Join Richard Cullen from Deptherapy for part 5 of his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

After an evening of chilling out by the pool and in the bar, we are back to the Roots House Reef this morning, with Keiron continuing his RAID Master Rescue Diver Course and enjoying Moudi’s vast experience as he learns more about advanced buoyancy skills.

Not sure where the week has gone; it’s Wednesday already.  A few different things happening today… Oatsie who has just started at Hull University on a Marine Biology Degree Course wants to complete his sidemount course and this afternoon he is out with Guy Henderson to start his learning.  Swars also wants to do the course, as he wants to get into cavern and cave diving.  Swars will start his course tomorrow afternoon and both will spend a day being taught be Steve Rattle on Friday. Hopefully they will both be certified as RAID Sidmount Divers at the end of their training.

Tom putting his sidemount rig together under Guy’s watchful eye

The morning sees Swars and I working with Corey again and taking him through the remainder of skills and OW dives.  He is improving massively but we still have to work on trim and propulsion.

Keiron, unfortunately for him, has Oatsie and Michael for his diver recovery exercises; I am told there may well be an entanglement to deal with!

Conditions are perfect again as we all look forward to three great dives during the day.

90% of those we work with have mental health issues, mainly Post Traumatic Stress Disorder as a result of serving in various theatres of war.  If you read some adaptive teaching manuals, they have a task to ‘teach a student with PTSD a skill.’ Hmmmmm how is Oatsie, Swars, Michael or Keiron any different than a student who is free from any mental illness?  The answer is they are not, they are exactly the same. Do you talk to them differently, do you demonstrate skills differently?  The answer is no.

If they have a flashback or a panic attack, then you need to step back and provide whatever assistance is necessary but only if there is a risk of them hurting themselves.  All our team have to undertake and pass the two-day Mental Health First Aid (MHFA) course so we can intervene appropriately where the circumstances require it.

Do you know what a panic attack looks like?  Do you know how to respond to a panic attack?

Flashbacks most frequently occur at night time but some do experience day time flashbacks.  Flashbacks can lead to the individual feeling physically and mentally drained and can be triggered by anything that reminds them of the traumatic incident(s) they experienced.  Sometimes there might be a need for one of our medical team to be involved. Often a period of quietness, rest and possibly sleep is required.

Keiron and Corey on the House Reef

We have seen lots of our beneficiaries learn to manage their PTSD. As Chris Middleton said on a BBC programme:

“You can’t beat PTSD but you can learn to manage it.”

In addition to the scuba diving, Deptherapy also provides 24/7 support for our beneficiaries.  Beneficiaries are encouraged to attend the MHFA course with their partner, parent, relative or friend.

Many will have read comments from our beneficiaries, that once they put their heads under the water their demons disappear.  There are several factors to this: the peace, the quiet and the tranquillity that occurs underwater, the beauty of the corals and the amazing aquatic life.

Roots is very much like a retreat for us, we are miles away from any towns, there are no distractions, the nearest town is El Quseir, which is orthodox Muslim so there is no alcohol on sale.  The recent bypass of the main Safaga to El Quesir/Marsa Alam road means that at night time there is no noise, just a brilliant star lit sky.

Roots at night from the beach

Beneficiaries are encouraged to talk openly with the team and their fellow beneficiaries about their injuries/illnesses and provide overwhelming support for each other as Corey found on this trip.

Our aim is to create a family atmosphere and Roots very much contributes to the sense of family and wellbeing.

Sadly, we live in a world where those with mental illnesses are largely discriminated against.  Because few understand mental health, they are fearful of it and try to ignore it.  Please look at the Mind website or even better sign up to a Mental Health First Aid Course.  If you run a business then run the course for your staff, the benefits will be massive.

Back to the diving, Michael and Tom under Moudi’s close supervision gave Keiron some very challenging diver recovery exercises.  Poor Keiron, but he responded tremendously.

Swars, is working well with Corey, ensuring horizontal trim and making sure he uses effective arm strokes for his swimming. We are organising an SMB session, so he can work with different types of SMBs.

Although we haven’t told him, he has finished all his skills but we still have work to do on his trim and propulsion.  We want him to go beyond standards, we want him to be a very competent diver, who despite his devastating injuries, can self-rescue and support a buddy if in need.

The afternoon dive sees Michael joining myself and Swars with Corey.  This dive is about buoyancy, trim and propulsion.  Keiron is doing some more advanced buoyancy work with Moudi.

All roads lead to Roots, is this the future of Google maps?

Oatsie had a great dive with Guy using sidemounts and is looking forward to completing the sidemount course with Swars and Steve Rattle on Friday.

In the evening, and before dinner, Moudi runs the RAID O2 Administrator Course for all five beneficiaries. It is a qualifying part of Keiron’s RAID Master Rescue Diver course but we decided it would benefit all of the guys.

Tomorrow we have decided to take Corey to 30 metres and for him to complete a narcosis test. Join us back here tomorrow to find out how we get on…

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

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