Written by DAN Staff
Being able to quickly and correctly provide emergency care during a dive incident can be the difference between a positive outcome and a fatality. Regardless of your level of personal experience with emergency management and response, providing adequate care requires regular refreshers of even the most basic skills, such as measuring vital signs. Accurate assessment of an individual’s condition not only provides EMS personnel with a good baseline for care, but can also help expedite needed medical interventions, and provide a valuable timeline of a patient’s condition. How well do you know your basic life support skills?
Time is a fundamental metric in emergency response. Regularly recording the patient’s condition and the corresponding time is important to creating an accurate timeline of the patient’s symptoms. A timeline can be used to determine whether the patient’s condition is worsening and can dictate medical interventions. Seriously ill patients should have their vital signs reassessed every few minutes, while patients who are stable may reasonably have their vitals checked less frequently.
Level of Responsiveness
A patient’s level of responsiveness (LOR) can be one of the most revealing indicators of well-being. LOR is generally measured with four basic questions:
- What is your name?
- Where are we?
- What time is it?
- What happened?
If an individual can answer all of these questions with reasonable accuracy, you can quantify the LOR as “Alert and Oriented to Person, Place, Time, and Event,” which is frequently written as “A+Ox4.” In the event that a person can’t respond to these, or is unconscious, you can further measure LOR by determining if the patient is responsive to verbal or physical stimuli. While this measurement may provide useful information to professional responders, it’s not likely to change the care you provide as a dive professional.
Pulse can be a very effective indicator of an individual’s wellness, especially if you measure strength and regularity of the beat in addition to frequency. To assess a pulse, place two fingers gently on either the carotid artery on the neck, or on a patient’s wrist just beneath the base of their thumb. If you difficulty finding a pulse, first confirm the location of your fingers, and then make sure you aren’t pressing too hard or too gently. Note not just the speed at which the heart beats, but also the strength and regularity of the beat, these can be important factors when determining injury severity.
Constantly monitoring a patient’s breathing is a crucial emergency care step. Because many people will alter their breathing if they know you’re trying to count their breaths, begin counting respirations immediately after measuring the patient’s pulse. Pay close attention to the sound of breath and listen for wheezing, gasping, or labored breathing. These can indicate the existence of specific conditions and be valuable information for healthcare personnel.
For more information on diver health and safety visit diversalertnetwork.org.
Are corals a shining beacon at night? Corals are not just a wonder to observe during the day, at night they glow. This isn’t just for our viewing benefit; it plays a vital role in the long term survival of coral.
Due to the richness of life they create, corals are often described as the rainforests of the ocean. Their structural complexity supports one of the world’s most productive ecosystems providing ecological diversity and outstanding beauty. The coral animal (polyp) co-habitats its calcium carbonate skeleton with photosynthetic algae called zooxanthellae. These algae harness energy from solar radiation and provide the polyp with 95% of its food. Coral is therefore limited to the habitat range of the algae, which in turn is limited by the penetration of the suns ray into the ocean; both the intensity and spectral diversity of light dramatically decreases with increasing depth. Although the blue/green portion of sunlight reaches depths of around 200m the algae requires the higher light levels found in the upper 30m of the ocean. Corals are therefore limited to the upper portion of the ocean; aptly named the sunlight ocean.
The corals exposure to high light levels is crucial for its survival, but this is not without consequence. The high light intensity that corals are subjected to everyday can damage coral and zooxanthellae – similar to our skin and sunburn. Shallow water corals have a solution to this: fluorescence. The coral contains special pigments (green fluorescent pigments (GFP) and non-fluorescent chromoproteins (CP) which act as sunblock. The fluorescent pigments are in particularly high concentrations and contribute to the beautiful rainbows of colours which can be observed on the reef. When the coral is subjected to high sun exposure the pigment concentration increases, hence limiting the damage experienced by the algae when under stress from sunlight. The pigments are also involved in growth related activities, including repair. Injured coral will produce colourful patches concentrating these pigments around their injury site which prevents further cell damage. Some corals have been found to distribute fluorescent pigments around their tentacles and mouth to attract prey.
We are able to observe the fluorescent pigments when corals are illuminated at specific wavelengths (generally blue light). In high pigment concentrations corals can become shining beacons at night. Light is absorbed by the pigments and then re-emitted. During this process some energy is lost resulting in a different colour being observed – generally green. During our blue light night snorkel it is possible to see corals glowing on the house reef at Gili Lankanfushi.
