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

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