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Code Blue: Diver Medic Technician Course

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Diver Medic Technician

Diver Medic TechnicianI recently attended the Diver Medic Technician course, run by Chantelle Newman, which was a great experience.

The Diver Medic Technician (DMT) course is run by DAN Europe at Code Blue Education. The idea behind the course is to ensure you are prepared for and are able to deal with any diving related medical emergency. There are both theory and practical-based elements to the course.

My first aid background began with an emergency first aid course back in 1991. I completed various other first aid and lifesaving courses over the next couple of years, and became an examiner and instructor for First aid in 1993 through an Occupational Health consultancy. I have maintained some form of lifesaving and first aid qualification for most of the 25 years since that first course in ’91, and have held qualifications with the RYA, BCU, COCLG, BSAC, SSI, EFR, AIDA and several other notable agencies. I have also qualified hundreds of First Aiders and rescue trained staff.

Diver Medic Technician

I’ve always wanted to improve my knowledge past this basic level, so when I discovered there was a course taking place in Brentford, London with www.thedivermedic.com I signed up immediately. In order to take the course you have to be over 18 years of age, a rescue diver (or equivalent) and above or have held a first aid at work certificate. You should also at least hold a current EFR/ BLS/First Aid Certification. This course was certainly at a different, much higher level of knowledge than I have been exposed to before.

The course was headed by Chantelle Newman. Chantelle is from South Africa, where in 1985 she became the youngest female diver to be NAUI certified and qualified. She has brought together her passions for diving and medicine to increase dive safety awareness worldwide. She is the founder of the Diver Medic Facebook Group and the magazine ‘Diver Medic.’  She was the second only female ever to develop a Diver Medic Technician (DMT) Course accredited by IMCA for Commercial divers and DAN Europe for recreational divers, a course which Chantelle is still the only female able to teach. She is on the DAN Europe Training Committee, and is a regular speaker at the UK dive shows. Chantelle continues to work on projects related to Dive Safety and Education. Chantelle has recently been inducted into the Women Divers Hall of Fame 2016.

Diver Medic TechnicianEveryone on the Code Blue team is an industry professional. This is vital, because this is not a course you want to take with amateurs at the helm. There is, in certain areas of the diving industry, almost what I would describe as desperation for some Instructors to try and make money from skills they have not yet mastered themselves, and simply either sign off through an agency or scrape together a basic CV of skills so they can pretend they are going to offer value for money. If their primary objective is short term financial gain from skills they don’t even possess properly, then the outcome will be courses with little value, no matter what they charge. Code Blue are one of the organisations doing it properly; they know their stuff, and they are highly experienced in their field. My advice is to seek out operators of this calibre when attempting to improve yourself, especially where safety is involved. The trainers were personable yet professional, knowledgeable and put together a course that was hands on, fun, and yet very educational too.

Before the course we were given several self-study tasks to achieve. It was a great refresher on Oxygen administration, AED, hazardous marine life injuries, First and decompression theory and a very comprehensive Diver medic technician book. I really brushed up on my knowledge and had learned a lot of new information before attending the course, which set me up for a great learning experience and got me a couple of extra qualifications in the process.

Diver Medic TechnicianThe equipment used on the course was exceptional. We were provided with – for free – lots of equipment, manuals, DVDs, and during the course many of the items we needed to use such as needles, gloves and sutures. This course must have cost a lot of money to put together and to run, but quality is its main goal. The manikin was the best I’ve ever used on a course – it was hooked to a unit so it could show deterioration or improvement depending on your actions; you could inject it; listen to its lung and stomach noises; test it for pulse and blood pressure; and you could of course also perform CPR like you can on standard dolls. It meant the many real life scenarios we were given were very realistic, which made the course that much better.

The DMT course was put together for commercial divers working remotely so they could deal with diving emergencies. The perceived risks of commercial diving are higher, but in fact more recreational incidents occur. The DMT is a 10 day course and you receive DAN Europe’s DAN Recreational Diver Medical Technician certification, which is valid for 2 years. I would recommend this course to anyone wanting to further their first aid knowledge to an advanced level, and to all teaching first aid instructors. Knowing those next steps gives a real insight into what you need to do to help a casualty. I would also recommend it to all scuba divers and freedivers so they are in a position to help their fellow divers in an emergency, but especially to career industry professionals, who are responsible for their students… because this course will certainly save lives.

