Table of Contents

RESCUE
COURSE MANUAL

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Table of Contents
TABLE OF CONTENTS
INTRODUCTION TO RESCUE SKILLS ...................... 3
Introduction and Chapter Objectives .................... 3
SELF-RESCUE SKILLS: ON THE SURFACE ............ 4
Potential Problems on the Surface ....................... 4
Overexertion ............................................................ 5
Muscle Cramps........................................................ 5
Choking on Inhaled Water ...................................... 5
Not Establishing Buoyancy ................................... 5
Coughing and Seasickness ................................... 5
Swimming on the Surface ...................................... 6
SELF-RESCUE SKILLS: UNDERWATER .................. 7
Descending in Open Water .................................... 7
Potential Problems Underwater............................. 7
Diving Outside of Your Ability Level ..................... 8
Losing Your Buddy ................................................. 8
Gas Depletion .......................................................... 8
Entering Decompression
Without Prior Planning ........................................... 9
Overexertion ............................................................ 9
Feeling Uncomfortable or Unwell ....................... 10
Entanglement ........................................................ 10
Freeflowing Regulator Second Stage ................. 10
PDC Not Working (No Display)
During your Dive ................................................... 11
Never Dive With a Cold
and Never Hold Your Breath ................................ 11
Never Dive With a Cold ....................................... 11
Never Hold Your Breath ...................................... 11
EQUIPMENT-RELATED PROBLEMS ...................... 12
Equipment Problems ............................................ 12
Preventing Problems Before a Dive.................... 12
Recognizing a Problem ........................................ 13
PROVIDING ASSISTANCE ....................................... 14
Assisting Another Diver ....................................... 14
Drowning and Unresponsive Diver ..................... 15
Artificial Respiration ............................................. 16
Cardiopulmonary Resuscitation (CPR) .............. 17
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Introduction to Rescue Skills

INTRODUCTION TO
RESCUE SKILLS
INTRODUCTION AND CHAPTER
OBJECTIVES
This chapter focuses on basic self-rescue skills. We believe
that you can help others only once you know how to help
yourself.

The following are the chapter objectives.

• Describe surface problems and how to avoid them

• Describe underwater problems and how to avoid
them
• Outline some more common equipment problems
• Describe how to assist another diver

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Self-Rescue Skills: On the Surface

SELF-RESCUE SKILLS: ON THE SURFACE

POTENTIAL PROBLEMS ON THE SURFACE
A diver can experience difficulties on the surface as well as under the water. In fact, the data collected by various organizations
concerned with this type of issue indicates that surface issues lead to more dive accidents than those at depth. Therefore, it is
important to consider some of the most common surface problems that divers may have to deal with. Here are some common
problems that you may encounter:

• Overexertion
• Muscle cramps
• Choking on inhaled water
• Not establishing positive buoyancy
• Coughing and seasickness

When you are on the surface, whether you are comfortable or having a problem, establish positive buoyancy that is sufficient to
keep your airways above the surface. Always inflate your buoyancy control device (BCD). If needed and especially when in distress,
discard your weights. Many, serious incidents could have been avoided had the divers involved simply let their ballast weights go.
So, if needed, drop the belt, get buoyant, and relax.

Do not try to tread water or swim once you have established positive buoyancy. This will exhaust you fast and is uncalled for. Let
your BCD do the work. Relax and wait for assistance. You can prevent or control most diving problems that may occur at the surface
by first establishing positive buoyancy. On the surface, be positively buoyancy and chill.

REMEMBER…
At any time if you don’t feel well or you are unsure of the situation, follow these guidelines.
• Stop all activity.
• Breathe normally.
• Think about your situation.
• Perform a logical action rather than a reaction.

In any situation where you are unsure or feel unwell, STOP, BREATHE, THINK, and ACT.

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Self-Rescue Skills: On the Surface

OVEREXERTION
Overexertion can give you a feeling of running out of air or being short of breath. In this state, you may not be able to swim to safety
or make sound decisions on how to do so. Having your buddy close by gives the option of buddy tows and support so that you can
make decisions together. If you are over exerted, first STOP, BREATHE, THINK, and ACT. If you feel you cannot catch your
breath, try forcefully breathing OUT first and then take a slow, full breath in. Get your composure, and work with your buddy to get to
safety.

