain a neutral spinal column position (A) for a

suspected neck injury, you need 1/2'' to 1" of padding
beneath the head of a reclined casualty (B). The head
extends (C) without padding, increasing spinal column
pressure.

Page 11
The traditional modified Trendelenburg position is of

questionable value.
Avoid the problems of the modified Trendelenburg position

by placing breathing casualties flat on their backs or on
their left sides.
piration. Roll injured divers onto their left sides because the openings
of their stomachs will be higher and regurgitation will be less likely
than if you place them on their right sides. Place the casualties' left
arms alongside their heads before you roll them so their arms will
support their heads and help keep their airways straight and open.
When convenient to do so, place a pillow or padding beneath the
casualty's head because the
For shore exits, position a casualty parallel to the water.

head on the arm may affect circulation to the arm.
Because the Trendelenburg position is of questionable value, causes
problems, and is difficult to maintain, lay casualties parallel to the
edge of the water when you remove them from the water and onto a
shore. Put casualties in as horizontal a position as possible. You can
help maintain an open airway for a casualty in the supine position if
you dig a shallow hole beneath a casualty's head and gently lower the
head into the depression.
There are several exceptions to the horizontal positioning
requirement. Casualties suffering heart attacks, asthma attacks, or
pulmonary barotrauma have difficulty breathing when lying down. If
casualties complain about breathing difficulties, allow them to find
positions that are comfortable for them. Comfortable positions may be
sitting or semireclined. As a general rule, use the horizontal position
whenever casualties have neurological deficits (see Secondary
Survey) and can tolerate lying down.
Removing the Exposure Suit
Most divers wear exposure suits, even in seemingly warm water. You
may need to remove parts of suits or cut them away so you can
provide proper care. Familiarization with various configurations of
exposure suits will help prepare you to manage this aspect of a diving
emergency.
A diver who faints may be the victim of a carotid sinus syndrome in
which pressure on the neck from a tight hood or neck seal presses on
the carotid sinus and slows the heart rate excessively. A diver losing
consciousness from a carotid sinus syndrome should regain
consciousness quickly when you relieve the pressure on the neck. If a
diver faints, you should remove the casualty's hood and/or cut the
neck seal to relieve pressure. Most exposure suits cut easily with
scissors. The

Page 12
angled type of scissors that paramedics use work best. Include suitable
blunt-nosed scissors in your diving first aid kit.
It is easy to unzip a shortie or jumpsuit when a diving accident occurs
in warm water. If there is a wind and the evaporative effect is chilling,
you should remove the exposure suit, dry the casualty, and maintain
the person's normal body temperature.
Removal of a casualty's exposure suit is more difficult for diving
accidents that occur in temperate waters. You have to remove a hood,
which is tucked inside a wet suit or attached. Unzip the suit before
removing a separate hood. Use scissors to cut away an attached hood.
Cut pull-over wet suit jackets down the middle, across the shoulders,
and down the arms. Cut wet suit pants along the side of each leg.
Dry suits for cold water climates can help keep injured divers warm.
You will need to cut the neck seal so you can check a casualty's pulse.
Cut a dry suit down the center of the chest if you need to give CPR.
Keep in mind that exposure suits provide some thermal protection. If
you do not have a blanket, cut away only what you must to provide
care for a casualty.
Moving Scuba Casualties
In general, you should not move injured divers unless you have
situations that require movement. First aid is your priority unless there
are immediate dangers such as high surf or an incoming tide. You
must move casualties to flat, firm surfaces whenever they require
CPR.
You may need to move or help move injured divers for evacuation.
Examples are moving divers from the shore to a vehicle or helicopter
or from a boat to a dock. The two primary rules to remember are to
handle casualties gently and keep them horizontal (unless they have
trouble breathing). The horizontal requirement limits the type of car-
If you must move diving casualties, handle them gently and

keep them in as horizontal a position as possible.
Proficiency Checklist: Moving Scuba Casualties
1. Assess the situation.
2. Determine need to move casualty.
3. Assess resources.
4. Determine best way to move casualty, if necessary.
5. Instruct helpers in advance.
6. Synchronize efforts to move the casualty.
7. Demonstrate improvised stretcher carry.
8. Demonstrate hammock carry.
9. Demonstrate cradle carry, if able.
10. Keep casualty horizontal.
11. Handle casualty gently.
12. Place casualty on his or her back.
13. Simulate removal of a casualty's exposure suit.
14. Roll casualty who is simulating vomiting.
15. Place casualty in the recovery position.

Page 13
ries you can use. A stretcher or backboard is the best means. You may
improvise with a surf board or similar item. A pair of oars inserted
through wet suit jacket sleeves is another good, improvised stretcher.
A hammock carry (see NSC First Aid and CPR, Level 2) is a
reasonable alternative if you do not have a stretcher or backboard. If
you are alone, have sufficient strength, and can avoid hurting yourself,
you may use a cradle carry. You may also use various rescue drags,
which are good because they keep casualties horizontal.
General Care
Primary Survey
General first aid procedures for an injured diver are identical to those
for any emergencythe ABCs. Survey the scene and the casualty.
Check responsiveness. If the person does not respond, send a
bystander for assistance. Open the airway and look, listen, and feel for
breathing. If the casualty is not breathing, begin rescue breathing.
Check the pulse for circulation after the first 2 breaths. If there is no
pulse, commence CPR. If you are the only person present to help the
injured diver, remain with him or her and do all you can. Do not leave
an injured diver unattended at a remote location. If the injured diver
has a pulse and is breathing and you can reach a phone within 1
minute, you may leave a casualty in the recovery position long enough
to summon aid. When you have life-threatening problems under
control, provide oxygen (see Chapter 3), give first aid for shock (next
section), and prepare the person for evacuation.
Shock
Shock is a factor in diving injuries as it is in all emergencies. Be
familiar with its signs and symptoms. Special concerns when helping
an injured diver are maintaining a normal, comfortable body
temperature and keeping the person well hydrated.
You do not want casualties to become chilled or overheated. Shade a
person lying in the hot sun. Cover a casualty when the air temperature
is cool or when wind makes a wet diver cold. Space blankets are
small, convenient, and are particularly effective for diving first aid.
When the surfaces beneath injured divers are cold, place insulation
beneath casualties unless you suspect a neck or back injury. Whenever
possible, place twice as much insulation beneath a casualty as you put
on top.
Progressive shock can lead to circulatory collapse and death.

Standard first aid for circulatory shock (low-resistance) includes
elevation of a casualty's legs. Keep the legs level if a casualty requires
artificial respiration. If you decide to elevate the legs, a height of 6
inches (15 cm) is sufficient. Provide support for elevated legs, but
avoid hanging the person's legs by the heels. Elevation increases
pressure on the diaphragm and increases breathing effort. The injured
person's comfort level dictates the duration of elevation. A casualty in
good condition probably will not tolerate leg elevation for more than
30 minutes. If lifting the legs causes discomfort or interferes with
breathing, discontinue elevation. It is a misconception that wet suit
pants act as MAST trousers for shock treatment. It is best to remove a
wet suit when a diver has a serious injury and you can maintain the
person's normal body temperature.
When you provide first aid, keep an injured diver at a

comfortable temperature and give a fully conscious diving
casualty water to drink.

Page 14
Oxygen is helpful and recommended for scuba diving casualties.
Provide the highest possible oxygen concentration. Chapter 3 includes
an introduction to oxygen first aid for scuba divers.
Standard first aid for shock dictates that injured people receive
nothing to eat or drink. A diving injury is an exception to the rule. Do
give conscious, injured divers water to drink as long as they can
consume it safely and their injuries are not likely to require surgery.
Water is preferable to any other fluid. The Divers Alert Network says
that balanced-solution sports drinks are undesirable. Water helps
reduce blood thickening, which can occur as a result of or contribute
to decompression illness. Record the amount of fluid a casualty drinks
and voids. Withhold fluid from injured divers who are not fully
conscious or have stomach pain, paralysis, or a distended bladder.
Evacuate any person suffering from shock to the nearest medical
facility. Advanced life support may be required to save an injured
person's life.
A diver with a collapsed lung may experience cardiogenic shock, a
serious and unique injury caused by damage to the heart. Impaired
heart function deprives parts of the body of blood. When one lung
collapses, there is greater pressure on one side of the heart than on the
other, so the heart shifts toward the side with less pressure. The injury,
called a tension pneumothorax, causes body parts to move and can
kink and twist major blood vessels to the heart, seriously restricting
circulation. First aid augmented with oxygen and rapid evacuation are
of great importance for cardiogenic shock. Fortunately, most lung
collapses do not lead to tension pneumothoraxes.
Secondary Survey
Diving injuries can affect the nervous system and present a variety of
symptoms that include, but are not necessarily limited to:
· Numbness
· Tingling
· Weakness
· Changes in mood, behavior, personality
· Paralysis
· Disturbances of vision
· Vestibular (balance) disturbances
· Loss of bladder and/or bowel control
· Confusion
· Convulsions
· Unconsciousness
The symptoms may occur anywhere from immediately after a dive to
several days afterward. The majority of seriously injured diving
casualties have symptoms in less than an hour.
After attending to life-threatening conditions, begin a secondary
survey, which consists of three steps: interview, vital signs check, and
a head-to-toe physical examination. Be prepared to write down the
information or have someone record it while you dictate. Give the
information to medical personnel before they depart the scene.
Interviews
Interview of a casualty has several objectives. Your goals, in order of
priority, are to find out if the casualty:
· Is oriented (remembers name, day, and location)
· Can remember what happened
· Knows where his or her buddy is (unless accounted for)
· Feels pain anywhere
· Has any medical conditions (Look for medical alert tags.)
· Is taking any medication
· Is allergic to anything
· Would like you to phone someone
Another important goal is reassurance. Give casualties
encouragement, even when they are unconscious. Be calm and patient
and speak normally. When you complete your secondary survey of a
casualty, interview the person's dive buddy and any bystanders who
may have helpful information.
Vital Signs Check
Following the interview, check a casualty's vital signs: pulse,
respiration, and skin conditions. Record your findings. Check the vital
signs every few minutes. Changes in vital signs indicate a change in
an injured person's condition.
Determine pulse rate and quality. Look for a weak, irregular, or
excessively fast or slow pulse. Count the number of heartbeats for 15
seconds and
A history of a casualty's vital signs provides valuable

information for medical treatment.