Here are some of the Diver Medic Technician course subject areas covered:

  • Bleeding
  • Fractures, sprains and muscle trauma
  • Shock
  • Burns
  • Electric shock
  • Asphyxia, pulmonary oedema
  • Respiratory arrest
  • Cardiac arrest
  • Convulsions
  • Hypothermia
  • Hyperthermia
  • The musculo-skeletal system
  • The nervous system
  • The heart, blood vessels, circulation and blood
  • The lungs
  • The ears, sinuses and vestibular organs
  • Personal hygiene in the management of injuries
  • The systematic method of examining injured or ill patients, including divers
  • Methods for monitoring vital signs such as pulse, respiratory rate, temperature, and blood pressure
  • Methods of caring for a casualty on site and during transportation
  • The administration of oxygen
  • Decompression illness, including pulmonary barotrauma and gas
  • Setting up intravenous infusions
  • Parenteral administration of drugs
  • Suturing
  • Catheterisation
  • Embolism
  • Squeeze
  • Ear problems – infections, barotrauma, routine hygiene in saturation environments
  • Injuries to skin and eyes
  • Near drowning, secondary drowning, vomiting under water
  • Carbon dioxide retention and poisoning
  • Carbon monoxide poisoning
  • Other breathing gas contaminants, e.g. hydrocarbons
  • Oxygen toxicity
  • Anoxia and hypoxia
  • Nitrogen narcosis
  • Underwater blast injury
  • High pressure nervous syndrome (HPNS)
  • Diving accidents
  • Thermal stress – the effect of cold on divers’ performance
  • Dental problems – recognition and first aid
  • Dangerous marine animals – treatment of common injuries
  • The first-aid equipment available at the site of a diving operation
  • The management of medical emergencies within a diving bell
  • Communications with EMS
  • Use and hazards of the drugs and intravenous fluids
  • Theoretical teaching of bladder catheterisation
  • Theoretical teaching and practice where available of Insertion of pleural drain for pneumothorax
  • Airway maintenance (laryngeal mask)

Contacts for the course:

E-mail: info@thedivermedic.com

Website: www.thedivermedic.com

Facebook: www.facebook.com/groups/thedivermedic

Steve Millard is a leading UK based AIDA and PADI Freediving Instructor Trainer who is the owner of Apneists UK freediving group - www.freedivers.co.uk. Currently Press officer to the British Freediving Association and Performance mermaids lead coach.

Dive Training Blogs

Deptherapy returns to its Roots – Part 3

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Join Richard Cullen from Deptherapy as we publish part 3 in his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

Today was planned to be our first day of open water diving in the Red Sea on the Roots’ House Reef. The Dive Centre and the House Reef are literally a 5-minute walk from the camp.  If some beneficiaries are unable to make the walk then transport is provided.

All your kit, weights, cylinders etc are laid out ready for you to assemble your kit.

For those who use wheelchairs there is a paving stone pathway from the dive centre to the entry point for the reef. This, as with the provision of four fully accessible rooms in the resort, was built by Steve Rattle and his team to meet Deptherapy’s needs and to make the resort and reef accessible to all divers with disabilities.

A point here: in many Adaptive Teaching/Disabled Diving Manuals it is suggested that dive centres might wish to purchase a beach wheelchair.  To justify the cost, you would need a considerable number of disabled clients who were unable to walk to the ocean entry point as they cost circa £3000.  Using an individual’s wheelchair across sandy beaches is difficult and not a good idea. Many wheelchairs, such as Corey’s, cost thousands of pounds and getting sand/grit in the bearings can result in costly repairs.  So, at Roots the staff have adapted and overcome the challenge, with the beach wheelbarrow.  A foam pad is placed in the bottom and a towel draped over it.  It is effective and allows divers like Corey to be taken to the beach, the wheelbarrow is pushed into shallow water and the diver either gets out of the transport himself or is lifted out by the Roots team.  Everyone finds it a lot of fun!

