Scuba Professional: Column No. 3

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Crystal Bay, Bali

Where’s the Oxygen?

Simon Pridmore looks at how prepared dive operations really are to deal with a diving accident and suggest that we ask one key question before we choose who we want to take us diving.

I was a guest on a dive boat a few months ago. We had just arrived in Crystal Bay, a notorious diving accident black spot on the outlying Balinese island of Nusa Penida, when our attention was drawn by a burst of frenetic activity next to a neighbouring boat. A wet-suited figure was being manhandled over the side of the boat and laid out on deck. A couple of crewmen hunched over the figure while everyone else on board stood to one side, heads craned in concern. Seeing us approach, one of the crew shouted over and asked if we had oxygen. We did and we handed everything we had over to them as the boats met bow to bow. They thanked us, then turned and headed off at full speed to the main island of Bali, a good 45 minutes rough ride away.

I never found out what happened to the injured diver, nor what had caused the accident, but the combination of cool water, fast current and depth at the edge of this bay, where oceanic sunfish come to be cleaned, has caused more than a few inexperienced divers to elect for a rapid ascent when they want to “just get out of there!”

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Japan is the only place I have seen oxygen delivery kits in the bathrooms on beaches used by divers

The Wrong Choice

Once the key first aid concerns of monitoring consciousness, airway and breathing have been taken care of, the recommended treatment in a situation like this is administration of 100% oxygen. The oxygen should be delivered as soon as possible and continuously until a diving doctor instructs that it should be interrupted or until there is no more left. Therefore every responsible dive operation, whether boat or land-based, should carry a sufficient supply to enable at least one diver to breathe oxygen all the way from the dive site until they arrive at a medical facility which has oxygen on tap.

I have seen and heard this statement or a variation of it repeated hundreds of times in my diving career. In fact, many of you probably just skimmed through the paragraph, saying to yourself “yeah, yeah, yeah, tell us something we don’t know.” As the importance of oxygen is so well known, therefore, you might expect that all dive operations would be adequately prepared to deal with a diving accident. Sadly, as the diver in this story discovered, this is not the case.

A Key Question

Before you dive with any operation, no matter how apparently professional it seems, make sure they have the right answer to a key question, “Where’s the oxygen?”

A friend tells a story of an enlightened diver who went to a resort destination in Southeast Asia and made a tour of the dive centres along the beach, enquiring about rates, service and facilities. When she popped the oxygen question, two shops told her they did not have any, telling her that oxygen was “over-rated.” When she replied that she had heard that it was actually essential, they suggested that she was gullible to fall for lies put about by more expensive dive centres to justify their higher rates.

It is not just cowboy operators like this who are under-prepared and under-equipped to deal with a diving emergency. In your excitement to go diving, you may not have noticed how many dive briefings gloss over the key issues of where the oxygen is and who among the dive team is qualified to deliver it. This is not always an oversight. In many cases there is actually no plan to deal with a DCI incident. The rationale given runs along the lines of “it hardly ever happens so it is not worth thinking about until it does.”

Failing to Plan

Even top dive operations are guilty of failing to plan adequately. For example, liveaboards often carry oxygen on board the mother-boat but not on the small tenders that ferry divers to and from the dive sites. Often this ferrying involves long rides to allow the mother-boat to float free in the deep channel away from the reefs. This means that if a diver blows to the surface, the nearest oxygen is a long way away and the delay in delivery could make the difference between tragedy and survival.

It is not enough just to have oxygen on board the tender. You also need sufficient personnel to bring an unconscious or disabled diver into the boat and to drive the tender while the diver is being given oxygen. Again, you might expect that dive operators would run training scenarios to make sure that they are able to deal effectively with an injured diver, but the number of times you encounter situations where there is only one person, the boat driver, left on the boat after the divers have gone underwater suggests that they do not. Or perhaps they run the accident scenarios but the problems that these raise and the amount of money and trained personnel that they would need to cure the problems mean that the issue is just filed away in the “too difficult” drawer and they revert to the “hardly ever happens” policy stance.

