PADI Rescue guide

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This document is an important component of the PADI Rescue Diver course instructional system. Use this guide with the Rescue Diver Manual, Lesson Guides, Video, Exam and Cue Cards when teaching Rescue Diver courses.

padi.com Rescue Diver Course Instructor Guide

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PADI Rescue Diver Course Instructor Guide © International PADI, Inc. 1989, 1990, 1991, 1998, 1999, 2000, 2002 All rights reserved. Portions of the Appendix of this section may be reproduced by PADI Members for use in PADI-sanctioned training, but not for resale or personal gain. No other reproduction is allowed without the express written permission of PADI. Published by INTERNATIONAL PADI, INC. 30151 Tomas Street Rancho Santa Margarita, CA 92688-2125 Printed in U.S.A. Product No. 79120 ii

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padi.com How to Use This Guide

Table of Contents How to Use This Guide

v

One Course Standards and Overview Course Philosophy

1-1

Course Standards

1-2

Key Standards

1-3

Course Overview

1-4

Referral Procedure

1-5

Two Knowledge Development One — Course Overview, Self-Rescue, and Diver Stress

2-2

Two — Diving First Aid

2-9

Three — Emergency Management

2-26

Four — Equipment Considerations

2-31

Five — Review and Exam

2-40

Three Open Water Training Exercise 1 — Tired Diver

3-2

Exercise 2 — Panicked Diver

3-4

Exercise 3 — Response from Shore/Boat (Conscious Victim)

3-5

Exercise 4 — Distressed Diver Under Water

3-7

Exercise 5 — Missing Diver

3-8

Exercise 6 — Surfacing the Unconscious Diver

3-9

Exercise 7 — Unconscious Diver at the Surface

3-10

Exercise 8 — Egress with an Unconscious Diver

3-12

Exercise 9 — First Aid for Pressure-Related Accidents

3-13

Exercise 10 — Response from Shore/Boat (Unconscious Victim)

3-14

Exercise 11 — Diving Accident Scenario One (Underwater Search)

3-15

Exercise 12 — Diving-Accident Scenario Two (Response, Egress and Management)

3-16

Appendix Open Water Diver Course Instructor Guide

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How to Use This Guide

How e s U to This e d i u G

Rescue Diver Course Instructor Guide Open Water Diver Course Instructor Guide

This guide contains three sections, each of which explores a different aspect of the PADI Rescue Diver Course. To use this guide most effectively, you should be familiar with the contents of each section. The following synopsis describes where to find specific standards, sequencing, recommendations and other information you need to conduct rescue diver training. All required standards, activities and performance requirements for the Rescue Diver course appear in blue boldface print. The blue boldface assists you in easily identifying those requirements that must be adhered to when you conduct PADI Rescue Diver courses. Items not in boldface are recommendations for your information or consideration. This clearly separates training requirements from supporting rationale, general recommendations and how-to information. This guide speaks to you, the PADI Instructor. Although PADI Divemasters and Assistant Instructors also use this guide, references to “you” generally mean “PADI Instructor.” If this is the first time you have used this guide, please begin by thoroughly reading section One: Course Standards and Overview. v

Section One Course Standards and Overview This first section lists the PADI Rescue Diver course requirements and deals with general considerations for course conduct. Here you will find: •

Course prerequisites and requirements

•

Training and equipment considerations

•

Course structure

•

Referral procedures

•

Key course standards

vi

Section Two Knowledge Development This section details how to guide student divers in selfdirected learning and how to enhance that learning with instructor-led knowledge development sessions. The section includes subsections that list the knowledge development topics and session objectives. The Presentation Notes, which make up the bulk of each subsection, serve as presentation outlines that support the Rescue Diver Lesson Guides. Material in this section corresponds to information presented in the PADI Rescue Diver Manual and may be used to supplement student diver understanding.

Section Three Open Water Training The 12 exercises outlined in this section form the foundation for dive emergency management. Student divers first learn and then master rescue skills during open water training (although you may choose to initially introduce some skills in confined water.) Because there are many important concepts to remember, this section gives you step-by-step instructions, objectives and presentation notes for conducting each exercise. For practical purposes, much of the key information contained in this section is also included on the PADI Rescue Diver Cue Cards. How to Use This Guide

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Course Goals

Course Philosophy

•

Expand diver knowledge in preparation for PADI leadership training.

•

Teach effective diver rescue and first aid skills.

•

Prepare divers to manage realistic rescue situations.

•

Increase awareness of dive safety.

•

Encourage divers to anticipate and prevent problems.

The PADI Rescue Diver course philosophy is that there is rarely only one way to accomplish a task. There is no “right” way to perform a rescue, but rather many options from which rescuers draw depending on the scenario. The course takes a flexible, conceptual approach to performing rescues — a rescuer’s relative size and strength, for example, as well as environmental factors dictate what rescue technique may be most effective. Rescue training exercises provide for individual differences and capabilities while encouraging divers to experiment with alternate techniques. Student divers learn to first think about the options available for handling an emergency, ciation al Asso tors n then to act using the best io s s Profe ing Instruc method for the situation. of Div

Rescue Diver Course Instructor Guide

1-1

Course Standards Course Prerequisites To qualify for PADI Rescue Diver training, an individual must: 1. Be certified as a PADI Advanced Open Water Diver or have a qualifying certification from another training organization. This is defined as proof of certification beyond entry level (at least two certifications total), and proof of 20 or more logged dives documenting experience in deep diving and underwater navigation. 2. Be 12 years of age or older. Note: Divers under the age of 15 may obtain a PADI Junior Rescue Diver certification. The Junior Rescue Diver certification card carries the requirement that the individual must dive with a certified adult.

CPR Requirement To be certified as a PADI Rescue Diver, the student diver must have successfully completed a sanctioned course in CPR within the past two years (24 months). The Emergency First Response Primary Care (CPR) course is highly recommended and can be used to meet this requirement. Emergency First Response is a basic training program in CPR and emergency care.

Training Considerations and Supervision Student divers must meet all Rescue Diver course skill performance requirements at an open water dive site that represents typical local dive conditions. Divers must complete all 12 training exercises during a minimum of five open water sessions conducted over at least two days. If possible, use a variety of training locations to represent the different types of dive environments found in the local area. For example, if boat diving is popular, then conduct at 1-2

least one session from a boat. It is recommended that you introduce, and have student divers practice, some of the more complex skills at a confined water site before progressing to open water. The maximum studentto-instructor ratio for open water activities is 8:1, with four additional student divers allowed per certified assistant. Use assistants as necessary to provide adequate supervision and realistic rescue scenarios.

Logging Dives Divers may log each of the five open water sessions as a dive. These dives may be applied toward the minimum logged dive requirements for PADI Divemaster and instructor certifications.

Equipment For open water training exercises, you must have a first aid kit and oxygen available (if legally permitted in the local area) as described in Section Two of the PADI Rescue Diver Manual. Additionally, you must have all equipment necessary to complete each training exercise, such as pocket masks, lines, floats, marker buoys and various other pieces of equipment as described in Section Three of the manual. Each diver must use proper equipment for the dive environment. This includes, but is not limited to: fins, mask, snorkel, cylinder, regulator, alternate air source, buoyancy control device (BCD) with low pressure inflator, weight system, appropriate exposure suit for the environment, timing device and depth gauge (or dive computer), compass, knife/dive tool (unless prohibited by local laws or regulations) and an emergency signaling device (whistle, flare, inflatable signal tube).

Training Materials The following materials are required when training PADI Rescue Divers: 1. PADI Rescue Diver Course Instructor Guide. 2. PADI Rescue Diver Manual and Diving Accident Management Workslate (if available in a language the diver understands). 3. PADI Rescue Diver Exam. One: Course Standards and Overview

The following materials are highly recommended:

mance on the PADI Rescue Diver Exam. Acceptable performance means that the diver scores 75 percent or better on the exam. If the diver scores less than 75 percent, then you must have the diver retest. In addition to scoring 75 percent or higher, the diver must understand all exam items. To accomplish this, review any missed questions with the diver until mastery is achieved. Have the student diver sign and date the exam statement to verify that you reviewed missed questions and that the diver understands the correct answers. It’s recommended, but not required, that you have divers initial missed questions in addition to signing the exam statement. You must keep a written record of the exam answer sheet in the diver’s permanent records (Student Record File).

NOTE: Junior divers, under the age of 15, must independently complete a written exam – an oral exam is not permitted. (The only exception is when junior divers have been diagnosed with a learning disability that affects their reading ability.)

•

PADI Rescue Diver Video

•

Rescue Diver Lesson Guides (digital, slide or paper versions)

•

Rescue Diver Cue Cards

•

Emergency First Response Participant Manual

•

The Encyclopedia of Recreational Diving Multimedia or book version

•

Recreational Dive Planner, table or The Wheel with appropriate Instruction for Use booklet

Knowledge Reviews Each chapter in the PADI Rescue Diver Manual ends with a Knowledge Review. Student divers must complete and turn in Knowledge Reviews. You must review any questions missed or left incomplete until the student diver understands them. After a thorough review, have the diver verify understanding by signing and dating the statement on each Knowledge Review. It’s recommended that you have divers initial missed questions in addition to signing the statement. You must keep a record of the completed and signed Knowledge Reviews in the diver’s permanent records (Student Record File).

Knowledge Assessment Prior to certification, the student diver must show mastery by demonstrating acceptable perfor-

Certification Procedures Any Teaching status PADI Instructor may conduct the PADI Rescue Diver course and certify PADI Rescue Divers. The certifying instructor obtains Rescue Diver certifications by submitting completed and signed PICs to the appropriate PADI Office. The instructor who conducts the student diver’s final open water training session is the certifying instructor. The certifying instructor must ensure that all certification requirements are met.

KEY STANDARDS Prerequisite certification: PADI Advanced Open Water Diver or qualifying certification Minimum age: 12 Recommended hours: 25 hours Minimum Open Water Training: 5 sessions over 2 days Student-Instructor ratio: 8:1 (4 additional students per certified assistant) Minimum instructor rating: Teaching status PADI Instructor Rescue Diver Course Instructor Guide

1-3

Course Overview Course Structure The curriculum for the PADI Rescue Diver course is performance-based. The amount of time required to complete the program is based upon class size, logistical considerations, student diver aptitude and performance. The course has two main components – knowledge development and open water training exercises. Knowledge development may occur through independent student study, instructor-led sessions or a combination of both. This flexibility permits you to accommodate a variety of student diver schedules. Open water training sessions consist of the 12 required course exercises. The following recommended sequence includes suggestions for grouping the individual exercises into open water sessions. Other arrangements are possible and may be required depending on diver performance and logistical considerations.

Course Sequence Session One

Session Three

Knowledge Development Topics: Introduction and Course Overview, Self Rescue, Diver Stress and Managing Diver Stress (PADI Rescue Diver Manual – Section One)

Knowledge Development Topics: Emergency Management (PADI Rescue Diver Manual – Section Three)

Review of open water skills: PADI Rescue Diver Manual – Section Five and Rescue Diver Video - exercises 1-4

Open Water – Exercise 7: Unconscious Diver at the Surface

Open Water – Exercises 1, 2, 3 and 4: Tired Diver, Panicked Diver, Response from Shore/Boat to a Conscious Diver, and Distressed Diver Underwater (overexertion and alternate air source ascents)

Session Two Knowledge Development Topics: First Aid Equipment and First Aid Procedures) (PADI Rescue Diver Manual – Section Two) Review of open water skills: PADI Rescue Diver Manual – Section Six and Rescue Diver Video - exercises 5-6 Open Water – Exercises 5 and 6: Missing Diver Procedures and Surfacing the Unconscious Diver

1-4

Review of open water skills: Rescue Diver Video - exercise 7

Session Four Knowledge Development Topics: Common Equipment Problems, Equipment Function, and Release Function and Problems (PADI Rescue Diver Manual – Section Four) Review of open water skills: Rescue Diver Video - exercises 8-10 Open Water – Exercises 8, 9 and 10: Egress with an Unconscious Diver, First Aid Procedures for Pressure-Related Accidents, and Response from Shore/ Boat to an Unconscious Diver

Session Five Review and Rescue Diver Exam Open Water – Exercises 11 and 12: Diving-Accident Scenarios

One: Course Standards and Overview

Referral Procedure The purpose of this procedure is to allow a student diver to complete a PADI Rescue Diver course with more than one PADI Instructor. A PADI Rescue Diver student may be referred to another PADI Instructor after any knowledge development session and/ or after any open water exercise. The student diver must complete the entire session or exercise to receive referral credit for that session or exercise. To refer a PADI Rescue Diver student, use the PADI Rescue Diver Course Training Documentation form found in the Appendix of this guide. This form, along with the diver’s completed Medical Statement, may be given directly to the diver to continue PADI Rescue Diver training with another PADI Instructor. A PADI Rescue Diver Course Training Documentation form is valid for 12 months from the last training segment completion date. Prior to conducting a Rescue Diver exercise for a referred student, a preassessment and the administrative requirements as outlined in PADI “General Standards and Procedures” must be completed (i.e. signed Medical Statement, Standard Safe Diving

Practices Statement of Understanding, and Liability Release and Assumption of Risk Agreement.) All PADI Instructors involved in the referral process, initial training or open water training, must retain a copy of the administrative paperwork, as well as the Rescue Diver Course Training Documentation form. When you receive a Rescue Diver referral student, you may check the status of PADI Instructors who previously signed off on the training documentation form by calling your PADI Office.

Step-By-Step Referral Procedures Summary 1. The instructor who conducts the student diver’s final open water training ensures that the diver has met all certification requirements and certifies the diver. 2. Use the PADI Rescue Diver Course Training Documentation form to verify completion of course requirements and keep the form in student diver’s file. 3. Complete a standard PADI PIC envelope and mail to your PADI Office to secure the student diver’s certification card.

Credit for Rescue Exercises 1 and 2 As part of the PADI Adventures in Diving program, a student diver may participate in an introduction to rescue diving skills. This skill introduction consists of Rescue Exercises 1 and 2 (Tired and Panicked Diver). The instructor who conducts these exercises issues a PADI Rescue Diver Course Training Documentation form with Exercises 1 and 2 signed off to the diver. To allow credit toward rescue diver course requirements, you must verify that the student diver successfully completed these exercises by reviewing the diver’s documentation form. At your discretion, you may credit the diver’s experience and continue with the remainder of the course. Treat this as you would any other referral. You may choose to incorporate a review of Rescue Exercises 1 and 2 skills into Exercise 3 (Response from Shore/Boat to a Conscious Victim) to assess student diver competence. Remediate diver skills as necessary. Rescue Diver Course Instructor Guide

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1-6

One: Course Standards and Overview

Two Knowledge Development stabourse e c r e v i D rgenRescue ve eme i I d D g A n P i l he d hand e as well as nt in t ing an t lopme s. e n scu e v e r e v e f d oblem sel ge r pr r d o e o f l f n s w e o o ajor pr i u t q m a Kn i d d n n n h the fou ar n tec with minor a lishes ivers le d ers t n e ud her div t o g cies. St n i st or assi those f

Development Options Knowledge Development for the PADI Rescue Diver course may be handled through independent study with the student diver using the PADI Rescue Diver Manual and Rescue Diver Video or it may include instructor-led sessions using this instructor guide and the Rescue Diver Lesson Guides. The recommended method for assessing student diver mastery is to use prescriptive teaching. Have the student divers begin by studying independently using the PADI Rescue Diver Manual and Video and completing the Knowledge Reviews in the manual. Schedule sessions to review the Knowledge Reviews. If student divers miss questions or need clarification, as indicated by the Knowledge Reviews, use the appropriate Rescue Diver Lesson Guides and instructor presentation notes to assure understanding. Rescue Diver Course Instructor Guide

Presentation Outlines and Lesson Guides This section is divided into five subsections. Each subsection includes the learning objectives for the topic written as questions, a presentation outline that may be used to cover the topic, and miniature copies of the Rescue Diver Lesson Guides that relate to the outline. The topic outlines were written for direct presentation to your student divers. However, you’ll want to customize the outline as necessary to meet diver needs and cover local dive information. You’ll find notes intended for you only set apart in brackets. Notes for emphasis to rescue diver students stand apart similarly, preceded by “Note to student diver.” on ssociati ional A Profess g Instructors of Divin

2-1

Knowledge Development

One Topic:

Course Overview, Self-Rescue, and Diver Stress

This first session sets the tone for the course and allows you to establish rapport with the student divers. It is important to be well-organized so that you can explain the course requirements clearly. Build enthusiasm during this session by explaining that the rescue diver program is different than other training divers may have experienced because it expands their awareness beyond themselves to assisting others. Emphasize that the course is challenging and deals with a serious subject, but is at the same time rewarding and fun. The first section of the PADI Rescue Diver Manual supports this topic. If possible, have student divers read the Introduction and Section One and complete the Knowledge Review before attending.

Presentation

PADI Rescue Diver Course

Overview and Learning Objectives I.

Welcome and Introductions

II. Course Overview

Rescue 1– 1

III. Self Rescue 1. What three areas of preparation increase your self rescue abilities?

Module One

2. What three dive procedures help prevent problems while diving?

● Course Overview ● Self Rescue

3. What should you do when you encounter a problem while diving?

● Diver Stress

4. What are four skills that increase your self rescue abilities?

IV.

