Let’s face the facts, diving accidents do happen. Thankfully not too often, but as an active scuba diver the law of probability states that sooner or later I will encounter some kind of first aid emergency. With this in mind I would hate to be unprepared or unable to help someone in their moment of need. So when I saw the advert on DAN Europe’s website promoting the diver medic technician (DMT) course run by Code Blue Education, I thought this was the perfect time for a refresher on the latest medical techniques and procedures.
As well as covering the basic ABC’s the 2-week (80 hour) course entered into the realms of suturing, IV cannulation, catheterisation and dealing with a real life pneumothorax. I was really looking forward to the suturing session but the thought of catheterising a patient didn’t really fill me with inspiration. In fact I went weak at the knees just thinking about the procedure.
My last dabble with any form of medical training was a St John’s Ambulance first aid at work course several years ago. I was worried that my level of knowledge would be way below the required standard, but Chantelle Taylor-Newman, Director of Code Blue Education, reassured me that my background would be fine. I didn’t need to bring along any materials as everything from tea, coffee, soft drinks and chocolate muffins to all the course notes and even my own personal stethoscope would be included. I was already starting to get delusions (but then again, Doctor Philpott did have a certain ring to it!).
Chantelle said the DMT course is aimed at commercial and recreational divers. It’s actually an offshore requirement to have one DMT in each commercial diving team. Chantelle, who is also a certified PADI Divemaster, said “The DMT course is designed for commercial divers, but these days there seems to be more accidents in recreational diving, so I feel that it should be taught to all recreational divers as well.”
Code Blue Education is based in Brentford, London. They offer the full range of DAN courses up to Instructor level. The DAN/IMCA (International Marine Contractors Association) accredited DMT course is a new addition to their medical training portfolio. Chantelle said “We are looking at running the course every 2-3 months.” The content is currently around 40% theory and 60% practical work. There is a mid-week multiple choice exam followed by a final written and practical exam watched over by a practising medical professional.
Chantelle gave me some website links for pre-course reading, so when I turned up on Monday morning, I was raring to go. Even having to give a personal introduction in front of the group couldn’t dampen my enthusiasm. There was a good mix of people from different countries and job backgrounds. Andrea had just completed a commercial job looking for dead bodies on the Concordia cruise liner in Italy, and Oliver had been welding pipe work inside a sewage tank somewhere in Oz. Jason was studying economics in Scotland and Chris was working for the forestry commission in the home counties. The white collar workers were represented by Morne from DAN South Africa and Clive who owned 2 decompression chambers in Cyprus.
The first two days mainly consisted of theory focusing on physiology and basic first aid principles. Chantelle emphasised that hygiene was extremely important by saying “you can find faecal matter just about everywhere” (that’s such a nice thought!). Guest speaker Cary Marcelo, a care procedures and resuscitation Instructor working at Harley Street, went through the signs, symptoms and treatment for patients suffering from a variety of injuries. We had quite a few acronyms to remember. ABCDE and SAMPLE were the most widely used. Cary’s catchphrase was “Always treat what kills first.” During the practical sessions everybody had to wear gloves and use the oral nasal masks. I never realised how easy it was to use an AED (automated external defibrillator) – the unit basically talked me through the whole procedure. We also went through how to check blood pressure using a sphygmomanometer and a stethoscope.
Police diver Steve McKenna turned up mid-week to go through wounds, bleeding and fractures. Steve has worked with the marine unit for the past 14 years and gets called out on jobs anywhere in London. He had some very interesting (and gory) stories about past investigations. I can still visualise the picture showing a severed penis! Steve’s catchphrase was “We are going to lose people.” Steve explained that even with first aid treatment some people will die; in fact, the actual quoted figure is a 5% survival rate if an accident happens out on the street.
The day wouldn’t be complete without a few new acronyms to memorise. This time SAFE and RICE seemed to be the favourites. By far the best product Steve showed us was Celox. The haemostatic granules were developed for military use to stop severe bleeding. They are now being used by civilian paramedics. DAN even sells the packs on their website. The practical session using spinal boards, scoop stretchers and cervical collars gave everybody a chance to stretch their legs. I soon realised that trying to manoeuvre a stretcher and patient up and over objects and around tight corners is not an easy task.