It is now widely accepted that fluorescent pigments aid in sun protection, so why do corals below 30m still have these pigments? In shallow reefs generally only green fluorescence is observed, whereas in the mesophotic zone (between 30 – 100m) corals shine green, orange, yellow and red. Fluorescent pigments are energetically costly to create, therefore the pigments must have a biological purpose, or else they would not exist at this depth. A study carried out by the University of Southampton found that deeper corals produce fluorescence without light exposure, which suggests that these corals are not producing pigments for sun protection. It is suspected that the corals are producing pigments to transform short light wavelengths received into longer wavelengths to enhance algae photosynthesis, thus producing more food for the polyp. It has also been suggested that it may link to behavior of reef fish, although more studies are required. Next time you are night diving take a look. Harnessing these fluorescent pigments could pose significant advances for medical, commercial and ecological purposes.
Marine biologists at the Scripps Institution of Oceanography at San Diego have suggested that monitoring fluorescence could be an easy and less invasive way to monitor reef health. Scientists measured the fluorescence levels after corals were exposed to cold and heat stress. The levels were reduced when exposed to both stresses, although coral subjected to cold stress adapted and fluorescence levels returned to normal. Corals subjected to heat stress lost their algae and starved. Therefore, if high fluorescence levels are observed it suggests that the reef has a healthy coral population. Additionally there are many medical benefits that can be gained through the understanding and utilization of coral fluorescence.
There are promising applications for biomedical imaging, for example pigments can be used to tag certain cells e.g. cancer cells which can then be easily viewed under the microscope. The fluorescent pigments also have the potential to be used in sun screen. Fish feeding on coral benefit from the fluorescent pigments which suggests that the pigments move up the tropic levels (food chain). Senior lecturer from King’s College London and project leader of coral sunscreen research, Paul Long and his team have suggested that if the transportation pathway up the food chain is identified it may be possible to use this to protect our skin against UV rays in the form of a tablet. This could a break-through in terms of reef safe sun screen.
Next time you are night snorkelling shine a blue light on the corals and view this natural wonder yourself!
PADI’s guest blogger Emma Bell introduces herself:
I am a marine biologist and scuba diver from England. I have had the privilege of working in Greece, Seychelles and Maldives. I have worked in an aquaculture research centre where I focused on hormonal manipulation of a pelagic fish species. In addition, I have experience with coral restoration projects including frames and ropes; habitat restoration – crown of thorns, drupella and invasive plant species removal; educational activities and social media updates including blogs. I have also monitored population dynamics of bird, turtle, shark and cetacean species to aid in their conservation. I started my career working in the Maldives and I have done a round trip via Greece, England and Seychelles, I hope to increase my skills set and knowledge further whilst I am at Gili Lankanfushi, Maldives.
It is that time of year again and winter is fast approaching, have you lined up your Courses accordingly? With this blog, I am going to list some options to try and help you get through the challenging winter months. There is a great deal of PADI Courses which can be done “dry”. Also, PADI has teamed up with Project AWARE to run #AWAREWeekUK which will take place from 1st to 10th December 2017 there is a lot of marketing support available through the landing page.
#AWAREWeekUK http://dive.padi.com/AWARE-Week-UK/ is being run with perfect timing fitting in with the latest BBC Wildlife documentary series on BBC One – Blue Planet II http://www.bbc.co.uk/programmes/p04tjbtx. If you have already started watching it, you will hopefully notice the importance they are placing on the environment. One thing that could help make some difference is your involvement in doing something about it and raising people’s awareness.
What I have learned from running Project AWARE events for both PADI and PADI Dive Centres is just how popular they are. The recent event I ran in Malta had people coming in just for the Dive Against Debris. Register your interest to take part in this joint PADI & Project AWARE event that https://www.eventbrite.co.uk/e/aware-week-tickets-37876244868
Other “Dry” course ideas for you to look at are:
Enriched Air/Nitrox (click on link for a MailChimp template)
Emergency Oxygen Provider
Having an arsenal of these courses over the winter months will help keep your customers engaged. We are doing some promotions to help, so give Emily a call in the office use promo code 17UKDP.
Using your CRM system you can drill into who has what course and with EFR when did they last have a refresher. If you would like help with making templates to go with these then just let your Regional Manager know.
