View Full Version : Incident - views sought
MSutcliffe
04-12-2007, 21:09
I am interested in the wisdom of the forum on this incident.
A Diver conducted a dive to 38m, accruing no decompression obligations. She and her buddy (the dive guide) made a very slow ascent with a safety stop.
On climbing the ladder back onto the boat, the diver was dizzy with blurred vision. Diver was laid down, O2 administered, Oral fluids commenced. Since in a hot climate, I choose to elevate the divers legs as a temporary test to see if the brain would respond to the fluid load - there was improvement.
Over the ensuing short period, the diver was slowly de-kitted, moved inside, encouraged to drink, and I kept her on O2.
The dive guide on the boat (a liveaboard) declined to telephone the local medical advice centre, as he believed it to be the case that she was dehydrated, and would improve in time.
The dizziness resolved within 10 minutes, and at no time could I find any neurological signs (I'm a Dr, so know a little of how to look for the basics).
Since the dive guide had declined to telephone for expert advice, I suggested that he take over responsibility for the casualty, and ensured that the casualty was willing to 'watch and wait' - I explained that there was a risk that this was DCI. She wanted to 'watch and wait'
After 4 hours, she remained unwell. Many folk on the boat were concerned. I saw her again - still no neurological symtpoms. Slight dehydration apparent despite oral fluids. I insisted at this point, supported by others on the boat, that the dive guide phoned for telephone advice. I was able to discuss, myself, the case with the hyperbaric physician locally - who in the abscence of specific neurological signs felt we could push more oral fluids, and review in an hour. We did. Casualty improved. We did not send her for decompression. She was not permitted to dive again that week.
My issues:
1. A dive guide, (PADI OWSI) with no medical qualification beyond EFR felt he could say "I think she's just dehydrated" in the face of a casualty who had just done a 38m dive.
2. His attitude was "if we phone them, we'll be going in as they will always say they should see the casualty" - we didn't go in, there were 4 doctors on the boat who could perform the necessary examination and communicate the results to the hyperbaric physician.
I would like to know, from the great wisdom on these fora:
1. In your view, was I right to force the dive guide to phone the hyperbaric advice service?
2. Is there anything in the PADI standards to say the professional advice should/must be sought in the event of an 'incident'.
Cheers
Martin
Martin
Reading your post, & in answer to your questions.
I think you where correct in pushing the point & insisting that the dive guide phoned or radioed the chamber specialist. You have a distinct advantage over many of us in that you have medical training & experience.
I think there is cause to be concern when the dive guides are reluctant to contact the specialist when there is a risk that a customer has DCI. Even if only (as in this case) to be told to monitor the situation. As we are all aware, delay in treatment can significantly reduce the chance of a full recovery if dci is actually the problem.
I am uncertain as to the position with regard to PADI standards.
Similarly, as to the position (with regard to insurance) if the instructor/guide was subsiquently to be found liable. (Whilst a full recovery is prefered, compensation would be desirable if the worst happened). In many parts of the world the requirements for liability insurance is not mandatory, & it may not be possible to win any legal action under the local legal system. Even if you did win your 'compensation' may be negligible. One significant advantage in having your own insurance!
Gareth
Rules are quite simple in my book, 'if in doubt check it out'... DCI doesn't always present with neurological symptoms, e.g. skin bend.
graham nurse
04-12-2007, 22:54
The dive guide in a moter boat anchor, well thats my view.
Rod Bateman
05-12-2007, 00:11
2. Is there anything in the PADI standards to say the professional advice should/must be sought in the event of an 'incident'.
Martin,
PADI Standards apply when a PADI course is being run. If the person is just being a dive guide then it has nothing at all to do with PADI.
I know what I would do especially if advised by a Doctor.
Rod
Sounds like a case of a dive guide more worried about the personal hassle and/or reputation than the well-being of the customer. Why is it that all over the world there are people who think calling for help is a bad thing?