Page 15
Neurological Exam Procedures
Head and neck
Can the casualty
Push against resistance in all directions?
Wrinkle the forehead?
Frown?
Stick out the tongue and move it in all four
directions?
Smile evenly?
Pucker the lips evenly?
Clench the teeth evenly?
Feel light touches with the eyes closed?
Swallow normally?
Eyes
Can the casualty
See clearly (with visual correction)?
Move the eyes in all four directions?
Follow finger movement smoothly while keeping the
head still?
See peripherally?
Are the pupils equal in size and do they respond to
light?
Ears
Can the casualty
Hear normally?
Hear equally well in both ears a thumb and finger
rubbed together?
Upper body
Can the casualty
Shrug the shoulders evenly?
Wiggle the fingers?
Raise and lower the elbows against resistance?
Squeeze two of your fingers with equal strength?
Feel light touches equally on both sides of the body?
Touch alternate fingertips to nose with the eyes
closed?
Breathe deeply without pain?
Lower body
Can the casualty
Wiggle the toes?
Raise and lower the legs against resistance?
Raise and lower the toes against resistance?
Unilateral (one side) responses suggest nerve damage.
multiply the number by 4 to obtain the pulse rate per minute. It may
be hard to find a pulse in an injured diver. Remember that a breathing
person almost always has a pulse. If you cannot find a pulse in one
part of the body, try another major artery.
Determine respiration rate and quality. Look, listen, and feel. Watch
for signs and symptoms of abnormal breathing. Count the number of
breaths in 15 seconds and calculate the rate per minute. Try not to let
casualties know that you are checking respiration because they may
attempt to modify their breathing patterns.
Feel the injured diver's cheek or forehead and determine the skin
conditions: temperature, color, and moistness. Record your findings.
Head-to-Toe Physical Examination
Use all your senses to detect anything abnormal. For example, an
unusual breath odor could indicate a diabetic condition. Unless you
have reason to suspect physical injury, your exam should focus on the
person's neurological condition because the nervous system is the
principal target of diving injuries. When an injury is serious enough to
lay a casualty down, keep the person horizontal throughout your
exam. Repeat a neurological exam every 30 minutes until evacuation
and record all findings. Practice the procedure frequently to develop
and maintain proficiency.
Look for differences between the functions of one side of the body
and of the other. Abnormal differences in hearing, vision, feeling,
strength, and movement suggest nerve damage. Do your testing with
the casualty lying in a face-up position. Avoid neurological tests that
require the subject to sit upright or stand.
Give your neurological exam records to EMS. Do not delay first aid
or evacuation to do a neurological exam.
Precautions against Disease Transmission
Blood, vomit, and body fluids may transmit disease. Avoid direct and
indirect contact. Whenever possible, use eye protection, hand
protection, and

Page 16
Proficiency Checklist: Secondary Survey
Interview
1. Check casualty orientation (name, day, location).
2. Ask what happened.
3. Ask dive buddy's location.
4. Ask about pain.
5. Ask about medications, allergies, diseases.
6. Ask about emergency contact person.
7. Reassure casualty.
Vital Signs
1. Check pulse rate and quality.
2. Check respiration rate and quality.
3. Check skin temperature, color, and moistness.
4. Record findings.
Head-to-Toe Exam
1. Head and neck exam. Can the casualty
Push against resistance in all directions?
Wrinkle the forehead?
Frown?
Stick out the tongue and move it in all four
directions?
Smile evenly?
Pucker the lips evenly?
Clench the teeth evenly?
Feel light touches with the eyes closed?
Swallow normally?
2. Eye exam. Can the casualty
See clearly (with visual correction)?
Move the eyes in all four directions?
Follow your finger movement smoothly while
keeping the head still?
See peripherally?
Are the pupils equal in size and do they respond to
light?
3. Ear exam. Can the casualty
Hear normally?
Hear equally well in both ears a thumb and finger
rubbed together?
4. Upper body. Can the casualty
Shrug the shoulders evenly?
Wiggle the fingers?
Raise and lower the elbows against resistance?
Squeeze two of your fingers with equal strength?
Touch alternate fingertips to nose with the eyes
closed?
Breathe deeply without pain?
5. Lower body. Can the casualty
Wiggle the toes?
Raise and lower the legs against resistance?
Raise and lower the toes against resistance?
Slide the heel of each foot down the opposite shin?
Record findings.
Secondary Survey Rules
Repeat exam every 30 minutes.
Give survey records to EMS.
Don't delay first aid or evacuation for neurological
exam.
rescue breathing masks with one-way valves to avoid contact. Wash

your hands with antibacterial soap as soon as possible after you assist
an injured diver. Familiarize yourself with and follow all the first aid
precautions that the Centers for Disease Control recommend.
Summary
Some standard first aid procedures vary for scuba diving injuries. You
should not leave a seriously injured scuba diver unattended for more
than 3 minutes. Account for an injured diver's buddy at the earliest
opportunity. Casualty positioning is a particularly important first aid
consideration for injured scuba divers. Whenever possible, keep
seriously injured scuba divers horizontal (unless they have breathing
difficulty). Handle them gently. Use scissors to remove exposure suits.
Give only fully conscious casualties water to drink. Know the signs
and symptoms of neurological injuries and how to do a complete
secondary survey. The head-to-toe physical examination for injured
scuba divers focuses on the neurological condition. You should learn,
plan, and practice all procedures described in this chapter so you will
be proficient in first aid procedures if a diving emergency occurs.
Provide injured divers with oxygen (see Chapter 3) as soon as
possible.

Page 17
Self-Check Questions

Page 19
Chapter 3
· Pressure-related Injuries · Gas-related Illness · Environment-related
Injuries ·
· Oxygen First Aid Introduction · Scuba Diving First Aid Supplies ·
· Scuba Diving First Aid Summary ·
Learning Objectives
· List the most frequent signs and symptoms of and describe the first
aid procedures for:
· Injuries due to lung overexpansion
· Decompression illness
· Squeezes
· Oxygen toxicity
· Carbon monoxide poisoning
· Carbon dioxide toxicity
· Seasickness
· Overheating
· Hypothermia
· Cramps
· Near drowning
· Injuries from aquatic life
· Vertigo
· Carotid sinus syndrome
· Fish poisoning
· Explain why oxygen first aid is valuable for diving injuries.
· Explain the oxygen equipment requirements for diving first aid.
· List 5 first aid supplies you should add to a standard first aid kit to
make the kit more useful for diving emergencies.
This chapter addresses various scuba diving injuries and illnesses.
You will learn to recognize and provide appropriate first aid for diving
injuries and illnesses in three categories: pressure-related, gas-related,
and environment-related. You will also read introductory information
concerning oxygen first aid. Scuba injuries may require some first aid
supplies not normally found in a standard first aid kit. The chapter
also contains a section about scuba diving first aid supplies.
We assume that you know what causes diving injuries and how to
prevent them. The purpose of this course is to help those who provide
diving first aid to recognize and respond to the signs and symptoms of
diving injuries and illnesses.
Pressure-Related Injuries
You should be able to detect signals that suggest barotrauma (a
pressure-related injury), which includes lung overexpansion injuries,
decompression illness (DCI), or squeezes. DCI may be the result of a
lung overexpansion injury, decompression sickness, or both.