On top of the Dry Courses and #AWAREWeekUK, there is the whole Christmas Gift market to look at. Like me you may have scorned the supermarkets and pubs for marketing Christmas for me what felt like as soon as easter finished, but, one thing that is for sure, venues are booked and people have started stocking up. You need to think ahead and promote, to plant the seeds and let them ideas take route. Acting now will give you the best run in for December sells.
Revisiting an idea of old was a DSD pack, the success of this was in the presentation. If you are reaching out to Customers to purchase a gift for friends and family (or even themselves) then you need to make it as easy as possible for them to give it as a present. Running with the Christmas theme your customers fall into 3 categories, Past, Present, and Yet to Come and like the ghosts from the Dickens classic, each has its own wants and needs and goals to achieve. As a Centre, you need to think about how to market to each of these groups.
Written by DAN staff
Heart health is essential to an active lifestyle that includes scuba diving. Symptoms of heart conditions are often subtle or easily missed, and in some cases, the first indication of a serious cardiac problem may be a heart attack. That’s why it’s imperative for divers to truthfully complete the RSTC Medical Statement and disclose their health histories before starting training. It’s also important for you to know the primary risk factors of heart disease because they apply to dive professionals just as much as student divers.
Hypertension, or high blood pressure, is a contributing factor in 13 percent of cardiac deaths, and may lead to a thickening and weakening of the tissues in the heart. This change in heart tissue can cause disturbances in heart rhythms, and elevate the risk of stroke, heart attack and kidney failure. While high blood pressure alone may seem relatively benign, it’s important to recognize that it can result in some very serious consequences if left unaddressed.
While smoking causes a well-known laundry list of cardiopulmonary issues, it’s also a leading cause of cardiac diseases. Smoking increases the risk of coronary heart disease, peripheral vascular disease, stroke, sudden cardiac death and cancer. It also increases blood pressure and lipid levels and can result in sustained, low-level inflammation that causes the cardiovascular system to deteriorate, and may increase DCS risk.
Hyperlipidemia or high cholesterol may double a person’s 10-year risk of dying, and increases risk of clotting conditions, high blood pressure and stroke. High cholesterol levels rarely give obvious symptoms until it cause a serious cardiac issue. Lipid levels should be tested regularly by a physician and can be controlled through diet and medication.
Inactive people are twice as likely to develop heart disease as active people. Regular exercise helps to maintain both health and a capacity for sustained exercise. Also, exercise can slow a decline in exercise capacity due to aging and reduce risks of many health-related hazards.
Obesity can be a difficult subject to address, but it significantly elevates a person’s risk of cardiac problems, among other hazards. Divers who struggle with obesity may need to exert themselves more while diving, which places additional strain on their heart, and may have difficulty dealing with the physical demands of strenuous dives, putting them at an increased risk of injury.
For more information on cardiac risks and diving, visit DAN.org/Health
Written by John Kinsella
It’s not too often you come across something that gets absolutely no hits on Google. Multiple-Level Training is one of those things. Where you will find it is under Organization in the Teaching Techniques section of PADI’s Guide to Teaching. If it’s been a while since you checked it out, take a moment to read it again, especially if you want to boost your Divemaster and IDC enrollment.
The basic idea is to have several different levels of training happening at the same time and at the same place. Done right, multiple-level training is not only an efficient use of resources; it’s a powerful way to motivate existing divers to consider going pro.
The key is planning and careful scheduling (there’s a great sample schedule in the Guide to Teaching) and to build in time for divers to mingle and socialize. It also helps to have a few certified assistants. Consider these strategies to maximize the cross promotional benefits of multiple-level training:
Have all divers together for the area orientation. Let everyone know what’s going on and take some time to introduce the divers to each other: “Welcome to the dive site, we have three activities going on this morning, the Divemaster Mapping exercise, the Advanced Open Water Diver Navigation Dive, and Open Water Dive One.” Cover the usual points, make sure to mention who is doing what (by name), then split up into individual course groups to finish the briefings.
Keep people moving and don’t waste their time. In this example, you could overview the Divemaster Mapping exercise seamlessly with the area orientation before breaking up the groups. This has the benefit of clearly highlighting an interesting part of Divemaster training to both the AOW and OW divers. Then have a certified assistant keep an eye on the Open Water Divers while they assemble their gear and get ready for your predive brief. Meanwhile you’re running through the (detailed) brief for the AOW Navigation dive and setting the divers up to practice their navigation patterns on land. (Which will certainly get the Open Water Divers attention.)