I think you did the right thing to insist, even if it wasn't DCI in the end, the guide didn't have enough medical knowledge to make that judgement.
Hoepfully those involved will learn from the experience and be more inclined to ask for help if there's a next time.
Iain.
BogSnorkeller
05-12-2007, 09:59
It's a very tricky call to make.
I know the advice normally given is to contact the dive chamber if there's any doubt. I, for example, sit in the pub after every dive, paranoid that every slight ache or pain on my body must mean impending doom and is not just the result of lugging heavy kit around in the freezing cold. I've visited the dive chamber twice, on both occasions being quickly diagnosed as suffering from nothing more than hypochondria.
I've also heard, many times, that you can get DCI regardless of depth or profile - its just a matter of probability.
However, I recently had a chance to discuss this in depth with the DDRC, and, although their normal mantra is to contact them if you have ANY doubt, they ultimately confessed that yes, divers must apply a certain amount of common sense. Otherwise the chamber would be permanently packed with worried divers.
You can only apply common sense if you have a reasonable understanding of what the symptoms of DCI are. I don't think the training regimes of either PADI or BSAC are sufficient here, nor should they be - or their courses would take forever. Each diver has a responsibility to get on the internet, or down the library ahd have a good read of actual accounts of DCI and find some photos of skin bends etc etc. Additionally, they need to try and get an appreciation for the level of statistical risk divers are exposed to on normal recreational dives - how likely is it that you'll get a bend whilst operating inside the no decompression limits?
Only when you're armed with this knowledge can you make the judgement call on the day when you notice a symptom.
In answer to the original question - if I'd come out of the water after a 38m dive and immediately started feeling really unwell, then yes, I'd be straight on the phone to the chamber. However, as already mentioned, I'm a bit of a hypochondriac by nature.
Michael Purcell
05-12-2007, 10:26
You have the "victim" not wanting to call. The problem is denial is a symptom of DCI. You have a liveaboard where where the person has paid a lot of money, plus the other people onboard will likely be inconvenienced as well. Once you call you have a duty of care to follow-up when they say bring the person in. One would want to balance the likelihood that it is a DCI vs something less serious (sea-sickness).
On a 38m dive I think I would err on the side of caution, but there has to be some sort of evaluation, escalation rather than I have a headache, off to the chamber.
In the end money shouldn't trump personal safety.
bakerstreet
05-12-2007, 10:53
A Diver conducted a dive to 38m, accruing no decompression obligations. She and her buddy (the dive guide) made a very slow ascent with a safety stop.
No Deco witha dive to 38m?? No stop is only about 13 minutes.
I dont know where you were diving, but its worth mentioinig that Egypt Dive Guides do in excess of 3000 dives a year and some of them will have yars of experience. They will have seen a lot. He may well have been scared for his career as well. Its still no reason to endanger another person though.
I aggree with you about seeking medical advice. The Dr at sharm was brilliant with me. It helped that my other half is a Snr. Physio and can do all the same nuro exams that a Dr. can do.
I have been in similar situations where I have suspected that I have DCI. I always check with the Dr if I am really scared.
Mike Rowley
05-12-2007, 11:03
I am interested in the wisdom of the forum on this incident.
A Diver conducted a dive to 38m, accruing no decompression obligations. She and her buddy (the dive guide) made a very slow ascent with a safety stop.
On climbing the ladder back onto the boat, the diver was dizzy with blurred vision. Diver was laid down, O2 administered, Oral fluids commenced. Since in a hot climate, I choose to elevate the divers legs as a temporary test to see if the brain would respond to the fluid load - there was improvement.
Over the ensuing short period, the diver was slowly de-kitted, moved inside, encouraged to drink, and I kept her on O2.
The dive guide on the boat (a liveaboard) declined to telephone the local medical advice centre, as he believed it to be the case that she was dehydrated, and would improve in time.
The dizziness resolved within 10 minutes, and at no time could I find any neurological signs (I'm a Dr, so know a little of how to look for the basics).