Rescue 1– 2

Diver Stress 5. What are seven causes and examples of physical stress? 6. What are five causes of psychological stress? 7. What effects can stress produce in a diver? 8. What is perceptual narrowing? 9. What two steps do you apply to recognize stress in a diver? 10. What should you do when you recognize diver stress?

2-2

Two: Knowledge Development

Outline I. Welcome and Introductions A. Introductions [Introduce self and staff. Have student divers introduce themselves. Keep it light and relaxed.] B. Paperwork [Complete administrative requirements and any additional documentation necessary for the course.]

II. Course Overview Introduction ● Course Structure ▲ Independent Study ▲ Academic Sessions ✔ Final Exam

▲ Open Water Sessions ✔ 12 Exercises

▲ Performance Requirements ▲ Equipment Needs Rescue 1– 3

A. Course Structure — Similar to other PADI courses, the structure of the Rescue Diver program allows for maximum flexibility. 1. Independent Study — This is the most flexible way to develop knowledge. By studying the PADI Rescue Diver Manual and Rescue Diver Video, you’ll get the foundation you need to progress through the course. The text includes exercise questions that confirm your understanding and Knowledge Reviews at the end of each chapter to verify your mastery of the material. [Assign independent study topics. If these materials are not available in a language the divers understand, explain how they will gain knowledge.] 2. Academic Sessions [Explain how you will organize academic or review sessions, and provide schedule.] a. Final Exam — Prior to certification, you will take the Rescue Diver Exam. This test provides proof that you have grasped the concepts necessary to become a PADI Rescue Diver. The exam only covers topics you have either studied independently or discussed in class, so you will be well prepared for it. 3. Open Water Sessions [Explain how you will organize training sessions, and provide course schedule.] a. Practical application and skill development occur in the open water environment. [If any confined water sessions are planned, explain how skill practice in confined water leads to application in open water.] b. There are 12 exercises that will be completed during at least five open water sessions. The exercises introduce skills in a logical sequence and subsequent exercises build on previous ones. Exercises 11 and 12 are rescue scenarios that require you to draw from earlier sessions and apply skills to realistic situations.

Rescue Diver Course Instructor Guide

2-3

B. Performance Requirements 1. The PADI Rescue Diver course philosophy is that there is no single “right” way to perform a rescue. Because people differ in their physical abilities and attributes, and dive environments can present unique challenges, rescue divers must adapt techniques to suit the situation. a. Each phase of the course has specific performance requirements that must be met, however, how you meet those goals may differ from the methods your classmates use. The end result is the same – everyone is able to perform an effective rescue. b. The study objectives and skills overview in sections Five and Six of the PADI Rescue Diver Manual, define what you will accomplish in open water. The Rescue Diver Video shows various techniques used to meet the skill performance requirements for the course. By reviewing these before an open water session, you will be better prepared to practice the skills. 2. Prior to certification, you must have completed an Emergency First Response Primary Care (CPR) course or another CPR course within the past two years. [If you are conducting an Emergency First Response course in conjunction with this course, explain the schedule. If not, explain the options student divers have for meeting this requirement.] C. Equipment Needs [Discuss diver equipment requirements and other logistical information. Answer student diver questions regarding the course.]

III.

Self Rescue ● How can you increase self

Self-Rescue

rescue ability?

▲

A. What three areas of preparation increase your self rescue abilities?

Preparation

Mental Physical

1. Physical preparation involves proper health, fitness and diet. Being in good shape prepares you to deal with increased physical demands should the need arise.

Equipment

Rescue 1– 4

2. Mental preparation involves confidence and a feeling of well-being about the dive. 3. Equipment preparation involves familiarity with use, inspection, recommended service and emergency accessories. a. Knowing what equipment you have available and how it works prepares you to quickly respond should a problem arise. 2-4

Two: Knowledge Development

b. A few emergency accessories that may help you get noticed in a rescue situation include power whistles, small emergency strobes, flares, dye markers and inflatable signal tubes. Inflatable tubes are especially helpful if you find yourself drifting away from a boat. The height of the inflated tube above the surface makes you much more visible. These items can fit into a BCD pocket for easy access. B. What three dive procedures help prevent problems while diving?

Self Rescue ● Self rescue ability...

1. Regular equipment maintenance lessens the chance of malfunctions and a thorough predive inspection allows you to catch potential equipment problems early.

▲ Prevention ✔ Maintain Equipment ✔ Anticipate ✔ Recognize

2. Often just realizing that a problem could occur allows you to avoid it. Anticipate what problems may arise and devise your dive plan to avoid them.

Rescue 1– 5

3. If you can recognize that a problem is occurring or is about to occur, you’ll be able to take early action. Recognition of problems is essential to self rescue ability. C. Performance – If you need to initiate a self rescue, you’ll need to be able to take the proper action. 1. What should you do when you encounter a problem while diving?

Self Rescue ● Self rescue ability... ▲ Performance

a. Stop all activity.

STOP

THINK

b. Think of possible actions.

BREATHE

ACT

c. Reestablish normal breathing patterns.

Rescue 1– 6

d. Take logical action rather than thoughtless reaction. 2. Visualize problems and proper responses to help you make the right choices quickly. 3. Practice emergency procedures often to keep skills sharp. Self Rescue Skills ● What skills increase self rescue ability? ▲ Buoyancy Control ▲ Airway Control ▲ Cramp Removal ▲ Handling Air Depletion ▲ Dealing with Vertigo ▲ Handling Nausea Under Water

D. What skills increase your self rescue abilities (name at least four)? 1. Good buoyancy control will help you avoid struggling to maintain your position either at the surface or underwater. It also helps you stay off the bottom, protecting both you and the aquatic life.

Rescue 1– 7

2. Proper airway control allows you to breathe past small amounts of water in your regulator or snorkel, thus avoiding choking. 3. Proficiency at cramp removal means that this minor discomfort is quickly relieved, which may stop it from becoming a bigger problem. Rescue Diver Course Instructor Guide

2-5

4. Handling air-depletion is something you practiced in your entry level course. To handle an out-of-air emergency without buddy assistance, consider having an independent alternate air source such as a pony bottle or self contained ascent bottle. 5. Vertigo is an unpleasant experience. Knowing how to reestablish orientation by grasping a stationary object is an important self rescue skill. 6. Vertigo or extreme water movement may cause nausea underwater for some divers. Being prepared to control your actions and calmly remove yourself from the situation will allow you to handle bouts of nausea.

IV.

Diver Stress A. What are the primary ingredients of diver stress? 1. Stress is defined as physical or mental tension that results in physical, chemical or emotional changes in the body. Stress can induce both positive or negative reactions. For example, stress allows you to gear up to participate in a race or causes you to freeze when confronted with something frightening.

Diver Stress and Anxiety ● What are the primary ingredients of diver stress?

▲ Stress = physical or mental tension ▲

resulting in physical, chemical or emotional changes in the body Primary ingredients

Initial Cause

Diver’s Disposition

Dealing with Stress

Rescue 1– 8 1

2. The primary ingredients, or flow, include: a. Initial cause – an incident, thought, image, etc. b. Divers disposition – whether the cause is viewed as positive, negative or insignificant. c. How the stress is dealt with. B. What are seven causes and examples of physical stress? Diver Stress and Anxiety 1. Divers sometimes fail to recognize the effects of ● What causes diver stress? physical discomfort. Even minor annoyances can Psychological Physical physical stress cold cause stress and if left uncorrected, can lead to more beliefs or attitudes seasickness task loading nitrogen narcosis peer pressure fatigue serious problems. perception of risk illness injury alcohol or drugs 2. Causes and examples of physical stress include: ill-fitted equipment a. Cold b. Seasickness c. Nitrogen narcosis d. Fatigue e. Illness f. Injury g. Alcohol or drugs h. Discomfort or impaired function caused by ill-fitted or malfunctioning equipment Rescue 1– 9

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Two: Knowledge Development

C. What are five causes of psychological stress? 1. Psychological stress results when divers perceive a “threat” to their safety or well being. 2. Possible causes of psychological threat include: a. Physical stress b. Individual beliefs and attitudes c. Task loading d. Peer pressure e. Perception that risk is greater than normal 3. Psychological stress stimulus can be either real or imagined. However, the stress that results is very real to the diver experiencing it.

Diver Stress and Anxiety ● What effects can diver stress produce?

D. What effects can stress produce in a diver? [Have student divers reference the Stress Management Chart in their PADI Rescue Diver Manual.] 1. When a problem arises, the diver feels stress.

Problem

Stress

Recognition

Stop Think Breathe

Action =

Solution

Reponse Panic Anxiety Reaction

Rescue Required

Rescue 1– 1 0

2. Stress evokes a physical and psychological response. 3. Depending on the diver’s disposition, the stress can either cause anxiety or cause the diver to recognize the problem and begin formulating a plan to correct it. 4. If the diver’s anxiety increases and the diver takes no corrective action, stress will increase. Left unchecked, this may cause the diver to react impulsively. 5. If the diver’s reaction does not solve the problem, this could lead to panic and the need for rescue. 6. However, if the diver stops, thinks, controls respiration and then takes corrective action, the problem is resolved. E. What is perceptual narrowing?

Diver Stress and Anxiety

PANIC (perceptual narrowing)

Active Mask off Regulator/snorkel out Grabbing Struggling Bolting Rescue 1– 1 1

Passive Frozen Trancelike Unaware

1. When the body prepares for emergency action, it releases adrenaline. This causes an increased breathing rate which results in decreased breathing efficiency. This may feel like suffocation to the diver, which can lead to panic. 2. A diver who panics may experience perceptual narrowing – a decrease in awareness. The diver may either actively or passively react: a. Active — mask off, regulator/snorkel out, grabbing, struggling or bolting b. Passive — frozen, trancelike, unaware or unresponsive

Rescue Diver Course Instructor Guide

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F. Recognizing Stress and Anxiety What two steps do you apply to recognize stress in a diver?

Recognizing Stress & Anxiety ● How can you recognize stress in a diver?

▲ Observe behavior

1. As a rescue diver, you’ll want to hone your observational skills. This includes being able to recognize stress in yourself, as well as in other divers.

— look for changes

▲ Verify meaning of behavior

Rescue 1– 1 2

2. Signs of stress can be subtle or they may be overt. You’ll want to be alert for behavioral changes, especially when a diver’s actions appear inappropriate or abnormal. 3. Because you may not always know the other divers (for example on a dive boat) or because changes in behavior may not be due to stress, you always want to verify the meaning of the behavior. a. Accomplish this by asking the diver about what you’ve observed. b. Be careful not to put undue pressure on the diver or make the individual feel uncomfortable. This may cause or add stress. G. Stress Management What should you do when you recognize diver stress? 1. When stress begins to cause anxiety, it’s important to break the cycle of stress response before it leads to more severe problems.

Stress Management ● What should you do when you recognize diver stress?

▲ Encourage solution thinking ✔ ✔ ✔ ✔

2. You do this by encouraging the diver to apply solution thinking. This includes four steps:

Recognize problem Formulate a plan Implement plan Eliminate/minimize problem

▲ Avoid sounding judgmental or

a. Problem recognition — through observation and questions you can help the diver recognize the cause of stress

applying peer pressure Rescue 1– 1 3

b. Plan of action formulated — by discussing the problem, encourage the diver to think analytically and form a plan. c. Plan successfully implemented — allow the diver to act on the plan and offer assistance if necessary. d. Problem minimized or eliminated — effective action leads to a solution and prevention of a more serious problem. 3. It’s critical that you, the Rescue Diver, avoid sounding judgmental or applying peer pressure.

Summary

Module One ● Course Overview ● Self Rescue ● Diver Stress

Summary [Answer student diver questions. Review Knowledge Review (if you haven’t already done so.) Assign independent study for next session.] 2-8

Review Knowledge Review Rescue 1– 1 4

Two: Knowledge Development

Knowledge Development

Two Topic:

Diving First Aid

This session reviews first aid procedures and equipment that apply to recreational scuba diving. If you are conducting an Emergency First Response program in conjunction with the PADI Rescue Diver course, it is recommended that you conduct it either immediately before or after this session. Explain to student divers that the CPR (cardiopulmonary resuscitation) discussion within this course is not a substitute for formal training, however the emergency care concepts are based on the same medical standards used to develop the Emergency First Response course. This session covers a good deal of material, so it is strongly suggested that student divers read Section Two of the PADI Rescue Diver Manual and complete the Knowledge Review before attending. If possible have a first aid kit, oxygen unit, mannequin and other emergency equipment available to show as examples during this session. Encourage students to maintain a dive first aid kit consistent with the list in their PADI Rescue Diver Manual. Urge students to continue their education in this area by taking more advanced courses in both diving and emergency care.

Presentation Overview and Learning Objectives I.

First Aid Equipment

Module Two

1. What supplies belong in a well-stocked first aid kit and how are they used?

● First Aid Equipment

2. What are three uses for a pocket mask?

● First Aid Procedures

3. What are the three primary types of emergency oxygen systems and which one is recommended for use by rescue divers?

Rescue 2– 1

4. What are two uses for backboards?

II.

First Aid Procedures 5. What are the eight steps for conducting a primary assessment? 6. What is meant by “Basic Life Support (BLS)”? 7. How does time affect Basic Life Support? 8. What are the two methods used to establish an open airway? 9. How do you check for breathing with an open airway?

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10. What are the proper steps and procedures used for administering mouth-to-pocket mask and mouth-tomouth rescue breathing? 11. How do you find the carotid pulse? 12. Where do you put your hands and how do you position yourself for delivering CPR? 13. At what rate and ratio do you give rescue breaths and chest compressions during CPR?

• Obstructed Airway 14. How do you remove something from an unresponsive and a responsive patient’s airway with abdominal thrusts?

• Bleeding 15. How do you tell the difference between arterial and venous bleeding? 16. What is the first step you should take to control severe bleeding? 17. What is a “pressure point”? 18. How does depth affect blood’s apparent color?

• Shock 19. What are the seven signs and symptoms of shock? 20. What is the procedure for treating shock?

• Secondary Assessment 21. What is the procedure for conducting a secondary assessment on a responsive, ill or injured patient? 22. How do you immobilize a suspected neck or back injury?

• Thermal Problems 23. What are the differences between heat exhaustion and heat stroke and how do you treat each? 24. What are seven signs and symptoms of hypothermia? 25. What is the proper procedure for rewarming a patient with hypothermia?

• Aquatic Life Injuries 26. What are three forms of aquatic life injuries? 27. What five signs and symptoms indicate venomous aquatic life injuries? 28. What are common local treatments for aquatic life injuries? 2-10

Two: Knowledge Development

• Near Drowning 29. What is the difference between “drowning” and “near drowning”? 30. What is the primary first aid for a near drowning accident?

• Decompression Illness 31. What is meant by decompression illness? 32. What is the most common cause of lung overexpansion injuries? 33. What are the differences between air embolism, mediastinal emphysema, subcutaneous emphysema and pneumothorax? 34. What are the typical differences between air embolism and decompression sickness? 35. What first aid steps should you take for a patient with decompression illness? 36. How do you administer oxygen to a breathing patient and to a nonbreathing patient? 37. Why should a decompression illness patient remain lying down?

Outline I.

First Aid Equipment

belong in a well-stocked first aid kit and how are they used?

A. What supplies belong in a well-stocked first aid kit and how are they used? [If possible, have a complete first aid kit available for student divers to examine. Review list of recommended items provided in the PADI Rescue Diver Manual.]

(See PADI Rescue Diver Manual)

B. What are three uses for a pocket mask?

First Aid Equipment ● What supplies

Rescue 2– 2

First Aid Equipment ● What are the advantages of using

1. Pocket masks are designed to make resuscitation easier and more effective. The soft air-filled rim allows it to seal on a variety of different faces and the one way breathing valve reduces worry about disease transmission.

a pocket mask?

▲ Seal allows both mouth ▲ ▲

and nose ventilations in and out of the water Eliminates direct contact Oxygen connection allows delivery of partially oxygenated air to nonbreathing patient

2. A pocket mask is advantageous in a rescue situation because it:

Rescue 2– 3

a. Seals around the nose and mouth which aids in keeping water out of the patient’s airway during an inwater rescue. b. Eliminates direct contact between patient and rescuer.

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c. May be connected to an oxygen delivery system. For a breathing patient it acts as an oxygen mask. For a nonbreathing patient, partially oxygenated air is delivered during rescue breathing. [Explain to student divers that they’ll have the opportunity to use a pocket mask during the open water exercises. Encourage divers to obtain a pocket mask for their personal dive kits.] C. Research and case studies show that administering oxygen is one of the single most important first aid steps for a diver suspected of suffering from decompression sickness, lung overexpansion injuries or near drowning. Prompt use of oxygen can make a significant difference. This is why having oxygen at a dive site or on a dive boat is so strongly encouraged. D. What are the three primary types of emergency oxygen systems and which one is recommended for use by rescue divers?

Administering oxygen to a diver suspected of suffering from decompression illness or near drowning is an important first aid step Rescue 2– 4

First Aid Equipment ● What types of oxygen delivery

1. The three main types of oxygen delivery units available include positive pressure or power resuscitation, continuous flow and nonresuscitator demand valve.

systems are available and which one is recommended for use by rescue divers?