To finish off the week we had a theory day on diving physics and diving related injuries. I already knew most of the information from my PADI Divemaster days so this was really just a refresher. Some of the pictures of skin and facial barotraumas (suit and mask squeeze) looked horrendous, but Chantelle reassured us that the injuries had healed up without any permanent injury.
The second week involved more complex procedures starting with IV cannulation. I am not a fan of needles so this was quite an interesting session. We all got to practise on the plastic/rubber training arms that were filled with fake blood. Even I managed to get the procedure right after a few tries. Catheterisation had everybody grimacing apart from Chantelle who seemed to be smiling as she performed the delicate demonstration. Watching someone put a 30cm long catheter inside a penis brought tears to my eyes (it wasn’t a real penis I might add. We used a training manikin). This is one procedure I would not want to do in real life. Morne, from DAN South Africa, pointed out to me that the correct medical term for the male genitalia is a winky!
Doctor Mark Downs was our next guest speaker. Mark is an HSE Medical Examiner. He is one of only eighty doctors in the country that can conduct commercial diving medicals. Mark is an active PADI Divemaster and has been diving for 10 years. We listened to Mark’s presentations on diving related accidents and how to check out a possible bends case. Mark said “the 5 minute neuro exam provides a reliable system to judge the urgency of a diving emergency. It also demonstrates to the diver involved that there is a problem and convinces them to commence oxygen first aid treatment.” Mark’s catchphrase was “Oxygen is the answer to all diving related injuries.” He stated that in two thirds of all DCI cases there will be some kind of neuro damage, which is quite a sobering thought. We looked at the DDRC, DAN and Mark Powell’s neuro assessment sheets and tried them out on each other for good measure.
Before taking the dreaded exams we spent an interesting day with Spencer Phillips at the Diver Clinic’s recompression chamber based in Reading. Spencer has more than 20 years experience in decompression therapy. We sat through an in-depth presentation on the ‘bends’ going through the general causes and treatments. Spencer said he had recently seen an increase in trimix rebreather related incidents quoting one particular case where a woman wasn’t carrying any bale out gas for a dive in the 50-100m range. When the unit failed she came to the surface missing a considerable amount of deco time. Spencer quoted some interesting statistics. He said that in the UK there is a one fatality per 200,000 dives and one decompression related incident for every 5,000 dives. Rapid ascents seemed to be the main problem. Between 70-80% of the cases he treats are Type 1 bends. 98% of symptoms appear within 24 hours, 50% are within the first hour. Spencer said “time to treatment is crucial for getting a good result.”
On the final day everybody passed the written exams and scenarios with flying colours. Code Blue Education’s second ever DMT course had been a resounding success. The problem I find with any course is trying to retain all the relevant information. After 2 full weeks of theory and practical sessions my brain was about to explode. I had thoroughly enjoyed the course, especially the practical scenarios. Having specialists speakers come in and give presentations definitely made the course more interesting and helped increase everyone’s attention span, although on a few occasions listening to different perspectives did lead to confusion as to what was the correct procedure to use.
Going through accident scenarios in a controlled classroom environment is never the same as facing a real life emergency situation. I kept wondering, how would I react? What I do know is Code Blue Education’s DMT course has certainly raised my first aid skill levels, so if there ever was a situation I had a far better chance of helping someone out.
Participant Fact File
Name: Morne Christou
Resides: Jo’burg, South Africa
Job title: DAN South Africa Office Manager
Years in diving: 12
Qualifications: PADI Instructor
Reasons for participating: To further my knowledge and see how the course is run from a DAN perspective so we can work together with Code Blue on future courses.
Observations: Great course, lots of information I didn’t know. Long days so need to stay focused.
Guest Speakers: From my experience it’s nice to have different speakers. It adds to the dynamics although sometimes there was conflicting information.
Best moments: Definitely the practical sessions, I can really relate to it.
Name: Clive Martin
Resides: Larnaca, Cyprus
Job title: Decompression Chamber owner
Years in diving: 27
Qualifications: PADI Master Instructor, BSAC Advanced Instructor
Reasons for participating: Increase knowledge.
Observations: Overall I really enjoyed the course. It’s not just diver related, other injuries are included.
Guest Speakers: Not so monotonous with other speakers, it really broke up the days.
Best moments: The hand’s on stuff, scenarios, especially the IV, advanced airway and suturing.