The Big Green Box

The reassuring visible presence of a big green box on a dive boat is not always, by itself, a reliable indicator that the dive operation is prepared to deal with an injured diver. Given that accidents that require immediate delivery of oxygen are thankfully rare, the oxygen kit can sit for a long time without being deployed. Stories abound in the dive industry of boat crews turning to the kit in an emergency and finding that the unforgiving marine environment has caused the rubber hoses to waste away and corroded the cylinder valve to the point of immobility!

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The Reassuring Green Box

So, when the question, “Where’s the O2?” is greeted with a vague gesture in the direction of the green box, make a point of asking someone to open it so you can see what sort of condition it is in and if that cylinder with the reassuring green band actually has gas in it.

This may not make you very popular with your busy guide but as a diver you have a vested interest in ensuring that the people you are paying to take you diving are taking their responsibilities seriously – and the prospect of a few awkward questions might just encourage the idle or negligent to get their act together!

Read more from Simon in his latest release Scuba Professional – Insights into Sport Diver Training & Operations and his bestselling book Scuba Confidential – An Insider’s Guide to Becoming a Better Diver, both available from Amazon in paperback and e-book versions.

Simon Pridmore

Simon Pridmore

Simon Pridmore is the author of scuba diving books, travel books and, as you might expect, scuba diving travel books. Originally from the UK, Simon has lived in Asia for over 30 years. As well as his books and guides, Simon writes regular columns for a number of magazines. He and his wife Sofie currently live in Bali, Indonesia but spend a lot of time exploring other places trying (but failing so far) to find a cure for their itchy feet. Simon's latest book - Scuba Exceptional – Become the Best Diver You Can Be - the follow-up to his best-selling Scuba Confidential, is available now in paperback and e-book versions from Amazon stores worldwide. Find out more about Simon and his books on www.simonpridmore.com

2 Replies to “Scuba Professional: Column No. 3”

  1. Phillip Sharkey says:

    I don’t think that the big green box does anything more than indicate that at one time, someone high enough on the operator’s food chain to have purchasing authority, either was actually concerned about safety or needed to meet some specification.

    The only thing that would actually warm the cockles of my Scientific Diving Safety Officer heart would be to witness a full scale diving incident practice scenario, that included in-water “rescue,” bringing the casualty aboard, neurological exam, administering oxygen, and starting transport to definitive care. Now … I’ve been diving for well over a half-century, and I have never seen such a thing in the recreational world.

    This is not new, half a century ago I edited a document for the National Science Foundation that, with minor changes in perspective and focus can teach operators how to significantly enhance the safety of their diving operations, and it is available free from Rubicon: http://archive.rubicon-foundation.org/xmlui/handle/123456789/9554 .

  2. Craig70mtr says:

    A very relevant discussion.We recently were in Bali diving with a well known operator from Kuta.They travelled the 2hr trip everyday to our accomodation at Candidasa and then returned to Kuta everyday.This was good for us being close to our dive sites.The plan fell apart when one of our divers showed signs and symptoms of a bend after some very easy social diving after the crew had left for home in Kuta.We had no access to O2.The hospital 2hrs away.
    A call to the dive centre was simple you need O2.We already knew that.Find a way they said.Fortunately across the road was Bentho’s Dive Centre,it was still open.We walked in late,in the rush we explained the situation without introduction,he pulled out a brand new O2 kit and bottle and handed it over without question.We’re trained up but a call to DAN confirmed our intentions and we administered the gas.Within minutes the improvement was noticeable.When the cylinder expired we called DAN again as requested to explain the diver’s condition.All was good.Further testing in Australia showed a PFO which she had treated and is diving again.
    Pick your operator carefully,use a local operator,a known operator.This is the third time we’ve needed to administer O2.Two times PFO.One a DSD run by a resort that resulted in my wife’s near drowning,now classified as drowning,went wrong.
    In that case the O2 unit completely failed and 100% O2 was administered via a regulator til the ambulance arrived.Another story.
    A big thanks to Bentho’s Dive in Candidasa,Bali.On return of the unit we had to convince our operator to reimburse Bentho’s for the O2.
    Great topic,it becomes more relevant after you’ve had to deal with it.

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