▲ Positive pressure resuscitator ✔ Requires professional training and certification Rescue 2– 5

2. To use a positive pressure unit you must have professional training and certification. If used improperly, these units can injure patients. This is why use is reserved for emergency medical professionals. 3. Continuous flow units deliver oxygen continuously by releasing a steady flow. Although these units are helpful in treating dive emergencies, they aren’t ideal. a. The primary drawback is that they don’t deliver 100 percent oxygen to the patient because the oxygen mixes with air before the patient breathes it. This results in a lower percentage of delivered oxygen and is somewhat wasteful.

First Aid Equipment ● Oxygen delivery systems... ▲

Continuous flow

✔ ✔

▲

Can’t deliver 100% oxygen Useful with pocket mask

Nonresuscitator demand valve

✔ ✔ ✔

Delivers nearly 100% oxygen Also may deliver continuous flow Highly recommended for diving emergencies

Rescue 2– 6

b. Continuous flow can, however, be used with a pocket mask during rescue breathing to deliver more oxygen to the patient. 4. Nonresuscitator demand valve units are the best choice for rescue divers to have and use for dive emergencies. a. These units have demand-type regulators much like scuba regulators which means that the patient receives close to 100 percent oxygen with every breath. 2-12

Two: Knowledge Development

b. Most demand valve units also have multifunction regulators that can be adjusted to deliver a continuous flow of oxygen. This allows use with a nonbreathing patient receiving rescue breaths through a pocket mask. c. Due to their efficiency and flexible use, it’s highly recommended that nonresuscitator demand valve units be available to use for dive emergencies. E. How do you determine how much oxygen to carry? Determine oxygen supply based on distance to emergency medical care. ● Carry as much as possible

● Check local

1. You should have enough oxygen available to keep the patient on pure oxygen until emergency medical personnel arrive. 2. When diving in remote locations, this may not always be possible, however, you should carry as much oxygen as you can. [Discuss options, if applicable to situations student divers are likely to encounter.]

regulations Rescue 2– 7

3. If traveling, be sure to check the local regulations regarding carrying oxygen and administering it to patients. F. What are two uses for backboards? First Aid Equipment ● How can you use a backboard? ▲

Immobilize patient – rigid support for back/neck injuries

▲ ▲

Stretcher for transport May be commercial or makeshift

1. Backboards or tilt boards provide rigid support under a patient with a suspected back or neck injury. We’ll discuss the importance of immobilizing patients with potential spinal cord injuries in a few minutes when we cover first aid procedures.

O2

2. For any patient that is incapacitated or must lie down, a backboard may also serve as a stretcher. This allows for easier handling and transport of the patient.

Rescue 2– 8

3. Although commercial backboards are available, other objects may be used if necessary. Surfboards, doors, tables, etc. can serve as makeshift backboards in an emergency.

II.

First Aid Procedures A. What are the eight steps for conducting a primary assessment?

First Aid Procedures ● What are the steps for conducting a primary assessment? Assess situation

Shock Bleeding Rescue 2– 9

Responsiveness

Circle of Care Pulse

Call for help

Airway Breathing

1. In the event of an accident or sudden illness, it is necessary to know what to do, act quickly, and attend to the patient using the correct priority of action. 2 Conducting a primary assessment is recommended in all life-threatening situations. Primary assessment is an initial prioritized check for serious conditions that may occur in an injured or ill person.

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3. Steps include: a. Assess the situation – look for hazards that may cause further harm to you or the patient b. Establish responsiveness c. Call for help if the patient does not respond d. Establish an airway e. Check for breathing – if the patient is not breathing, start rescue breaths f. Check for circulation (heartbeat) – if the patient has no heartbeat, begin CPR g. Check for bleeding – if the patient is breathing and has a heartbeat, determine if there is any serious bleeding that must be controlled h. Manage shock – the previous steps are part of shock management 4. Continue with the monitor the ABCD’S of the patient’s lifeline until a medical professional takes over. B. What is meant by “Basic Life Support (BLS)”? 1. Basic Life Support (BLS) includes emergency procedures designed to treat failure of the respiratory or cardiovascular system. Failure of either system results in no oxygen to the body. a. BLS means manually breathing for the nonbreathing patient using mouth-to-pocket mask, mouth-to-mouth or other ventilation methods.

First Aid Procedures ● What is Basic Life Support (BLS)? ▲ If nonbreathing = ventilation ▲ If no pulse = artificial circulation ▲ Ventilations + circulation = CPR

Time is critical! Rescue 2– 1 0

b. For a patient with no heartbeat, it means providing artificial circulation through chest compressions. c. If both ventilations and artificial circulation are required the combined technique is called cardiopulmonary resuscitation (CPR). 2. How does time affect Basic Life Support? a. BLS should begin as soon as the need is recognized because time is critical. Without oxygen, brain damage can occur in four to six minutes. After six minutes, brain damage is likely and after 10 minutes it is almost certain. 3. Whenever BLS procedures are used, the local Emergency Medical Service (EMS) system should be activated. C. Rescue Breathing [If possible, demonstrate techniques on a mannequin.] 2-14

Two: Knowledge Development

First Aid Procedures ● How do you open an airway,

1. What are the two methods used to establish an open airway?

check for breathing and administer rescue breathing?

a. If a patient is not responsive during a primary assessment you should establish an open airway.

▲ Jaw thrust or head tilt/chin lift

▲ Look, listen and feel ▲ Two full breaths then

b. The jaw thrust method is accomplished by lifting the patient’s jaw, thus moving the tongue away from the back of the throat. This technique is preferred when neck/back injuries are suspected.

one every 5 seconds Rescue 2– 1 1

c. The head tilt/chin lift method is accomplished by tilting the patient’s head back so that the chin is pointing straight up. With a gentle lift of the chin, the patient’s tongue moves out of the way opening the airway. This technique is effective in or out of the water thus making its use common for dive scenarios. 2. How do you check for breathing with an open airway? a. In general, you don’t want to ventilate a patient who is breathing, so it’s important to check carefully. The “look, listen and feel” method is used after establishing an open airway. b. Look for the rise and fall of the patient’s chest. c. Listen for breathing by placing your ear near the patient’s mouth. d. Feel for exhaled breath on your ear and face. 3. What are the proper steps and procedures used for administering mouth-to-pocket mask and mouth-to-mouth rescue breathing? a. Once you determine the patient is not breathing, begin ventilations or rescue breathing immediately. Start by giving two full breaths and continue with one breath every five seconds. b. If using a pocket mask, position it over the patient’s nose and mouth and hold it in place while you blow through the tube.

First Aid Procedures ● What is the proper position for delivering CPR?

▲ No pulse detected ▲

during primary assessment Trace along rib cage to find proper hand position on breastbone

Rescue 2– 1 2

c. If performing mouth-to-mouth ventilations, pinch the patient’s nose closed while making a seal over the mouth and delivering a breath. D. Artificial Circulation [If possible, demonstrate techniques on a mannequin.] 1. As discussed, BLS may include artificial circulation for a patient with no heartbeat. Because it’s difficult to feel for a pulse in the water and near impossible to deliver effec-

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tive chest compressions without a solid surface, CPR cannot begin until the patient is out of the water. 2. How do you find the carotid pulse? a. Checking for a pulse follows checking for breathing during a primary assessment. Usually, it’s best to check for a pulse at the carotid artery - the large blood vessel that goes from the heart to the brain. b. After delivering two full rescue breaths, put three fingers on the patient’s larynx and slide them toward one side of the patient’s throat. Using light pressure, you should feel a pulse in the groove between the larynx and neck muscle. c. If not, try the other side of the patient’s throat. Hold this position for several seconds to be sure. d. If you detect no pulse, chest compressions are necessary. Note to student divers — Never practice CPR on a person with a heartbeat. This interferes with normal heart functions. 3. Where do you put your hands and how do you position yourself for delivering CPR? a. For effective delivery of chest compressions, it’s important to properly place your hands and body. Because you’ll switch between giving breaths and chest compressions, you’ll need to practice positioning and repositioning yourself. b. To find the proper position: 1. Start by kneeling next to the patient, with your knees against his rib cage. 2. Trace your fingers along the inside of his rib cage toward the center of the chest up to the breastbone. 3. Measure a couple of fingers up from this spot, toward the patient’s head, and place the heel of your other hand on the breastbone. 4. Place the hand that found the breastbone on top of the other hand and move over the patient so that your shoulders are directly over the breastbone. 5. Apply chest compressions by pressing downward. 2-16

Two: Knowledge Development

First Aid Procedures ● What is the ratio of rescue breaths to compressions during CPR?

▲ ▲

Give 15 compressions followed by 2 rescue breaths Continue until pulse returns, medical personnel or another person takes over, or you’re physically unable to continue

Rescue 2– 1 3

4. At what rate and ratio do you give rescue breaths and chest compressions during CPR? a. The proper rate for chest compressions is 100 per minute b. The ratio of chest compressions to rescue breaths is 15:2 5. Continue with CPR until: a. The patient’s heartbeat returns b. You are relieved by another qualified individual c. You are physically unable to continue 6. If the patient revives, continue primary assessment, treat for shock and transport to a medical facility. E. Obstructed Airway

First Aid Procedures ● How do you remove an obstruction from a patient’s airway? Abdominal thrusts for unresponsive patient

Rescue 2– 1 4

Abdominal thrusts for responsive patient

1. How do you remove something from an unresponsive and a responsive patient’s airway with abdominal thrusts? a. In an unresponsive patient, you may discover an airway obstruction when you attempt to deliver rescue breaths. A conscious patient will indicate an obstructed airway by signalling choking. b. In either case, abdominal thrusts are the preferred method for clearing the airway. Abdominal thrusts compress air in the lungs which exerts pressure on the lodged object expelling it. c. In an unresponsive patient: 1. If no air enters during rescue breathing, reposition the head tilt/chin lift or jaw thrust and try another rescue breath. If air still does not enter, assume an obstructed airway. 2. Straddle the patient just below the hips and place the heel of one hand against the abdomen – below the rib cage and just above the navel. 3. Place your other hand on top of that hand and give five inward and upward thrusts. 4. If the obstruction pops free, stop thrusting. If not, grasp the patient’s tongue and jaw and sweep the patient’s mouth and throat in a hooking motion with your fingers to clear the obstruction. 5. Repeat rescue breaths, abdominal thrusts and mouth sweeps as necessary.

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d. In a responsive patient who is choking (getting no air): 1. Position yourself behind the patient with your arms wrapped around his waist. 2. Make a fist and place the thumb side against the patient’s abdomen – below the rib cage and just above the navel. 3. Put your other hand on your fist and quickly thrust inward and upward. 4. Repeat as necessary to clear the obstruction. Note to student divers — Never practice abdominal thrusts on a person who doesn’t have an obstructed airway. F. Bleeding 1. The human body can compensate for some blood loss, however excessive bleeding diminishes the supply of oxygen reaching tissues. Controlling severe bleeding is critical to sustaining life. This is why this step comes after ensuring breathing and circulation. 2. How do you tell the difference between arterial and venous bleeding?

First Aid Procedures ● What steps should you take to control severe bleeding?

▲ Arterial vs. venous bleeding ▲ Protect yourself with barriers ✔ ✔

Apply direct pressure with dressing Use a pressure point

Underwater, blood looks brown or green Rescue 2– 1 5

a. Arterial bleeding involves injury to a vessel leading from the heart. It is characterized by bright red blood, usually shooting from the wound in spurts. b. Venous bleeding involves injury to a vessel leading from the body tissue. It is characterized by dark red blood that flows steadily from wound. Note to student divers: CAUTION — Contact with or handling blood or body fluids may be hazardous to your health. Wear latex gloves and use barriers. 3. What is the first step you should take to control severe bleeding? a. After conducting a primary assessment and discovering severe bleeding, the first step is to apply direct pressure on the wound. b. Use a sterile dressing if possible, however don’t hesitate — use whatever is available. c. Once a dressing is applied, do not remove it. Apply additional dressings on top of saturated ones, if necessary. 2-18

Two: Knowledge Development

4. What is a “pressure point”? a. If direct pressure does not arrest bleeding from an arm or leg, use pressure points. b. Pressure points are areas where an artery lies close to the skin and over bone. This allows you to restrict blood flow by applying pressure. [Demonstrate pressure points.] 5. How does depth affect blood’s apparent color? a. Recognizing bleeding underwater is not always easy because blood appears brownish in shallow water and green at depths below 9 metres/30 feet. G. Shock First Aid Procedures ● What are the signs and symptoms of shock? Sign (observed)

Labored breathing Pale, clammy skin Rapid, weak pulse Vomiting Confused and restless

Symptom

1. Shock is a state in which profound depression of vital body processes occurs. Severe, sustained shock is a critical condition that can have permanent effects, even death.

(described)

Nauseous Thirsty Anxious

Rescue 2– 1 6

2. What are the seven signs and symptoms of shock? a. A sign: something you observe about the patient by looking, listening, feeling. A symptom: something the patient describes to you. b. Signs and symptoms of shock may include: 1. Shallow breathing, labored gasping, noisy inhalation/exhalation 2. Pale tissue color 3. Moist, clammy skin 4. Rapid, weak heartbeat 5. Restlessness and anxiety 6. Nausea, vomiting and thirst 7. Mental confusion 3. What is the procedure for treating shock?

First Aid Procedures ● How do you treat shock? ▲ ▲ ▲ ▲ ▲ ▲ ▲

Start with primary assessment Maintain body temperature Keep patient lying down Elevate legs if no head, neck, back or leg injury Circle Don’t give food or liquids of Seek medical aid Care Continue circle of care

Rescue 2– 1 7

a. Treatment for shock begins with primary assessment b. Maintain body temperature c. Keep patient lying down d. Elevate legs – except when head or chest injury, heart problem, stroke or fractures are present e. Give nothing by mouth f. Seek medical aid g. Continue monitor the ABCD’S of the patient’s lifeline.

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H. Secondary Assessment Procedures First Aid Procedures ● What is a secondary assessment?

1. What is the procedure for conducting a secondary assessment on a responsive, ill or injured patient?

▲ Performed on a responsive patient after primary assessment:

a. A secondary assessment is performed on a responsive patient after a primary assessment determines that no life-threatening conditions exist. [Explain that learning how to conduct secondary assessments is part of the Emergency First Response Secondary Care (First Aid) course.]

✔ ✔ ✔ ✔ ✔

Activate emergency medical system Don’t move patient unless necessary Assess from head to toe Administer first aid for injuries Maintain circle of care

Rescue 2– 1 8

b. Follow these guidelines for a secondary assessment: 1. If necessary, give bystanders the information to activate the Emergency Medical Service system. 2. Keep the patient in the position in which he was found and ask him not to move unless it is absolutely necessary. 3. Examine the patient from head to toe. Ask the patient to tell you if an area hurts when you touch it. Look for deformity, fluid, swelling or a reaction to pain. 4. Begin first aid treatment of any injuries discovered during this assessment. 5. Closely monitor the ABCD’s of the patient’s lifeline until medical personnel arrive. 2. How do you immobilize a suspected neck or back injury?

First Aid Procedures ● How do you immobilize a suspected neck or back injury? Although neck and back injuries in diving are rare, they can occur from falls

a. If a neck injury is identified, discontinue the secondary assessment and immobilize the head/neck.

If movement is necessary, turn head and body as one unit.

1. Use a backboard, if available, or an improvised stretcher to immobilize the patient’s head and keep the patient still.

Rescue 2– 1 9

2. If nothing is available, hold the patient’s head in place until help arrives. b. If the patient must be moved, take care to turn the head and body as one unit. c. Although rare in diving, spinal injuries may occur from surf, rolling boats, or slippery rocks.

First Aid Procedures ● What is heat exhaustion? ▲ Cause – inadequate intake of fluids

I. Thermal Problems 1. What are the differences between heat exhaustion and heat stroke and how do you treat each? 2-20

to offset loss through perspiration

▲ Signs/symptoms – cool, clammy ▲

skin, nausea, dizziness, weakness or fainting, and rapid pulse Treatment – primary assessment, move to cool location, lie down and drink water

Rescue 2– 2 0

Two: Knowledge Development

a. Heat exhaustion occurs when intake of fluids is inadequate to compensate for losses as a result of perspiration. [Discuss what could lead to heat exhaustion in the local area.] b. Signs and symptoms include: 1. Cool and clammy skin, but body temperature may be normal 2. Nausea, dizziness, weakness and fainting 3. Rapid heartbeat c. Treatment for heat exhaustion includes: 1. Primary assessment 2. Move patient to cool location and remove exposure suit 3. Urge patient to lie down 4. If alert, have patient drink water 5. If body temperature remains elevated, transport to medical facility First Aid Procedures LIFE THREATENING THREATENING ● What is heat stroke? LIFE ▲ Body’s temperature control system stops working

▲ Signs/symptoms – hot, dry, flushed

▲

skin, no perspiration, high body temperature, strong then fading pulse, convulsions or unconsciousness Treatment – primary assessment, immediate cooling and emergency medical care

2. Heatstroke occurs when the body is subjected to more heat than it can handle and normal body cooling methods are disrupted. This is a life-threatening emergency. [Discuss what could lead to heat stroke in the local area.] a. Signs and symptoms include: 1. Hot, dry, flushed skin

Rescue 2– 2 1

2. Absence of perspiration, although some moisture may remain on skin from earlier perspiration 3. Body temperature may rise to 39°C/103°F or higher 4. Pulse rapid and strong at first, fades as patient becomes unresponsive 5. Sudden convulsions or unconsciousness may occur b. Treatment for heat stroke includes: 1. Primary assessment 2. Quickly lowering body temperature by removing patient from hot environment, removing exposure suit, covering with wet towels or placing in cold water First Aid Procedures ● What is hypothermia?