Since the dive guide had declined to telephone for expert advice, I suggested that he take over responsibility for the casualty, and ensured that the casualty was willing to 'watch and wait' - I explained that there was a risk that this was DCI. She wanted to 'watch and wait'
After 4 hours, she remained unwell. Many folk on the boat were concerned. I saw her again - still no neurological symtpoms. Slight dehydration apparent despite oral fluids. I insisted at this point, supported by others on the boat, that the dive guide phoned for telephone advice. I was able to discuss, myself, the case with the hyperbaric physician locally - who in the abscence of specific neurological signs felt we could push more oral fluids, and review in an hour. We did. Casualty improved. We did not send her for decompression. She was not permitted to dive again that week.
My issues:
1. A dive guide, (PADI OWSI) with no medical qualification beyond EFR felt he could say "I think she's just dehydrated" in the face of a casualty who had just done a 38m dive.
2. His attitude was "if we phone them, we'll be going in as they will always say they should see the casualty" - we didn't go in, there were 4 doctors on the boat who could perform the necessary examination and communicate the results to the hyperbaric physician.
I would like to know, from the great wisdom on these fora:
1. In your view, was I right to force the dive guide to phone the hyperbaric advice service?
2. Is there anything in the PADI standards to say the professional advice should/must be sought in the event of an 'incident'.
Cheers
Martin
As a UK liveaboard skipper of some 20 years I have seen a few cases of DCI and discussed a few with friends who are also skippers. Generally I take the view that if someone is displaying symptoms and I administer O2 then I call the authorities and follow their advice, usually that is evacuation to recompression facility. If the casualty shows no symptoms after a thorough examination I usually administer water, an asprin and monitor the casualty closely over the next few hours. The first sign of symptoms they are on the O2 and I call the cavalry.
However, in the UK and France where I mostly work we are never far away from a well organised rescue agency and good radio communications. Overseas this might not be the case. On an overseas exped a couple of years ago we were 24 hours from port and there was no medivac facilities. We had a casualty with a mild lympth bend in one arm and treated that successfuly by prolonged O2 and fluids. I understand from Bennet that lympth bends don't respond to recompression treatments in any case but not being medical I will defer to others on that.
The point is that things are often complicated when abroad and particularly in the more remote parts of the world. However, I would not have been confident enough to overide a doctor's view and if there was a hyperbaric centre to contact I would definately have contacted them immediately, if only to cover my own backside from the lawyers.
My view for what it is worth is that you definitely did the right thing.
Mike
Nigel Hewitt
05-12-2007, 11:12
No Deco with a dive to 38m?? No stop is only about 13 minutes.But with a typical warm water triangular profile it could be very no-stop at all points.
This is not the UK so as soon as you make the call there is probably a bill to pay and until they get you in their waiting room signing things you bet it is booked against the boat. The guide has probably seen it all before. They get dehydrated, they feel bad after a dive, you emphasis the 'must drink lots of water', they learn, everybody lives happily ever after.
If they are obviously bent they're insured so call.
Was the diver qualified to dive to 38m and were they insured?
I read recently about a diver going to 35m whilst on holiday and getting bent. They were only qualified to 30m, so the insurance company refused to pay and the diver was left with the £40,000 bill. Just a thought on why they might have been hesitant to go to the deco chamber.
Rob.
Graham Barker
05-12-2007, 14:18
......, but its worth mentioinig that Egypt Dive Guides do in excess of 3000 dives a year.....
'Over 3000 dives a year' - do me a favour ;) !!!!!!!!!!!!!!!!!!!!!!!!!
Graham
Nigel Hewitt
05-12-2007, 14:57
'Over 3000 dives a year' - do me a favour ;) !!!!!!!!!!!!!!!!!!!!!!!!!Hey not everybody has a clue that that is more than 8 dives a day all year.
kids these days can't do division...
To true, wonder how many dives guides actually do on average?