Page 20
Lung Overexpansion
Rapid, breath-holding ascents are the most frequent cause of
pulmonary barotrauma (pressure-related lung injuries). But illness and
disease can obstruct airways, trap air in the lungs during ascent, and
cause lung ruptures. Do not rule out an injury due to lung
overexpansion just because a diver made a normal, breathing ascent.
Air escaping from an overpressurized lung can cause serious, life-
threatening injuries.
When a lung rupture occurs, air becomes trapped inside the body.
Pulmonary barotrauma signs and symptoms range from discomfort to
death and vary with the location of the trapped air. There are several
types of injuries caused by overexpansion of divers' lungs, all of
which are serious and require medical attention. Multiple lung
overexpansion injuries are not uncommon. You do not need to
diagnose the precise injury or injuries. You should recognize
pulmonary barotrauma signals and provide immediate first aid.
The following examination may help you confirm that a diver has a
lung-overexpansion injury. The exam consists of three parts:
observation, palpation (feeling with the hands), and auscultation
(listening to body sounds). Affirmative answers to one or more of the
following questions suggest pulmonary barotrauma.
Observation
· Is the casualty experiencing any chest pain?
· Is the casualty's breathing labored, whistling, or wheezy?
· Is the casualty's breathing rate slow or rapid?
· Is the casualty coughing?
· Does the casualty have difficulty swallowing?
· Does the casualty's throat feel full?
· Does the casualty's voice sound unusual?
· Is the casualty leaning to the affected side?
· Is the casualty holding an arm against the affected side (guarding)?
· Does the casualty have poor chest movement on the affected side?
· Is the casualty's windpipe deviated to one side?
· Is the casualty's skin bluish?
· Is the casualty displaying signs and symptoms of shock?
· Is the casualty unconscious?
Palpation
· Does the casualty have a pulse?
· Is the casualty's pulse rapid or irregular?
· Does the casualty's skin feel crackly (like there is air beneath)?
· Does one side of the chest feel different than the other?
· Is there an area of tenderness?
Auscultation
(Use a simple, inexpensive stethoscope.)
· Are lung sounds equal and symmetrical?
· Are crackles (abnormal respiratory sounds) present?
· If you detect crackles, what is their approximate anatomical
location? (right or left lung? apex, middle, or bottom?)
· If you detect crackles, are they moist or dry? (Does it sound like
there is fluid in the air passages?)
· If you detect crackles, what do they sound like? (tinkling, ringing,
snoring, whistling, squeaking, crackling, or hissing)
Record your findings and give the information to medical personnel.
First aid for all serious diving illnesses or injuries is similar. A serious
illness or injury is one that affects breathing, circulation, or the
nervous system. The following list contains the 5 basic first aid steps
for a serious diving injury.
1. Provide primary care (ABCs).
2. Keep casualties horizontal (unless they have trouble breathing).
3. Strive to obtain urgent medical aid.
4. Have casualties breathe oxygen at the highest possible
concentration.
5. Give first aid for shock. Encourage conscious casualties to drink
water.
Discourage the use of aspirin or analgesics. Do not attempt to
recompress injured divers in the water. Insist that all divers who lose
consciousness receive medical evaluation. Include other first aid
measures as needed for specific injuries.
Decompression Illness
Divers who ascend too rapidly after absorbing nitrogen at depth
develop decompression sickness (DCS). The signs and symptoms of
decompression sickness vary greatly and develop within minutes to
days after diving. A cerebral arterial gas embolism (CAGE) can
produce immediate, strokelike symptoms. A small CAGE may trigger
DCS that would not otherwise occur. Decompression illness (DCI) is
a recent term for symptoms of CAGE, DCS, or both. Because various
signals of decompression illness are similar and the first aid
procedures are identical, you do not need to determine the precise
injury.
The 7 most frequent initial symptoms of DCI are:
· Pain
· Numbness
· Severe headache

Page 21
Lung Overpressurization Injuries
A. Air escaping the lungs enters the pulmonary

capillaries and travels to the arterial system
where the bubbles block arteries, especially
those leading to the brain.
B. If a lung rupture does not force air into

circulation, the air may travel along the
bronchi and enter the middle area of the chest,
called the mediastinum.
C. Air expanding in the mediastinum can migrate
upward along the breastbone, producing
subcutaneous emphysema.
D. If a lung ruptures at its surface and allows air to

escape into the potential space between the lung and
the pleural lining, a pneumothorax occurs and the
lung collapses.
E. If the tear in a collapsed lung produces a one-way
valve effect or if air outside a lung expands during
ascent, the injury can progress to a tension
pneumothorax, an extremely serious condition
(See page 14).
General:
Lung overpressurization injuries can be
life-threatening and may occur in combination.

Page 22
Give the some general diving first aid for all serious
diving injuries and illnesses. You do not need to diagnose
the specific condition.
· Extreme fatigue
· Dizziness
· Weakness
· Change in mood, personality
Less frequent signs and symptoms include:
· Nausea
· Difficulty walking
· Difficulty breathing
· Disturbances in vision
· Paralysis
DCI first aid procedures are the 5 basic steps described in the previous
section. Oxygen first aid is especially beneficial and strongly
recommended.
Squeezes
Pressure differentials on body air spaces can damage ear, sinus, eye,
and facial tissues. Ear, sinus, and mask squeezes are painful, but not
life threatening. There are only a few first aid measures you can take
to help squeeze victims until they obtain medical assistance, but you
should know what to do when divers complain about their injuries.
Ears
Ear barotrauma can lead to permanent hearing loss, ringing in the
ears, and balance disturbance. If divers have any of the following
symptoms after a dive, discourage further diving pending medical
examination.
· Persistent ''fullness" in an ear
· Muffled hearing
· Bleeding from the nose
· Mild ache and tenderness in and behind the ear
· Crackling sounds in the ear when chewing or swallowing
Encourage divers to cease diving if they complain of ear

injury or hearing difficulty. Also encourage prompt
medical evaluation to prevent permanent damage.
· Vertigo (spinning sensation), nausea, and vomiting
Also discourage:
· The use of aspirin and other analgesics, which may inhibit the body's
healing mechanisms. You may condone the taking of decongestants,
but you should not recommend medications unless you are a physician
qualified to prescribe drugs.
· The use of ear drops for an ear injury. Drops are a waste of time for
an ear squeeze because they do not reach the injured area. Also, you
should put nothing in an ear if you suspect a ruptured eardrum.
· Equalization attempts, nose blowing, heaving, lifting, bending over,
flying after diving, and high elevations. These actions generate
pressure waves in the ear and aggravate the injury.
Encourage divers with ear injuries to sit down, remain still, keep
quiet, and obtain prompt medical treatment. Delaying medical
attention for more than a day can lead to irreversible and permanent
damage.
Sinuses
Divers bleeding from the nose after a dive may have ear injuries or
sinus squeezes. Severe, persistent headaches provide another clue to
damaged sinus tissue. The sinus areas of the face may be swollen and
tender. First aid recommendations for sinus barotrauma are the same
as those for ear injuries. Facial ice packs may provide some pain
relief. Although sinus injuries rarely cause permanent damage, divers
with injuries should obtain prompt medical treatment to prevent
infection.

Page 23
A mask squeeze causes discomfort, but usually is not

serious.
Face
A mask squeeze is likely to cause facial bruising, tightness of the face,
and extreme redness in the whites of the eyes. Divers suffering mask
squeeze should cease diving until the injury heals. Ice packs and
analgesics may provide some relief for facial discomfort. Unchecked
bleeding in an eye can cause disturbed vision and requires prompt
medical attention.
Gas-Related Illnesses
Various gases that divers breathe or may breathe while diving have
undesirable effects when breathed in high concentrations. You should
be able to recognize the effects of gas-related illnesses and know the
first aid procedures for them.
Nitrogen Narcosis
The definitive first aid is a rescue. You need to get the person to
shallower water to reduce nitrogen's narcotic effects. If possible, try to
get the diver to ascend without assistance. When a diver behaves
strangely at depths greater than 80 feet and does not respond to an
ascent signal, you may decide to
First aid for narcosis is a rescue; get the diver to

shallower water.
make physical contact with the diver and help him or her ascend. If
the signs and symptoms persist after surfacing, the problem is
something other than nitrogen narcosis.
Oxygen Toxicity
The danger of oxygen toxicity is greater today than it was in years
past. Some contemporary divers breathe enriched air (nitrox) that
contains 11 to 15% more oxygen than air. When divers using nitrox
equipment exceed the maximum depth limit for the gas they breathe,
they may experience seizures. Divers may breathe 100% oxygen
while decompressing under water. The cumulative effect of breathing
high partial pressures of oxygen can cause seizures.
Signs of oxygen poisoning are loss of consciousness, respiratory
arrest, and convulsions. Victims usually resume breathing
spontaneously after a seizure and remain unconscious for several
minutes. Casualties are likely to be drowsy or confused after regaining
consciousness.
Rescues are the first aid for convulsing divers at depth. Keep
convulsing victims at the depths where the seizures occurred until the
seizures subside. Surfacing convulsing divers will cause lung
overpressurization because the victims will be breath-holding during
the incident. Do your best to keep convulsing divers from drowning.
Rescue actions might include turning the victims to face-down
positions to keep water from flowing into them, holding the victims at
a constant depth, close and continuous monitoring, and covering the
mouths if the victims eject their regulators. Seizures usually last less
than one minute. When victims stop convulsing, take them to the
surface as quickly as possible. You must allow expanding air in the
lungs to escape, so the victims' mouths

Page 24
must be uncovered during the ascent. Keep victims' mouths pointed
downward to form an air trap and exclude water. It is acceptable to
allow victims' heads to slump forward while you tow them to the
surface. Heads do not have to be tilted back for expanding air to
escape. You need to open airways to get air into unconscious people,
but air will come out quite well regardless of head position. Tilting a
victim's head back during rescue ascents is detrimental because water
flows into victims' airways and lungs. If victims do not resume
breathing at the surface, commence rescue breathing. Provide first aid
for decompression illness after surfacing convulsing divers.
Carbon Monoxide Poisoning
A deadly gas that divers fear is carbon monoxide (CO). Once
absorbed, CO prevents oxygen in the lungs from reaching body
tissues. Slight amounts of CO contamination in breathing gas at depth
can be deadly because the poisoning severity increases in proportion
to the partial pressure of the gas. Increased partial pressure of oxygen
at depth helps oxygenate body tissues because the higher pressure
dissolves oxygen in blood plasma. When divers ascend, the partial
pressure decreases and hypoxia (oxygen insufficient to body tissues)
ensues because CO incapacitates the hemoglobin, a blood component
that normally transports oxygen. Divers developing CO poisoning at
depth often lose consciousness during ascent.
Loss of consciousness and cessation of breathing may be the only
signs of CO toxicity. Suffering divers who surface may complain of
headache, nausea, and weakness. They may be confused or clumsy.
Cherry-red lips and nail beds are unreliable signs that may not occur
at all or may occur only at death.
First aid under water begins with a rescue. Get victims to the surface
and begin rescue breathing, if necessary. After victims are out of the
water, provide the same first aid that you would for any life-
threatening diving accident. Oxygen first aid is particularly valuable.
Prompt medical treatment is important. Carbon monoxide poisoning is
deadly.
Carbon Dioxide Toxicity
Divers who breathe or rebreathe concentrated carbon dioxide (CO2)
or who do not breathe properly, especially at depth, have labored
breathing, which may be the only sign of CO2 toxicity. Underwater
first aid involves getting victims to stop all activity, rest, breathe
deeply, and recover. If the foregoing procedures do not provide relief,
assist divers to the surface and have them breathe fresh air while you
assist them to the exit point. Improvement should be rapid. A
headache may persist after recovery. Medical treatment probably will
not be necessary.
Environment-Related Injuries
The beautiful and magnificent underwater world attracts people;
however, some of the wonders that make diving appealing can cause
injuries. This section addresses injuries and illnesses related to or
caused by the diving environment.
Seasickness
Signs of seasickness, in addition to nausea and vomiting, may include
dizziness, withdrawal, pallor, increased salivation, and cold, clammy
skin. The best first aid for mal de mer is recovery on solid ground.
Whenever possible, take seasick divers ashore in a dinghy, allow them
to recover, suggest they consider a nonprescription preventive
medication, and return them to the boat. Mildly seasick divers may be
able to resolve their symptoms by snorkeling in shallow water.
Vomiting can cause dehydration, which is bad by itself, but terrible for
divers. Sufferers who drink fluids may vomit more than they would if
they abstained. When seasick people request fluids, give them small
amounts until they demonstrate the ability to keep fluids down. Avoid
giving anti-seasickness tablets to those who are seasick. The
medications that help prevent seasickness are not an effective first aid
measure once people become ill.
Divers who vomit while submerged may aspirate water. Discourage
diving if divers become seasick. Ill divers who do not vomit at the
surface may proceed to throw up underwater. You may need to rescue
a seasick diver who vomits while submerged.
Position sufferers near the center of a boat where they can breathe
fresh air. Have them lie down and keep their heads still and their eyes
closed. Prolonged seasickness can lead to a medical emergency that
requires evacuation.
Sunburn
Sunburn clues (redness, tenderness, pain) are well known. Your first
aid goals are to help reduce pain and to prevent dehydration. Have
victims take cool fresh-water showers or apply moist compresses over
their burns. Have sunburn victims rest in a cool location and drink
water. Encourage them to seek medical attention if they feel ill or their
burns