▲ Body’s core temperature drops ▲ Signs/symptoms – shivering,

▲

numbness, blueness, loss of coordination, weakness, confusion and unconsciousness Treatment – primary assessment, move to warm place, cover head and apply heat

Rescue 2– 2 2

3. Continue to monitor the patient’s lifeline. Monitor temperature and seek medical assistance.

37° C – 98.6°F

3. What are seven signs and symptoms of hypothermia? a. Hypothermia occurs when the body’s core temperature drops due to insufficient exposure insulation.

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[Discuss what could lead to hypothermia in the local area.] b. Signs and symptoms include: 1. Mild – shivering, numbness and blueness 2. Moderate to severe – lack of coordination, weakness, confusion and unconsciousness c. What is the proper procedure for rewarming a patient with hypothermia? 1. Primary assessment 2. If patient is alert, remove from cold environment; remove exposure suit and towel dry. Cover patient’s head, and add heat to the neck, armpits and groin. 3. Patients with severe signs must be treated in a hospital. Prevent further heat loss and handle carefully until medical personnel take over. J. Serious Aquatic Life Injuries 1. What are three forms of aquatic life injuries?

First Aid Procedures ● What are common aquatic

a. Bites

life injuries and how do you treat them?

b. Abrasions, cuts or punctures

▲ Bites ▲ Abrasions, cuts

c. Stings or venomous wounds

and punctures

▲ Stings and venomous wounds

2. What five signs and symptoms indicate venomous aquatic life injuries?

● In the local area... Rescue 2– 2 3

a. Venomous aquatic animals can cause a variety of problems for divers, although serious cases are rare. Injury signs and symptoms are specific to type of creature encountered, however in general they include: 1. Excruciating pain 2. Local swelling, inflammation or welts 3. Weakness, nausea, mental confusion and shock 4. Spreading numbness, paralysis and convulsions 5. Unconsciousness, respiratory or cardiac arrest 3. What are common local treatments for aquatic life injuries? [Review treatments specific to the local area] a. Primary assessment b. Remove any foreign objects – spines, tentacles, stingers, etc. 2-22

Two: Knowledge Development

c. Soak afflicted area in hot water (43-49°C/110-120°F) for at least 30 to 90 minutes d. If afflicted area is a limb, keep the limb below heart level e. Treat for shock f. Continue to monitor the patient’s lifeline and transport to medical assistance as soon as possible Note to student divers — Do not use unprotected hands to remove tentacle pieces or other stingers. Use forceps, other tools or irrigate the wound with water. K. Near Drowning First Aid Procedures ● What is the first aid for a near

1. What is the difference between “drowning” and “near drowning”?

drowning accident?

a. A drowning victim is someone who suffocates (or is asphyxiated) underwater and cannot be revived. Near drowning occurs when a diver suffers asphyxiation underwater, but is revived.

▲ Begin primary assessment ▲ If breathing, administer oxygen

▲ Always send revived patient to medical facility — even if patient appears fully recovered Rescue 2– 2 4

b. A near drowning victim may display coughing, shortness of breath, rapid breathing, cyanosis (blueness) of lips, convulsions, unconsciousness, cessation of breathing or cardiac arrest. c. Regardless of the length of submersion, begin emergency care immediately. 2. What is the primary first aid for a near drowning accident? a. Primary assessment b. If nonbreathing, begin rescue breaths c. If breathing, administer oxygen d. Treat for shock and continue to monitor the patient’s lifeline. e. Transport as soon as possible to nearest medical facility — even if the patient appears fully recovered. Note to student divers — Medical treatment after near drowning is important because water may have entered the patient’s lungs. If left untreated, it will eventually cause damage and interfere with the body’s ability to obtain oxygen. Complications could be fatal.

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L. Barotrauma (pressure injuries) 1. If a diver fails to equalize a body air space, either descending or ascending, complications and pressure injuries (barotrauma) may occur. 2. Forgetting to, or being unable to, add air to the ears, sinuses, mask or dry suit on descent may result in a squeeze. a. Dives can avoid squeezes by descending in a controlled manner and using proper equalization techniques to add air to body air spaces. [Briefly review equalization for the ears, sinuses, mask and dry suit, as appropriate.] b. Divers should also avoid diving when congested due to a cold or allergies. When using a dry suit, divers should conduct a predive equipment check to be certain their suit’s inflator mechanism is working. c. If you encounter a diver who is having trouble equalizing, encourage the diver to stop or ascend until he can equalize before continuing to descend. d. If you encounter a diver who is injured due to a squeeze, advise the diver to discontinue diving, provide first aid as necessary and encourage the diver to seek medical assistance. 3. If body air spaces, such as the ear and sinuses, do not equalize to the ambient pressure on ascent, a reverse squeeze or reverse block may occur. a. Expansion of trapped air could result in overexpansion injuries which can be serious. [Explain that you’ll discuss lung overexpansion injuries in the next topic.] b. To avoid barotrauma on ascent, divers should ascend slowly while breathing normally and avoid diving if congested. c. If you encounter a diver who is suffering from a reverse block, encourage the diver to stop or descend slightly to relieve pressure, then slowly work his way to the surface.

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Two: Knowledge Development

M. Decompression Illness 1. What is meant by decompression illness? The term decompression illness (DCI) encompasses both lung overexpansion injuries and decompression sickness (DCS).

a. As a rescue diver, you need to understand the differences between decompression sickness and lung overexpansion injuries. However, it is often difficult to distinguish between the two at an accident scene because the signs and symptoms are very similar.

● Signs/symptoms may overlap ● First aid is the same ● Diagnosis unimportant at scene — appropriate action is critical Rescue 2– 2 5

b. The term decompression illness is used to encompass both decompression sickness and lung overexpansion injuries. Since emergency procedures for handling both are the same, there is no need for a specific diagnosis. First Aid Procedures ● What is the most common cause

2. What is the most common cause of lung overexpansion injuries?

of lung overexpansion injuries?

a. Lung overexpansion injuries result from breath-holding during ascent while on scuba or when air is trapped in part of the lung during ascent.

▲ Breathhold or obstructions trapping air during panicked, out-of-air ascent

Check your air and your buddy’s air supply often while diving!

b. Proper breathing technique and being in good physical condition are key to avoiding problems. Also, monitoring air supply to avoid panicked out-of-air ascents is important.

Rescue 2– 2 6

First Aid Procedures ● Lung overexpansion injuries... Pneumothorax

Subcutaneous Emphysema

3. What are the differences between air embolism, mediastinal emphysema, subcutaneous emphysema and pneumothorax?

Air Embolism Mediastinal Emphysema Never, ever hold your breath while diving! Rescue 2– 2 7

a. Air embolism is the most serious lung overexpansion injury. It occurs when expanding air is forced into the blood vessels surrounding the lungs and bubbles travel through the blood stream. These bubbles may lodge in body tissue and block blood flow. Bubbles blocking blood flow to the brain cause symptoms similar to a stroke. b. Mediastinal emphysema occurs when expanding air gets lodged in the chest cavity between the lungs causing pain and breathing difficulty. c. Subcutaneous emphysema occurs when expanding air travels up under the skin around the neck and collar bone. d. Pneumothorax is a complete or partial collapse of the lung. This is caused when air that is forced into the chest cavity expands and puts pressure on the lungs.

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4. What are the typical differences between air embolism and decompression sickness? [Review “Comparison of Symptoms” chart in the Rescue Diver Manual and on lesson guide.]

First Aid Procedures ● What are the typical differences between air embolism and DCS? Embolism

5. What first aid steps should you take for a patient with decompression illness?

DCS

Onset

± 5 minutes

Delayed

Symptoms

Unconsciousness

Pain, fatigue

Location

One side of body

Both sides

Change

May improve with first aid

No change or worsening

Rescue 2– 2 8

a. Always begin with a primary assessment. b. Encourage a responsive patient to lie down and relax.

First Aid Procedures ● What is the first aid for DCI?

c. If possible, ask patient questions to complete the PADI Diving Accident Management Work Slate. [Review slate with student divers.] d. Have a breathing patient breathe oxygen. How do you administer oxygen to a breathing patient and to a nonbreathing patient? 1. If using a nonresuscitator demand valve unit, place the mask on the patient’s face and tell him to breathe normally. 2. If ventilating a nonbreathing patient with a pocket mask, hook oxygen to the inlet valve and set it for continuous flow.

▲

Begin primary assessment

▲

Encourage patient to lie down and relax

▲

Ask questions and document using PADI Diving Accident Management Work Slate

Circle of Care

Rescue 2– 2 9

First Aid Procedures ● First aid for DCI... ▲ Give breathing patient oxygen ▲ Protect patient from excess heat or cold

▲ Arrange for evacuation and medical care

▲ Keep patient lying down Rescue 2– 3 0

e. Protect the patient from excess heat or cold — manage shock. f. Arrange for emergency evacuation and medical care 6. Why should a decompression illness patient remain lying down? a. Field experience has shown that some patient’s symptoms have worsened significantly after sitting up. Note to student divers: Do not attempt to recompress a patient in the water. This can actually worsen the situation, delay medical care and jeopardize the safety of other divers.

Summary [Answer student diver questions. Review Knowledge Review (if you haven’t already done so.) Assign independent study for next session.]

Summary

Module Two ● First Aid Equipment ● First Aid Procedures Review Knowledge Review Rescue 2– 3 1

2-26

Two: Knowledge Development

Knowledge Development

Three Topic:

Emergency Management

This session discusses problem prevention, recognition and rescue management skills relevant to situations divers are likely to encounter at local dive sites. Stress the importance of rescuer readiness which includes establishing an emergency assistance plan. If possible, have sample plans available to show student divers. Explain that divers will get hands-on practice using this information during open water training sessions. Encourage student divers to keep their skills sharp by participating in rescue workshops or practice sessions after certification. It is recommended that student divers read Section Three of the PADI Rescue Diver Manual and complete the Knowledge Review before attending.

Presentation Overview and Learning Objectives I.

1. What can you do to be ready to manage an emergency?

Module Three ●

Readiness

●

Managing an Emergency

Readiness

2. What considerations and procedures are involved with forming a local emergency assistance plan?

II. Managing an Emergency

Rescue 3– 1

3. What are the two possible roles a Rescue Diver may have at a dive accident scene? 4. What are the basic steps for emergency management?

Outline I.

Readiness ● What can you do to be ready to

Readiness A. What can you do to be ready to manage an emergency?

manage an emergency?

▲

Rescuer readiness

✔ Physical fitness ✔ Training and practice

✔ Attitude

1. Preparation, or readiness, is key in handling emergencies quickly and efficiently. As a rescue diver, you need to consider your personal readiness to face a variety of challenges. This may include: a. Maintaining your overall physical fitness. Staying in shape ensures that you’ll have the stamina and strength to assist others, if necessary.

Rescue 3– 2

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b. Participating in continuous training and practice. Keeping your skills sharp allows you to perform them quickly and confidently when needed. c. Having the proper attitude. When you commit yourself to following safe diving practices and being aware of other divers, you are better prepared to handle emergencies as they arise. Mental rehearsal and visualization help ready you to act quickly and confidently. B. Equipment Readiness 1. In addition to first aid equipment and oxygen, there are other equipment items that may help you manage an emergency. [Review the list in Section Three of the PADI Rescue Diver Manual.] a. Depending on the location, number of divers and access to Emergency Medical Services (EMS), having some or all of these items available can help make you more efficient when faced with a rescue situation.

Readiness ● What can you do... ▲

Equipment

✔ ✔ ✔

Have items available Be resourceful Know how to use

• Binoculars • Rope • Compass • Flares • Whistle • Bullhorn • Radio

(See PADI Rescue Diver Manual for list) Rescue 3– 3

b. You may find that you can improvise or substitute items if necessary. For example, you can use a surfboard as a backboard. Be resourceful. c. Knowing how to use available equipment is just as important as having it there. If unsure, get training before you actually need it. C. Information Readiness 1. What considerations and procedures are involved with forming a local emergency assistance plan?

Readiness ● What can you do... ▲

a. For areas where Emergency Medical Services (EMS) are available, most people are familiar with emergency contact numbers – for example, 911. However, it’s a good idea to have local emergency numbers written down and easily accessible at the dive site. Your Diving Accident Management Work Slate may be used as a ready reference. [Discuss local contact information]

Information

✔ Local emergency contact ✔ Divers Alert Network (DAN) and Diving Emergency Services (DES)

✔ Have an Emergency Assistance Plan Rescue 3– 4

b. If the Divers Alert Network (DAN) or Diving Emergency Services (DES) provides consultation for your area, you should also have those numbers handy. 1. DAN is located at Duke University Medical Center - (919) 684-8111, Nonemergency number; (919) 684-2948. 2-28

Two: Knowledge Development

2. Diving Emergency Services (DES) — within Australia – 61-3-9563-1151 or 1-800-088-200; FAX 61-39563-1139. Outside Australia – 61-8-373-5312 c. Having an Emergency Assistance Plan is especially important when visiting a new dive site or diving in a remote location. [Explain to student divers that PADI Divemaster candidates are required to produce Emergency Assistance Plans for local dive sites. In preparation for moving on to the divemaster course, they can gain experience in producing plans now.]

II. Managing an Emergency ● What roles can a Rescue Diver play at an accident scene?

▲ Skilled rescue assistant

▲ Emergency manager

Managing an Emergency A. What are the two possible roles a Rescue Diver may have at a dive accident scene? 1. You never know when or where a dive accident may occur. For this reason, your role as a rescue diver may vary depending on who is at the scene and what resources are available. a. When a more qualified person is present, such as an instructor or divemaster, your role will most likely be that of a skilled rescue assistant.

Rescue 3– 5

b. If you are the most qualified diver present, then you may coordinate the rescue as an emergency manager.

Managing an Emergency ● What are the basic steps for emergency management?

▲ Anticipate ✔

Identification, prevention and preparation

▲ Assess the situation ✔ ✔ Rescue 3– 6

Consider victim, location and resources Flexibility is key

B. What are the basic steps for emergency management? 1. As discussed, readiness is key to dealing with emergencies. This includes anticipating what, where and when problems are most likely to occur, then devising plans to handle those situations. Identifying hazards can assist you in preventing problems or in better preparing to deal with those that do occur. 2. If faced with an emergency, the first step is to assess the situation. a. Follow the stop, breathe, think then act protocol. Stop and look at the situation — who is involved, where is it happening, what do you have available to assist you? Then, think about the best solution and get ready to act on your plan. b. Because every emergency is unique — you must be flexible and adapt to changing factors.

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3. The next step is to act on your plan. a. If you assume the role of emergency manager, then you need to take charge and quickly implement a plan of action.

Managing an Emergency ● Basic steps... ▲ Act on your plan ✔ Assist more qualified diver or take control

▲ Assign tasks – delegate ✔ Call for help, rescuers, observers,

b. If you are assisting a more qualified diver, carry out tasks as appropriate.

notetaker, account for other divers and control bystanders, etc. Rescue 3– 7

4. There are many tasks that do not require your personal attention. If possible, assign tasks or delegate responsibilities to other divers or bystanders as appropriate. Assignments may include: a. Calling for help b. Assisting other rescuers c. Observing the victim or directing inwater rescuers d. Notetaking e. Accounting for all those not involved in rescue f. Controlling bystanders 5. Attending to injuries is the next step after the patient is out of the water. a. As discussed, first aid begins with a primary assessment and continues with a secondary assessment if no life-threatening conditions are discovered.

Managing an Emergency ● Basic steps... Circle ▲ Attend to patient

✔ Conduct primary and secondary assessments

✔ Provide BLS and first aid

▲ Administrate — control the scene ✔ Coordinate activities and provide information to emergency services personnel Rescue 3– 8

b. In more serious accidents, you may need to provide Basic Life Support (BLS) and other primary care until relieved by medical personnel. 6. If sufficient help is available, a rescue diver’s best role may be to coordinate activities or administrate. This may include: a. Providing evacuation personnel with appropriate information regarding the patient and accident. The Diving Accident Management Work Slate was designed for this purpose. b. Obtaining contact information from all those involved in the rescue or who witnessed the accident. c. Make arrangements to contact patient’s family. d. Submit an incident report to local authorities, if appropriate.

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of Care

Two: Knowledge Development

7. You may need to arrange for evacuation of the patient in more serious dive accidents.

Managing an Emergency ● Basic steps... ▲ Arrange for evacuation

a. Even if you suspect that a patient will need hyperbaric treatment, it’s important to transport the diver to the closest medical facility. Dive accident patients require medical stabilization and support prior to and during chamber treatment.