Name: Jason Teoh
Resides: Malaysia, Kuala Lumpa
Job title: Student studying economics at St Andrews in Scotland.
Years in diving: 5
Qualifications: PADI Instructor, Emergency Medical Technician.
Reasons for participating: I already have basic EMT knowledge but wanted more diving related knowledge.
Observations: Very informative. It covers lots of topics and encompasses lots of diving aspects. I originally trained on the American system so it was good to learn the European standard.
Guest Speakers: It was nice to get different perspectives.
Best moments: Definitely the suturing.
Name: Chris Jenkins
Resides: UK, Devon
Job title: MD of a forestry company
Years in diving: 2
Qualifications: PADI Rescue Diver
Reasons for participating: Increase personal knowledge.
Observations: I haven’t wasted my time, it was a good course. On a medical level I learnt an adequate amount. I would recommend it to the right person.
Guest Speakers: Nice to break the 2 weeks with different speakers.
Best moments: the practical sessions, especially life support.
Name: Andrea Cerilli
Resides: Monza, Italy
Job title: Commercial Diver
Years in diving: 4 years as a commercial diver, 8 saturation jobs including the Concordia.
Qualifications: PADI Instructor, air and saturation diver
Reasons for participating: There has to be a DMT on every sat diving team. It’s nice to learn more so maybe I can help someone.
Observations: Generally very good, I learnt a lot.
Guest Speakers: I liked the different lectures. It was nice to hear them talking about their own experiences.
Best moments: the practical
Name: Oliver Bittar
Resides: Perth, Australia
Job title: Commercial Diver, NW shelf
Years in diving: 4 years as a commercial diver
Qualifications: SSI Master Diver, commercial air diver, degree in marine biology
Reasons for participating: Gain better employment opportunities, extra knowledge.
Observations: Brilliant, really like the course. Lots of information condensed into 2 weeks, particularly the 2nd half. Good course construction and particularly good revision for me.
Guest Speakers: Having specialists added a massive part to being a good course.
Best moments: The hands on practical, especially the IV cannulation.
Sidemount: Not just for Technical Divers
By Heather McCloskey
In the 1960’s, dry cave explorers in the UK became the first “sidemount divers” when they began clipping scuba cylinders to their caving harnesses as a means to cross sumps, or water-filled cave passages. Over the past 50 years, countless divers and equipment manufacturers have developed and refined sidemount diving and configurations through trial and error.
Today we see many technical divers in sidemount configuration and it remains especially popular with cave divers. There are clearly countless benefits of sidemount for technical diving, but did you know many of them cross over to recreational diving as well? Yep, that’s right: sidemount is not just for technical divers. In fact, I believe that everyone could benefit greatly from a technical sidemount course, even if they do not have an interest in technical diving.
Here’s why everyone should try sidemount diving:
STRENGTHEN DIVING FUNDAMENTALS & KNOWLEDGE
I think it is important to constantly learn new things. If you’re looking for a course with the potential to truly challenge you, reframe the way you think about diving, and improve your fundamental skills tenfold, look no further than a technical sidemount course.
In addition to teaching you how to safely dive in a new configuration, a technical sidemount course is like boot camp for your diving fundamentals: buoyancy, trim, and propulsion.
Even if you have good buoyancy control going into the course, a good instructor will push you to fine tune it even further. This will force you to extend your awareness and control of where you are in the water at all times, even when being distracted by problems.
You’ll work on propulsion techniques and likely focus more on how you’re kicking than you ever have before. Your instructor will help you perfect your frog kicks and helicopter turns, show you how to backfin effectively, and teach you special techniques for silty areas. After your sidemount course, you’ll know how to move through the water more gracefully and efficiently than you thought possible.
Furthermore, you’ll think about trim more than ever before and you’ll start to see how seemingly small things like the weight of your regulators and the buoyancy profile of your fins have huge impacts on a diver’s natural trim and you’ll learn how to effectively compensate for these things.
COMFORT & STREAMLINING
In sidemount, cylinders are mounted at your sides under your arms rather than on your back, giving you a much more streamlined profile. Even with two cylinders, propelling yourself through the water and maintaining proper trim feels much easier in sidemount than in single tank backmount.