REMEMBER…
If you are taking the Junior Scuba Diver or Scuba Diver program, you will be certified to dive with a dive professional,
not a buddy.

If you are taking the Junior Open Water or Open Water 20 program, you will be certified to dive with a certified dive
buddy. Junior Open Water divers must dive with a certified adult dive buddy.

MUSCLE CRAMPS
When exercised, muscles can become tired and, in some cases, start to cramp. There are a few simple techniques that we can use
to alleviate the discomfort and restore muscle function. We will practice these in the water-training sessions.

CHOKING ON INHALED WATER

If the ocean is rough on the surface, there is a chance of divers getting salt water in their mouths. This can cause choking and
coughing. The best way to avoid this is to keep your regulator mouthpiece in place and breathe through it while surface swimming.
This way you will have a clear airway. Should you start coughing while the regulator is in your mouth, cough through the regulator
rather than removing it.

NOT ESTABLISHING BUOYANCY

As soon as a diver reaches the surface, he or she should establish positive buoyancy as a first priority. This is best achieved by
inflating the BCD. The diver can then relax and make visual or audible contact (or both) with the boat or surface support.

COUGHING AND SEASICKNESS

The second-stage regulator is designed to function through a wide range of situations including coughing and seasickness. The best
thing for you to do in these situations is to keep the mouthpiece in your mouth. If you remove it, the likelihood of inhaling water is
high. You will practice using the mouthpiece in a variety of situations in the water.

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Self-Rescue Skills: On the Surface

SWIMMING ON THE SURFACE

You will have an opportunity to practice surface snorkel swimming in confined water, but in the open water, there may be currents,
waves, and longer distances to swim. Follow these guidelines when you are in open water.

• First, partially inflate your BCD (fully inflating will cause unnecessary drag).
• Streamline yourself, arms at your side.
• Set off in a steady comfortable pace, kicking from the hip.
• Keep your mask on with your head in the water, and breathe through your snorkel. If there is a little water in it, breathe out
forcefully to clear it.
• Every now and again, look up to check on your direction and on your buddy.
• Don’t leave your buddy behind!

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Self-Rescue Skills: Underwater

SELF-RESCUE SKILLS: UNDERWATER

DESCENDING IN OPEN WATER
You will practice descents in your confined water sessions and your open water sessions.

Although some divers are taught to do a feet-first decent and heads-up ascent, this program encourages divers from the very
beginning to start their dives in trim (horizontal body orientation). This is an excellent habit to adopt early and does three important
things: maximize water resistance that makes control of descent and ascent speed easier, keep fins from contacting the bottom first,
and orient divers correctly for swimming position.

Your instructor will teach you correct positioning and proper equalizing. There are a few points to remember when you descend in
open water.

• You may be changing from fresh water in confined water to salt water for actual dives, so adjust your weight accordingly.
• There are dive sites in the ocean that have currents. Pay attention. Keep visual contact with your buddy or the dive leader.
Orient yourself to the direction you wish to dive.
• Descend, together with your buddy. After a few meters or feet, look where you are going, and drift or swim down slowly
while equalizing. (This is a skill that will take time to master. Go slowly and practice.) Before you reach the bottom,
establish neutral buoyancy to avoid kicking and silting up the bottom or destroying the reef.
• It is always a good idea to descend down a reference line or the boat anchor line. Stay oriented, and enjoy the dive.

REMEMBER…
Before any descent, always know how much breathing gas you have.

POTENTIAL PROBLEMS UNDERWATER

Most underwater problems arise from a lack of awareness of your own surroundings and actions (lack of situational awareness).

• Here are some basic rules to follow.

− Dive within your limitations and training.
− Watch your gas supply.
− Watch your dive times.
− Keep close to your buddy.
• The following are common problems that occur underwater.
− Diving outside your ability level
− Losing your buddy
− Depleting your gas
− Entering decompression without prior planning
− Overexerting yourself
− Feeling uncomfortable or unwell
− Getting entangled
− Having a freeflow mouthpiece/regulator
− Having your personal dive computer (PDC) go sideways during the dive (no display)

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Self-Rescue Skills: Underwater

DIVING OUTSIDE OF YOUR ABILITY LEVEL

Pushing yourself into situations beyond your level of training can be dangerous for you and the people you are diving with. Part of
your planning before each dive is to ensure the whole dive team is comfortable that their recent experience and level of training is
appropriate for the particular demands of the dive.

