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Deptherapy returns to its Roots – Part 4

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Join Richard Cullen from Deptherapy for part 4 of his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

We are all back to the house reef today; the weather is lovely, the sea calm, the tide will soon be slack, so a great day’s diving in store.

A few yards away from the beach dive centre, on the Roots’ beach is their day time restaurant. It is where we take lunch when diving, and there is a continual supply of tea, coffee and soft drinks, and some marvellous lunches.  There are also male and female toilets and a fully accessible toilet for those using wheelchairs.

A few thoughts around working with amputees and those who have paraplegia. Firstly amputees – the part of the limb remaining is known as the ‘stump’, and we have worked with a substantial number of bilateral leg amputees (both legs), single leg amputees and single arm amputees.  The level of amputation can be above or below the knee or elbow, or through the knee. In one case the amputation was transpelvic and in another through the shoulder.  Some like Chris Middleton have one leg amputated above the knee and one below the knee.  This is rare, but each type of amputation offers a different challenge.

Many people think the amputation is clean and the skin neatly tidied up after surgery. Although that occurs in a few cases, in most the stump is rather rugged.  Elasticity of the skin around the stump is often exceptionally poor and can easily be damaged.  Some of our beneficiaries, as they were injured as young men, suffered from heterotopic ossification – this is where the bone tries to grow after amputation and often penetrates the skin, resulting in further surgery being required to cut back the bone and of course the stump needs to be restitched.  Very often stumps are sealed with skin from elsewhere on the body.

Swars kitting up

Few divers have never experienced a graze or cut underwater but such an experience for those with amputations can have serious consequences.  Stumps are more likely to get cut or grazed as the skin is so tight. We all know that there are lots of infections in seawater and if infected the cut or graze can cause very serious problems for the amputee.  Tailored wetsuits are one preventative measure, as are daily stump checks, making sure there is no damage and if there is, applying medication and or protecting the stump.

Those with paraplegia provide an additional challenge, not being able to feel their lower limbs they can easily damage them, so cuts, abrasions, and even sunburn can go unnoticed.  Donning a full-length wetsuit can be a challenge as toes can easily be broken and hairs pulled out of legs.  On the Deptherapy Education Professionals’ Course we show how to fit a wetsuit properly.

In recent discussions between our dive medicine advisor Mark Downs and our VP Richard Castle, who is a consultant psychologist, we have been looking at areas for further medical research in terms of diving for those with disabilities.  One area of suggested study is thermoregulation. The theory is that those with amputations and those with paraplegia suffer more with the cold as their body is unable to regulate heat. Certainly, in Corey’s case, he feels the cold more quickly than those diving with him. Chris Middleton can feel the cold more quickly than others with amputations but that may well be that Chris is muscle and bone where, to put it nicely, others have a more substantial covering.

Some AMEDs and Dive Referees will not sign off amputees as being fit to dive. That is their professional opinion and although we can show that even triple amputees are more than capable divers, capable of progressing to Rescue Diver standard even, they still refuse to sign them off. Last year Oli and Mark invited us to speak at the UK Annual Hyperbaric Medicine Conference in London where Josh Boggi, the world’s first triple amputee Rescue Diver and a Deptherapy beneficiary spoke about how amputees can become safe and successful divers.

Corey, Swars and Michael

For Corey, he wears full leg coverings and diving boots in the water; as he cannot use his legs there is no purpose in wearing fins.

Another point around amputations is that most of the general population make an assumption that a leg amputation is the result of a traumatic incident.  That is incorrect; by far the majority of leg amputations in the UK are the result of diabetes. Those whose legs are amputated as a result as diabetes are more likely to have poor healing of the stumps.  This also presents an issue of comorbidity that may well result in an AMED or Dive Referee declining to sign them off as ‘fit to dive’.  If signed off you would need to be very aware of the health of a stump; I certainly would not take someone with an open wound diving and the fact that they will be on medication for the diabetes.  You also have to be aware that they may well be on other medication to manage pain etc.

You need to be very clear with those who have paraplegia and other conditions that they must let you know if they start to feel cold.

Managing air – diving just using your arms for propulsion can, for many, be very tiring and a considerable amount of effort is required.  This, plus other factors, may result in enhanced air consumption by the diver.  This may increase if a current is encountered, even one which most divers who have use of their legs and dive with fins would not cause the least concern.

Within Deptherapy we very much work on the ‘rule of thirds’ – a third of your air to get you down and to see what you want to see, a third to get you back to the surface and a third in reserve.  This in most circumstances will ensure no ‘low on air’ or ‘out of air’ situations.

Say if we have 210 bar in a cylinder that means 70 bar out, so turn on 140 bar, 70 bar to return and to the surface so we should have 70 bar reserve at the surface.