Page 25
show signs of infection. Discourage breaking blisters, peeling skin,
and using ointments.
Overheating
Divers wearing exposure suits for extended periods before or after
diving in warm weather may overheat. Various heat exhaustion signals
include:
· Profuse perspiration
· Rapid, weak pulse
· Rapid breathing (usually shallow)
· Cool, clammy skin
· Headache
· Dizziness
· Nausea
· Paleness
· Weakness
· Muscle cramps
· Fainting
When divers exhibit signs and symptoms of overheating, have them
move to cool surroundings, remove exposure suits, lie down, and cool
off. Provide cool water to drink (except to nauseated casualties). You
may need to sponge casualties with cool water. Heat exhaustion is not
a medical emergency. Recovery usually occurs quickly. Discourage
casualties from diving until they recover completely (no lingering
symptoms) and have had time to rehydrate. Light yellow or clear urine
indicates adequate body hydration, and dark urine suggests
dehydration.
Heat exhaustion can proceed to heat stroke, an uncommon but
extreme medical emergency requiring urgent medical aid. When body
temperature rises beyond a critical temperature, the body's heat
controlling mechanism shuts down and body heat rises quickly to
dangerous levels that can cause brain damage or death. Sweating
stops, the skin feels hot and dry, the pulse becomes full and strong,
breathing becomes rapid and shallow, and casualties lose
consciousness. Other signs include mental confusion or convulsions.
In addition to the first aid for heat exhaustion, you must attend to first
aid ABCs and cool casualties with cold water. Immerse casualties in
tepid water, give sponge baths, or wrap wet cloths around them.
Hypothermia
Excess loss of body heat lowers the body's core temperature.
Shivering, blotchy skin, and blue extremities are well-known signs of
mild hypothermia. Numbness is a common symptom. First aid for
mild hypothermia involves moving casualties to warm environments,
getting them dry, insulating them to retain heat, and providing warm,
nonalcoholic, noncaffeinated drinks. Act quickly to prevent additional
heat loss. Mild hypothermia is not a medical emergency. Discourage
casualties from diving until they become warm enough to perspire.
Perspiration is a reliable indicator of excess body heat.
Severe hypothermia is a medical emergency. Signs include slow
breathing, a slow and irregular pulse, muscle stiffness, mental
confusion, hallucinations, and decreasing consciousness. Care for life-
threatening problems first and seek urgent medical assistance. Handle
casualties gently. Check for a pulse for 1 full minute because
circulation may be weak and extremely slow. Prevent further heat
loss, but refrain from vigorous rewarming attempts (showers, baths,
heat packs) in the field. The objective is to warm victims gradually
from the inside out. Body-to-body contact is an acceptable rewarming
procedure. Breathing warm air helps. Conscious victims who can do
so safely may drink warm, nonalcoholic, noncaffeinated drinks. Keep
casualties lying down. Watch for signs of shock as casualties revive.
Victims of severe hypothermia must receive medical attention even if
they appear to recover.
Progression of heat-related illnesses
Progression of cold-related illnesses

Page 26
Stretch and squeeze cramped muscles, but do not pound or

knead them.
Cramps
Heat, cold, and/or restricted circulation can cause the painful,
involuntary muscle contractions of cramps, which may occur either in
or out of the water. Tight-fitting wet suits on a hot day may cause
cramps before or during a dive. In addition to muscle spasms, signs
and symptoms of cramps include weakness, fatigue, dizziness, and
nausea.
General first aid procedures for cramps:
· Stretch cramped muscles and squeeze them gently to help relax
them. Avoid pounding and massaging cramps.
· Remove casualties from the environment where cramps occur and
have them lie down and rest.
· Encourage casualties to drink water unless they are nauseated. Salt
tablets are inappropriate because they reduce circulatory fluid.
· Apply ice packs to muscles that cramp from overheating.
Near Drowning
Drowning means death by suffocation while submerged. Near
drowning means that a person survives such suffocation for at least 24
hours. Divers may inhale water in an emergency or aspirate a fine
mist through a defective scuba regulator without realizing the
consequences. Both the emergency and nonemergency causes produce
similar signals, which may include:
· Coughing
· Shortness of breath
· Chest pain
· Cyanosis
· Pink, frothy sputum
· Unconsciousness
· Respiratory arrest
· Cardiac arrest
Note: Signs and symptoms of near drowning by inhalation usually
develop rapidly; signs and symptoms of near drowning by aspiration
may be delayed for more than 1 hour.
First aid for a victim of near drowning is the same as that for any
serious diving injury. Primary care (ABCs) is the obvious first aid
priority. Provide the highest possible oxygen concentration at the
earliest opportunity. Treat for shock. Carefully and continuously
monitor near-drowning casualties. Seek urgent medical assistance.
There is a general misunderstanding that hypothermia and the "diving
reflex" somehow prolong life for scuba divers who nearly drown.
Casualties who recover from near drowning after prolonged
immersion without breathing are usually children who succumb
quickly in icy fresh water; not insulated, exhausted, slowly cooled
divers in temperate or tropical waters. Do all you can to save a life,
but don't have unrealistic expectations for scuba-diving victims that
you cannot rescue promptly.
Injuries from Aquatic Life
Many aquatic animals are hazardous to divers. Tropical animals
generally pose greater first aid problems than creatures who live in
temperate waters. Always inquire about the first aid procedures for
injuries from local aquatic life.
Scrapes
Coral, barnacle, and oyster lacerations can cause infection because
they retain animal matter. Remove as much foreign matter from the
wound as possible. Scrub the wounds vigorously with antibacterial
soap and water and flush the area thoroughly with clean, fresh water.
Use hydrogen peroxide to further flush the wounds. Apply sterile
dressings to serious wounds. Minor wounds do not require dressings.
Antibiotic powder or iodine can help reduce the chance of infection.
Encourage casualties to scrub and rinse their wounds twice daily and
seek medical aid at the first sign of infection. Discourage diving until
the wounds heal.
Stings
Skin contact with jellyfish, sea nettles, fire coral, hydroids, anemones,
sponges, bristle worms, and other marine organisms can cause painful
stings. Some stings only cause discomfort; others threaten life.
In addition to pain and red welts, signs and symptoms of stings
include decreased touch and temperature sensations, severe backache,
mental confusion, breathing difficulty, shock, cyanosis,

Page 27
Fire coral is one of several forms of marine life that

can inflict painful stings.
convulsions, and unconsciousness. Severe stings, such as those from
the Australian box jellyfish or the Portuguese man-of-war, may cause
casualties to require rescue breathing or CPR. Seek urgent medical aid
for any severe sting, which may require an antivenin to neutralize the
toxin.
Assist casualties from the water promptly, have them lie down, and
keep them as calm and quiet as possible to minimize absorption of the
venom. Use tweezers and forceful sea-water rinsing to remove animal
residue. Apply vinegar soaks for pain relief (except for stings from
Portuguese man-of-war, Atlantic and hair jellyfish, and Chesapeake
Bay sea nettles). Acceptable alternatives to vinegar include baking
soda paste, boric acid, or unseasoned meat tenderizer. Refrain from
using fresh water, alcohol, kerosene, turpentine, and gasoline. Avoid
rubbing the skin. Some references recommend ice packs for pain
relief, but others strongly discourage application of ice.
Apply shaving cream or baking soda paste and shave the affected
area, then reapply vinegar, baking soda, or meat tenderizer. Apply an
anesthetic ointment to reduce pain. Encourage victims to watch for
signs of infection.
Punctures
Fish, starfish, rays, cone shells, and sea urchins can cause painful
puncture and laceration wounds. Signs, symptoms, and first aid vary.
It is important to find out which animal caused an injury.
Injuries from fish spines, sting rays, crown-of thorns starfish, and sea
urchins may cause the following signs and symptoms:
· Severe, localized pain
· Localized swelling and redness
· Nausea and vomiting
· Shock
· Fainting
· Breathing difficulty
· Cardiac arrest
· Paralysis
Provide first aid by immersing wounds in fresh, hot (110°113° F or
43.3°45° C) water for 30 to 90 minutes. Use tweezers to remove any
animal parts remaining in wounds, then rinse the wounds thoroughly
with fresh water. Allow wounds to remain open. Seek urgent medical
aid for stonefish injuries. Encourage casualties to seek medical
assistance if wounds show signs of infection or if it has been more
than 5 years since casualties had a tetanus inoculation.
Tropical cone shell venom causes death in 1 of every 4 victims. There
is no antivenin. Typical signs and symptoms of a cone shell wound
include:
· Variable sensations (stinging, burning, or no pain)
· Spreading numbness and tingling
· Weakness
· Muscle paralysis
· Swallowing and speaking difficulties
· Respiratory arrest
· Cardiac arrest
Fish, ray, and urchin wounds may require a tetanus

booster shot.