LOSING YOUR BUDDY

You should maintain contact with your buddy or dive professional throughout the dive. Staying within 3 meters/10 feet is a good rule
to follow. If you do lose the group, you should have a safety plan that allows everyone to return to the surface safely. The general
rule is to search for one minute and then make a safe controlled ascent to the surface. Your team should follow the same protocol
and meet back up with each other on the surface.

GAS DEPLETION

Monitoring gas supply is one of the most important considerations for any diver on any dive regardless of experience and
certification level. This is a habit that even technical instructor-trainers, cave divers, and rebreather divers are careful to cultivate.

An out-of-gas situation can quickly become life-threatening. It is important for you to understand the options available that will get
you back to the surface safely. Now is the time to start to plan your bottom time based on your actual documented gas consumption
rate. Your instructor will help you.

In the unlikely event that you are low or out of breathing gas: STOP, BREATHE, THINK, and ACT.

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Self-Rescue Skills: Underwater

You have two main options to consider.

• The safest option is to get your buddy’s assistance. You will learn to locate, secure, and breathe from an air source
supplied by a friendly donor—your buddy! This is a gas-sharing ascent.
− Signal that you are out of gas to your buddy. Your buddy will then provide his or her primary regulator and locate his or
her alternate air source (AAS). Don’t put the regulator in your mouth upside down! Link arms with your buddy, and
once comfortably breathing, ascend together keeping eye contact, and monitor your gauges and PDC.
− To simulate the skill, your instructor will ask you to swim horizontally for 10 meters/33 feet, and you will have a chance
to act as both a receiver and a donor. This will be practiced in confined water before further training in open water.
• What if you have no buddy and you are out of gas? This is an unlikely but very serious situation. It means you have not
monitored your buddy or your gas supply or you have suffered from a catastrophic equipment failure. In the unlikely event
that you have this problem, you will have to perform a controlled emergency swimming ascent (CESA).
− Since you already have some air in your lungs, you can use this breath to help you reach the surface. Ascend and
slowly exhale all the way to the surface, keeping an open airway because the air will expand on ascent. Swim no faster
than 9 meters/30 feet per minute on your way up. Exhale continuously while making an aahhh sound through your
regulator mouthpiece, indicating that you have an open airway. This will prevent lung expansion injury. Do not remove
your regulator—this will help you avoid inhaling water.
− This skill needs to be practiced. A CESA can be initiated if you are in 9 meters to 12 meters/30 feet to 40 feet of water
and if you are low or out of air and your buddy is too far away to assist. Your instructor will simulate the skill in confined
water while swimming horizontally. You will have time to practice this skill and understand that you can reach the
surface on one exhaled breath.

REMEMBER…
Always maintain buddy contact and monitor your gauges.

ENTERING DECOMPRESSION WITHOUT PRIOR PLANNING

Breaking the no decompression limit (NDL) of your dive is a potentially serious situation. If this were to happen, you would be
entering an extremely advanced diving situation that can safely be done only with very specific prior planning, special gases, and a
complex dive management plan.

Dives beyond the NDL would require you to make staged decompression stops on your way back to the surface to help avoid the
threat of decompression-related injuries. The best way to avoid this is to plan conservatively, watch your time and depth, and use a
PDC. A PDC will constantly update your decompression status and display safe dive times and warnings if you are approaching
your limits.

One of the most serious consequences of unplanned decompression diving is that you may run low on breathing gas while you are
performing the required stops. Occasionally, a dive boat will have a spare cylinder and regulator, commonly referred to as a “hang
cylinder,” hanging over the side of the boat to provide extra gas for this situation. However, this should not be taken as an open
invitation to abuse limits. Stay well within the NDL on all dives.

OVEREXERTION
This can happen underwater as well as on the surface and can give you a feeling of running out of air or being short of breath. You
should first STOP, BREATHE, THINK, and ACT.

