Page 1
The Divemaster's Quick Accident
Response Guide
This is basically a graphical version of the excellent document written by Dr Ernest S Campbell, which you can get online at
http://scuba-doc.com/qkrsp.htm
The objective of this document is to provide you with an easy way to print and build Emergency Response slates, that can help
you or your dive buddies solve a diving emergency. The slates present a nice way of carrying this information with you on every
dive together with the rest of your gear. You just never know when you're going to need it.
To get the latest version of the document and instructions on how to build the slates from it please check regularly the Diving
Medicine Online site at http://scuba-doc.com/
Slate Graphical Version
Pedro Miguel Paixão

Original Text
Dr Ernest S Campbell, MD, FACS
Diving Medicine Online
http://www.scuba-doc.com
Legal Disclaimer
The authors cannot be in any form responsible for misuse or misapplication of the material in this work. The information
contained herein can be freely copied and distributed as long as you don't change anything. You cannot sell or profit from
this document without written permission by its authors. If you decide to create the slates and use them it means you've
agreed with this disclaimer and you free the authors from any liability.
Page 2
Used Icons
Transfer to Recompression Chamber
Transfer to the Hospital
No Need to Transfer Give First Aid
Name
Phone
DAN America
1-919-684-9111
DAN America-Mexico
52-5-6299800 code
33937 or 4258
DAN Europe
41-1-383-1111
DAN Japan
81-3-3812-4999
DAN Southern Africa (Outside South Africa)
27-11-242-0112
DAN Inside South Africa (Toll Free)
0800-020111
S.E. Asia-Pacific Region
DES Australia
Within Australia
1-800-088-200
From Overseas
61-8-8373-5312
DES New Zealand
64-9-4458454
Singapore Naval Medicine & Hyperbaric Center
65-750-5546
DAN S.E.A.P. -Philippines
63-2-815-9911
Diving Emergency Phones
Name
Phone
Local Emergency Phones
I
n an emergency remember to:
1. Stop
2. Breathe
3. Think
4. Act
Circle of Care
1. Arousal
2. Establish an Airway
3. Check for Breathing
4. Check for Pulse
5. Check for Bleeding
6. Shock Management
Check for Circulation (Pulse)
Check for Bleeding
Check the carotid pulse to determine if the patient has a
heartbeat. If there is no pulse, a combination of artificial
circulation and mouth-to-mouth respiration must be performed.
Full CPR should be continued as long as necessary giving victim
two full breaths every 30 chest compressions.
Once the heart is pumping blood, either naturally or artificially, the
victim must be checked for serious bleeding. Both visually scan
and feel the body for indications of heavy blood. Any serious
bleeding must be controlled or the victim will bleed to death.
Shock Management
Signs and symptoms of shock may include:
Shock Treatment:












Shallow breathing, labored gasping, noisy inhalation exhalation.
Pale tissue color.
Moist, clammy skin.
Rapid, weak pulse.
Restlessness and anxiety.
Nausea, vomiting and thirst.
Mental confusion.
Maintain body temperature, but do not overheat.
Keep patient lying down.
Elevate legs unless other conditions indicate otherwise.
Give nothing by mouth
Seek professional medical help by activating an Emergency
Medical Service.
Arousal
Establish an Airway
Check for Breathing
Tap on the shoulder and shout, "Are you okay?" This step is to
help determine the concious level and responsiveness of the
patient.
If there is no response to the tap and shout, establish an open
airway using either the jaw-thrust or the head-tilt/chin-lift.
Look, listen, and feel for breathing. If not breathing, initiate
mouth-to-mouth respiration.
First Aid Basics
Page 3
Transport to nearest emergency facility
closely associated with a recompression
chamber. Do not waste time evaluating
and stabilizing at a facility unaccustomed
to diving emergencies.
Call DAN or your own preferred
emergencynumber!
Air evacuation should be at sea level
pressure or as low as possible in
unpressurizedaircraft
Contact hyperbaric chamber, send
diver's profile with the diver, and send
all diving equipment for examination or
have it examined locally.
This is possibly
themostimportantthingyoucando!
WARNING
Air Embolism
SYMPTOMS APPEAR DURING OR IMMEDIATELY AFTER SURFACING
Signs
!
!
!
!
!
!
!
Disorientation
Chest pain
Paralysis or weakness
Dizziness
Blurred vision
Personality change
Voice change in tonal quality
(mediastinal air)
!
!
!
!
!
!
!
CPR, if required
Open airway, prevent aspiration, intubate if trained person available
Give O2, remove only to open airway or if convulsions ensue. Mask, if available
If conscious, give nonalcoholic liquids
Place in horizontal, neutral position
Restrain convulsing person loosely and resume O2 as soon as airway is open
Protect from excessive cold, heat, water or fumes
Early Management
Symptoms
Signs
!
!
!
!
!
!
Bloody froth from nose or mouth
Paralysis or weakness
Unconsciousness
Convulsions
Stopped breathing
Apparent Death
Transport to nearest emergency facility
closely associated with a recompression
chamber. Do not waste time evaluating
and stabilizing at a facility unaccustomed
to diving emergencies.
Call DAN or your own preferred
emergencynumber!
Air evacuation should be at sea level
pressure or as low as possible in
unpressurizedaircraft
Contact hyperbaric chamber, send
diver's profile with the diver, and send
all diving equipment for examination or
have it examined locally.
This is possibly
themostimportantthingyoucando!
WARNING
Decompression  Sickness
SYMPTOMS APPEAR 15 MINUTES TO 12 HOURS AFTER SURFACING
Signs
!
!
!
!
!
!
!
Tired feeling
Itching
Pain, arms, legs or trunk
Dizziness
Numbness, tingling or paralysis
Chest compression or shortness
of breath
Anything unusual after the dive
!
!
!
!
Stabilize patient the same way as for Air Embolism
Urgent recompression after stabilization in trauma facility closely associated with
a recompression chamber
Immediate oxygen breathing, continue even if person improves markedly. Use a
mask, if available.
Always take to recompression treatment for all forms of decompression sickness
Early Management
Symptoms
Signs
!
!
!
!
!
!
Blotchy rash
Paralysis or weakness anywhere
in the body
Coughing spasms
Staggering or instability
Unconsciousness
Personality change
)
Page 4
Pneumothorax
Signs
!
!
!
!
!
!
!
Disorientation
Chest pain
Paralysis or weakness
Dizziness
Blurred vision
Personality change
Voice change in tonal
!
!
!
!
CPR, if required
Open airway, prevent aspiration, intubate if trained
person available
Give O2, remove only to open airway or if convulsions
ensue. Mask, if available
If conscious, give nonalcoholic liquids
Early Management
Symptoms
Signs
!
!
!
!
!
!
Bloody froth from nose
or mouth
Paralysis or weakness
Unconsciousness
Convulsions
Stopped breathing
Apparent Death
Signs
!
!
!
!
!
!
!
Disorientation
Chest pain
Paralysis or weakness
Dizziness
Blurred vision
Personality change
Voice change in tonal
quality (mediastinal
!
!
!
!
CPR, if required
Open airway, prevent aspiration, intubate if trained
person available
Give O2, remove only to open airway or if convulsions
ensue. Mask, if available
If conscious, give nonalcoholic liquids
Early Management
Symptoms
Signs
!
!
!
!
!
!
Bloody froth from nose
or mouth
Paralysis or weakness
Unconsciousness
Convulsions
Stopped breathing
Apparent Death
Mediastinal Emphysema
Allergies  and  Poisoning
Severe Allergic Reaction











Remove any remnant of allergen (i.e., jellyfish
tentacles, foreign material)
Epinephrine injection, if available
Decadron injection or tablets
Antihistamine, if available
Wash out wounds or injury with alcohol, vinegar or
sea water
Call for help and immediate transport
Treat for shock
CPR if no pulse or respirations
Keep warm
Oxygen
Pain relief, if available
Mollusks (Cone shells, Blue-ringed Octupus)