✔ Transport to nearest medical facility ✔ If necessary, provide information about dive accident scene

▲

Special procedures for helicopter evacuation

Rescue 3– 9

b. If necessary, provide information about dive accident care so that medical personnel understand the nature of the injury/illness and requirements for care. 8. There are special procedures that must be followed when a helicopter evacuation is involved. [Have student divers follow along in their PADI Rescue Diver Manuals as you review these procedures] a. Direct communication between ground and helicopter is necessary. b. The helicopter pilot will direct boat/ground personnel regarding direction, speed, clearing, etc. c. Remove and secure objects that may interfere with helicopter. d. Prepare patient as directed - with personal floatation device, oxygen unit, etc. e. Do not touch or grab line/basket from helicopter until it touches the ground. f. Load the patient quickly. g. Never approach a helicopter from the rear. Always wait for directions from the helicopter pilot/ crew.

Summary [Answer student diver questions. Review Knowledge Review (if you haven’t already done so.) Assign independent study for next session.] Summary

Module Three ● Readiness ● Managing an Emergency Review Knowledge Review Rescue 3– 1 0

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Knowledge Development

Four Topic:

Equipment Considerations

This session familiarizes student divers with the basic function and design of various types of dive equipment. Discussions focus on possible problems that may occur as a result of equipment malfunction or improper use of equipment. If possible have a variety of dive equipment available for student divers to examine as you discuss problems and solutions. Emphasize the need for student divers to become familiar with as wide a range of equipment as possible. Encourage divers to seek the assistance of professional dive retailers when trying to acquaint themselves with new equipment. It is recommended that student divers read Section Four of the PADI Rescue Diver Manual and complete the Knowledge Review before attending.

Presentation Overview and Learning Objectives I.

Common Equipment Problems Module Four

1. What are six general causes of equipment-related problems? 2. What are the causes, effects and prevention of problems with masks, snorkels, fins, exposure suits, BCDs, weight systems and scuba units?

●

Common Equipment Problems

●

Equipment Function

●

Equipment Releases

Rescue 4– 1

II. Equipment Function 3. How does a regulator, tank, tank valve, alternate air source, submersible pressure gauge, and BCD low pressure inflator function? 4. How does each piece of equipment’s operation relate to the common problems associated with it?

III.

Equipment Releases 5. What are six types of releases commonly found in scuba systems and what problems may they have?

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Two: Knowledge Development

Outline I. Common Equipment Problems

● What usually causes equipment-related problems?

▲ Using unfamiliar equipment

▲ Ill-fitted equipment ▲ Substituting standard

Common Equipment Problems A. What are six general causes of equipment-related problems? 1. The problems divers have with equipment are usually caused by one of the following situations: [Provide local examples as appropriate.]

items with makeshift equipment

a. The diver uses unfamiliar equipment or uses specialized equipment without proper instruction and controlled practice.

Rescue 4– 2

b. The diver uses equipment that is too small, too large or just doesn’t fit properly. Or the diver uses the wrong equipment for the environment or type of dive. c. The diver attempts to substitute standard items with makeshift or homemade equipment. d. The diver lacks essential equipment and chooses to dive anyway.

Common Equipment Problems

● What causes problems... ▲ Lacking essential equipment ▲ Severely modifying

e. The diver modifies equipment to the point that it no longer functions as designed.

equipment Improper maintenance and inspection

▲

f. The diver fails to properly inspect, adjust and maintain the equipment.

Rescue 4– 3

Common Equipment Problems ● What are the causes, effects and prevention of equipment problems for the following items?

▲ ▲ ▲ ▲ ▲ Rescue 4– 4

Mask, snorkel and fins Exposure suit BCD Weight system Scuba unit

B. What are the causes, effects and prevention of problems with masks, snorkels, fins, exposure suits, BCDs, weight systems and scuba units? [Have student divers refer to the Common Problems List in the PADI Rescue Diver Manual. Supplement list with local examples and show equipment, as appropriate. Encourage divers to provide additional examples from their own experience or observations.] 1. Mask 2. Snorkel 3. Fins 4. Exposure suits 5. BCD 6. Weight system 7. Scuba unit

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II.

Equipment Function A. How does a regulator, tank, tank valve, alternate air source, submersible pressure gauge, and BCD low pressure inflator function? AND How does each piece of equipment’s operation relate to the common problems associated with it? 1. Being familiar with how various pieces of dive equipment work helps you to more easily recognize a malfunction or decline in function. This may allow you to act quickly should a minor equipment problem occur and to prevent a more serious problem altogether. We’ll look specifically at basic equipment function and potential operational problems. 2. For more information about dive equipment, consider enrolling in a PADI Equipment Specialist course, reviewing the dive equipment section of The Encyclopedia of Recreational Diving Multimedia or book, looking at dive equipment manufacturer catalogs, and seeking advice from dive professionals at PADI Dive Centers and Resorts. B. How does a scuba unit function? 1. A scuba unit consists of a tank and regulator. We’ll discuss tanks as well as various regulator attachments in a few minutes. For now, we’ll concentrate on the regulator first stage and second stage. a. A regulator first stage attaches to the tank valve and reduces tank pressure to an intermediate pressure. This low pressure air flows through the hoses to the second stage, low pressure inflator and alternate air source. The first stage also allows high pressure air to flow to the submersible pressure gauge.

Function and Problems ● How does a scuba unit function? ▲ ▲

Basic operation Mouthpiece

Definitions:

✔ Balanced From ✔ Fail-safe Tank ✔ Downstream Rescue 4– 5

Diaphragm

Downstream valve

b. The regulator second stage is the part from which you breathe. As you breathe in through the mouthpiece, a diaphragm moves inward, causing a valve to open which allows air to flow from the hose. When you exhale, the valve closes and your breath exits via the exhaust valve, bubbling into the water. [Use diagram to explain second stage function] 2. To fully understand regulator function, you need to know the following terms: 2-34

Two: Knowledge Development

a. Balanced refers to a regulator design in which breathing resistance is unaffected by tank pressure. b. Fail-safe means that a malfunctioning regulator has the tendency to free flow, rather than terminate air delivery. c. Downstream refers to a valve design in which the valve opens in the direction of the air flow. This goes along with the fail-safe feature. C. What may interfere with proper tank and tank valve function? Function and Problems ● What may interfere with proper tank and tank valve function?

▲

Tanks

✔ ✔ ✔

Corrosion Contamination Positioning

▲ ✔ ✔ ✔

Tank Valves Not open Reserve valve O-ring leak

1. You already know that scuba cylinders are either made of aluminum or steel and they hold compressed gas. 2. You also probably remember that there are two basic types of valves — K and J — and that regulators attach to the tank with a yoke screw or DIN fitting.

Rescue 4– 6

3. The most common problems with tanks include: a. Corrosion due to water or other particles entering the tank. Corrosion may cause structural weakness and excessive debris inside a tank can clog valves and regulators. b. Contamination occurs when poorly filtered or unfiltered gas is pumped into a scuba tank. Although rare, contaminated air can be hazardous and you need to be alert for it. c. Improper tank positioning or adjustment may cause problems both in and out of the water. Tanks that are not firmly secured to a BCD may slip and those that are positioned too high may hit the diver in the head. 4. The most common problems with tank valves include: a. Not opening the valve — Occasionally a diver will open a tank valve to check air supply, then close the valve or only partially close it. If the diver forgets to reopen the valve, he may begin the dive and immediately run “out of air” or have difficulty drawing enough air. b. Reserve valves — A J-valve must be positioned “up” to work as a reserve valve and the diver must be able to pull it down to access the reserve. If the valve is not positioned correctly or is accidently moved to the down position during a dive, the diver will not have the expected reserve. Proper use, as well as monitoring a submersible pressure gauge helps avoid J-valve problems. Rescue Diver Course Instructor Guide

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c. O-ring leaks — Worn, dirty, or dislodged o-rings may cause air to escape from the tank valve. A minor leak is an inconvenience, but a major leak could cause reduced air flow to the regulator or rapid loss of tank air. Careful predive inspection and regular valve maintenance helps avoid 0-ring problems. [Ask divers if they have observed other tank or tank valve problems and discuss these as appropriate.] D. What may interfere with proper regulator function? 1. All regulator hoses need to be inspected often for wear, particularly at the point of attachment. It’s best to replace hoses at the first sign of aging. a. Although uncommon, hoses can rupture if damaged or allowed to wear thin.

Function and Problems ● What may interfere with proper regulator function?

▲

Hoses

✔

▲

Rupture and configurations

Regulators

✔ ✔

Second stage problems First stage problems

Rescue 4– 7

1. A low-pressure hose rupture at the surface will usually flail about wildly. This is unlikely underwater, but extreme bubbling indicates a potential rupture. 2. A ruptured high-pressure hose does not flail due to the restricted orifice at the regulator first stage, but may be quite loud. b. When observing other divers, watch for hose configurations that may cause difficulties. Dangling hoses have entanglement potential. Regulator configurations that twist or sharply bend hoses may cause diver discomfort or decrease equipment efficiency. 2. Problems associated with scuba regulators are most often the result of poor maintenance and care. Salt and mineral deposits will reduce regulator efficiency or even prevent it from working properly. Always rinse your regulator thoroughly in freshwater and have it professionally serviced once a year or more often, if necessary. a. Problems with regulator second stages may include: 1. Free flowing caused by sand or debris preventing valves from sealing properly. 2. The exhaust valve sticking due to deposits or clogging with debris. 3. Water leaking in through a torn mouthpiece or diaphragm. b. Problems with regulator first stages may include: 2-36

Two: Knowledge Development

1. Free flowing due to improper valve seal caused by poor maintenance. 2. Malfunctions due to freezing in cold water caused by lack of, or inadequate environmental seals. [Ask divers if they have observed other regulator problems and discuss these as appropriate.] E. How do different alternate air sources function? Function and Problems ● How do different alternate air sources function?

▲

Redundant air tank

✔ Pony bottle ✔ Self-contained ascent bottle

▲

Alternate connected to primary tank

1. An alternate air source is now considered a standard piece of equipment by most divers. However, because there are a variety of alternate air sources available, features and configurations are not standardized. The two basic types include:

✔ Extra second stage ✔ Alternate inflator regulator

a. Those connected to a redundant air tank.

Rescue 4– 8

b. Those connected to the primary air tank. 2. Alternate air sources connected to a redundant air tank have the advantage of allowing a diver to rescue himself. These may include: a. A small, compact tank often referred to as a pony bottle. These tanks are secured to the diver’s main tank and have a separate regulator attached. b. Self-contained ascent bottles are miniature tanks with built-in regulators. These tanks provide a diver with the small amount of air necessary to reach the surface. 3. Alternate air sources that connect to the primary air tank are the most common type used by divers. a. Extra second stages (often called octopus regulators) allow an out-of-air diver to quickly find his buddy’s spare regulator. Longer hoses, common to most extra second stages, make ascents easier by providing the divers with maneuvering room. b. Second stages built into low-pressure BCD inflators (called alternate inflator regulators) also provide each diver with a regulator, however the donor typically switches to this alternate while providing his buddy with the primary regulator. Function and Problems ● How do you position an alternate air source? In triangle formed by chin and rib cage corners

F. How do you position an alternate air source? 1. Although alternate air source types and techniques used for sharing air differ among divers, there is general agreement on these three points:

Rescue 4– 9

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a. The second stage intended for use by the out-of-air diver should be clearly identified. b. The additional second stage should not be allowed to dangle when not in use. c. The alternate air source should be secured in plain view in the triangular area between the mouth and the lower corners of the rib cage. [Ask divers what types of alternate air sources they use. Discuss placement variations and techniques for use. Ask if they have observed alternate air source problems and discuss these as appropriate.] G. What may interfere with the proper function of a submersible pressure gauge (SPG)?

Function and Problems ● What may interfere with the

1. Divers have several types of submersible pressure gauges to choose from, including:

proper function of a submersible pressure gauge (SPG)?

▲ Mechanical, electronic and hoseless SPGs

a. Mechanical gauges, which have been around the longest, measure pressure by routing air through a flexible, coiled metal tube that is connected to the gauge needle. As the tube flexes, the needle registers the pressure.

✔ ✔ ✔ ✔

Connections and leakage Computer/battery failure Signal interference (hoseless type) Most common — failure to monitor

Rescue 4– 1 0

b. Electronic gauges are usually integrated into a dive computer. They use a transducer that measures electronic resistance as the air pressure changes. c. Hoseless pressure gauges combine the use of a pressure transducer with a transmitter that sends information to a dive computer on the diver’s wrist, thus eliminating the need for a hose. 2. Problems to watch for with SPGs include: a. Wear at the first stage connection or other spots along the hose. b. Leaking o-rings at either the first stage connection or where the hose connects to the gauge. c. With integrated electronic and hoseless gauges, computer or battery failure will cause you to lose all your dive data - including your current air supply. d. The most common problem is simply a diver’s failure to monitor the gauge. 3. Having your SPG serviced regularly and inspecting it carefully before a dive can help you avoid functional problems. However, it takes a proper attitude and following safe diving practices to avoid the most common problem. 2-38

Two: Knowledge Development

[Ask divers what types of SPGs they use and if they have observed any problems. Discuss these as appropriate.] H. What may interfere with the proper function of a buoyancy control device (BCD)? Function and Problems ● What may interfere with the

1. BCDs are designed to be sturdy and durable while functioning as tank holders and floatation devices. Because they are less complicated than other scuba equipment, they present relatively few problems. A few that do occur include:

proper function of a buoyancy control device (BCD)?

▲

BCDs

✔ Inflation ✔ Deflation ✔ Improper fit Rescue 4– 1 1

a. Inflation difficulties may include both overinflation and the inability to inflate. 1. Overinflation may be caused by the low pressure inflator getting stuck in the open position. At the surface, a rapidly filling BCD is an inconvenience, but underwater it could cause an uncontrolled ascent. It’s a good idea to practice disconnecting a low pressure inflator hose while in the water to quickly handle this problem should it occur. 2. A diver’s inability to inflate the BCD may be caused by difficulty locating the inflator mechanism or the diver’s lack of dexterity due to cold hands or gloves. 3. Occasionally, a BCD’s quick dumping mechanism may leak and release air that the diver needs to stay positively buoyant. If this happens the diver may need to drop his weights. b. Deflation problems may include a diver’s inability to locate the deflation mechanism or improper body positioning. c. It’s also important that a BCD fit the diver properly and provide enough lift. Improper fit can make it difficult for the diver to maintain a comfortable position on the surface. [Ask divers what types of BCDs they use and if they have observed any problems. Discuss these as appropriate.]

III. Equipment Releases ● Which releases are common in scuba equipment and what problems may they have?

▲ ▲ ▲ ▲ ▲ ▲

Quick release buckle Quick disconnect fasteners Touch fasteners Tank band releases Inflator quick connect Integrated weight releases

Rescue 4– 1 2

Equipment Releases A. What are six types of releases commonly found in scuba systems and what problems may they have? 1. Quick release buckles are common weight belt fasteners. Improper webbing alignment or not locking the buckle in position may cause a sudden release. 2. Quick disconnect fasteners are common on BCDs. Putting too much strain on one could cause it to release.

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3. Touch fasteners join fabrics together – the most common is Velcro™. Sand, lint and debris may cause these fasteners to be less reliable. 4. Tank band releases snug the webbing holding the tank in place. Improper threading or the nylon webbing stretching when wet may cause problems with these bands. 5. Low pressure inflator hoses are connected to BCDs via a quick disconnect mechanism. These connections are also used for dry suit hoses and air powered accessories. As discussed, knowing how to quickly disconnect them is important for dealing with overinflation problems. 6. Integrated weight releases allow a diver to quickly dump weights that are contained within BCD pouches or weight harnesses. Familiarity with operation is key to avoiding problems with these releases. [Ask divers if they have observed any problems with various releases and discuss these as appropriate.]

Summary [Answer student diver questions. Review Knowledge Review (if you haven’t already done so.) Assign independent study and review for next session.] Summary

Module Four ● Common Equipment Problems

● Equipment Function ● Equipment Releases Review Knowledge Review Rescue 4– 1 3

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Two: Knowledge Development

Knowledge Development

Five Topic:

Review and Exam

This last session provides an opportunity to review all course material and answer any remaining student diver questions before administering the Rescue Diver Exam. If you haven’t already gone over the Knowledge Reviews for Sections Five and Six of the PADI Rescue Diver Manual, do so during this session. One effective way to review material and spark discussion is to question divers about the scenarios at the start of each section of the Rescue Diver Manual. You may also present similar scenarios realistic to the local environment that require divers to apply what they’ve learned. You should also overview any remaining Rescue Exercises that divers need to complete. Again, encourage divers to apply what they’ve learned to actual dive circumstances. Use the PADI Rescue Diver Video to show divers the skills they will practice in open water. It is recommended that student divers read Section Five and Six of the PADI Rescue Diver Manual (if not previously assigned) and bring all their completed Knowledge Reviews to this session.

Module Five ● Questions? ● Knowledge Reviews

Presentation Overview

— Five and Six

● Rescue Diver Exam ● Exam Review

I.

Answer Student Diver Questions

II. Review Knowledge Reviews

Rescue 5– 1

III. Discuss Rescue Exercises Open Water Training Exercises 1 — Tired Diver 2 — Panicked Diver 3 — Response from Shore/Boat (Conscious Victim) 4 — Distressed Diver Under Water 5 — Missing Diver 6 — Surfacing an Unconscious Diver 7 — Unconscious Diver at the Surface Rescue 5– 2

Open Water Training Exercises 8 — Egress with and Unconscious Diver 9 — First Aid for Pressure-Related Accidents 10 — Response from Shore/Boat (Unconscious Victim) 11 — Scenario: Underwater Search 12 — Scenario: Response, Egress and Management

IV.