2 per day, 6 days per week, 50weeks per year would be 600.
(I cna multiply, if not divide...)
I reckon it's generally be less than that as they must take time off sometime and I can't think anyone would be doing 4 dives per day every day unless they were tiddly little training dives.
I suppose dive guides do get to see more incidents and may have some judgement in respect of people suffering egyptian tummy versus DCI, but they still ain't doctors..
Iain.
Rod Bateman
05-12-2007, 18:11
Whilst working as a guide I did at least 3 and normally 4 dives a day plus a night dive. You had one day off per week and TBH I normally went diving on those days.
Just looked back through my logbook and in Oct 2005 I did 140 'working' dives and 15 'pleasure' dives. Still not enough for 3000 a year.
resting rifleman
05-12-2007, 18:20
Like mr. Rowley, I have seen a few incidents over the years! some when medico's have been aboard, some not. I can't understand how anyone who has assumed any responsibility for the well being of divers aboard a vessel at sea, would not defer to a doctor in these circumstances.
mike.
bakerstreet
05-12-2007, 19:15
Fair enough. Got that figure of 3000 wrong. I had 3000 in my head from a DG in Egypt. The maths certainly suggests that was an over estimate :D
Steve in Sharm
05-12-2007, 19:29
I am interested in the wisdom of the forum on this incident.
A Diver conducted a dive to 38m, accruing no decompression obligations. She and her buddy (the dive guide) made a very slow ascent with a safety stop.
On climbing the ladder back onto the boat, the diver was dizzy with blurred vision. Diver was laid down, O2 administered, Oral fluids commenced. Since in a hot climate, I choose to elevate the divers legs as a temporary test to see if the brain would respond to the fluid load - there was improvement.
Over the ensuing short period, the diver was slowly de-kitted, moved inside, encouraged to drink, and I kept her on O2.
The dive guide on the boat (a liveaboard) declined to telephone the local medical advice centre, as he believed it to be the case that she was dehydrated, and would improve in time.
The dizziness resolved within 10 minutes, and at no time could I find any neurological signs (I'm a Dr, so know a little of how to look for the basics).
Since the dive guide had declined to telephone for expert advice, I suggested that he take over responsibility for the casualty, and ensured that the casualty was willing to 'watch and wait' - I explained that there was a risk that this was DCI. She wanted to 'watch and wait'
After 4 hours, she remained unwell. Many folk on the boat were concerned. I saw her again - still no neurological symtpoms. Slight dehydration apparent despite oral fluids. I insisted at this point, supported by others on the boat, that the dive guide phoned for telephone advice. I was able to discuss, myself, the case with the hyperbaric physician locally - who in the abscence of specific neurological signs felt we could push more oral fluids, and review in an hour. We did. Casualty improved. We did not send her for decompression. She was not permitted to dive again that week.
My issues:
1. A dive guide, (PADI OWSI) with no medical qualification beyond EFR felt he could say "I think she's just dehydrated" in the face of a casualty who had just done a 38m dive.
2. His attitude was "if we phone them, we'll be going in as they will always say they should see the casualty" - we didn't go in, there were 4 doctors on the boat who could perform the necessary examination and communicate the results to the hyperbaric physician.
I would like to know, from the great wisdom on these fora:
1. In your view, was I right to force the dive guide to phone the hyperbaric advice service?
2. Is there anything in the PADI standards to say the professional advice should/must be sought in the event of an 'incident'.
Cheers
Martin
If I could, I'd sack the guide, If I couldn't sack him/her I'd kick seven bells of **** out of em, I may be trained in 1st aid - and I may see many many more cases of suspected or real DCI than any other recreational diver but I still aint a doctor - everytime I see something I cannot diagnose correctly myself then the chamber gets a call - saved a few lives last year with that mantra....
And any decent dive centre here follows that mantra - would be interested in a PM to see who it was (I have my suspicions..)
Martin, she was conscious - why not lie her down on her left side? Feet up I'm confused shock/DCI etc etc!!!