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Self-Rescue Skills: Underwater

Notify your buddy or dive professional to stop, and cease all activity. If there is a bare rock or something nearby you can hold without
damaging it or any growth on it, steady yourself. Then, take a series of slow, full breaths to regain normal breathing patterns. When
you have recovered, continue the dive but control your activity level.

FEELING UNCOMFORTABLE OR UNWELL

There may be various causes for this feeling. You should STOP, BREATHE, THINK, and ACT.

• Signal, if you are able, that something is wrong to your buddy or dive professional, and SLOWLY begin ascent procedures.
• Check the depth and gas supply (submersible pressure gauge, or SPG) while ascending.
• Ensure that you concentrate on buoyancy control during ascent.
• When reaching the surface, concentrate on establishing positive buoyancy.
• Signal to the surface support for assistance.

ENTANGLEMENT
It is very uncommon that divers get entangled. You may become entangled in the buoy line; a fishing line; tree branches; or long,
thick seaweed. If this happens to you, stop, think, and get your buddy or dive professional to help you. Or slowly free yourself. Never
twist or turn. If your scuba unit is tangled, you may have to remove it. This is something you will practice in confined water.

FREEFLOWING REGULATOR SECOND STAGE

This simple skill is performed so that you will have some first-hand experience of a freeflow (rushing of gas) from the mouthpiece of
your regulator’s second stage. This event is rare if regulators are serviced regularly by certified regulator technicians, but
sometimes, things happen. You should know what to do if it should happen to you.

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Self-Rescue Skills: Underwater

To simulate freeflow, start by tilting your head down to the right, and with your finger, press down on the purge button to simulate the
freeflow of gas for 15 seconds, and breathe normally. Then check your pressure gauge. Always keep a reserve of 50 bar/750 psi of
air so that, with proper planning, you can make a comfortable ascent. (Note: On pressure gauges, the closest reading you could see
is 50 bar/700 psi.)

If your mouthpiece freeflows during a dive, you now know how to breathe from it. It is best to secure your buddy’s AAS because your
air will escape quite fast through the freeflow. Check your air pressure, and perform an ascent with your buddy.

You may also be asked to shut down your tank during a simulated freeflowing regulator drill. Attempt this only when breathing from
your buddy’s donated long hose (AAS).

PDC NOT WORKING (NO DISPLAY) DURING YOUR DIVE

This means there is a fault that could give you incorrect information or the PDC’s battery is dead. Here is what you should do if your
PDC is not working.

• Signal to your buddy, indicate you have a broken PDC, and follow these ascent procedures.
• Stop at 10 meters/33 feet for 2 minutes if you are below 10 meters/33 feet.
• Stop at 5 meters/15 feet for 15 minutes or until your SPG reads 50 bar/750 psi and then surface normally.
• Ask your buddy to indicate the depths.

NEVER DIVE WITH A COLD AND NEVER HOLD YOUR BREATH

Be sure to not do the following when you are diving.

Never Dive With a Cold

Diving with a cold can be dangerous due to the fact that the tiny air sacs (alveoli) in your lungs can trap air if there is mucus present.
This could become an issue during ascent, where the air will expand. Any airway blockage that does not allow air to escape on
ascent can cause lung damage. This can cause serious injuries and is to be avoided.

Never Hold Your Breath

Always breathe as normally as possible to avoid potential lung overexpansion injuries. Never hold your breath while using scuba
gear.

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Equipment-Related Problems

EQUIPMENT-RELATED PROBLEMS
EQUIPMENT PROBLEMS
Most equipment problems will come from inexperience or a lack of knowledge relating to the equipment. In other words, the problem
comes from the diver rather than the equipment. Generally, these problems are related to the following.

• Improper equipment modifications

• Improper equipment servicing
• Equipment that does not fit correctly
• Trying to use specialized equipment that is beyond the diver’s training and/or experience level

Consult your dive center or instructor for information on correct equipment for your diving. They can also make sure your equipment
is in good working order, is serviced regularly, and fits you correctly.

Any specialized equipment, such as drysuits, reels, cameras and twin cylinders, require further training to be proficient and safe in
the water. Gain experience, log some dives, and add to your dive gear (and task loading) slowly and carefully.