Administer Rescue Diver Exam

V.

Review Exam

Learning Objectives Student divers must show mastery of course material by demonstrating acceptable performance on the PADI Rescue Diver Exam. Any missed questions must be reviewed until mastery is achieved. [See Knowledge Assessment guidelines in Section One of this guide.]

Rescue 5– 3

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Two: Knowledge Development

Three Rescue Exercises first lls and i k g s t n n ini ergency manageTmhee 12 trainingue a r T r e t a resc ment. the em simple evelop apply d m s o e r r g f e d v s i e s an OpenateW ent d knowl progre tating r, stud during resusci ivers to duce

d rn as nw st intro , allow hey lea s, such In ope t n l l o i s i e k t s c u d to fir e e q x s i e those n s l n g i i p h h s c t e m ractice re d e co d in p r aid te a e o o n s i t e l m s t i m u o t e rc er for es o he exe r tows, llow th rk bett T e a o . v exercis r i w n e d e s t e s h a t w losoqu such a divers, in the rse phi techni o u t h m o i c s c i t skills, e c r h i u e v w q v ny scious techni scover cue Di uncon her ma DI Res vers di arious t i v A a d til P r d , t e e n c u h a i t lls cise un ract ber ue, b r p c e s m x g e e e r n i the ski m r h a c u Re r for m hin ea ques. D t situations. y to pe ills wit a techni k n s w e r e ” t c e i f h t n dif o “rig o prac them i ere is n tinue t h n t o t c a s r h t e phy is ments. ns. Div requir e e optio l e b c a n k a r wo r for m ing pe master

Training Considerations The Rescue Exercises are designed to challenge divers, yet present realistic scenarios that divers are likely to encounter at local dive sites. Although the nature and context is serious, the course should be enjoyable and build diver confidence. If possible, conduct Rescue Exercises between Knowledge Development sessions. (See Course Sequence in Section One of this guide.) This allows divers to more quickly apply what they’ve learned to skills practice and to relate open water experiences to subsequent knowledge development sessions. Use different open water dive sites, if possible, to give student divers experience in dealing with a variety of environmental conditions and logistical challenges. It’s a good Rescue Diver Course Instructor Guide

idea to conduct at least one open water session from a boat if boat diving is popular in the local area. You may choose to first introduce and have student divers practice some of the more complex skills in confined water. This will help make open water sessions more efficient and keep divers more comfortable, especially when dive conditions limit exposure time. When exercises require student divers to use different pieces of rescue equipment — pocket masks, first aid kits, oxygen units, etc. — organize practice so that all divers have adequate practice time. If necessary, have multiple pieces of equipment n available. sociatio s ional A rs Profess ing Instructo of Div

3-1

Supervision The maximum student diver-toinstructor ratio is 8:1, with four additional student divers allowed per certified assistant. Use certified assistants as appropriate for added control and realism. For example with larger classes, assistants can supervise teams of three or four divers while you work with another team. For small classes, assistants can act as victims or rescue assistants, as necessary, to meet the exercise performance requirements.

NOTE: The following Rescue Exercise performance requirements, procedures, and skill and technique practice information is duplicated on the PADI Rescue Diver Cue Cards. Using your cue cards during open water training sessions will help you introduce skills and verify that student divers meet performance requirements.

Rescue Exercise 1 Tired Diver Overview This exercise teaches student divers the correct procedures for responding to a distressed diver who, although still rational, needs assistance. Encourage divers to focus first on recognizing and assessing the problem, then on providing the necessary assistance.

Procedures 1.

2.

3.

4.

3-2

Position student divers wearing full scuba in water too deep to stand up in. Divide class into two groups (“victims” and “rescuers”). Reverse roles at the conclusion of each phase. Demonstrate and have class practice each phase of response as outlined. The nature of this exercise is more instructional than evaluative. Emphasize identification and solving of common problems more than development of full competence.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate the correct procedures for the following phases of response to a distressed (rational) diver: •

Approach

•

Evaluation

•

Making Contact

•

Calming the Victim

•

Assists and Transport

•

Equipment Removal

Three: Rescue Exercises in Open Water

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Approach a.

Proper surface swimming: head out of water, continuously watching victim. b. Speed of approach must be paced for rescuer to have sufficient energy upon arrival to victim.

2. Evaluation a.

Halt approach near, though out of reach of, the victim to assess victim’s mental state (rational or irrational). b. Note the location and type of BCD inflator. c. Attempt to talk victim through difficulty by providing commanding, clear and concise directions. (“Inflate your BCD!”)

3. Making Contact a. b.

Establish substantial personal buoyancy. Continue to approach from front while explaining what is being done or requesting that the victim take action. c. Use contact-support position to stabilize and reassure victim. d. Provide victim with positive buoyancy (use of low-pressure inflator preferred).

4. Calming the Victim a.

Continually reassure the victim through eye contact and by talking to him. b. If surface conditions are not adverse, allow victim to remove mask, regulator/snorkel and rest before resuming activity.

5. Assists and Transport a. b.

c. d.

Allow victim to do as much for himself as possible. Criteria for effective transport: • victim’s face above water • victim and rescuer positively buoyant • near horizontal • adequate control of victim • rescuer must be able to swim effectively • adequate communications and eye-to-eye contact Inwater cramp releases Review and discuss the following: • underarm push (one and two rescuers) • modified tired-swimmer carry • use of BCDs as swimming aids • tank-valve tow

6. Equipment Removal a.

Victims often do not discard their equipment due to impaired thought processes caused by stress. b. Practice removal of tank from victim to facilitate swimming. c. Practice use of rescuer’s BCD as an extension to victim. d. Practice procedure for removal of weights as appropriate. Rescue Diver Course Instructor Guide

3-3

Rescue Exercise 2 Panicked Diver Overview In this exercise, student divers learn to evaluate and respond to a panicked diver. While applying techniques practiced in the previous exercise, divers should focus on safely making contact with an irrational diver and assisting the diver as necessary. Encourage realism, but caution divers about not demonstrating extreme physical panic.

Procedures 1.

Position student divers wearing full scuba in water too deep to stand in.

2.

Divide class into two groups (“victims” and “rescuers”). Reverse roles at conclusion of each phase.

3.

Demonstrate and have class practice each phase of response as outlined.

4.

5.

Nature of exercise is to be more instructional than evaluative. Emphasize identification and solving of common problems more than development of full competence.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate the correct procedure for the following phases of response to a panicked (irrational) diver. •

Evaluation

•

Making Contact

•

Releases

Stress that dealing with a panicked victim is the most dangerous situation the rescuer will ever deal with, and therefore, great caution must be exercised.

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Evaluation a.

Halt approach near, though out of reach of the victim, to assess victim’s mental state (rational or irrational). b. Note the location and type of BCD inflator. c. Attempt to talk victim through difficulty by providing commanding, clear and concise directions (“Inflate your BCD!”). d. If victim is unresponsive, assume panic and treat accordingly.

2. Making Contact a.

3-4

Underwater approach • Approach from knee to ankle level (weights may be removed at this time). • Turn or swim around victim to attain a position from behind. Three: Rescue Exercises in Open Water

•

b.

Ascend maintaining contact, grasp tank valve and assume the “knee-cradle” position. • Inflate victim’s BCD. Surface approach • Attain substantial personal buoyancy. • Attempt to swim behind victim staying out of reach. • Grasp tank valve and assume the knee-cradle position. • Inflate victim’s BCD.

3. Releases a.

Attempt release from victim’s grasp by pushing up and away from victim. (Note that proper action is dictated by relative size of victim and rescuer.)

Rescue Exercise 3 Response from Shore/Boat (Conscious Victim) Overview This exercise guides student divers through the use of nonswimming and swimming assists to help a diver who is in trouble. Demonstrate and discuss the most effective methods to respond from the shore or a boat. Emphasize efficiency and build upon skills practiced in previous exercises.

Procedures 1.

Review entry considerations, egress, post attendance and nonswimming assist techniques from Section Five of the PADI Rescue Diver Manual.

2.

Divide class into two groups (“victims” and “rescuers”).

3.

Position victims in water 50-100 metres/yards from shore/boat (rescuers positioned on shore/ boat).

4.

Assign victims the role of either tired or panicked divers.

5.

Rescuers are to respond to victims (without scuba) and take appropriate action.

6.

Terminate exercise once victim is on shore/boat.

Performance Requirements By the end of this session, the diver will be able to: 1.

Demonstrate several procedures which may be useful in providing assistance to a diver in distress, including: • Nonswimming Assists • Entry Considerations • Egress with Conscious Victim • Post Attendance

2.

Demonstrate application of information and skills reviewed in Exercises One and Two.

Rescue Diver Course Instructor Guide

3-5

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Nonswimming Assists a.

Demonstrate and practice proper technique for throwing a line and retrieving a distressed diver approximately 9 metres/30 feet from shore/ boat. b. Discuss use of a stern or tag line trailed behind an anchored vessel as a rescue/assistance device. c. Demonstrate and practice using floats, such as rescue boards, life rings, etc., to provide assistance to a diver, without making physical contact. d. Demonstrate and practice using “makeshift” items such as BCDs, fender buoys, and other buoyant objects to provide assistance to the distressed diver.

2. Entry Considerations a.

Always respond with at least mask, fins, snorkel and some form of floatation. b. When and where to don equipment depends on circumstance. [Review considerations appropriate to training location.] c. To reduce swimming distance, always enter water at point nearest to victim. d. Never enter the water in a manner that obstructs your view of the victim.

3. Egress with a Conscious Diver a.

If exit is difficult, allow victim to rest in order to save energy for when it is needed most. b. If the victim is incapable of assisting himself, follow procedures for unconscious victim (covered in Exercise 8). c. Review techniques appropriate to specific training location.

4. Post Attendance a.

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Discuss considerations for handling the victim once out of the water.

Three: Rescue Exercises in Open Water

Rescue Exercise 4 Distressed Diver Under Water Overview This exercise switches the student diver’s focus from surface rescues to assisting a diver experiencing problems underwater. During skills practice, divers deal with overexertion and out-of-air situations. For most divers, this will be a review of skills learned in entry-level training. Emphasize that as rescue divers, they need to be able to recognize these problems quickly and respond appropriately.

Procedures

Performance Requirements

1.

Recommended depth is 9 metres/30 feet.

2.

Assign buddies roles as “victims” and “rescuers.”

3.

Victims to simulate distress/overexertion by breathing rapidly and appearing to be near exhaustion.

4.

At a distance appropriate for local conditions and visibility, the rescuer is to respond and take appropriate action to assist the victim in regaining control and proper breathing rhythm.

5.

Once victim is composed, he is to indicate, “out of air.”

6.

Rescuer is to execute an alternateair-source ascent with the victim.

By the end of this session, the diver will be able to: 1.

2.

Demonstrate proficiency in identifying and responding to a diver experiencing distress/overexertion while underwater. Demonstrate proficiency at conducting an alternate-air-source ascent (as donor) with a diver simulating an out-of-air situation.

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Dealing with Distress/Overexertion While Under Water. a. b. c. d.

Have victim stop all activity by demonstrating the hand signal stop. Maintain physical contact to support/provide tactile feedback to victim. Have victim reestablish normal breathing rhythm. If possible, place victim in contact with stationary object to facilitate resting.

2. Simulated Out-of-air Emergency. a.

Discuss proper procedures and options relating to: • which regulator to donate. • attachment of regulator. • approach to donor. b. Rescuer should ensure that the victim is calm and has reestablished normal breathing before initiating ascent. Rescue Diver Course Instructor Guide

3-7

Rescue Exercise 5 Missing Diver Overview During this exercise, student divers organize and conduct a search for a missing diver. It’s best to have divers look for an object, rather than an actual diver because a bubble trail may be too easy to spot. Review basic navigation with divers who need a refresher and provide a thorough orientation to search techniques for those with little or no previous experience.

Procedures

Performance Requirements

1.

Review missing diver procedures.

By the end of this session, the diver will be able to:

2.

Review search patterns and techniques appropriate for area.

3.

On shore, conduct a dry run of search pattern(s).

Demonstrate how to quickly and efficiently search for and locate a missing diver using an underwater search pattern prescribed by the instructor.

4.

In teams, conduct an underwater search for a simulated missing diver.

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Missing Diver Procedures a. Determine where the diver was last seen. b. Post spotters to watch for bubbles and to direct rescuers. c. Immediately dispatch two skin divers to mark the last known location and to begin the initial search (have marker buoys available). d. Determine if diver may have left area without informing anyone. e. When ready, dispatch scuba teams with equipment to initiate underwater search.

2. Underwater Search Techniques a. Establish a recall system to avoid delay once diver is found. b. Never subject searchers to undue danger from decompression sickness by allowing single-handed searching or by using inexperienced divers. c. Sink, do not swim, to the bottom in order to simulate how an unconscious diver might be affected by current. d. If only inexperienced or unqualified divers are present, conduct the search personally (with a buddy) rather than coordinating the activity. e. Terminate the search in 30 minutes if the victim is not found. Turn the search over to professionals. 3-8

Three: Rescue Exercises in Open Water

Rescue Exercise 6 Surfacing the Unconscious Diver Overview This exercise allows student divers to review and practice using controlled positive buoyancy during an ascent – first alone and then with a diver simulating unconsciousness. Emphasize proper positioning and control. Encourage divers to begin thinking about the next rescue step when they reach the surface.

Procedures 1.

Recommended depth is 7-9 metres/ 25-30 feet.

2.

Demonstrate the use of positive buoyancy as an ascent aid and allow student divers to practice.

3.

Demonstrate procedures and options for surfacing an unconscious diver.

4.

Have student divers practice several ascents attempting various options demonstrated to determine most preferred procedure.

5.

Remind “victims” who are simulating unconsciousness to continue normal breathing at all times.

Performance Requirements By the end of this session, the diver will be able to: 1.

Demonstrate the use of controlled positive buoyancy as an aid to ascent.

2.

Demonstrate how to bring an unconscious diver to the surface using buoyancy control of either victim or rescuer.

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Positive Buoyancy Ascents (without victim) a. b. c.

Demonstrate both mechanical and oral inflation. Be prepared to vent excess air at all times. Demonstrate how to slow ascent by flaring out, if necessary.

2. Surfacing an Unconscious Diver. a.

Upon discovering the victim, take note of the situation, but do not waste time. • Cause of accident obvious? • Equipment in place? • Position of victim relative to bottom (face down, floating off bottom, etc.) b. If regulator is in victim’s mouth, hold it in place during ascent. c. If regulator is not in victim’s mouth, don’t waste time trying to replace it. d. Grasp victim from behind or by tank valve and maintain head in a normal position. Rescue Diver Course Instructor Guide

3-9

e.

Establish positive buoyancy (victim or rescuer); weights may also be removed at this time. f. Do not hyperextend (pull back) the victim’s head or squeeze the chest. g. During the ascent, visualize what to do upon reaching the surface.

3. During Student Diver Practice: a. b. c.

Watch for correct and efficient positioning. Allow student divers to experiment with when, how and who jettisons his weights and inflates his BCD. Note and discuss how techniques may require change, if confronted with different equipment configurations.

Rescue Exercise 7 Unconscious Diver at the Surface Overview This exercise teaches student divers to prepare a nonbreathing diver for resuscitation and to use various methods of inwater resuscitation. Properly attending to an unconscious diver at the surface is a foundational skill for all rescue divers. Divers who progress to leadership-level courses are required to demonstrate proficiency at this skill. Consider introducing techniques in confined water then progressing to open water practice. Organize practice to avoid dropping or losing equipment. Encourage divers to experiment with various techniques and, if possible, to practice with victims who have different equipment configurations.

Procedures

Performance Requirements

1.

Conduct initial demonstration and practice in shallow water.

By the end of this session, the diver will be able to:

2.

Divide class into teams and assign “victims” and “rescuers.”

3.

Conduct artificial respiration (four methods) in full scuba and in water too deep to stand up in.

4.

Using the most preferred technique, rescuers are to remove all equipment necessary for removal from water while continuing to administer effective artificial respiration.

3-10

1.

Demonstrate the four steps in preparing a victim for inwater resuscitation at the surface.

2.

Demonstrate resuscitation in water too deep to stand up in. • mouth-to-mouth • mouth-to-nose • mouth-to-snorkel • pocket mask

3.

Demonstrate the ability to remove the masks, weight belts and BCD/tank from both the victim and rescuer while continuing effective resuscitation in water too deep to stand up in.

Three: Rescue Exercises in Open Water

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. Unconscious diver at the surface (priorities) a. b. c. d.

Confirm that the victim is unresponsive. Get the victim’s face above water. Establish buoyancy. Check for respiration.