If you have back or shoulder problems, you’ll likely find sidemount more comfortable in general because it allows more flexibility in those areas and the bulk of the weight is not on your spine.
During a proper sidemount course, you and your instructor will spend a lot of time adjusting your sidemount system to fit and function just right. You’ll also spend time trying to get properly trimmed and adjusting trim weight placement as needed. This part of the process may feel frustrating to some, but as soon as your system, weights, and trim are all right where they need to be you will realize it was well worth the trouble. When done properly, sidemount is an incredibly comfortable configuration to dive in.
REDUNDANCY & LESS RELIANCE ON BUDDY
One of the biggest benefits of sidemount is it offers true redundancy in case of a gas or regulator failure. When diving with two tanks in sidemount configuration you have two completely independent cylinders, first stages, and second stages. If one of these points fails, you have a backup.
In a proper sidemount course with a qualified instructor you will learn how to independently solve various equipment problems that could come up while diving. This training and configuration makes you more safe, more self-sufficient and less reliant on a buddy. Self-sufficiency is especially beneficial if you travel without a regular dive buddy and find yourself buddied up with strangers often. I’ll address more benefits of self-sufficiency, specifically solo-diver training, in a future post.
MORE GAS = LONGER DIVES
If you’re an air hog, or simply enjoy making long dives, sidemount configuration is a great way to carry more gas with you while staying streamlined. While diving twinset would be another way to have more gas, you may not be able to find twinset tanks at every single diving destination you visit. Another benefit of sidemount is that you do not need to hunt down special tanks to dive in sidemount configuration.
SIDEMOUNT TRAINING PREPARES YOU FOR THE FUTURE
If you don’t have interest in tech diving right now, that’s perfectly fine. However, training and experience diving in sidemount configuration will help you gain confidence and leave you well-prepared for any technical training that you may want to do in the future. And it may be just the thing that convinces you to try technical diving after all. 😉
To find out more about International Training, visit www.tdisdi.com.
Skills Workshop: Hovering Neutrally Buoyant
By Mark Lewis
I’ve recently been coaching some divers on ways to improve their neutral buoyancy hover when in the water. A common thing I’ve seen is a diver maintaining their buoyancy by finning. There are many reasons why this may happen, including weighting, kit setup, etc.
After eliminating all of the other more common reasons, I’ve found it sometimes comes down to the students not being comfortable in their dry suits or simply not understanding how it works.
Sometimes dry suit training doesn’t incorporate everything that it should, as it often gets combined with other training courses and appears to predominantly centre on resolving inversions rather than focusing on air migration.
What is air migration?
Simply put, it’s utilizing the air in your dry suit to balance (trim) you in the water, allowing you to maintain a neutrally buoyant hover in the water column.
To teach air migration, I use a skill where I take a student into shallow waters (maybe six metres) and get them comfortable on a training platform with handholds on it, so that if they do have a problem, they can hold onto the platform initially whilst they get used to the skill. Then, we remove our fins and focus on our hovering.
Fins provide propulsion, so without them on, a diver’s senses are heightened, and they notice immediately when things don’t feel right, allowing them to compensate with the air in their suit rather than with their fins.
The reason I choose to do this with no fins is that it helps them focus on the air migration in the suit, without compensating by finning, thus allowing the diver to focus on their breathing and their dry suit as their means of buoyancy. In order to maintain the neutrality of their position once they have the right balance of air in their suit, the diver can continually adjust by controlling their breathing.
How long should this drill last?
I’ve found that in an hour’s session, maybe the first twenty minutes are tough, with a lot of corrections and adjustments… and then in most cases, it clicks, and the diver can maintain their position without much effort. Once they’ve attained this skill of hovering, other tasks and skills become more achievable.
Bring in the fins
Then, when they put their fins back on, it simplifies everything, and suddenly the diver has a new perspective on neutral buoyancy hovering. This ultimately makes them a safer diver and improves their competency.
I will add that this is not a skill required within any course that I teach, but something I do occasionally in a skills workshop to help divers progress. In my experience, it works, but if you’re going to try it, ensure that you have an understanding buddy who is happy to keep an eye out for you.
To find out more about International Training, visit www.tdisdi.com.
Win a Mares Magnetic Connector BCD Accessory!!!
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WIN an XDEEP Radical Frameless Mask!!!
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