Immobilize
Pressure dressing
Cleanse puncture site
Tetanus
Analgesics
Topical antibiotics
CPR, if necessary, to treat possible respiratory distress or
paralysis
To a facility as soon as possible
Sea Snakes







Recognize that there are few symptoms
early on
Immobilize site
Hospitalize immediately because of
possible need for respiratory support
Give sea snake antivenin
Polyvalent land snake antivenin can be
used
Hemodialysis useful if no antivenin available
CPR, if needed
Stinging Fishes (Stingrays, Scorpionfish)










Immobilize
Remove spine and debride (scrub) the wound
Irrigate wound
Soak in hot water (thermolabile toxin) 50 degree C.
for 30 to 90 minutes
Tetanus treatment
Treat for shock, hydrate
Topical antibiotics
Local injection Emetine 50 mg if available
Stonefish antivenin
Heat for pain
(Australia Commonwealth Serum Lab.)
LungOver-Expansion
LungOver-Expansion
ALWAYS ASSOCIATED WITH PNEUMOTHORAX
)
Page 5
Near  Drowning
Oxygen Toxicity
(with convulsions)
Oxygen Toxicity
(with convulsions)
SYMPTOMS ARE USUALLY TOO LATE TO BE HELPFUL
Decreased or loss of
consciousness
followed by
Convulsions
!
!
!
Avoidance of gases with high O2 concentrations (as in
Nitrox at inappropriate depth)
Avoid CO2 retention which can precipitate O2
convulsions at any depth
If convulsions occur at depth, be prepared to treat near
drowning and /or air embolism
Treatment=Prevention
Symptoms
Signs
!
!
!
!
!
Nausea
Dizziness
Ringing in the ears
Abnormal vision
Confusion
Suspected Heart Attack, Stroke







Call for help and immediate
transport
Treat for shock
CPR if no pulse or respirations
Keep warm
Oxygen
Pain relief, if available
Aspirin
Severe Trauma or Large Predator Injury
(head injury, limb injury due to falls, equipment crush, prop injuries)










Call for help and immediate transport
Open airway
Treat for shock on site and stabilize before
evacuation
Face up neutral position
Direct pressure over bleeding wounds
CPR if no pulse or respirations
Keep warm
Be aware of the possibility of neck injury
O2 if any question of hypoxemia (Low oxygen in the
blood)
Splint limb injuries
Other  Accidents
Try to identify the time the victim was last seen breathing
Free entanglements if present
Maintain control of victim
Positive buoyancy of the victim, drop victim weight belt, inflate victim BC
Rescuer maintains dive status
Controlled ascent
On surface - open airway
Rescue breathing if necessary
Signal for help
Start CPR , removal of gear and in water transport to the boat or shore
In dive boat, horizontal position
Immediate call for help and transport to a facility
Assess ABC's-airway, breathing and circulation
Clear airway
Chest compression if no carotid pulse felt
Continue rescue breathing begun in the water
Oxygen
Consider the possibility of concurrent hypothermia (low body core temperature)
Do not use Entonox (Nitrous oxide/oxygen)
Do not use PASG (MAST) trousers
Recognition



Unconsciousness
Lack of respirations
Cyanosis (bluish pallor, face lips, nail beds)
WARNING: DON'T DO CPR IF YOU FEEL THE
VICTM'S PULSE
)/)
Page 6
Hypothermia







Keep core temperature above 95 degrees F.
Keep airway open
Immobilize
Wrap in blankets, preferably next to another person
Basic life support, CPR, if needed
Warm liquids, if alert, unless very coldthen avoid due to
possibility of ventricular tachycardia (rapid, useless fluttering of
the heart)
Avoid O2 due to the cooling effect , unless the O2 is
humidified and warm. (Nemiroff coffee jug technique)
Hyperthermia