Page 28
Cone shell venom can be fatal. Caution divers to avoid

handling cone shells.
Prompt first aid obviously is critical. If possible, identify the animal.
Assist casualties from the water promptly, have them lie down, keep
them as calm and quiet as possible to minimize absorption of venom,
and provide constant reassurance. Use pressure-immobilization (see
next paragraph) to reduce venom absorption. Refrain from incision,
suction, and use of tourniquets. Monitor casualties carefully and
constantly because they may require CPR. Arrange immediate
evacuation and seek urgent medical aid.
The pressure-immobilization technique reduces absorption
of venom. Apply a broad bandage over the wound and
as far up the limb as possible, then bind a splint to the
entire limb.
Applying pressure to and immobilizing wounded limbs reduces
absorption of venom. Apply a broad (preferably elastic) bandage
directly over the wound at the earliest possible opportunity. Bind the
wound snugly, then bandage the remainder of the limb from top to
bottom. Do not stop circulation. Fingers and toes should remain pink
and have normal sensation. Use any rigid object to splint the limb by
binding the object firmly to the entire limb. Use a splint and a sling to
immobilize an injured hand or forearm. The technique restricts
circulation and requires urgent medical attention. Remove the
bandages if casualties do not receive medical care within 4 hours.
Bites
Fish, eel, mammal, octopus, and sea snake bites can be serious.
Bleeding and infection are primary concerns. The venom injected by
some bites can threaten life and is another grave concern. While bites
from aquatic life are rare, you do need to know the first aid procedures
for them.
For shark or barracuda bites, encourage casualties to remain as calm
as possible while you apply direct pressure to bleeding wounds and
assist the casualties from the water. Lay casualties down, elevate the
bitten area above heart level, keep casualties still, and provide
reassurance. Apply a pressure bandage. For severe bleeding that you
cannot arrest with direct pressure and elevation, apply firm pressure to
the nearest pressure point (brachial or femoral artery). Use a
tourniquet only on arms and legs and not below the knee or elbow. Do
not loosen or remove a tourniquet, which is a last resort measure when
sacrificing a limb may save a life.
If internal organs or bones protrude from a wound, cover them with
clean, moist cloths but do not attempt to reposition them inside the
body. When wet suits help hold casualties together, do
Shark or barracuda bites, although rare, can cause severe

bleeding.

Page 29
not remove the suits. Immobilize site injuries after you stop the
bleeding. Treat for shock. Obtain urgent medical assistance.
You may need to kill a moray eel that will not release its grip on a
diver. Avoid pulling on a live eel attached to a diver because you will
tear the victim's flesh. Clean puncture wounds and remove any tooth
fragments. Leave the wounds open because the risk of infection is
great. Encourage medical treatment.
Bites by sea snakes and by the Australian blue-ringed octopus are life-
threatening injuries. Bites from other species of octopus are not as
dangerous. Signs and symptoms are similar to those described for
cone shell envenomation wounds and also may include puncture
marks, limb stiffness, aching, dark urine, muscle contractions, and
thirst. The first aid for sea-snake and blue-ringed octopus bites is
identical to that previously described for cone shell venom injections.
Also clean the area around a sea-snake bite to remove any surface
venom. Seek urgent medical aid. There are antivenins that can help
combat the toxins. If possible, identify the animal. If you cannot
obtain medical aid, you may need to provide rescue breathing for up
to 12 hours.
Electrical Shock
Electric rays and eels in temperate ocean waters and some fresh-water
rivers can shock divers who touch the animals or get too near. The
shock may stun a diver temporarily and cause a near drowning. A
rescue may be necessary. Assist stunned divers from the water, have
them rest, and suggest medical attention if effects of the shock persist.
Vertigo
Sometimes erroneously called dizziness, vertigo is the false sensation
that you or your surroundings are spinning or moving. Vertigo is an
environmentrelated illness that occurs when your vestibular system
sends misleading information to your brain. Causes are many and
include unequal vestibular stimulation (either pressure or
temperature), ear barotrauma, nitrogen narcosis, gas toxicity, or
weightlessness combined with a lack of reference. Alternobaric
vertigo is a term for dizziness resulting from unequal pressures in the
ears during descents and ascents.
Associated signals include nausea, vomiting, visual disturbance,
fainting, and sweating. It may be difficult to determine when divers
have vertigo under water. They may panic, clutch a fixed object for
reference, or hug themselves. Assist any nonresponsive diver to the
surface so you can discuss the problem. Assist dizzy divers from the
water, have them lie down with their heads elevated and their eyes
closed, and remain still. Fortunately, the duration of the problem
usually is short. If you suspect ear barotrauma, instruct casualties to
avoid coughing, straining, or nose blowing (see page 22). Encourage
immediate medical evaluation by an ear, nose, and throat specialist.
Discourage driving. If divers experience vertigo for reasons other than
lack of spatial reference, discourage further diving until they obtain
medical approval.
Carotid Sinus Syndrome
Tight neck seals or hoods can cause divers to faint because pressure
on the carotid sinuses in the neck tricks the brain into reflex slowing
of the heart and reduces blood pressure. Watch divers with tight neck
seals who tug at them or complain about the tightness.
If possible, catch fainting people to prevent injuries from falls. Lay
casualties down, do a primary survey (ABCs), and loosen, remove, or
cut away restricting clothing, particularly at the neck.
Unconsciousness from fainting is brief. Do a secondary survey when a
casualty regains consciousness. Fainting by itself is not a medical
emergency, but you should encourage divers who faint to obtain
medical examinations before diving again.
A tight hood or neck seal can cause a carotid sinus
syndrome and fainting.

Page 30
Some types of fish are poisonous when eaten.

Seafood Poisoning
Divers who eat fish and shellfish, especially from unfamiliar areas,
may be poisoned by one of several forms of poisoning. Signs and
symptoms for scrombroid poisoning (inadequate fish preservation)
usually occur less than 1 hour after ingestion and include a flushed
appearance, nausea and vomiting, diarrhea, itching, and slight
shortness of breath. Severe or prolonged reactions require urgent
medical care. If victims consume large quantities of fish, exhibit
symptoms, and do not vomit, use syrup of ipecac to induce vomiting.
Provide first aid for shock and monitor victims carefully. Call the
local poison control center.
Signals of more serious forms of fish and shellfish poisoning include:
· Spreading numbness and tingling
· Drooling
· Swallowing difficulty
· Abdominal pain
· Speaking difficulty
· Lack of coordination
· Uncontrollable shaking
· Weakness
· Dizziness
· Paralysis
· Seizures
· Shock
· Blurred vision
· Breathing difficulty
If victims have eaten toxic fish or shellfish within 3 hours, use syrup
of ipecac to induce vomiting unless the victims have already vomited,
are unconscious, or have difficulty swallowing or breathing. Seek
urgent medical assistance and call the poison control center. Use
artificial respiration to assist breathing when victims are short of
breath. Monitor victims closely and constantly. Be prepared to
manage vomiting. Provide reassurance, particularly for paralyzed
victims. If possible, save some of the fish or vomit for laboratory
analysis.
Oxygen First Aid Introduction
We strongly recommend a separate course for oxygen first aid for dive
accidents. The purpose of this section is to provide an introduction to
a valuable diving first aid measure. Familiarity with oxygen first aid
will help you understand its benefits and the need for proper
equipment and training.
Oxygen first aid is valuable for any illness or injury that causes
hypoxia (insufficient oxygenation of tissues). Oxygen is particularly
helpful for victims of near drowning, carbon monoxide toxicity,
decompression illness, and serious injuries from aquatic life.
Anyone who can scuba dive is healthy enough to receive oxygen as a
first aid measure. Do not hesitate to give oxygen to any diver who
feels ill. Discontinue oxygen first aid temporarily if casualties vomit
or have seizures. Oxygen first aid can never substitute for medical
evaluation and treatment, no matter how dramatic casualties'
improvement may be.
Oxygen is especially beneficial for decompression illness because
eliminating nitrogen in inspired (breathed-in) gas removes nitrogen
from the body. The higher the oxygen concentration inspired, the
greater the benefit. Oxygen also can help overcome the effects of
hypoxia, minimize shock, and may ease breathing. Prompt oxygen
first aid can enhance medical treatment and help injured divers avoid
residual symptoms. For many diving injuries, there is no better first
aid measure than oxygen.
A good system can deliver a high concentration of oxygen

to two casualties at the same time.