PREVENTING PROBLEMS BEFORE A DIVE

Make sure you are prepared for each dive. Have all your planning done, and ensure the rest of your team is ready as well. Pay close
attention to the following to be sure that you have done everything to give yourself the best experience.

• Ensure your gear is properly maintained according to the manufacturer’s specifications.

• Don’t dive if you feel unwell.
• Don’t ignore small equipment problems. Even a tiny issue can become serious underwater.
• Properly plan your dive with your buddy or team.
• Plan to dive within your limitations.

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Equipment-Related Problems

RECOGNIZING A PROBLEM
Generally, if divers need help, they signal for it. Sometimes, divers can have minor problems that they can correct themselves. You
can ask them if they are OK when you see them doing something out of the ordinary.

Divers with serious problems will be noticeably panicky. Panicked divers may fear drowning and exhibit the following behaviors:

• Struggling to hold their heads high above the water, using lots of energy in their movement
• Forgetting to establish positive buoyancy
• Spitting out the mouthpiece
• Taking their masks off or shoving the masks to the top of their heads
• Breathing rapidly
• Taking no notice of instructions

These divers require immediate help because they will continue to struggle until they become exhausted and unable to stay afloat.

Note: As a novice diver, it is recommended that you do not endanger yourself when trying to assist a panicking diver. Do not make a
bad situation worse by needing to be rescued yourself. Be cautious. Remember that, on the surface, establishing buoyancy is key.
Drop the weights when in doubt.

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Providing Assistance

PROVIDING ASSISTANCE
ASSISTING ANOTHER DIVER

First, determine that the diver is, in fact, in need of assistance. When you find a diver face down on the surface, you should tap him
or her on the shoulder to see if you get a response.

If there is none, treat them as unresponsive. Establish positive buoyancy, and assess the diver from there. If he or she is face down,
roll the diver onto his or her back so his or her face is not submerged, You may need to call for help.

If the diver does respond, try to determine if he or she needs help. If you are responding from a boat or shore, you will need to
establish buoyancy by throwing the distressed diver a float. If responding from in the water, inflate the BCD and/or drop the weights.

Calm the diver by talking quietly, getting the diver to relax and breathe deeply. And if necessary, assist by doing a tired diver tow.

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Providing Assistance

DROWNING AND UNRESPONSIVE DIVER

Drowning occurs when a diver has become unresponsive (unconscious, or unable to respond or act coherently) and has stopped
breathing while submerged underwater. Possible contributing factors are ingesting water, extreme fatigue, entanglement, lung
overpressurization, panic, inefficient breathing, throat blockage, exhaustion, heart stoppage, and unconsciousness.

If the diver is unresponsive underwater, follow these steps.

1. Follow ascent procedures and bring the diver to the surface, where you immediately establish positive buoyancy.
2. If the mouthpiece is in the mouth, try to keep it there. If not, do not worry about the mouthpiece.
3. Call for help.
4. It is preferable to get the diver out the water as soon as possible before initiating rescue breathing. Remove the diver from
the water onto a hard surface. If no other more qualified personnel are in attendance, check for airway breathing and
circulation.
5. If there is no breathing, refer to the cardiopulmonary resuscitation (CPR) guidelines, presented later in this unit. If there is
no pulse/circulation, initiate CPR.

If, after a near drowning, the diver is breathing, administer 100% oxygen. Monitor the airway breathing and circulation until medical
personnel are in attendance. Keep the diver warm and as calm as possible. If there is a more qualified person attending to the
diver/patient, then assist where necessary.

The patient may become unconscious or experience difficulty with breathing, confusion, lowered alertness, disorientation, unclear
thinking, visual problems, paralysis, and chest pain. Make a note of these. Secure all dive equipment for reference and future
investigation.

SAFETY TIP
You should attend training for rescue breathing, CPR, and oxygen provider. Your instructor or dive center can assist
you with locating the best local provider for this specialized training.

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Providing Assistance

ARTIFICIAL RESPIRATION

Artificial respiration is generally known as “the kiss of life” or “mouth-to-mouth resuscitation.” It is the act of simulating respiration for
a person who is not breathing or not making sufficient respiratory effort on his or her own.