2. Inwater artificial respiration a.

Priorities • Prevent water from entering airway. • Maintain effective and adequate ventilations. • Pace physical exertion to avoid exhaustion. b. Buoyancy — provide only enough to maintain comfortable and effective technique. • Be careful not to overinflate BCD. • Often buoyancy from exposure suit is sufficient. • Remove weights from victim, and usually rescuer. • Additional buoyancy is often helpful if placed between victim and rescuer. c. Positioning • do-si-do • head cradle • mouth-to-nose d. Ventilation • To avoid submerging the patient, he should be lifted toward the rescuer. • Administer two slow, full breaths. • In adverse environmental conditions, cover mouth while not ventilating. • Administer two slow, full breaths if interruptions occur between ventilations. e. Mouth-to-Snorkel • Review snorkel types acceptable for effective technique. • Review positioning of snorkel, hands and patient. • Always administer two slow, full breaths via mouth-to-mouth, then proceed to mouth-to-snorkel. f. Pocket Mask — review procedures for use (note manufacturer’s instructions).

3. Equipment Removal a.

Equipment removal is always a secondary priority to administering effective ventilations. b. When and what equipment requires removal depends upon: • distance to exit • type of exit • size of patient • size and capabilities of rescuer • type of equipment used c. Remove equipment in stages or short steps so that ventilations are not interrupted. Rescue Diver Course Instructor Guide

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Rescue Exercise 8 Egress with an Unconscious Diver Overview This exercise allows student divers to try various egress techniques suitable for the local open water environment. Stress that the rescuer’s size as compared to the victim’s size is an important consideration for choosing the appropriate technique. If possible, conduct this exercise at a site with varying physical characteristics for broader egress practice – for example, a sandy beach that also has a low pier.

Procedures 1.

Demonstrate unassisted egress (exit) techniques appropriate to local area.

2.

Have divers practice in teams.

3.

Demonstrate assisted egress techniques appropriate to local area.

4.

Have divers practice in teams.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate how to remove an unconscious diver, both with and without assistance, from the water at an open water location typical of the local area.

Skill and Technique Practice Use the following notes to coach student divers as they practice these skills:

1. General Considerations a.

For a nonbreathing victim, main priority is maintaining continuous ventilations. b. For breathing victim, main priority is close monitoring to ensure continued breathing. c. If ventilations must be interrupted: • Never interrupt ventilations longer than 30 seconds. • If possible, administer two ventilations prior to interruption and readminister two slow, full breaths prior to initiating ventilations again. d. Call for assistance as soon as possible.

2. Techniques for egress onto shore a. b. c. d. e. f. g. h. 3-12

Drag (May be most feasible for small rescuer.) Fireman’s carry Saddleback carry Packstrap carry Surf exit (if appropriate for area) assisted and unassisted Rocky exit (if appropriate for area) assisted and unassisted Two-person carry Any other exit techniques appropriate to local area Three: Rescue Exercises in Open Water

3. Techniques for egress onto boat, dock or other steep vertical exit a. b. c. d. e.

Roll-up Use of backboard (if available) Standard lifesaving lift Ladder carry (if available) Any other exit techniques appropriate to local area

Rescue Exercise 9 First Aid for Pressure-Related Accidents Overview In this exercise, student divers practice providing emergency care to a diver suffering from decompression illness. Have divers set up an oxygen unit and stress the importance of oxygen in diving accidents. If possible, have different oxygen units and pocket masks available for expanded practice.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate the recommended first aid procedures for a suspected lung overexpansion injury or serious decompression sickness.

Rescue Diver Course Instructor Guide

Procedures 1.

Review PADI Accident Management Work Slate.

2.

Demonstrate and practice proper positioning of patient. Discuss use of backboards and other makeshift items to maintain diver comfort.

3.

Review procedures for use of nonresuscitator demand valve and/or free flow oxygen equipment.

4.

Review use of pocket mask with oxygen when administering artificial respiration.

5.

Review Emergency Management from Section Three of the PADI Rescue Diver Manual. 3-13

Rescue Exercise 10 Response from Shore/Boat (Unconscious Victim) Overview This exercise combines most of the skills student divers have practiced in previous exercises. It involves assessing an emergency situation, organizing a plan and responding from a boat or shore to the needs of an unconscious, nonbreathing diver. The goal is to provide student divers with an opportunity to apply the skills and knowledge presented throughout this course to a realistic scenario.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate with minimal assistance, the application of inwater resuscitation, egress and appropriate first aid procedures as a single integrated activity under realistic conditions.

Procedures 1.

Divide class into four-person teams (victim, rescuer, assistant and equipment handler).

2.

Position victim and equipment handler 50-100 metres/yards offshore. Have victim on surface simulate unconsciousness.

3.

Rescuer (without scuba) enters water, responds to victim and initiates artificial respiration.

4.

Rescuer transports victim toward shore/boat, removing equipment as needed.

5.

Near shore/boat, rescuer calls for assistant. With aid of assistant and while continuing artificial respiration, victim is removed from the water and appropriate first aid measures are taken (assume patient has a pulse but is not breathing).

6.

Alternate roles and repeat exercise.

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Three: Rescue Exercises in Open Water

Rescue Exercise 11 Diving Accident Scenario One (Underwater Search) Overview During this exercise, student divers are asked to respond to a missing diver situation with little or no coaching from the staff. This scenario allows them to realistically apply the emergency management and search techniques they developed in previous exercises. Emphasize that this is not a test, but an opportunity to practice and strengthen skills. Repeat the scenario as necessary to build confidence, improve student diver performance and allow everyone to play different roles.

Procedures 1.

2.

Performance Requirements

3.

By the end of this session, the diver will be able to: Demonstrate a procedure for locating a lost diver through participation in an accident simulation. Procedure to include: •

Interviewing the victim’s buddy and drawing logical conclusions from the conditions present

•

Organizing and conducting a quick, effective search (surface and underwater)

4.

A diver (staff member) surfaces and indicates that he has lost contact with his buddy. There isn’t an accurate determination of depth and time. Little, if any other direction should be provided at the briefing (other than preassignment of the divemaster) as the degree of preparedness and response is what is being evaluated. Staff should provide no additional comments, except in the interest of safety, once the exercise has commenced. The “lost diver” should be an object rather than a person, as a diver’s bubble trail could give away location. Be sure to inform student divers of this at briefing.

Evaluation Criteria Use the following questions to evaluate student diver performance:

1. Were duties and tasks quickly delegated? 2. Were all the necessary tasks assigned? (spotters and skin divers to initiate search and mark area, scuba divers with search equipment, etc.)

3. Was the search method appropriate for the area? If not, why? 4. Was the search conducted in an effective and efficient manner? If not, why? 5. Was the victim found? If so, how long after notification of divemaster? If not, how long did search continue until divemaster contacted authorities? 6. What was the overall evaluation of the exercise? Rescue Diver Course Instructor Guide

3-15

Rescue Exercise 12 Diving-Accident Scenario Two (Response, Egress and Management) Overview This exercise requires student divers to use all the skills and knowledge they’ve acquired throughout the course to manage a diving accident scene. This goal is to develop and assess the student diver’s ability to work with a group of divers to effectively rescue an injured diver. Emphasize that this is not a test, but an opportunity to practice and strengthen skills. Repeat the scenario as necessary to build confidence, improve student diver performance and allow everyone to play different roles.

Procedures 1.

A diver (staff member) surfaces, calls or signals for assistance and abruptly disappears from the surface.

2.

The “victim” returns to the bottom and assumes a motionless position, simulating unconsciousness (though continuing to breathe). Instruct student divers to assume victim is not breathing.

3.

4.

3-16

Little, if any, additional information should be provided at the briefing (other than preassignment of the divemaster) as the degree of preparedness and response is what is being evaluated. Staff should provide no additional comments, except in the interest of safety, once the exercise has commenced.

Performance Requirements By the end of this session, the diver will be able to: Demonstrate the organization of a group of divers to effectively respond to locate, surface, transport and egress an unconscious nonbreathing diver, using appropriate first aid procedures, site control and summoning medical assistance, through participation in an accident simulation.

Class is to employ appropriate procedures to bring about the following: a. Recover victim from the bottom. b. Provide artificial respiration. c. Transport and remove equipment. d. Exit from the water with victim. e. Provide necessary first aid. f. Control scene and summon assistance. Three: Rescue Exercises in Open Water

Evaluation Criteria Use the following questions to evaluate student diver performance:

1.

Was the nature of the problem properly assessed?

2.

Were duties and tasks quickly assigned?

3.

Were all the necessary tasks assigned?

4.

Were the techniques used to surface the victim effective? If not, why?

5.

Was artificial respiration administered immediately and maintained effectively at the proper rate? If not, identify problems.

6.

Was equipment removal done in an effective manner? If not, identify problems.

7.

Was the exit technique used effective and appropriate for the particular situation/location? If not, why?

8.

Were proper and effective first-aid procedures performed? If not, what should have been done?

9.

Was the accident scene maintained in a controlled manner? If not, what else could have been done?

10. Were the appropriate authorities contacted? 11. How long did the entire exercise take from beginning to end? 12. What was the overall evaluation of the exercise?

Rescue Diver Course Instructor Guide

3-17

3-18

Three: Rescue Exercises in Open Water

Appendix

Table of Contents Rescue Diver Course Training Documentation Sheet

A-2

Divers Alert Network

A-3

Rescue Diver Exam Answer Sheet

A-4

Rescue Diver Exam Answer Key

A-5

Knowledge Review Answer Keys

A-6

Rescue Diver Course Instructor Guide

on ssociati ional A uctors s s fe ro P g Instr of Divin A-1

A-2

Appendix

Phone number (____) ____________________

Country _______________________________________________Zip/Postal Code ____________

__/__/__ __/__/__ __/__/__

Mod. 3, Emergency Management

Mod. 4, Equipment Considerations

Mod. 5, Review and Passed Exam

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Exercise 5, Missing Diver

Exercise 6, Surfacing the Unconscious Diver

Exercise 7, Unconscious Diver at the Surface

Exercise 8, Egress with an Unconscious Diver

Exercise 9, First Aid for Pressure-Related Accidents

Exercise 10, Response from Shore/Boat

PADI No.

PADI No.

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Initials Student / Inst.*

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Initials Student / Inst.*

© International PADI, Inc. 2002

* “I certify that this student has satisfactorily completed this module/exercise as outlined in the PADI Rescue Diver Course Instructor Guide. I am a Teaching status PADI Instructor for the current year.”

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Exercise 4, Distressed Diver Under Water

Exercise 12, Diving-Accident Scenario Two

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Exercise 3, Response from Shore/Boat

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Exercise 2, Panicked Diver Exercise

Exercise 11, Diving Accident Scenario One

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Exercise 1, Tired Diver Exercise

Date Completed

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Mod. 2, Diving First Aid

II. OPEN WATER TRAINING EXERCISES

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Date Completed

Mod. 1, Overview, Self-Rescue, and Diver Stress

I. KNOWLEDGE DEVELOPMENT SESSIONS

FAX (____) ___________________________

Phone (____) _________________________ Business Phone (____) ________________________

PADI No. ______________ Dive Center/Resort No. ______________

City _______________________________________ State/Province _________________________ Mo

Yr

Mo

Yr

Fax number (____) _____________________

Day

Date ____/____/____

Mo

Yr

Fax number (____) _____________________

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Date ____/____/____

Phone number (____) ____________________

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PADI No. ______________ Dive Center/Resort No. ______________

PADI Instructor Name _________________________ Signature _________________________

Phone number (____) ____________________

PADI No. ______________ Dive Center/Resort No. ______________

PADI Instructor Name _________________________ Signature _________________________

Phone number (____) ____________________

PADI No. ______________ Dive Center/Resort No. ______________

PADI Instructor Name _________________________ Signature _________________________

PADI INSTRUCTORS INVOLVED IN TRAINING

Fax number (____) _____________________

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PADI Member Name _________________________ Signature _________________________

Emergency First Response Primary Care (CPR)

Student Mailing Address ___________________________________________________________

Student Name ________________________________________________ Birth Date _________

Rescue Diver Course Training Documentation

DIVERS ALERT NETWORK Q. What is DAN? A. The Divers Alert Network (DAN), established in 1980, is a nonprofit organization dedicated to diving safety. DAN unites hyperbaric chamber facilities into a nationwide communications network to advise divers and their physicians to arrange consultation, transportation and treatment by using a single central emergency telephone number. Diving-medicine physicians at hyperbaric facilities experienced in treating diving-related injuries coordinate activities in the local region. In the United States, DAN operates a 24-hour emergency medical hotline 1(919) 684-8111 and a 9 a.m.-5 p.m. information line 1-(919) 684-2948, among other diving safety services. DAN is supported by a membership association of safety-conscious individuals and diving businesses. DAN is a diver advocate on diving issues. DAN membership includes: •

•

Safe Divers Kit. Includes: Diving First Aid Manual, Member Card, Tank Decals, Insurance application and safety information. Diver’s Medical Insurance eligibility. For a low yearly premium, DAN members can purchase diving medical expense protection. An insurance application comes with every “Safe Divers” Kit.

Rescue Diver Course Instructor Guide

•

Alert Diver, DAN’s newsletter, offering the latest medical and safety information along with news of upcoming courses, seminars and dive research trips.

Q. What number do I call if it isn’t an emergency and I just need information on a student’s fitness to dive? A. Call (919) 684-2948 Monday-Friday 9 a.m.-5 p.m. Eastern Standard Time (United States). Q. What other kind of information is available? A. The Nonemergency Service can provide a variety of other information. New research is a common topic on the nonemergency lines, and assistance in emergency preparedness plans, and consultation on oxygen equipment and evacuation plans are also available. DAN will sometimes forward reference materials to instructors and others who are interested in a particular area. Q. Should I have my students to call DAN for chamber location information? A. No. DAN does not provide the location of “the nearest chamber” for nonemergency use. The reason for this is simply that when a true emergency comes up, the rescuers should generally be concerned with getting an acutely sick patient to

the nearest medical facility. In an emergency situation, arrange transport to medical care, and then call DAN’s Emergency Service to get help with hyperbaric consultation and treatment. In some cases, rescuers have bypassed this first step and transported to what they had written down as the nearest chamber, only to arrive and find that the facility is no longer in operation or temporarily down. DAN keeps constant tabs on changes in the status of these facilities, but please do not have your divemaster and rescue diver students acquire “nearest chamber” information for a preparedness plan. They should have first aid and evacuation plans and the DAN emergency number only. Q. How can I better promote DAN in my dive classes? A. First, have DAN membership application available and explain what DAN is and the benefits of becoming a member. Free membership brochures and counter displays are available for the asking. DAN also has introductory slides or videos available. For more information on this and the rest of DAN’s Sponsor Program, write: DAN Sponsor Program, Box 3823, Duke Medical Center, Durham, NC 27710, USA.

A-3

Name ____________________________________________________________ Date _______________________ (Please Print)

ANSWER SHEET — PADI RESCUE DIVER FINAL EXAM Directions:

Upon making your answer choice, COMPLETELY fill in the space ■ below the proper letter. If a mistake is made, erase your selection or place a dark X through your first answer.

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STUDENT STATEMENT: I have had explained to me and I understand the questions I have missed. __________________________________________________________________________________________________________________________________ Student Signature Date PRODUCT NO. 70307

A-4

© International PADI, Inc. 1986

Appendix

Name ____________________________________________________________ Date _______________________ (Please Print)

ANSWER KEY — PADI RESCUE DIVER FINAL EXAM Directions:

Upon making your answer choice, COMPLETELY fill in the space ■ below the proper letter. If a mistake is made, erase your selection or place a dark X through your first answer.

A

B

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STUDENT STATEMENT: I have had explained to me and I understand the questions I have missed. __________________________________________________________________________________________________________________________________ Student Signature Date Rescue Diver Course Instructor Guide

A-5

KNOWLEDGE REVIEW – CHAPTER ONE Complete this Knowledge Review and hand it in to your instructor. 1. List three areas of preparation that increase your self rescue abilities:

1. Physical 2. Mental 3. Equipment 2. List three dive procedures that help prevent problems while diving.

1. Checking your equipment 2. Thinking ahead/anticipating potential problems 3. Recognizing problems; stop and rest before becoming overexerted. 3. Explain what steps you should take if you encounter a problem while diving.

1. 2. 3. 4.

Stop Breathe Think Act

4. List four specific skills that increase your self rescue abilities.

1. 2. 3. 4. 5

List seven causes and examples of physical stress.

1. 2. 3. 4.

A-6

Establish buoyancy at the surface Cramp release Use of an independent alternate air source Reestablish your sense of direction Cold – Improper exposure protection Seasickness – Long rolling boat rides Fatigue – Long walks or surface swims Drugs/alcohol – Before/after a dive

Appendix

5. Discomfort/reduced mobility – due to poor equipment fit/ adjustment 6. Illness/injury – Divers physical condition 7. Nitrogen narcosis – Impaired judgment 6 List three examples of psychological stress caused by physical stress.

1. Tired after long swim, triggering fear of not making it back to boat 2. Miscalculate and run out of air, triggering fear of drowning 3. Overexertion, triggering fear of air starvation and suffocation 7. List four examples of psychological stress causes other than physical stress.

1. Stress in reaction to perceived threats in the environment (real/imagined) 2. Task loading – Trying to accomplish too much at once 3. Peer pressure – Perception that a dive is beyond divers’ abilities 4. Self-pressure – Pressure to make dive due to distance traveled, money spent 8. Define “perceptual narrowing.”

