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Dive Rescue

Dive

Barotrauma/Decompression Illness: Dive Illness

General Guidelines

Barotrauma and decompression illness are caused by changes in the surrounding atmospheric pressure beyond the body’s capacity to compensate for excess gas load. These injuries are most commonly associated with the use of SCUBA (Self-Contained Underwater Breathing Apparatus). SCUBA diving emergencies can occur at any depth, with the most serious injuries manifesting symptoms after a dive. If a patient took a breath underwater, from any source of compressed gas (e.g., submerged vehicle, SCUBA) while greater than three (3) feet in depth, the patient may be a victim of barotrauma. Barotrauma may cause several injuries to occur, including arterial gas embolism (AGE), pneumothorax, pneumomediastinum, subcutaneous emphysema, and the “squeeze.” Decompression illnesses may also include decompression sickness (“bends”).

TREATMENT GUIDELINES
Supportive Care
• Universal Patient Care Protocol: General Care Protocols. Administer 100% oxygen via
non-rebreather mask at 15 L /min based on SpO2.
• Trauma Supportive Care Protocols and Spinal Immobilization Criteria Protocol
• Place the patient in a supine position.
• Complete the Dive Accident Signs and Symptoms checklist (Appendix Section).
• Obtain a Dive History Profile, if possible (the patient’s dive buddy may be helpful in
answering many of these questions).
• Whenever possible, have the legal authority in charge (e.g., police, Florida Marine Patrol, U.S.
Coast Guard) secure all of the victim’s dive gear and maintain the proper chain of custody for
testing, analysis, and other measures.
• Manage the patient according to the appropriate protocol(s).
• Transport the patient to the closest emergency department or trauma center with a helipad (air
transport of diving accident victims must remain at an altitude of less than 1000 feet).
• Contact the Diver’s Alert Network (DAN) at Duke University Medical Center, by calling
919-684-4326, for further assistance (a).
• Bring the dive computer to the hospital if available.

Note: DAN may be contacted while on scene or after arrival at the hospital. If the
contact is made at the hospital, provide DAN with the name of the ED physician and the ED phone number.

Dive History Profile

DIVE HISTORY/PROFILE Complete as much as possible.
1. Type of Dive: Rescue ____ Commercial ____ Recreational ____
2. Type of Gas Used: Compressed Air ____ Nitrox ____ Heliox ____ Other _____________
3. Water Type: Contaminated ____ Fresh ____ Salt ____
4. Water Temperature: ___________
5. Number of Dives in the Past Several Days: _______
List Each Dive with:
Maximum Depth Bottom Time Surface Interval
_____________ _____________ _____________
_____________ _____________ _____________
_____________ _____________ _____________

6. Time of Last Ascent:
7. Did Diver: Panic? _______ Emergency Ascend? ________ Run out of Air? _______
Hold Breath Upon Accent? ________ Miss a Decompression Stop(s)? _______
8. Problems During Dive (e.g., Buoyancy, Clearing Ears, Equipment):
9. Possible Contact with Dangerous Marine Life: _______
10. Fly After Diving: ______ How Long After: _____________
11. Alcohol Ingestion: _____ When: _____ Quantity: ____________________________
12. Dive Workload (e.g., Currents, Hard Work, Over-weighted):
13. Any Post-Dive Physical Activity: _______________________________________________
14. Dive Buddy: _____ Is He/She Present? _____ Name and Phone Number:
15. Other Witnesses (Names and Phone Numbers):
16. Statements and Other Information:

Dive Accident: Signs and Symptoms Enter “Y” (yes) or “N” (no). Explain where needed.
1a. Joint Pain _____ 1b. Location_____________________________________
2a. Head Pain ____ 2b. Location ____________________________________
3a. Chest Pain ____ 3b. Location ____________________________________
3c. Increase with Inspiration or Cough _____ 3d. Radiates _____
3e. Location __________________________________________________________
4a. Abdominal Pain _____ 4b. Encircling Pain _____
5a. Unconsciousness _____ 5b. When __________________________________________
6a. Difficulty Breathing _____ 6b. Rapid Respirations _____
7. Convulsions _____
8. Confused/Disoriented _____
9. Extremity Edema _____
10a. Rash _____ 10b. Blotching _____ 10c. Itching _____
11. Shock _____
12. Weakness/Fatigue _____
13a. Numbness _____ 13b. Tingling _____ 13c. Decreased Sensation _____
13d.Location ___________________________________________________________
14a. Faintness _____ 14b. Dizziness _____
15a. Difficulty Urinating _____
15b. Difficulty Moving Bowels _____
16a. Difficulty Hearing _____ 16b. Which Ear? __________
17a. Difficulty Speaking _____ 17b. Facial Droop _____ 17c. Which Side? _____
18a. Staggering _____ 18b. Paralysis _____ 18c. Location _____________________________
19. Visual Disturbances _____
20a. Apnea _____ 20b. Bloody Froth from Mouth _____ 20c. Cough _____
21a. Cyanosis _____ 21b. Location ________________________________________________
22a.Feeling of Blow to Chest During Dive _____ 22b. When? ___________________________

Dive Accident Rapid Field Neurological Exam Record Answer yes or no.
Mental Status: Does He/She Know
1a. His/her name?_______ 1b. Where he/she is?_______ 1c. Time of day?_______
1d. Most recent activity?_______ 1e. Speech is clear, correct?_______
Sight
2a. Correctly counts fingers?_______ 2b. Vision clear?_______
Eye Movement
3a. Move all four directions?_______ 3b. Nystagmus absent?_______
Facial Movements
4a. Teeth clench okay?_______ 4b. Able to wrinkle forehead?_______
4c. Tongue moves all directions?_______ 4d. Smile symmetrical?_______
Head/Shoulder Movements
5a. Adam’s apple moves?_______ 5b. Shoulder shrug normal, equal?_______
5c. Head movements normal, equal?_______
Hearing
6a. Normal for that diver?_______ 6b. Equal in both ears?_______
Sensations: Present, Normal, and Symmetrical Across
7a. Face?_______ 7b. Chest?_______ 7c. Abdomen?_______ 7d. Arms (front)?_______
7e. Hands?_______ 7f. Legs (front)?_______ 7g. Feet?_______ 7h. Back?_______
7i. Arms (back)?_______ 7j. Buttocks?_______ 7k. Legs (back)?_______
Muscle Tone: Present, Normal, and Symmetrical for
8a. Arms?_______ 8b. Legs?_______ 8c. Hand grips?_______ 8d. Feet?_______
Balance and Coordination
9a. Romberg okay?_______ 9b. If supine, heel-shin slide okay?_______
9c. Alternating hand movements okay?_______

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