Page 31
You may need to give oxygen first aid to breathing or nonbreathing
divers or to both simultaneously. You need the proper equipment to
manage various situations. An optimum oxygen delivery system can
deliver oxygen to multiple casualties simultaneously: 100% via a
demand inhalator valve to one or two casualties and up to 90%
oxygen via constant flow to another casualty. Positive pressure
systems (resuscitators) are undesirable for general scuba diving first
aid because they require a high level of emergency medical training
and may harm divers who have lung injuries. A positive pressure
system functions as a demand valve system if you do not depress the
button or lever, so don't think that you cannot use a positive pressure
system.
Oxygen Delivery Systems
An oxygen delivery system consists of a cylinder, a regulator, hoses,
and breathing devices. There are various types of each component.
Oxygen must be stored in cylinders that are designed and cleaned for
the gas. Do not use scuba equipment for oxygen first aid. There are
various sizes of oxygen cylinders. Large or multiple tanks to extend
oxygen first aid are desirable, but any quantity of oxygen is better
than none at all.
The two basic types of regulators are constant flow and demand valve.
Constant-flow systems may be fixed rate (not recommended) or
adjustable rate. Demand-valve systems may be positive pressure (not
recommended without professional-level training) or demand-
inhalator valve. An ideal delivery system regulator is a combination
adjustableflow and demand-inhalator device.
Regulators deliver oxygen to demand valves through intermediate
pressure hoses and to constant-flow breathing devices through clear,
plastic
Oxygen first end can require the ability to use various
masks.
If you cannot use a constant-flow system and a mask with

an oxygen inlet valve to provide oxygen to a nonbreathing
casualty, breathe oxygen yourself and exhale it into the
casualty.
tubing. You attach masks to a demand-inhalator valve or to the plastic
tubing and use the masks to provide oxygen to injured divers. Nose
prongs (nasal cannulas) are unacceptable breathing devices because
they provide a low quantity of oxygen. You need to learn when and
how to use various oxygen masks.
Oxygen First Aid Procedures
As a minimum, you should know how to give oxygen to breathing and
nonbreathing divers. A demand-inhalator valve works only with
breathing casualties, so you must use a constant-flow system for
nonbreathing casualties. If possible, use a Pocket Mask or similar
mask that has an oxygen inlet valve. With oxygen flowing into the
mask at a rate of 15 liters per minute, rescue breathing once every 5
seconds provides three times as much oxygen as expired-air artificial
respiration. If you do not have a mask with an oxygen inlet valve or
do not have a constant-flow system, you can breathe oxygen from the
delivery system and exhale it into a casualty. Learn how to get oxygen
into a nonbreathing diver.

Page 32
The oxygen supply is a first aid concern. Provide the highest possible
oxygen concentration as long as you can. Do not reduce the rate of
flow to make the supply last longer. Try to obtain additional oxygen.
Don't be concerned about the effects of breathing pure oxygen for
extended periods because casualties may breathe oxygen continuously
for 5 hours. It isn't likely that you will be able to provide oxygen first
aid for more than 5 hours or that you will not be able to obtain
medical aid within that time. If your oxygen supply and first aid
requirements exceed 5 hours, allow a casualty to breathe air for 30
minutes, then resume oxygen first aid.
Discontinue oxygen first aid temporarily when casualties vomit, have
seizures, or you evaluate ABCs. Resume oxygen first aid promptly
after you clear the airway of vomit, the seizures subside, or you have
assessed the ABCs.
High-pressure oxygen can be hazardous. When using oxygen, be sure
the area is open or well ventilated. Eliminate all fire ignition sources
because oxygen greatly enhances combustion. Keep oil, grease, and
petroleum products away from oxygen equipment. Be safety
conscious.
Training is essential. There is much more to oxygen first aid than
opening a valve and placing a mask on a casualty. The value of
oxygen first aid for dive accidents cannot be overstated. Acquire the
skills and knowledge you need. Complete a course specially designed
for providers of oxygen first aid.
Scuba Diving First Aid Supplies
Be prepared for emergencies. In addition to first aid training, you
should have various first aid supplies readily available at the dive site.
A charter boat, dive club, or a dive operation may provide the
necessary equipment and supplies for organized dives. When you dive
independently, especially at remote locations, thorough preparation
requires the following supplies:
· Scuba Diving First Aid Kit (See Appendix A.)
· Oxygen delivery system
· Communications (radio or telephone)
· Emergency contact information (phone numbers, radio frequencies)
· Emergency action plan (procedures, script)
· Blankets
· Towels
· Drinking water
· Backboard with tie-downs
Practice your first aid skills at least once each year to

maintain your proficiency in all skills.
Note that you need some items that are not part of standard first aid
kits, including:
· Elastic bandages
· Vinegar
· Baking soda
· Hydrogen peroxide
· Decongestants
· Seasickness preventive
· Rescue breathing mask
· Stethoscope (inexpensive OK)
Be sure to inventory your first aid kit and supplies frequently. Replace
promptly any items that you use. Update your emergency contact
information for new areas. Discuss your emergency action plan with
everyone in your dive group. Test your communications every dive
outing. Practice using first aid equipment at least annually to maintain
proficiency in all skills.
Scuba Diving First Aid Summary
Pressure changes, breathing gases, and the environment can cause
diving injuries and illnesses. Many maladies produce similar signals,
making diagnosis difficult. Your responsibility is to provide first aid,
not diagnose a condition. A serious illness or injury is one that affects
breathing, circulation, or the nervous system. The first aid for all such
conditions generally is the same basic procedure: horizontal position
(except for breathing difficulty), ABCs, oxygen, treatment for shock,
reassurance, and urgent medical aid. Use common sense for less
serious problems. Renew your first aid knowledge and skills
periodically.

Page 33

Page 34

Page 35
4
· Priorities · Dive Accident Tasks · Task Delegation · Emergency
Services ·
· Evacuation Procedures · Scuba Diving Accident Management
Summary ·
Learning Objectives
· List 10 dive accident management tasks and arrange them in
chronological order (See Emergency Action Plan in Appendix B.)
· Explain how to summon emergency services for a dive accident
· Delegate at least 10 accident management tasks
· Explain the procedures for evacuating an injured diver on land
· Explain the procedures for helicopter evacuations of an injured diver
(land and sea)
First aid is a part of accident management, but there are many tasks
you need to manage in addition to caring for injured divers. When
there are other people present, you may be able to delegate tasks, but
you need to know what assignments to make and how to give
instructions clearly and concisely. In this section you will learn the
elements of dive accident management. You also will become familiar
with several proven, effective procedures that can help you manage
accidents.
Priorities
The first priority in an emergency is to remove casualties from life-
threatening situations. You may have to rescue distressed divers, so
you should have training in dive rescue techniques. If you go to the
rescue, assign one person to call EMS and another to prepare the first
aid equipment. If someone else does the rescue, designate someone to
call EMS while you prepare the first aid equipment and clear an area
for the casualty. Assuming you know how, also prepare to remove the
injured diver from the water in a horizontal position. Do all you can to
minimize rescue exit and first aid delays.
When a diver in the water has a serious injury, the victim's dive buddy
is an immediate concern. Ask rescuers to find an injured diver's
buddy. If
Depending on the situation, you may assign someone to

prepare the first aid equipment or you may do it yourself.

Page 36
aboard a boat equipped with a recall siren, ask the captain to sound the
recall. Assign someone to muster everyone not involved with rescue
or first aid and keep the people clear of the area where you will be
assisting casualties.
Other important tasks you should delegate include:
· Sending someone to meet and direct emergency medical personnel
· Assigning a recorder to write down all pertinent information
· Having someone locate a casualty's identification
· Preparing for evacuation (detailed later in this section)
There are other accident management tasks that relate to the legal
aspects of dive accidents. Although not part of first aid, you may wish
to:
· Secure the casualty's equipment.
· Take photos of the general area and conditions (not the victim).
· Obtain information (name, address, telephone numbers) to contact
witnesses.
· Write an accident report and send it to the Diver's Alert Network
(DAN).
You must remain calm, keep thinking, and use common sense in an
emergency. Use a firm, confident voice, which is much more effective
than shouting. Include an emergency action plan (see Appendix B) in
your first aid kit to help you recall important emergency tasks.
Practice and previsualization can help you prepare to manage dive
accidents efficiently and effectively. Practice delegating tasks orally.
Develop the ability to delegate tasks clearly and concisely.
Dive Accident Tasks
· ''Spot" casualty's exact location in the water.
· Send skin-diving rescuer(s).
· Send scuba-diving search and rescue pair.
· Call EMS.
· Prepare emergency equipment.
· Prepare to remove injured diver from water.
· Assist with rescue exit.
· Account for casualty's diving buddy.
· Recall remaining divers, take roll.
· Meet and direct EMS.
· Record all pertinent information.
· Locate casualty's identification.
· Prepare for evacuation.
· Secure casualty's equipment.
· Take photos of general area and conditions.
· Obtain information to contact witnesses.
· Send accident report to DAN.
Discuss emergency procedures before diving.
Task Delegation
First aid preparation includes preparing yourself, preparing first aid
supplies, and coordinating with other people. Discussing and
coordinating emergency procedures before accidents occur can be
invaluable. Saving a few seconds in an emergency can mean the
difference between life and death or complete recovery and permanent
disability.
A dive group leader should discuss emergency procedures as part of a
dive briefing. If you are not a dive leader, tell the leader that you are
trained in scuba diving first aid. If you are the group leader, identify
everyone who has rescue, first aid, diving first aid, and emergency
medical training. Doctors, nurses, EMTs, and paramedics who know
how to manage medical emergencies should be known to everyone.
Discuss potential roles and tasks for a diving emergency. Discuss who
is best qualified to do what. Explain the location and operation of the
communications. A radio or cellular phone is useless if someone you
ask to call for help does not know how to operate the device. Discuss
whom to call in an emergency and how to call them. Make sure you
have all necessary calling numbers. Coordinate recall procedures.
Decide what to do for a missing diver. Discuss evacuation procedures.
How would you get a casualty to a medical center? A few minutes
spent coordinating emergency procedures before diving is an
extremely worthwhile use of the time and will minimize confusion if
an accident occurs.
Emergency Services
Whom do you call in an emergency? 911? Most areas in the United
States have a 911 EMS number, but some areas do not. Know your
local emer-