Your transport awaits!

Working with those with life-changing mental and/or physical challenges does require careful risk management, not just in the general risk models for groups of divers but individual risk assessments.

On the Deptherapy Education Professionals’ Course and adopted in all our programmes is the ‘Three Tick Model’. Before taking an individual diving, each of the following must be ticked off:

  • Doctor certifies student fit to dive
  • Student signs assumption of Liability and Risks
  • Instructor is happy given the medical information to instruct the student.

As an Instructor, or as a dive centre owner you may wish to check that your insurance covers you for working with those with severe disabilities.

The instructor will meet with the student and complete a personalised risk assessment and will review whether there have been any changes in the student’s physical or mental health since their consultation with their doctor (in our case an AMED or Dive Referee).  They will also check that the medication or its daily dosage has not changed.

In terms of those with severe challenges, an AMED or a Dive Referee may require full disclosure of medical records before making a decision.  For Deptherapy we also reserve the right to refer a final decision to our two medical advisors, Dr Mark Downs or Dr Oli Firth, both of whom have considerable experience in dive medicine.

At the end of Day 1 the team were happy for Keiron to move forward; he is a strong, fit man and a capable diver who gives 100%.  Corey is an amazing guy and was very quickly embraced as a member of the Deptherapy ‘family’. But sometimes there has to be tough love and in Deptherapy we are always very open with our beneficiaries.  Some reach a level of certification beyond which they cannot progress.  For Corey there was a serious discussion with the teaching team. He had completed his skills in the pool and met the standard required BUT none of us, especially me, had any confidence that he was the standard to be an Open Water Diver.  A hard message to give to a young man who already had a certification card that said he was an Open Water Diver.  He had either not been taught properly and certified without having met the required standards or he had forgotten all he had learned.  My view is he is a bright young man and that the former reason must be correct.

Corey, Keiron and Swars between confined dives by the Roots pool

The RAID definition of mastery:

When a student/learner can comfortably demonstrate proficiency and competence, when completing an entire motor skill including all the components of the skill in a manner that demonstrates minimal stress or hesitation.’

Each mainstream diving training agency defines mastery in similar terms. It was not Corey’s ability to do the skills, it was his ability to ‘dive’ that concerned us.

If weather conditions are right, the Roots House Reef meets the requirements for a ‘confined environment’ and on Day 3 it did.

Entry to the reef is through a channel and it goes from extremely shallow to 3-5 metres.  There is a rope that allows a diver to control their descent and for use at the end of a dive if the current is running.

Most instructors will have seen nervous divers who say they have ear issues, not at a depth when there is any noticeable change in pressure, and those who continually fidget with their masks and other kit in an attempt to avoid descent. Corey displayed these traits.

We made the decision to move to the open water as it would give Corey more of an opportunity to get himself in a horizontal position rather than the upright position we saw in the pool.  We struggled to get him down the line and into the sea.  Eventually after much hard work we got there.  He maintained the upright position and was using tiny arm and hand movements to propel himself forward.  His buoyancy was poor.  We decided to end this session and return to the pool.

A note here on trim and posture in the water for both amputees and those with paraplegia.  When working with a leg amputee, especially a bilateral amputee, their balance at the surface is often poor, they tip forward, backwards and from side to side. This is often to do with weighting but also the fact that they do not have legs to weigh them down or to balance them.  They also are often unaware of where their stumps (the term for the part of the limb remaining) are, and their stumps come up at right angles to their body.  We have exercises to make amputees aware of this.

Those with paraplegia adopt a different stance, often they are upright in the water and their legs trail down, even when in trim their legs hang below the rest of their body.  The team needs to ensure that the diver is properly weighted and that the horizontal position in the water in reinforced.  Spatial awareness also needs to be created in the diver so that their legs and feet do not drag along the bottom or come into contact with coral.  They need to become aware of where their legs and feet are in the water.

This was very hard for Corey and I was quite honest that he needed to improve considerably and learn to dive properly before I would allow him to move forward. He was gutted but up for the challenge, and what we saw over the next few days was a man committed to succeed!