Heat Exhaustion (due to excessive fluid loss)
Remove from source of heat
Lower temperature
Keep calm
Keep airway open
Give salt (1tsp/8ounces water)
Heat Stroke





Remove all clothing
Cover with cool wet sheet
Place in air-conditioned area
O2 Cold packs to neck, scalp, groin and armpits
Treat convulsions if they occur
Paralytic shellfish, Elasmobranch,
Tetrodotoxin and Clupeotoxin Poisoning






Notify all who may have eaten the same food
Induce vomiting, if they haven't already done so
Respiratory paralysis can be fatal
O2 if short of breath
Life support and CPR
Hospitalize immediately
Thermal Problems
Scombroid



(Similar to paralytic shellfish poisoning except due to
severe allergic reaction.)
Ventilation and CPR
Hospitalize
Ciguatera





Treat as paralytic shellfish poisoning
Oral fluids
Diphenhydramine, if itching
R/O diving illness
Transport to a medical facility
Poisoning
C
oral and Barnacle Cuts







Stop bleeding
Clean well with a brush, soap and water
Alcohol or vinegar flush
Scrub and debride foreign particles
Bed rest, elevation, antibiotics for severe cuts
Be aware of danger of anaerobic infection and clostridial
infection
Topical antibiotics
Coelenterate Injury
(fire coral, hydroids, Jellyfish, sea wasps, sea anemones)








Injury all caused by nematocysts
Flush with alcohol or vinegar or dilute household ammonia (1:3
water)
Flush with saline or sea water, no fresh water
Meat tenderizer
Non-steroidal anti-inflammatory cream (where available, Not in
USA)
Pain relief, sedation, diphenhydramine
Be aware of possible severe systemic reactions
Shaving cream, shave or flush
Sea Lice
(Caused by nematocysts in Thimble jellyfish larvae)




Remove clothing
They should be flushed off with sea water-not
rubbed off
or washed off with fresh water or they will fire off
Spraying on shaving cream and washing the
cream off along with the nematocysts
Echinoderms
(Sea Urchins)






The small black dots may not be the tips of the
spines
but dye and will be eventually absorbed by the
body
Hot water 30 minutes
Do not beat or pound the part to "crush" the
spines
Surgical removal is indicated only if a granuloma
(hard knot) is formed or if it gets infected
and needs pus to be drained
NSAID for anti inflammatory effect and pain relief
Topical antibiotics
Batfish Punctures


Remove any residue
Hot water immersion 30 minutes
Hazardous Marine Life Injuries
)
C)
Page 7
Echinoderms (Sea Urchins)
Sponges
Segmented Worms, Bristle Worms













The small black dots may not be the tips of the spines
but dye and will be eventually absorbed by the body
Hot water 30 minutes
Do not beat or pound the part to "crush" the spines
Surgical removal is indicated only if a granuloma
(hard knot) is formed or if it gets infected
and needs pus to be drained
NSAID for anti inflammatory effect and pain relief
Topical antibiotics
Deactivate toxins, acetic acid 5%, 10-15 minutes
or isopropyl alcohol soaks for 10 minutes
Sticky side of adhesive tape
Repeat soaks and tape
Steroid cream
Acetic acid (Vinegar) to bites of blood worms
Remove bristles with forceps or adhesive tape
several times, ammonia 3:1, isopropyl alcohol
Hazardous Marine Life Injuries
Starfish Injuries
Catfish Injuries
Stress, Anxiety and Hyperventilation
Reassure












Hot water immersion 30 minutes
Debride
Soap and water scrub and rinse
Monitor for infection
Hot water immersion 30 minutes
Debride
Rinse with soap and water
Reassure
Slow down respiratory rate
02
Rebreathe in a paper bag
Do not encourage further diving
Nitrogen Narcosis



Inappropriate
behavior at depth
Ignoring hand
signals and
instructions
Stupor or coma



Ascend until free of symptoms
Surface with controlled ascent
Intense counseling session!
Treatment=Prevention
Symptoms
Signs