Page 37
Proficiency Checklist: Scuba Diving Accident
Management Task Delegation
For the following exercise, assume a nonbreathing scuba
diver under water and 2 to 10 divers with rescue and first
aid training. Delegate all possible tasks. When people
complete one task, they may be assigned others. You
should deploy:
1. Two "spotters" to pinpoint the casualty's location
2. A skin-diving rescuer
3. Two search-and-rescue scuba divers
4. A person to call EMS
5. A person to prepare the emergency equipment
6. Two people to prepare to remove the casualty from the
water
7. A person to account for the casualty's buddy
8. A person to recall and muster remaining divers
9. A person to provide first aid
10. A person to record all pertinent information
11. A person to meet and direct EMS
12. A person to control bystanders
13. A person to locate the casualty's identification
14. A person to prepare the area for a helicopter evacuation
gency medical services phone number. When diving from a boat, the
emergency radio frequencies are channel 16 (VHF), 156.8 MHz, and
2182 MHz (Single Side Band). Learn how to use a marine radio and
what to say.
When you call for emergency assistance or send someone to call, be
sure to include the following information:
· State that you have a scuba-diving emergency.
· State your identity and exact location.
· Give your phone number or radio frequency.
Be sure that EMS terminates the call. Report the call to those
providing first aid. If possible, have someone stand by the phone or
radio to receive return calls or transmissions.
In addition to summoning local emergency assistance, you may wish
to consult with a diving physician at the Divers Alert Network (DAN).
You may phone DAN's emergency number 24 hours a day. The
number is (919) 684-8111. Don't hesitate to call for advice or
assistance. The medical experts at DAN are anxious to help.
Evacuation Procedures
Prompt evacuations to medical centers can save lives and prevent
residual symptoms. Although some casualties of dive accidents must
be treated in a recompression chamber, injured divers need to go to
medical centers (see page 7) because they may require advanced
medical care to sustain life. Encourage medical center physicians to
talk to the diving physicians at DAN. DAN's doctors can educate
nondiving physicians who may be reluctant to transfer diving
casualties to a hyperbaric (recompression) facility. Contact the local
hyperbaric facility if you can and let them know that you have a
diving casualty who may require treatment. Request that the chamber
personnel stand by. Tell the chamber personnel your evacuation plans.
When you need to evacuate casualties by land, allow professional
emergency medical personnel to do the job whenever possible. If you
are in a remote location not served by emergency services, you will
need to evacuate casualties. Handle seriously injured casualties gently
and keep them horizontal. If possible, have someone else drive so you
can attend to casualties. Encourage safe and sensible driving. One
emergency should not create another. Be sure to obtain directions to
the medical center and find out where to go when you get there.
Air evacuations for serious accidents require advance preparation. For
evacuation from land, you need to select a large (at least 100 × 100
ft.), clear area for a landing site. Have people secure anything that
could be blown about by hurricaneforce wind, which is what a
helicopter down draft equals. The problem with loose objects is not
that they will be blown away, but that they can be blown upward and
sucked into the aircraft engine's air intake, causing a disaster.
Have a landing coordinator stand at one corner of the landing site and
point both arms in the wind direction. The coordinator should wear a
face mask to keep flying dust and debris from entering the eyes. When
the helicopter lands, no one should

Page 38

Page 39
approach it until and unless the pilot motions to them. Any approach
should be in a crouching position and only from the front of the
helicopter. Avoid the tail rotor area, which is dangerous because the
rotor is invisible when turning.
Helicopter evacuations from a vessel are more complex than land
operations. Do not transfer casualties requiring CPR because the
interruption of chest compressions would be fatal. CPR interruption
during evacuation is a controversial subject, but the general rule is that
CPR delays exceeding 30 seconds are unacceptable. Helicopter
evacuations require more than 30 seconds.
Prepare the boat and the casualty in advance. Time is a critical factor
for both the hovering aircraft and the casualty. Prepare the boat by
securing all loose items and clearing a lifting area. If there is no deck
space on the boat, put the casualty into a dinghy or raft and tow it
behind the vessel. Display a distress signal to help the pilot identify
your boat. Have the captain proceed at the heading and speed
specified by the helicopter pilot. Try to establish and maintain
communications with the helicopter. If you have to lower the antenna
when the helicopter hovers over the vessel, you may have to rely on
hand or light signals. Never shine a light directly at a helicopter
because you may blind the pilot.
The helicopter will lower a trail line that also is a guide line for a
stretcher. Before you touch the trail line, allow the line to discharge
the static electrical charge generated by the aircraft. Do not secure the
trail line, or any line from the helicopter, to the boat! If you have to
place a casualty into a stretcher basket, detach the basket from the lift
line, place a life jacket on the casualty, tie the casualty into the basket
face up with the arms and legs secured inside the basket, then
reconnect the lift line. Signal the helicopter that you are ready. Use the
trail line to help guide the stretcher and keep it from spinning.
Always send information with an evacuated casualty. Include the
person's name and address,
A requirement for scuba-diving first aid is knowing how

to coordinate helicopter evacuations from land or sea.
an explanation of what happened, and a history of signs, symptoms,
vital signs, and first aid. See the Scuba Diving Accident Information
Form in Appendix C.
Scuba Diving Accident Management Summary
There are many tasks you need to manage when a scuba-diving
accident occurs. You need to know what tasks need to be done, how to
delegate the tasks, who can and will do the tasks, and how to assign
them. You need to learn and practice this delegation. Emergency
preparedness and advance coordination are important and can be
invaluable. Develop an emergency action plan, update it for any new
area, and have it readily available. Know whom to call in an
emergency, how to place a call, and how to tell others to call. Learn
and practice evacuation procedures. There are many details to recall.
Previsualization, frequent practice, and an emergency action plan can
help you manage accidents effectively.

Page 41

Page 43
Appendix A
Scuba Diving First Aid Kit
Bandages
Elastic bandages (4" × 60") for pressure-immobilization (2)
Pressure bandages/pads (sanitary napkins are excellent)
Triangular bandages (5)
Gauze roller bandages (2-inch width)
Gauze pads
Cotton swabs
Adhesive bandages
Adhesive tape
Solutions
Vinegar (1 quart or liter)
Hydrogen peroxide
Eye irrigation
Antibacterial soap
Syrup of ipecac
Medications
Analgesic (acetaminophen)
Anesthetic ointment (for relief of pain from stings)
Decongestant (pseudoephedrine)
Iodine
Seasickness preventive
Miscellaneous
Stethoscope
Blunt-end scissors
Tweezers
Safety pins and needles
Chemical cold packs
Chemical heat packs
Hot water bottle
Baking soda (box)
Disposable gloves
Rescue breathing mask (pocket mask)
Diving first aid book
Emergency contact information
Emergency action plan
Paper cups
Flexible straws (for drinking)
Pen and paper
Flashlight
Blankets (mylar type good)
Ground cloth
Clean towels
Other First Aid Supplies
Oxygen delivery system
Drinking water (2 quarts or liters)
Backboard with tie-downs
Communications (phone or radio)

Page 45
Appendix B
Scuba Diving Emergency Action Plan
If the Casualty Is in the Water
· Deploy "spotters" to pinpoint the casualty's exact location.
· Deploy a skin-diving rescuer.
· Deploy a scuba search and rescue team.
· Designate a person to call EMS.
· Prepare emergency equipment.
· Prepare to remove casualty from the water.
For All Serious Scuba Emergencies
· Keep casualty horizontal.
· Account for casualty's buddy.
· Check airway, breathing, and circulation.
· Monitor the casualty continuously.
· Designate a person to record all times and events.
· Designate a person to meet and direct EMS.
· Designate a person to control bystanders.
· Provide oxygen first aid.
· Treat for shock and give conscious casualty water to drink.
· Conduct a secondary survey.
· Designate a person to locate the casualty's ID.
· Prepare the area and casualty for evacuation.
Know the Following
· Exact location
· Phone number, radio frequency, and call letters
· Vessel ID number
· Local emergency contact numbers and frequencies
Emergency Contact Information
Divers Alert Network:

USA (919) 684-8111
Australia (808) 088-200
(inside)
Australia (618) 223-2855
(outside)
Italy (85) 899-0125
U. S. Coast VHF Channel 16
Guard
Coast Guard ____________________
local phone
Marine Radio 156.8 MHz
emergencies 2182 MHz (SSB)
Local EMS ____________________
Local diving ____________________
physician
Local ____________________
recompression
chamber
Poison control ____________________
center
Your doctor ____________________
(name)
Your ____________________
emergency
contact
(name)

Page 47
Appendix C
Scuba Diving Accident Information Form
This casualty is a scuba diver who may have pulmonary and/or
neurological injuries that require hyperbaric treatment. For
information concerning treatment procedures, call the Divers Alert
Network (DAN) at Duke University Medical Center in Durham, North
Carolina. DAN's emergency consultation number is (919) 684-8111.
Casualty's name ____________________ Age
___
Address
_________________________________
Emergency contact name and number
___________
________________________________________
Medical problems, if any
_____________________
Allergies, if any
____________________________
Accident time ________
Accident location
__________________________
Dive profiles
______________________________
Brief description of accident:
Signs and
symptoms
(S/S):
Time S/S
______ _________________________
Time S/S
______ _________________________
Time S/S
______ _________________________
Time S/S
______ _________________________
Time S/S
______ _________________________
First aid
provided:
Fluids:
Drank (type)
_______________________________
Amount ____________________ Time
__________
Voided amount ______________ Time
__________
Drank (type)
_______________________________
Amount ____________________ Time
__________
__________
Drank (type)
_______________________________
Amount ____________________ Time
__________
__________
Vital signs:
Time ____ Pulse ____ Respirations ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Skin ____
Evacuation: Time _______________
By
_____________________________________
Comments:

Page 49
Appendix D
Scuba Diving Accident Signs and Symptoms
Compare casualty's signs and symptoms to the following list
(alphabetical order), find an illness that is common to the signs and
symptoms, then refer to the illness in the text (see Index) to confirm
the first aid procedures.
Abdominal pain Seafood poisoning
Aches DCI, ear injury, injury by marine life, near drowning
Blotchy skin Hypothermia, sting from marine life, DCI
Blue extremities Hypothermia
Breathing difficulty DCI, injury by marine life, seafood poisoning,
gas toxicity, near drowning
Cardiac arrest Lung overexpansion, near drowning, injury by marine
life
Chest pain Near drowning, DCI, lung overexpansion, heart attack
Cold, clammy skin Seasickness, heat exhaustion, shock
Confusion DCI, carotid sinus syndrome, carbon monoxide toxicity,
drugs, heat stroke, hypothermia, nitrogen narcosis (at depth)
Coughing Near drowning
Crackling sounds in the ear Ear injury
Crackly skin Lung overexpansion
Cramps Heat exhaustion, injuries by marine life
Cyanosis Lung overexpansion, hypothermia, near drowning, DCI
Deviated windpipe Lung overexpansion
Drooling Seafood poisoning, seasickness
Diarrhea Seafood poisoning, DCI
Difficulty breathing DCI
Difficulty walking DCI
Dizziness DCI, ear injury, heat exhaustion, cramps, seafood
poisoning, carotid sinus syndrome, shock
Extreme eye redness Mask squeeze
Extreme fatigue DCI, cramps
Facial bruising Mask squeeze
Fainting Heat exhaustion, carotid sinus syndrome, injury by marine
life, vertigo
Frothy sputum Near drowning, lung overexpansion injury
Hearing loss Ear injury
Holding an arm against the affected side Lung overexpansion
Hot, dry skin Heat stroke
Itching Seafood poisoning, DCI, sting by marine life, allergy
Labored breathing Carbon dioxide toxicity
Leaning to the affected side Lung overexpansion
Muscle stiffness Hypothermia, injury by marine life
Nausea DCI, ear injury, seasickness, carbon monoxide toxicity, heat
exhaustion, cramps, wound by marine life
Numbness DCI, hypothermia, injury by marine life, seafood
poisoning
Pain DCI, wound by marine life
Paleness Seasickness, heat exhaustion, hypothermia, shock
Paralysis DCI, injury by marine life, seafood poisoning
Personality change DCI
Rapid heart rate Lung overexpansion
Rapid, shallow breathing Heat exhaustion, heat stroke
Rapid, weak pulse Shock, heat exhaustion
Respiratory arrest Carbon monoxide toxicity, near drowning, injury
by marine life
Ringing in the ear Ear injury
Seizures DCI, oxygen toxicity, heat stroke, seafood poisoning
Severe headache DCI, carbon monoxide toxicity, carbon dioxide
toxicity, heat exhaustion
Severe bleeding Animal bites, deep cuts

Page 50
Shivering Hypothermia, shock
Shock Any injury or illness
Shortness of breath Near drowning, injury by marine life, seafood
poisoning
Slow, irregular pulse hypothermia, carotid sinus syndrome
Speaking difficulty Seafood poisoning
Swallowing difficulty Lung overexpansion, injury by marine life,
seafood poisoning
Swollen face Sinus or mask squeeze
Thirst Injury from marine life, heat exhaustion, shock
Throat fullness Lung overexpansion
Tightness on the face Mask squeeze
Unconsciousness Lung overexpansion, near drowning, carbon
monoxide toxicity, heat stroke, severe hypothermia
Uncontrollable shaking Seafood poisoning
Unusual behavior at depth Nitrogen narcosis
Vertigo see Dizziness
Visual disturbances DCI, seafood poisoning
Voice changes Lung overexpansion
Vomiting Ear injury, seasickness, wound from marine life, seafood
poisoning
Weakness DCI, carbon monoxide toxicity, heat exhaustion, cramps,
injury from marine life, seafood poisoning

Page 51
References
References
1. Divers Alert Network (DAN). (1993). 1991 Report on Diving
Accidents and Fatalities. Durham, NC: Divers Alert Network (DAN).
2. Ryan, R. J. (1990). ''Supine Is Fine!" Sources, Jan./Feb., p. 53.
Montclair, CA: National Association of Underwater Instructors.
3. National Oceanographic and Atmospheric Administration. (1990).
Trendelenburg Position. NOAA Diving Safety Bulletin # 903, Seattle,
WA: National Oceanographic and Atmospheric Administration.
4. Lippmann, J., and Bugg, S. (1991). The DAN Emergency
Handbook. Victoria Australia: J. L. Publications.
5. Divers Alert Network. (1993). Oxygen First Aid in Dive Accidents.
Durham, NC: Divers Alert Network.
6. Divers Alert Network. (1992). Oxygen First Aid in Dive Accidents
Instructor's Manual. Durham, NC: Divers Alert Network.
7. Harpur, G. (1974). "Ninety Second Deep Scuba Rescue." NAUI
News, January, Montclair, CA: National Association of Underwater
Instructors.
8. National Oceanographic and Atmospheric Administration. (1991).
NOAA Diving Manual. Washington, D.C: U. S. Govt. Printing Office.
9. Professional Association of Diving Instructors. (1987). PADI
Rescue Diver Manual. Santa Ana, CA: Professional Association of
Diving Instructors.
10. Bove, A. A., and Davis, J. C. (1990). Diving Medicine.
Philadelphia, PA: W. B. Saunders.
11. CPR for the Professional Rescuer. (1993). St. Louis, MO: Mosby.
12. Telford, H. W. (1988). Diving Rescue Techniques and Diver First
Aid Manual. Capalaba, Queensland, Australia: NAUI Australia.
13. Edmonds, C. (1992). Diving Medicine for Scuba Divers. Carnegie,
Victoria, Australia: J. L. Publications.
14. National Safety Council. (1994). First Aid and CPR Level 2.
Boston, MA: Jones and Bartlett.
15. British Sub-Aqua Club. (1987). Safety and Rescue for Divers.
London, England: Stanley Paul & Co.
16. Telford, H. (1988). Diving Rescue Techniques Course Notes.
Capalaba, Queensland, Australia: NAUI Australia.
17. Auerbach, P. (1987). A Medical Guide to Hazardous Marine Life.
Jacksonville, FL: Progressive Printing.
18. Graver, D. (1993). Scuba Diving. Champaign, IL: Human
Kinetics.
19. Graver, D. (1989). Diver Rescue: Advanced Diving Technology
and Techniques. Montclair, CA: National Association of Underwater
Instructors.
20. Graver, D. (1994). "An Evaluation of Aquatic Rescue Breathing
Techniques." Sources, July/Aug., p. 42. Montclair, CA: National
Association of Underwater Instructors.
21. Pierce, A. (1985). Scuba Life Saving. Royal Life Saving Society,
Champaign, IL: Human Kinetics.

Page 52
Notes

Page 53
Notes

Page 54
Quick Emergency Index

A
Accidents, 1
Air embolism, 20, 21
Alternobaric vertigo, 29
Asthma, 3, 11
Auscultation, 20
B
Bites, 28
Blood pressure, 7, 35
Breathing difficulty, 11, 16
Buddy diver, 7
C
CAGE (see Air Embolism)
Carbon dioxide toxicity, 24
Carbon monoxide poisoning, 3, 7, 24, 30
Cardiogenic shock, 14
Cardiopulmonary resuscitation, 12, 39
Cardiovascular disease, 3, 4
Carotid sinus syndrome, 11, 29
Cramps, 6, 26
D
Decompression illness, 19, 20, 22, 30
Decompression sickness, 19, 20
Dehydration, 24, 25
Diabetes, 3
Disease transmission, 15, 16
Divers Alert Network, 14, 36, 37
Dizziness (see Vertigo)
Drowning, 7, 26
E
Ear injuries, 22, 29
Electrical shock, 29
Emergency action plan, 36, 37
Emphysema, 21
Environmental problems, 3
Equipment problems, 3
Evacuation, 12, 14, 15, 16, 36, 37
Examination, written, 3
Exposure suits, 11, 12, 25, 26, 28
F
First aid kit, 32
H
Handling injured divers, 7, 12
Helicopter, 37, 39
Hydration, 6, 13, 14
Hyperthermia, 7, 25
Hypothermia, 7, 25, 26
I
Interviews, 14
L
Lung overexpansion, 20
M
Mask squeeze, 23
N
Near drowning, 26, 30
Neurological survey, 7, 14, 15, 16
Nitrogen narcosis, 4, 6, 23, 29
O
Overweighting, 3
Oxygen delivery systems, 31
Oxygen toxicity, 23
Oxygen, 14, 30
P
Palpation, 20
Panic, 3
Positioning, 6, 10
Primary survey, 13
Pulmonary barotrauma (see Lung overexpansion)
Pulse, 14, 15
Punctures, 27
R
Recompression chamber, 7, 37
Regurgitation, 10
Rescue breathing, 6, 29
Rescue, 5
S
Scrapes, 26
Seafood poisoning, 7, 30
Seasickness, 24
Secondary survey (see Neurological survey)
Seizures, 6, 23, 30, 32
Shock, 13, 24, 30
Sinuses, 22, 23
Spinal injury, 6, 8, 9, 10
Squeezes, 22
Stings, 26, 27
Stonefish, 27
Stress, 3
Sunburn, 24
Syncope, 7
T
Tension pneumothorax, 14, 21
Trendelenburg position, 10, 11
V
Vertigo, 6, 22, 29
Vital signs, 14

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