We also work our students through SAC rates and looking at the air consumption of others in their team.

Checking the team’s air frequently during a dive is stressed to all our Pro team.

Keiron became very engaged with this concept as the result of the online RAID study for his Master Rescue Diver.

On expeditions we normally dive in small teams, a DM/TDM with three programme members.  They work as a team and understand each other’s air consumption. Of course, they also dive as buddy pairs.

Today offered perfect conditions for diving, and Keiron, Moudi, and this time TDM Oatsie were kitted up and in the water within minutes.

Pause for thought… those with paraplegia will have different toileting arrangements to those who do not have the condition. This also applies to some who have suffered traumatic limb loss.  They may use catheters for urination, some may have Stoma bags etc.  This all has to be planned into your dive schedule to ensure the safety and comfort of your student.  For young people talking about these very personal arrangements may be very difficult.  Those with Stoma bags may be embarrassed by people seeing them.  This is another part of seeing beyond the injury or condition – it is the person inside that you are dealing with.

Corey on the Roots House Reef

So, Corey, Michael and myself were joined by Swars.  Swars, although he joined the DM programme at the same time as the other guys, because of work commitments was unable to join us in September 2019 at Roots where we ran a DM introductory programme alongside the crossover of our Pro Team to RAID.  Swars has become a really good mate; he is a great diver, with an engaging personality.

Michael and Oatsie were a known quantity to me as they had been on the September 2019 programme and both have travelled to my home dive centre Divecrew in Crowthorne, Berkshire, to work on courses, pre-COVID.  During COVID Michael and I, plus a few of the guys from Divecrew, have dived at Wraysbury together.

Just as Roots is our base in Egypt, Divecrew is our base in the UK, and through this relationship, Martin (who owns Divecrew with his wife Sue) is one of our trustees. Together they have established a centre where pretty much 100% of the Pros are Deptherapy Education trained.

I asked Swars straight away to brief a dive for Corey. I gave him the briefing slate, a few tips and then ten minutes later he came back with a perfect briefing… and I mean perfect.  So, a great briefing under his belt; now to watch him work with Corey in open water. He looked the Pro, he knew what he should be doing, he understood his role. We assigned Michael as Corey’s buddy and said he would lead the dive. I was there to assess the TDMs and supervise very closely Corey’s skill demonstrations.

Again, it comes as no surprise that many beneficiaries in Deptherapy can move straight into dive management, as several were NCOs, as was Swars, and they are used to briefing individuals and teams.

We had decided that we would mix up the dives required to complete Corey’s OW 20 RAID dives with some general diving as trim and swimming arm action are all important. We also needed to concentrate on spatial awareness.

We agreed a signal for horizontal trim and Swars reinforced the swim stroke that Corey needed to do to get propulsion.  Every time Corey moved out of horizontal trim Swars was there reminding him about trim and reminding him of his swim stroke.

The Roots’ House Reef is amazing – at a metre you encounter a shoal of black Damselfish, at 3 metres a shoal of Unicornfish, there are Butterflyfish and all manner of other fishes in great profusion.  The coral is in great condition. It really is a place of beauty and tranquillity.

Oatsie and Swars relaxing by the Roots pool after a long day

Although we had problems getting Corey underwater again, once we got him in skill demonstration mode his anxieties disappeared.  We then took him diving. Steve Rattle, the owner of Roots joined us and was taking photos that provide a great record of the week’s diving.  Steve commented on the quality of Swars and Michael’s supervision and control underwater of Corey and gave them feedback on how impressed he was.

Meanwhile on the RAID Master Rescue Course, Oatsie who was in the same Regiment, same Platoon and Section as Keiron in Afghanistan was more than willing to be a very uncooperative victim for his brother-in-arms.  I think Keiron gave Oatsie some feedback about this!

For me this was a hard week, combining running the RAID OW 20 for Corey but also the assessment of our three TDMs.  A week underwater but no opportunity to dive for myself.  People often think Deptherapy Expeditions are holidays for the Dive Team; they are not, it is hard work and I mean hard work.

Tomorrow is Day 4 in the water Day 5 of our trip. We are on the House Reef again, and things are starting to come together. Join us back here on Monday 26th October…


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

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SSI Welcomes its Newest Diver Specialty Program: Computer Diving

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computer diving

In this digital age, SSI makes keeping up with technology a priority. Over the years, we have seen more and more divers invest in a personal dive computer. Now that the MySSI App is capable of integrating with participating manufacturers’ dive computers, we wanted to create a program that will ensure every SSI diver knows how to fully utilize their dive computer’s unique features. Therefore, we are excited to introduce SSI’s newest specialty diver program, Computer Diving.