Inflexible mentation (thinking)
Decrease or loss of judgment
False sense of security
Lack of concern for safety
Inability to think through
problems
Panic
Near unconsciousness or loss
of consciousness at depth
Carbon Dioxide Poisoning



Slowed responses
Muscle irritability
(twitching)
Loss of
consciousness




Remove the cause ( skip breathing, over-exertion, equipment
failure, rebreathers, etc.)
Stop and rest during early symptoms to avoid loss of
consciousness
Surface
Consider O2 toxicity if diving with EAN.
Treatment=Prevention
Symptoms
Signs





Rapid breathing
Feeling of suffocation,
shortness of breath,
impending doom and panic
Headache, nausea , dizziness
Rapid heartbeat
Confusion and unclear
thinking
Nitrogen & CarbonDioxide
)
Page 8
Ear Problems & Sea Sickness
Middle ear barotrauma






Keep quiet and calm
Without DCS or rupture of the round or oval windows,
give
Benadryl 25 mg po, Claritin po or Sudafed.
Antibiotics po if marked fluid accumulation in middle
ear.
Get ENT evaluation
Discontinue diving until cleared by ENT
Sea Sickness






The best medications have been found to be "Meclizine",
"Bonine", Dramamine and Trans-derm Scop.
Keep your eyes on the horizon
Stay on deck
Keep yourself well hydrated with non-alcoholic beverages
Try antacid tablets or lemon drops. If diving, try to be the first
diver in from a heaving boat.
Check our web site at
http://www.scuba-doc.com/seask.html
Tips for Equalizing
1. Several hours before the dive gently equalize your ears
every few minutes
2. Try it again before you go on board the boat
3. Equalize at the surface before you go down
4. Descent feet first
5. Don't descent too fast, try using a descent line
6. Equalize often and before you feel pain
7. If it hurts, stop, ascend a few feet try again
8. You should equalize whenever you need not only during
descent
9. Keep mask clear
Inner Ear Barotrauma




Recognize round or oval window damage( loss balance,
ataxia, tinnitus, deafness)
Headup and affected ear elevated
Discourage straining
ENT evaluation, no more diving until cleared by ENT
WARNING


Do not dive if you cannot Equalize properly
Discontinue all diving if you suffer Ear
Barotrauma and see an Ear Mouth Throat
(ENT) Specialist ASAP






















Gloves
Cortisone Cream 1%
Q-Tips
Deodorant cleansing soap (antibacterial)
Lighter or waterproof matches
Tongue depressors
Household Vinegar solution (neutralize jellyfish stings)
Absorbent dressings (control severe bleeding with
pressure)
Disposable cups
Household ammonia
Squeeze bottle of water, 6 oz. (irrigating eyes and
wounds)
Razorblades, single edged
Antibiotic Ointment
Squeeze bottle of sterile saline
Shaving cream
Non-aspirin pain reliever
Sterile cotton, gauze pads, and adhesive tape
Tweezers or forceps
Hot pack
Backboard, splints and neck brace, if space permits
Bandage scissors
Cold packs (pain relief)








Pocket mask (eliminates direct contact while resuscitating
a person)
Needle nosed pliers with wire cutters (to remove
fishhooks)
Denatured alcohol, 12 oz. bottle (sterilizing instruments)
Penlight
Band-Aids and butterfly bandage
Telfa pads or plastic wrap (cover burns)
Space blankets
Seasickness medication
First Aid Kit
O2 is an absolute necessity on a Dive Boat.
Oxygen is the one first aid treatment that can be used with
the full knowledge that it can only help and usually is the one
treatment that will turn a serious diving injury around. It is the
first thing you should think of in all serious decompression
illness and should be used even if you're uncertain of its need.
For purposes of hospital and insurance follow-up and to avoid
any legal problems, it would be a good idea to record as
many of the events as possible during an episode. A pen and
small notebook would be good to have in this respect.