Make good use of your own time. Once you’ve covered the AOW brief, have those divers assemble and set up their gear and present themselves for the dive at a specific time. Head over to the entry point where the OW Divers are ready to go and your certified assistants have the shot line already positioned. Enter, run the dive and when you exit you find the AOW divers ready to go. You supervise that dive from the surface and while the AOW divers are breaking down their gear post dive, you debrief the OW divers before you debrief them.
By now the Divemaster candidates are wrapping up their mapping exercise and you check with them before everyone settles down to enjoy lunch.
All you have to do now is sit back and let the buzz do your marketing work for you.
The PADI Master Scuba Diver™ rating is often described as “the black belt of scuba.” While most people know what a karate black belt is, entry-level divers may not understand the prestige of the Master Scuba Diver rating. You need to inspire all your customers to join the elite group of divers who reach this level.
Why? Because it’s not only the ultimate rating that signifies an accomplished and experienced diver, but also because you gain a customer who takes eight courses, commits to more than 50 dives, and will likely purchased a full set of gear. There are at least three reasons why you should implement or bolster your Master Scuba Diver program today:
- Offer and fill more courses. The Master Scuba Diver program sets goals for your customers and they enroll in the courses needed to reach their goals.
- Support active divers. The more training your divers receive, the more dives they make, the more gear they purchase, and then they dive even more.
- Create loyal customers. Your diver retention rates will increase as your divers become more competent and comfortable in the water.
Here are a just few ideas for raising awareness and interest in your Master Scuba Diver program:
- Create a wall of fame in your store to recognize customers who have achieved the prestigious Master Scuba Diver rating.
- Publicly chart the progress of current Advanced Open Water and Rescue Divers to encourage friendly competition among students.
- Invite Master Scuba Divers to be guest speakers at your next course orientation.
- Give special recognition to your Master Scuba Divers at a dive club meeting or store BBQ.
- Develop a five specialty program for your area that showcase local diving, or perhaps focuses on the environment – Cold Water Master Scuba Diver or Eco-Master Scuba Diver.
- Offer an exclusive dive trip only for Master Scuba Divers.
Written by DAN staff
Few divers can claim to have never used over-the-counter (OTC) drugs before a dive. Whether it’s a decongestant to deal with allergy symptoms or aspirin to deal with sore muscle, OTC drugs are perceived be less of a concern than prescription drugs. As a dive professional, you know there are risks associated with using OTC drugs before diving. What you don’t always know, however, is when students are self-medicating to make it possible to complete a dive or finish a course. By being clear about the effects of OTC drugs and sharing that information with your student divers, you can help them make good decisions during and after training.
Antihistamines, like diphenhydramine, are most often used to provide symptomatic relief of allergies, colds and motion sickness. Antihistamines often have side effects that include dryness of the mouth, nose and throat, visual disturbances, drowsiness, or undesired sedation and depression. They can also depress the central nervous system (CNS) and impair a diver’s ability to think clearly.
Decongestants are vasoconstricting drugs that narrow the blood vessels of the nasal airways and often temporarily improve breathing. Common active ingredients include pseudoephedrine and phenylephrine. Decongestants may cause mild CNS stimulation and side effects like nervousness, excitability, restlessness, dizziness, weakness, and a forceful or rapid heartbeat. These drugs may have significant undesirable effects on divers, and should be avoided by individuals with diabetes, asthma, or cardiovascular disease.
Anti-Inflammatories and Analgesics
These drugs are typically used for temporary relief of minor aches and pains. Keep in mind that these may relieve symptoms, but the injury is still present. Limitations in range of motion due to an injury, swelling or pain can put a diver at risk of additional injury. Active ingredients include naproxen sodium and ibuprofen, with side effects such as heartburn, nausea, abdominal pain, headache, dizziness and drowsiness. These should be avoided by individuals with heartburn, ulcers, bleeding problems or asthma. They may also have interactions with individuals using anticoagulants, insulin and nonsteroidal anti-inflammatories (NSAIDs).
While in many cases the use of these drugs is warranted and relatively low-risk, unwanted side effects, drug reactions and reactions to increased partial pressures of nitrogen can raise injury risk during a dive. Susceptibility to adverse side effects can vary greatly from person to person, and divers should refrain from taking a new medication for the first time before diving. Many medical professionals will advise anyone who requires medication in order to dive to wait until symptoms resolve to resume diving. If you have any questions about the safety of an OTC drug, seek an evaluation from a qualified healthcare professional.