Decreased awareness – Which may cause the diver to overlook things that would otherwise be obvious 9. Describe the psychological and physiological effects high stress can produce in a diver.

The diver may experience rising fears, shallow, ineffective breathing and involuntary stress responses. Emotions may exceed ability to control them, diver panics, abandoning new or seldom used dive skills for random instinctive skills. 10. List the two steps you apply to recognize stress in a diver.

Observe diver behavior characteristics that indicate stress Verify meaning of behavior – simply ask the diver about what you observed Rescue Diver Course Instructor Guide

A-7

11. Explain what you should do when you recognize diver stress.

On the surface – If based on observations and tactful questions you uncover undue stress, encourage the diver to apply analytical solution thinking. Talk gently to the diver, avoid sounding judgmental and avoid strong opinions. Underwater – Stop the diver, ask if he’s okay, try to determine source of stress to head off problems before they become accidents

I have had explained to me and I understand the answers to the questions I missed. Signature______________________________________________________________ Date __________

A-8

Appendix

KNOWLEDGE REVIEW – CHAPTER TWO Complete this Knowledge Review and hand it in to your instructor. 1. Describe the differences between nonresuscitator demand valve and continuous flow oxygen units.

Nonresuscitator – Oxygen flows when the patient inhales while the continuous flow releases oxygen continuously and is more wasteful 2. List the steps of a primary assessment in order of priority.

1. 2. 3. 4.

Assess the situation Establish responsiveness No response, call for help Establish airway

5. 6. 7. 8.

Check breathing Check pulse Check for bleeding Manage shock

3. Describe how to open the airway and explain the procedures for rescue breathing.

Using barriers, establish airway by either jaw thrust or head tilt/chin lift. Check for breathing – look, listen and feel. If patient is breathing, maintain open airway. If patient is not breathing, using either mouth-to-pocket mask or mouth-tomouth; blow a long, slow breath into patient, allow patient to exhale, repeat the breath. After two breaths, look, listen and feel. If patient is not breathing, continue with one breath every five seconds. 4. Describe the procedures, positioning and breath/compression ratio for CPR.

Check responsiveness, call for help, open airway, give two slow rescue breaths, check pulse. If you find no pulse, kneel next to patient, trace inside of ribcage to locate breastbone, two fingers up, place heel of one hand with second hand on top. Press downward 3 to 4 centimetres/1.5 to 2 inches. Release pressure and repeat. Give 15 compressions at a rate of 100 compressions per minute. After 15 compressions, give 2 breaths. While giving rescue breaths, look, listen and feel. Check pulse.

Rescue Diver Course Instructor Guide

A-9

5. Describe the primary method for controlling severe bleeding.

Direct pressure – Followed by applying pressure to a pressure point, if direct pressure doesn’t control bleeding. Apply a tourniquet if bleeding is uncontrolled, and only in a life or death emergency. 6. Explain what to do when a patient is suspected of having a neck or back injury.

If you suspect a neck or spine injury, immobilize the head and stop your secondary assessment. Do not move the patient and ask him not to move. Call for medical assistance. 7. State the differences between heat stroke and heat exhaustion, and describe the first aid for each.

Heat Exhaustion – Not normally life threatening – normal body temperature, profuse perspiration, cool, clammy skin. Move patient to cool area, remove exposure suit, encourage him to drink water. Heat stroke – Life threatening – no perspiration, hot, dry, flushed skin – the body can’t keep up with rising temperatures. Cool the patient, move to cool area, apply cool wet towels, immerse in cool water. 8. Describe the symptoms of hypothermia and explain what first aid steps to take for it.

Symptoms – Shivering; numbness; blueness of fingers, lips, toes; may be weak, confused, weak pulse. Get the patient to where it is warm, remove exposure suit, dry him off, rewarm patient. 9. List five signs and symptoms that may indicate a venomous aquatic life injury.

Excruciating pain, local swelling, inflammation, weakness, nausea, shock, unconsciousness, confusion, spreading numbness, paralysis, convulsions; in some severe cases, respiratory and cardiac arrest.

A-10

Appendix

10. Identify the most common cause of lung overexpansion injuries.

Lung overexpansion results when a diver holds his breath and ascends or when physiological conditions trap air in the lungs during ascent. 11. Describe the signs and symptoms of DCI and the first aid procedures to follow if you suspect DCI.

Blurred vision, dizziness, sudden unconsciousness, loss of coordination, bloody froth in mouth, breathlessness, coughing, personality change, pain, unusual fatigue, vertigo, paralysis, loss of sensation, respiratory/cardiac arrest. First aid: Primary Assessment, have patient lie down, protect from heat and cold. Provide patient with 100% oxygen until you can get patient emergency care.

I have had explained to me and I understand the answers to the questions I missed. Signature ______________________________________________________________ Date __________

Rescue Diver Course Instructor Guide

A-11

KNOWLEDGE REVIEW – CHAPTER THREE Complete this Knowledge Review and hand it in to your instructor. 1. List three areas you can prepare in to be ready to handle an emergency, and describe each.

1. Rescuer readiness: Physical, mental and training preparation. 2. Equipment readiness: Having equipment on hand ready for use and knowing how to use it. 3. Information readiness: Having contact information for local medical system, recompression chamber, radio frequencies for emergency uses. 2. List eight pieces of specialized equipment that may be useful in a rescue situation, and what you use each for.

1. 2. 3. 4. 5. 6. 7. 8. 9.

Binoculars: Spotting divers on surface Pen/paper/clipboard: Recording information Rope: Throw to diver at surface, U/W search Sweep anchor: U/W search Marker buoys: Mark locations Flares: Signal help/boat to boat Bullhorn: Coordinate rescue efforts Radio (CB/VHF): Contact emergency care U/W recall system: Recall divers in case of emergency

3. Describe an emergency assistance plan, including what information it should contain and where you might keep this information.

Emergency contact information relevant to dive site, including contact information for local emergency medical system – 911, etc. Contact information for recompression chamber, DAN and DES. Radio frequencies for emergencies, USCG, etc. Keep this information in your first aid kit.

A-12

Appendix

4. Describe the two possible roles a Rescue Diver may have at the scene of a dive accident.

1. Rescue assistant 2. Emergency management/scene manager 5. Outline the six basic steps for managing a dive emergency.

1. 2. 3. 4. 5. 6.

Assess the situation Act on your plan Delegate Provide BLS/first aid Control the scene Evacuate the patient

6. Describe the procedures involved with evacuating a patient by helicopter from a boat.

1. 2. 3. 4. 5. 6. 7. 8.

Boat/helicopter communications Boat heads into wind Prepare boat, lower tall and secure loose objects Prepare patient, don PFD When ready, signal helicopter Don’t grab line – static electricity Load patient into basket Ask helicopter to fly low w/DCI patient

I have had explained to me and I understand the answers to the questions I missed. Signature _______________________________________________________________Date _________

Rescue Diver Course Instructor Guide

A-13

KNOWLEDGE REVIEW – CHAPTER FOUR Complete this Knowledge Review and hand it in to your instructor. 1. What is the most common cause of equipment related problems?

Misuse of equipment, human error not equipment failure 2. List and explain six general causes for equipment problems:

1. Use of unfamiliar or specialized equipment without learning to use it. 2. Equipment that does not fit 3. Homemade, makeshift or obsolete equipment 4. Diver lacks essential equipment for environment, or uses wrong equipment 5. Diver severely modifies the equipment 6. Diver does not properly maintain and inspect equipment 3. Identify two causes each that can lead to problems with the following: mask, snorkel, fins, exposure suit, BCD, weight system, scuba unit.

Mask: torn skirt, improper fit Snorkel: leaky self-drain, incorrect positioning Fins: too large, broken strap Exposure suit: improper fit, zipper failure BCD: leaky valve, trapped hose Weight system: belt under BCD, release frozen, strap too long Scuba unit: poor maintenance, free flow 4. Explain how to prevent the problems identified in Question 3.

Mask: visual inspection, inhaling to test Snorkel: check before entering water Fins: proper fit, inspect and/or replace strap Exposure suit: check fit, proper maintenance A-14

Appendix

BCD: proper maintenance, check prior to dive Weight system: check system, adjust after entry Scuba unit: proper maintenance, service 5. Briefly describe how each of the following operates, and how to avoid problems with each:

Regulator: First stage connects to valve on tank, reduces tank pressure to intermediate pressure delivered to second stage, LPI, and alternate air source. High pressure is delivered to SPG. Inhalation from second stage diaphragm flexes inward, opens valve, releases air you breathe. Exhalation, returns diaphragm to normal, valve closes, exhaled air exits through exhaust valve. Proper maintenance, annual service will help prevent problems. Submersible pressure gauge: High pressure from first stage through a hose to SPG, air enters flexible tube, pressure tries to straighten the tube, tube flexes, rotates gauge needle to indicate pressure. There are also computer integrated SPGs and hoseless SPGs that use electronic transducers to determine and display pressure. Secure gauge so it doesn’t dangle and cause problems, watch for signs of wear, look at gauge needle before turning air on. 6. Explain the advantages and disadvantages of the donor giving the alternate second stage in an out of air emergency, and giving the primary.

Alternate: Better control, donor retains his air source, giving alternate allows donor to route longer hose out of way until needed. Disadvantage: Delay in finding if not secured where it is easy to find. Primary: No question primary works, easy to locate. Disadvantage: Both divers have no air momentarily, if longer hose is used, it protrudes and may snag easier than standard hose.

Rescue Diver Course Instructor Guide

A-15

7. List six types of releases you may commonly encounter in scuba equipment.

1. 2. 3. 4. 5. 6.

Quick release buckle: Weight belts Quick disconnect fasteners: BCD, accessories Touch fasteners (Velcro™): BCD, wet suit Tank band releases: Tank/BCD Inflator quick disconnect: LPI, BCD, low pressure accessories Integrated weight release: BCD/weight systems

I have had explained to me and I understand the answers to the questions I missed. Signature ______________________________________________________________ Date _________

A-16

Appendix

KNOWLEDGE REVIEW – CHAPTER FIVE Complete this Knowledge Review and hand it in to your instructor. 1. List and describe the signs and behaviors that indicate a diver may have a problem at the surface.

Signs: Doesn’t return signals, change in kick, lags behind, choking, coughing, vomiting, treading high out of water, head back, using hands/arms, mask off, nothing in mouth, snorkel or regulator. 2. List and describe the signs and behaviors that indicate a diver may have a problem underwater.

Underwater signs are more subtle. Watch for rapid breathing, awkward kicking, signs of exhaustion, tiring, wide eyes, jerky movements, using arms to swim, rejecting mask and regulator and bolting to surface. 3. Explain why a rescuer’s safety takes priority over the victim’s safety during a rescue.

If you’re in trouble, you’re no longer able to help anyone. If no one else is present, there’s no one to assist you or call for help. If you’re in trouble, it divides rescue efforts between you and original victim. 4. List three nonswimming assists you can use to help a responsive diver at the surface.

1. Extending anything that will reach 2. Throwing something to provide flotation with line attached to tow diver 3. Taking a boat or watercraft to the victim 5. Describe how to approach, evaluate and help a responsive tired diver at the surface.

As you approach the victim, stop outside of reach, assess victim’s condition, give rescue statement – the victim’s response helps evaluate his state. While outside victim’s reach – note location of BCD inflator. Direct the victim to drop weight belt and inflate BCD. Establish buoyancy, have diver relax, assist to exit. Rescue Diver Course Instructor Guide

A-17

6. Describe how to approach, evaluate and help a responsive panicked diver at the surface.

As you approach the victim, stop outside of reach. Establish buoyancy; if you have an object that floats, extend to victim. Assess victim, communicate, determine surface or underwater contact, make contact, establish control of victim, reassure the victim, have him lie back and relax, assist to exit. 7. Explain what to do to help a diver with these underwater problems: overexertion, uncontrolled descent, excessive buoyancy, cramps, entanglement, entrapment, passive panic and active panic.

Overexertion: Stop everything, rest, breathe Uncontrolled descent: Stop descent by adding air to BCD Excessive buoyancy: Quick dump air from BCD, flare Cramps: Help diver stretch and massage the cramp Entanglement: Stop, reassure and have diver hold still while you free him Entrapment: Ensure you have adequate air to free diver, if not ascend to get air and help. Passive panic: Approach diver, give “ok” signal; if no response, go behind diver, hold regulator in place, assist diver to surface. At surface, establish buoyancy, assist to exit. Active panic: Stop outside of reach, attempt to calm diver; if diver bolts for surface, grab a leg or foot to help control ascent. At surface, establish buoyancy, assist to exit. 8. List the factors to consider when removing equipment from a responsive victim.

1. How far do you have to go with the diver? 2. What is the environment like? 3. What is the victim’s condition? There is no single answer, you’ll need to use your judgment based on circumstances.

A-18

Appendix

9. List the general criteria for tows used to transport a responsive victim in the water.

1. A tow that keeps victim’s face out of water 2. A tow that reduces drag – lets you and victim move through the water horizontally 3. A tow that gives you control 4. A tow that does not restrict your swimming 5. A tow that allows you to communicate with the victim 10. Explain what to consider when helping a responsive victim exit the water.

Exit conditions Your condition Victim’s condition/feelings Removing unneeded equipment Best exit techniques, based on above

I have had explained to me and I understand the answers to the questions I missed. Signature______________________________________________________________ Date __________

Rescue Diver Course Instructor Guide

A-19

KNOWLEDGE REVIEW – CHAPTER SIX Complete this Knowledge Review and hand it in to your instructor. 1. List and describe the steps to take if you discover that a diver is missing underwater.

1. 2. 3. 4. 5.

Time is important Have someone call for emergency help (EMS). Assign spotters to look for bubbles ; direct rescuers to area. Try to determine if diver left without telling anyone. Immediately assign qualified divers to don scuba equipment and begin underwater search. Immediately send two or more skin divers to search area with buoys.

2. List four search patterns that may be useful for finding a missing diver.

1. 2. 3. 4.

“U” pattern Expanded square Circular search Surface led search

3. Explain what to consider when implementing a search for a missing diver.

1. 2. 3. 4.

Have a way to recall searchers. Search in buddy pairs only. Consider currents, tidal currents and surge. If no qualified divers are available, choose a buddy and start search. 5. Search as long as you can or until you find victim.

4. Describe the procedures for bringing an unresponsive diver to the surface.

Getting victim to surface takes priority over everything else 1. Quickly note details of positioning, clues of accident and check if regulator is in mouth. A-20

Appendix

2. If regulator is in mouth, hold it in place. 3. Hold victim from behind, regulator in mouth, head in normal position. 4. For best control, use your own BCD for ascent. 5. During ascent, hold victim’s head in normal position, air will vent. 6. As you ascend, think of what action you will take at surface. 7. Consider victim’s weight belt as you approach the surface. 5. Describe the procedures to follow when beginning a rescue of an unresponsive diver at the surface.

Drop victim’s weight belt, avoid inflating BCD more than necessary, watch for bubbles that indicate breathing, turn victim face up, remove victim’s regulator and mask, open the airway, look, listen and feel. If victim is not breathing, give two slow rescue breaths. Be cautious to protect airway. If victim is not breathing, ventilate every five seconds, pace yourself and exit water as soon as possible. 6. Describe the techniques for mouth to pocket mask, mouth to mouth and mouth to snorkel in water rescue breathing.

Mouth to pocket mask: Retrieve and prepare pocket mask, place mask on victim, hold in place, open airway and administer two rescue breaths. Leave mask on while you look, listen and feel. Mouth to Mouth: Secure the victim’s head, open the airway, pinch the nose, roll victim toward you, provide two rescue breaths. Mouth to snorkel: Start with mouth to mouth to give initial two breaths, remove equipment and when you are ready to move, place the snorkel mouthpiece in victim’s mouth, holding in place with middle and ring finger. Pinch off nose, ventilate.

Rescue Diver Course Instructor Guide

A-21

7. Explain what to do if you think a victim has no pulse while in the water.

Finding a pulse may be difficult, often impossible; there is no practical way to provide CPR in the water. Assume there is a pulse, continue to ventilate and tow to exit. 8. Explain what to consider when deciding whether to remove equipment from an unresponsive diver at the surface.

1. If close to shore or boat, it may be easier to tow victim with everything on. 2. Don’t remove anything you need to provide buoyancy. 3. Make similar decisions regarding your own equipment. Base equipment removal considerations on how you can best maintain contact with victim; keep victim’s head out of water; maintain proper ventilation. 9. Describe the suggested procedures and techniques for removing equipment from an unresponsive diver while providing in water rescue breaths.

The order of removal is not important, provided you progress logically. Remove weight before removing BCD, remove dry suit inflator hose before removing scuba unit. Maintain ventilations. May need to take several steps to remove BCD/ scuba unit. A second rescuer makes equipment removal easier. Do not interrupt ventilations for more than 30 seconds. 10. List and describe techniques for exiting with an unresponsive diver onto shore, and into a boat or onto a dock.

If you have removed victim’s equipment, the actual method will depend on your strength or if you have help. For shore exit, consider the saddleback, fireman’s carry or packstrap carry. If exiting onto swim steps, low docks, stable boat, consider lifeguard exit. I have had explained to me and I understand the answers to the questions I missed. Signature _______________________________________________________________Date __________

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Appendix