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First Aid Kit

Oxygen Resuscitation Equipment

Dive Accidents Requiring Immediate Transport to a Chamber Facility

I. First Aid Kit
The following items are offered as an example of a list of first aid supplies which can be modified according to your needs and experience:Gloves
Deodorant cleansing soap (antibacterial)
Household Vinegar solution (neutralize jellyfish stings)
Household ammonia
Antibiotic Ointment
Cortisone Cream 1%
Non-aspirin pain reliever
Hot packs
Cold packs (pain relief)
Denatured alcohol, 12 oz. bottle (sterilizing instruments)
Telfa pads or plastic wrap (cover burns)
Absorbent dressings (control severe bleeding with pressure)
Squeeze bottle of water, 6 oz. (irrigating eyes and wounds)
Squeeze bottle of sterile saline
Sterile cotton, gauze pads, and adhesive tape
Band-Aids and butterfly bandages
Q-TipsTongue depressors
Disposable cups
Razor blades, single edged
Shaving cream
Tweezers or forceps
Needle nosed pliers with wire cutters (to remove fishhooks)
Bandage scissors
Lighter or waterproof matches
Space blankets
Backboard, splints and neckbrace, if space permits
Penlight
Seasickness medication
Pocket mask (eliminates direct contact while resuscitating a person)

None of these items will be of any use at all if there's no one on the boat who knows how to administer first aid. All divemasters and instructors should be fully certified in First Aid and their certification should be up-dated at least yearly.

Oxygen Resuscitation Equipment

The DAN Oxygen System provides an O2 cylinder in a case with appropriate pressure regulator, flow meter, tubing, airways and ventilation devices. Other oxygen sources are available-but the important thing is that the equipment should be up-to-date, readily available and someone should know how to use it properly.

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.

It probably would be a good idea to have a backup kit-since most dives are 40-60 minutes away from the shore and the O2 tanks hold generally only 20 minutes of oxygen. A larger O2 tank would solve this problem but in most boats the space is limited.

If possible, have your divemasters take a DAN oxygen course or at least have studied their oxygen manual.

DAN now offers 'Remo2', a partial rebreathing apparatus that prolongs the oxygen supply of the O2 bottle.
 

Diving Accident Management
Model Accident Action Plan

II. First Aid for Diving Accidents
Requiring Immediate Transport to a Chamber Facility

A. Air Embolism

Recognition (This usually occurs during or immediately after surfacing )

Symptoms (one or more of the following)
Disorientation
Chest pain
Paralysis or weakness
Dizziness
Blurred vision
Personality change
Voice change in tonal quality (mediastinal air)

Signs (one or more of the following)
Bloody froth from nose or mouth
Paralysis or weakness
Unconsciousness
Convulsions
Stopped breathing
Apparent Death

Early Management
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
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. This is possibly the most important thing you can do!
Call DAN at 919-684-8111 in the USA, +41-1-383-1111 in Europe, +81-3-3812-4999 in Japan, (800) 088-200 from within Australia, +61-8-373-5312 when calling Australia from overseas,  0800 4 DES 111 (0800 4 337 111). in New Zealand and +65-750-5546 to get the Singapore Naval Medicine & Hyperbaric Center. or your own preferred emergency number.
Air evacuation should be at sea level pressure or as low as possible in unpressurized aircraft
Contact hyperbaric chamber, send diver's profile with the diver, and send all diving equipment for examination or have it examined locally.

B.Decompression Sickness

Recognition (Symptoms usually appear 15 minutes to 12 hours after surfacing)

Signs
Blotchy rash
Paralysis or weakness anywhere in the body
Coughing spasms
Staggering or instability
Unconsciousness
Personality change

Symptoms
Tired feeling
Itching
Pain, arms, legs or trunk
Dizziness
Numbness, tingling or paralysis
Chest compression or shortness of breath
Anything unusual after the dive

Early Management
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
Mask, if available)
Early recompression treatment for all forms of decompression sickness
See Decompression Accident Management

III. First Aid for Diving Accidents
Requiring Transport to a Hospital Facility

Pneumothorax

Recognition

Symptoms
Pain in the chest
Shortness of breath

Signs
Shallow, rapid breathing
Cyanosis (blue skin, lips, fingernails)
Possible crackling under the skin of the neck
Possible mediastinal shift (Heart sounds not in the usual place)

Treatment
No recompression necessary, if there is no arterial gas embolism associated
A physician needs to insert a chest tube, withdraw air so that the lung can reinflate
If recompression therapy is required because of AGE or DCS, a chest tube is a must to prevent "Tension pneumothorax"

Mediastinal Emphysema (Lung over pressure accident)

Recognition (Always associated with pneumothorax)

Symptoms
Pain in the chest (beneath the breastbone)
Faintness
Shortness of breath

Signs
Obvious difficulty breathing
Brassy change in voice

Treatment
O2
Should be seen by physician and observed for 24 hours.
No chamber recompression needed unless associated with air embolism or DCS

Drowning-Near Drowning

Recognition
Unconsciousness
Lack of respirations
Cyanosis (bluish pallor, face lips, nailbeds)

Management
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 victims weight belt, inflate victims 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

Oxygen Toxicity (with convulsions)

Recognition

Signs

Prevention
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

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

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 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

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 (Australia Commonwealth Serum Lab.)
Heat for pain

Mollusks (Cone shells, Blue-ringed Octupus)
Immobilize
Pressure dressing
Cleanse puncture site
Tetanus
Analgesics
Topical antibiotics
CPR, if necessary, to treat possible respiratory distressor 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

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 cold—then avoid due to possibility of ventricular fibrillation (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

Ingested Marine Toxins (liveaboards)

Paralytic shellfish poisoning

IV. First Aid For Injuries
That Can be Treated On Board

Nitrogen Narcosis

Recognition

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

Symptoms
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

Treatment
Ascend until free of symptoms
Surface with controlled ascent
Intense counseling session!
 
Carbon Dioxide Poisoning

Symptoms
Rapid breathing
Feeling of suffocation, shortness of breath, impending doom and panic
Headache, nausea , dizziness
Rapid heartbeat
Confusion and unclear thinking

Signs
Slowed responses
Muscle irritability (twitching)
Loss of consciousness

Treatment
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.

Ear Disorders

Middle ear barotrauma

V. Hazardous Marine Life Injuries
Not Requiring Transport

Coral and Barnacle Cuts