SSI designed the Computer Diving program to help certified divers become familiar with the numerous features and benefits of using a dive computer. By ensuring your customers understand how to use all the functions of a dive computer, you will not only increase their dive safety but also help make planning and executing dives easier. The SSI Computer Diving program explores the functions and capabilities of different dive computers and explains how to seamlessly integrate these features into the entire dive experience, from pre-dive preparations to post-dive reflecting and logging. Practical application topics within the course include setting and changing nitrox settings, using the pre-dive planning feature, and downloading dives to keep a digital logbook.

The appeal of the SSI Computer Diving Specialty extends beyond the realm of scuba divers. Your certified Freedive and Mermaid customers will also enjoy taking this course. All breath-hold divers can benefit from learning how the various tools within their dive computer can increase performance and safety while training and executing their actual dives.

If you are an SSI Training Center or Pro, your students can start their Computer Diving program online today by contacting your SSI Training Center to purchase and download the materials. Don’t have an SSI Pro certified to teach the Computer Diving specialty yet? Have them log into their MySSI profile to upgrade to this new SSI offering.

This specialty program is just one of the many tools SSI provides its Training Centers. Now is the time to reap the benefits of SSI’s continued growth in its training offerings. Call SSI at 1-800-892-2702 or visit us at https://my.divessi.com/become_trainingcenter to become an SSI Pro or Training Center today!

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BSAC launches Divesoft Liberty rebreather course

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The British Sub-Aqua Club (BSAC) is bolstering access to technical dive training with the new BSAC Divesoft Liberty CCR course.

This course is a first step (MOD 1) into the silent bubble-free world of rebreather diving, and opens up a new world of diving experiences and possibilities for members.

Benefits of the Divesoft Liberty rebreather

Founded in 2013 in the Czech Republic, Divesoft developed its closed circuit rebreather (CCR) primarily with the guidance of cave divers. The Divesoft Liberty was the first fault-tolerant electronically controlled rebreather released into the recreational diving market. The Liberty is designed where all vital electronic elements have redundancy so that no single failure can disable the system.

Even if a critical systems error occured, the diver can safely return to the surface on the Liberty, maximising safety and efficiency. The design follows the same approach utilised in many safety-critical applications in the aerospace industry.

The Liberty’s modularity and ease of maintenance allow the diver to maintain the unit in all environments, including the harsh conditions of an expedition.

Divesoft Liberty rebreather

BSAC Divesoft Liberty CCR Diver course

The brand new BSAC Liberty CCR course will teach a suitably qualified open-circuit diver to safely dive their rebreather to a maximum depth of 45m. This highly versatile unit offers a wide range of adjustability and settings, making it great for beginners and expert CCR divers alike.

Students get a thorough grounding in rebreather technology, and in-depth Liberty-specific training. The course includes decompression diving, and trimix gas planning, and teaches all the skills and drills required to dive the Liberty and address all possible situations.

The course is open to BSAC Sports Divers or above, who have completed a 35m depth certification. Trainees must also hold the Accelerated Decompression Procedures qualification or be an Advanced Nitrox diver (or equivalent.)

Divesoft Liberty rebreather

The BSAC Liberty course covers decompression diving and trimix gas planning, with skills and drills required to dive the Liberty and address all  possible situations. Trainees can choose to dive with air as a diluent, but will have been trained using 20/35 trimix as a diluent,  so when they use 20/35 are allowed to dive to a  maximum depth of 45m, at the MOD 1 level of training.

The dry practical sessions will cover assembly, preparing and maintaining the Liberty, including updating the control firmware and downloading dives from the unit, using the Divesoft PC and phone applications.

All the new skills will be introduced during the sheltered water training dives, including applying the student’s current rescue skills to CCR diving: the sheltered water training is followed by seven open-water dives.

Nick Jewson, BSAC Technical Liberty Instructor said:

“The introduction of the Liberty CCR MOD 1 course demonstrates that BSAC continues to evolve its technical dive offering for members. We plan to have a minimum of four BSAC Liberty instructors in place early in the 2024 season, and with potential students waiting to do the course we can’t wait to see BSAC-qualified Liberty divers using this impressive rebreather in exciting expeditions very soon.”

Divesoft Liberty rebreather

The BSAC Liberty CCR MOD 1 course will be officially launched at the Go Diving Show near Kenilworth, Warwickshire on the weekend of 2nd-3rd March 2024, where Divesoft will have units on display.

Nick continued: “Visitors should head to stand N4 to get a hands-on look at the Divesoft Liberty and talk to the BSAC Liberty course team. Come and have a look, book your place on a regional Liberty try dive event, or sign up for the BSAC MOD 1 Liberty CCR Diver training course. We’ll ready to show you how the Liberty CCR can transform your diving!”

To learn more about the BSAC diving community, visit www.bsac.com

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