Michael and Keiron

So back to the pool with Oatsie and Michael. We went through all the skills for RAID OW20 twice and focussed on buoyancy, performing the skills neutrally buoyant, getting Corey in trim and teaching him how to swim underwater without the use of his legs.  It is a pity that Chris Middleton, one of our divemasters and a bilateral amputee had to miss the expedition because of wisdom tooth surgery. Chris is a role model of how to swim underwater without the use of your legs.

Although I, all our Instructors and our DMs/TDMs can demonstrate how to swim underwater, not using your legs and using a modified free diving stroke, it is far better for someone with no legs or no use of their legs to demonstrate the skill.

By the end of the day Corey had progressed substantially and the Red Sea awaited him on Day 4.

Keiron had progressed well with his instructor Moudi and Swars and was getting added value with extra work on advanced buoyancy and SMB and DSMB deployment.

Tomorrow I will talk a little more about our TDMs; we expect very high standards from them.  Michael and the two Toms have over 100 dives each. Michael dived with us in Chuuk Lagoon and both Toms have been on Red Sea liveaboards. We look for them to go beyond DM level and to progress to Instructor level.  Swars had delayed the start of his DM programme, initially because of work and then COVID. He impressed, and here again, veterans have some advantages as they are used to briefings and therefore when you give them a model for a briefing they can quickly pull a high quality briefing together.

RAID Skill Briefing Checklist and OW20 slates

Throughout the week I found the RAID skills briefing slate excellent for the TDMs and the plastic skills slates are a great aide memoire for the whole team.


Find out more about the work of Deptherapy and Deptherapy Education at www.deptherapy.co.uk

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Dive Training Blogs

Deptherapy returns to its Roots – Part 2

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Join Richard Cullen from Deptherapy as we publish part 2 in his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

So here we are at Roots Red Sea, El Quseir, Egypt, and it is our first day of diving.

We have two students – Corey who is new to Deptherapy, and Keiron who is undertaking his RAID Master Rescue Course and has progressed from learning to dive with us. We also have three trainee divemasters: Tom Oates ‘Oatsie’, Tom Swarbrick ‘Swars’, and Michael. Each has progressed from OW diver with the charity.

Michael prepares Corey for a deep water entry into the Roots pool

As all our programme members are open about their mental and or physical challenges these are the challenges they face:

Corey is 20 years old and was involved in a horrendous car accident while he was training to be a soldier with the Royal Anglian Regiment.  The accident resulted in his spine being broken at T1 and T4.  He is now paraplegic, unable to walk and he has no sensation in his legs.

Keiron was in the Scots’ Guards and served two tours in Afghanistan. He has Chronic PTSD.

Oatsie was in the Scots Guards and served one tour in Afghanistan. He has Chronic Complex PTSD.

Swars was in the Royal Anglian Regiment and he served two tours of Afghanistan. He has survivor guilt and Chronic PTSD from his first tour, and on his second tour he was shot by a sniper, losing five pints of blood and his life was saved by the excellence of battlefield medics. That tour compounded his PTSD.

Oatsie and Swars are both Deptherapy Ambassadors.

Michael was in the Royal Engineers and he has Multiple Sclerosis (MS) and Chronic PTSD. Michael is a Trustee of the charity and looks after Programme Member Liaison.

Corey and trainee divemaster Tom Oates in the pool

Every Deptherapy beneficiary has to undertake a ‘fit to dive’ medical with an HSE Approved Medical Examiner of Divers (AMED) or a Doctor who is a ‘Dive Referee’. A GP ‘sign off’ is not acceptable to Deptherapy as some conditions and medications are contraindicated to scuba diving.

After sorting out kit the whole team were required to undertake a Scuba Review as, with the exception of Michael and myself, none had been diving since last year.

Adaptive teaching requires a special mindset from instructors and divemasters. There are no experts in adaptive teaching, although some profess such expertise. Some, like myself, are very experienced in working with those who have a range of life-changing mental and or physical challenges, but we do not have all the answers.  There are no “I know the answers” in adaptive teaching, every student is different, every student is an individual.