No Nigel - you're wrong, the chamber here do not charge for a "consultancy" if the disgnosis is hypochondria.
IanC - I average 400 a year, sometimes less.
As for the PADI view - PADI do not teach "guiding" and therefore are not interested in this sort of stuff, hence all the previous threads were people have complained about XYZ centre doing stuff wrong and no word from PADI, they are a pyramid selling organisation specializing in courses - nothing else, and they aint interested in dive shops guiding divers.
Regards all
Steve
scott.l.
06-12-2007, 09:39
Martin, as far as I am concerned you certinally did the right thing.
I was once the 'victim' as you might remember me telling you during one of my lectures.
My first reaction was denial, and it was only the insistance of my fellow dive buddies who made me realise to get on O2 and seek help asap.
You were certianlly right to help! You have a lot more knowledge than the 'normal' diver, and how would you have felt if the outcome was different if you hadn't forced the issue?
Scott.
MSutcliffe
06-12-2007, 09:56
Martin, as far as I am concerned you certinally did the right thing.
I was once the 'victim' as you might remember me telling you during one of my lectures.
My first reaction was denial, and it was only the insistance of my fellow dive buddies who made me realise to get on O2 and seek help asap.
You were certianlly right to help! You have a lot more knowledge than the 'normal' diver, and how would you have felt if the outcome was different if you hadn't forced the issue?
Scott.
Yes, I remember you telling that tale on an O2 course. We all had so many stories on that course it was great.
Thanks all for your comments. My own view has always been, and I think always will be that if someone has been diving, and subsequently 'is not quite right', then they should be on O2, and advice should be sought from a hyperbaric physician. Simple as that.
You may recall my other story that a chap who was not quite right after a dive was put on O2, but then decided he didn't need it, and refused it. Then he died. It was not dive-related (heart attack due to atherosclerosis, not bubbles is thought), but still - given that, if I had insisted on keeping him on O2 then it might have been that he would not have died. That does't cause me sleepless nights, but it does make me think. I was worried such an isolated incident may be clouding my judgement. The panel, however, seems to agree with me. Thanks all.
MSutcliffe
06-12-2007, 10:02
would be interested in a PM to see who it was (I have my suspicions..)
Was not diving out of sharm... Liveaboard out of Hurghada.
The dive guide on the boat (a liveaboard) declined to telephone the local medical advice centre
Does the 07831 number still work?
It might not be cheap to phone from Egypt, but I suspect it'd be cheaper than a wasted journey to the pot. And much cheaper than not taking a necessary trip there!
Vic.
Does the 07831 number still work?
Hmmm. Perhaps it doesn't.
Google only knows of one instance of that number on either bsac.org or bsac.com - and that's in the AED Instructor Manual (which is, I suspect, a draft, given that it's stated to be at revision 0).
Has the number been withdrawn?
Vic.
allan.goodwin
06-12-2007, 11:36
Hmmm. Perhaps it doesn't.
Google only knows of one instance of that number on either bsac.org or bsac.com - and that's in the AED Instructor Manual (which is, I suspect, a draft, given that it's stated to be at revision 0).
Has the number been withdrawn?
Vic.
Still valid I believe -
see - http://www.gnn.gov.uk/imagelibrary/downloadMedia.asp?MediaDetailsID=157904
"With regards to obtaining medical assistance and advice, it should also be noted that the contact telephone number for divers in Scotland has changed. The new number is 0845 4086008. For all other UK regions the Institute of Naval Medicine (telephone number 07831151523) remains the first point of contact."
Still valid I believe
Yes - I found another instance on bsac.org with different spacing in "Safe Diving Practices D". There are also a couple of documents in the uploads/ area that have the number as well.
That's good news!
But for anyone at HQ - should we not have this number somewhere a bit more prominent? I think it's rather important...
Vic.
Ben Panter
06-12-2007, 12:08
Like the back of every membership card?
;-)
Ben
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