To be able to achieve internal respiration, the heart must be beating. Pulmonary ventilation is performed by the diver rescuer
through manual inflation of the person’s lungs by blowing into them. This is called insufflation. Insufflation, generally known as
“rescue breath ventilations,” is the act of physically forcing air into a person’s respiratory system. (It is advised that the rescue diver
has an up-to-date certificate in artificial respiration and CPR.)

There are various methods for artificial respiration.

• Mouth to Mouth: The rescuer makes a seal between his or her mouth and the person’s mouth. The rescuer blows air into
the person.
• Mouth to Mask: The recommended method for delivering rescue breaths while in water is the use of a pocket mask. The
pocket mask protects the injured diver from the surrounding water since it covers the mouth and nose and is held in place
with an elastic retainer. The mask provides a higher tidal volume and reduces the cross infection risk. Because a person
metabolizes very little oxygen (± 4% of 21% oxygen) within a breath, there is more than enough residual oxygen available
in the exhaled breath.
• Mouth to Nose: It is the rescuer’s choice to use this method because there may be vomit in the mouth or injuries. This
method will not be practiced.
• Giving Oxygen: The amount of oxygen delivered to a victim during mouth-to-mouth resuscitation is about 16% (compared
to 21% in normal fresh air). If a pocket mask is utilized, oxygen feeds can be fitted to the mask without removing it from the
diver. This saves time that, of course, is essential. When using a constant flow system for addition of oxygen, this increases
to about 40% oxygen. If a mechanical respirator is used with an oxygen supply, this rises to 99% oxygen. This is the most
common method. The greater the oxygen concentration, the more efficient the gas exchange will be in the lungs.

REMEMBER…
The dive center or instructor should always have an oxygen kit available in a secure case at that location or on the
boat. Ask your instructor to show you the system. You will find it very informative.

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Providing Assistance

CARDIOPULMONARY RESUSCITATION (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest (the heart has stopped
beating) and respiratory arrest. CPR consists of artificial blood circulation and artificial respiration, for example, chest compressions
and lung ventilation. (A person who is in respiratory arrest has a pulse but is not breathing; therefore, artificial respiration is
appropriate. If it is difficult to detect a pulse, CPR may be used in both cases.)

CPR is generally continued, usually in the presence of advanced life support, until the patient regains a heartbeat or is declared
dead. (In the absence of advanced life support, basic life support can be provided, using the principles of airway, breathing, and
circulation, or the ABCs.) CPR is unlikely to restart the heart, but it is used to maintain a flow of oxygenated blood to the brain and
heart, preventing tissue death. Defibrillation and advanced life support are usually needed to restart the heart.

Defibrillation is the treatment for life-threatening cardiac arrhythmias of ventricular fibrillation, and it consists of delivering a
therapeutic dose of electrical energy to the heart with an external device called an automated external defibrillator (AED). This
device allows normal rhythm to be re-established. Divers can use the unit successfully with little to no training.

The brain may sustain damage after blood flow has ceased for about 4 minutes and irreversible damage after about 7 minutes. If
blood flow ceases for 1 to 2 minutes, the brain cells will start to die. The heart loses the ability to maintain a normal rhythm. Low
body temperature, as sometimes seen in drowning, is thought to prolong the time the brain survives. CPR is likely to be effective
only if commenced within six minutes after the blood flow stops.

Studies have shown the importance of immediate CPR followed by defibrillation within three to five minutes. The survival rate is
about 30%, but without these two actions, the survival rate is only about 2%.

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Providing Assistance

Here are a few key points about CPR.

• The patient with a bystander performing CPR can have a survival rate of 4 to 5% until emergency medical service (EMS)
arrive.
• CPR has resulted in a few complete recoveries, but is less effective without defibrillation.
• CPR does not revive the patient but preserves the body for defibrillation and advanced life support provided by paramedics
or medical personnel.

Hypothermia seems to protect the victim by slowing down metabolic and physiologic processes, greatly decreasing oxygen
requirements of tissues. There are cases in which CPR, defibrillation, and advanced warming techniques have revived victims after
substantial periods of hypothermia.

CPR training by a recognized training authority is essential for divers. Further training in first aid, CPR, and AED is highly
recommended. See your diver center to find out more. Remember, CPR cannot be performed in the water, and there must be a
stable base or platform available.

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