The huge danger is that ‘experts’ say I have already taught a paraplegic so teaching this paraplegic is the same; it is not!

The physical or psychological manifestation of the injury or illness is a mechanical issue, the skill is to see past the challenges and see the person you are working with – the real person. 

Many have been living with their conditions for many years and have adapted to overcome the challenges that their injury or condition presents them with.

An example: Can you tie a neck tie using one hand? I bet not!  I know two Deptherapy programme members who can do that and tie their shoelaces in the same way.

Your job, as an Instructor, is to allow the student to achieve the standards necessary for them to be certified as a diver. In Deptherapy we work to full mainstream certification; for us, the base is RAID Open Water Diver.  We do not use the RAID Restricted Certifications of D1, D2, D3.

Veterans have a can-do mindset and very much want full certification and not a certification card that has the word ‘disabled’ on it.  Do not look at what our beneficiaries achieve and think then that every person who wants to learn to dive and has a physical or mental challenge will apply themselves with such vigour.  Veterans are used to ‘drills’ so skills are easy for them to learn and to master.

It’s important not be afraid to ask the student “This is what you have to do to achieve the required standard for a skill and ask how they might perform that skill.”

So, we prepared for the pool! Keiron is a known quantity for us, he is a good diver who had completed all his RAID on-line learning, quizzes and the final exam. Corey was new to us having qualified as a PADI Open Water diver on a trip to the Florida Keys with another charity last year.

Oatsie asking if Corey is OK during the RAID OW 20 Confined Dives skills

Our intention was to put Corey through his RAID Advanced 35 Course. He had completed all the online learning, and passed the quizzes and exams. Corey is a lovely person; he has a great personality and a determination to succeed in everything he does.  As a person, the whole team absolutely loved him.

When kitting up and about to complete a deep-water entry into the pool it became clear that Corey, who is a bright young man, had never carried out some of the skills to the standard required to be an Open Water Diver.  We therefore decided to take him through the RAID OW 20 Confined Water dives with our TDMs Oatsie and Michael, who have excellent skill demonstration abilities, running the sessions under my close supervision.

While Oatsie and Michael worked with Corey on Day 1, Swars worked with Keiron whose instructor was Moudi, the Roots General Manager and a very experienced instructor, through the pool dives of the RAID Master Rescue Course.

Keiron, trainee divemaster Tom Swarbrick, and instructor Moudi in the pool

For those with physical challenges such as paraplegia or missing limbs, weighting becomes of absolute importance.  Paraplegics who have no sensation or movement in their legs swim with a leg down posture.  If not balanced with correct weighting they swim underwater in an upright position and not horizontally.  Corey assumed this upright position.  In Deptherapy we use ‘Bright Weights’ that are attached to the BCD at chest level to help get the student in a horizontal position.  Corey had never done a forward descent but had done ‘legs down’ descents and had only dived with support.

Michael and Oatsie did a tremendous job in building up Corey’s skills and confidence. Deptherapy has very high standards when it comes to qualifying divers and we insist on pushing boundaries.  Because of the negative stance that many in the diving industry take about divers with disabilities, our expectation is that our students will exceed the required standards.

An Instructor who shows pity or sympathy for a disabled individual and allows them to qualify as divers when they clearly have not met the required standards firstly puts that student at risk, it puts their buddy at risk, and it damages the reputation of all those disabled divers across the world who have met the required standards.

Despite starting from a low base, our determination was by the end of the week to turn Corey into a more than competent RAID Open Water Diver capable of safely being an independent diver, diving with and being able to support a buddy if they required assistance.

Corey, being Corey, accepted the challenge and knew that he had a lot to do. It says a lot about this young man that he faced the challenge square on.

Keiron meanwhile had successfully navigated his way through his confined water dives.

A relaxing and positive evening followed where everyone got to know each other and to talk openly about their challenges and how they dealt with them.

Check back tomorrow as we move to our first day of Open Water training on the magnificent Roots’ House Reefs.


Find out more about the work of Deptherapy and Deptherapy Education at www.deptherapy.co.uk

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