For more information on OTC drugs and diving, or safe diving practices, visit DAN.org/Health
Blog written by guest blogger and marine biologist Clare Baranowski
Preserving coral reefs is a growing concern in the Maldives
At Gili Lankanfushi, we are recovering our coral reefs through the Coral lines Project. By growing small fragments of coral on hanging ropes (lines) and then transplanting them to our house reef near One Palm Island, we hope to see regeneration and aim to kick start the health of our house reef.
Our Coral Lines Project started three years ago and currently holds around 7484 coral colonies. We are consistently adding small fragments of coral to the already growing population on 153 lines.
The vulnerable nature of coral populations mean that they undergo cycles of disturbance and recovery. Our house reef was affected by warmer waters created by the El Nino event in 2016 which bleached much of the corals. Yet against all odds, most fragments in our coral lines nursery survived. They have also been faced with a Crown of Thorns (coral predators) outbreak this year and have still remained intact.
In some cases, the corals in our lines are no longer present on shallow reefs in the area.
Now, is the perfect time to begin stage two of our coral restoration project by moving coral from our nursery to our house reef. Transplanting coral is a delicate procedure with a lot of trial and error. We began slowly by creating a test site with a small number of coral colonies to ensure we would not lose healthy coral unnecessarily.
We found a site with conditions not too dissimilar to the nursery. The area had to be flat and solid, with no loose material and space for growth. It also had to be an area that is easily accessible for monitoring, but nowhere in danger of tampering or accidental damage. We chose a depth of 8 metres in the middle of house reef drop off where we regularly snorkel. Another major concern was the Crown of Thorns Starfish, so we placed the coral in an area visited regularly by Harvey Edwards, Ocean Paradise Dive Centre manager, who has been removing these starfish from the reef for months.
The next step was to cut the colonies from the lines in the nursery, and transport them in mesh bags in the water. We decided to use three different Acropora species to begin with as they are fast growing and like a lot of light and a moderate current. Once at the site, we cleaned the area of algae and attached the coral to ensure protection from extreme water movement. We placed them an equal distance apart to allow quick growth and attached the coral using epoxy, which is a clay like cement. We were aware from previous studies that Miliput (epoxy clay) has been seen to kill the part of the coral it is attaching, so we placed small amounts of putty at the base of the coral.
Once a week, for a total of six weeks, we will measure growth and survivorship of the coral. We hope to replicate the test at different depths and locations to find a suitable site to start a larger restoration project. However, we will hold off on most of the major transplantation until after the monsoon season.
Due to the fragility of coral species, our rehabilitation plans are very flexible, and subject to a long monitoring period. We expect to adapt our approach and long term management to ensure we keep up with the changing environment of the reef. Previous restoration plans have been hindered by external threats, so we are so excited to finally begin this project. We will be producing scientific data along the way which we hope will contribute to current coral reef rehabilitation knowledge.
Although our transplants are working well so far, we will still have many question to answer in the future such as: are the corals on the house reef still reproducing? As these corals survived the last bleaching, will they be more genetically suited to future hostile conditions? The answers to these questions are all just a work in progress and we will have to keep on watching and learning as we replant and monitor these corals over the next few years. As our house reef sustained a lot of mortality and the coral cover is low, we hope that this new project will help to rejuvenate the reef and raise awareness.
PADI’s guest blogger Clare Baranowski introduces herself:
I am a marine zoologist from the UK who has worked throughout the tropics researching mega fauna and reef ecosystems in the Caribbean and Indian Ocean. I have experience monitoring and restoring coral and surveying manta, turtle and dolphin populations. I began my career as a science communicator before moving into research and management roles, this is why I incorporate outreach and education into every project I work on and I hope to continue this at Gili Lankanfushi.
Written by DAN Staff
Explaining decompression sickness (DCS) to student divers is a balance between emphasizing how serious DCS can be while focusing on how conservative diving practices help keep the incident rate low. Similarly, as a dive professional, you need to balance your preparedness to deal with a DCS incident with your focus on reducing risk for your student divers and yourself before, during and after each dive.
Most training dives are likely to be conservative and well planned, especially for entry-level courses, thus the steps to reduce DCS are role-modeled and practiced by student divers in the water. However, post-dive DCS catalysts may be less frequently addressed. Dehydration, strenuous exercise and thermal stress can all increase DCS risk. It’s important to consider how much physical exertion may be required by student divers to move gear after a dive or hike out of a dive site. Because student divers are not as knowledgeable as experienced divers, share dive-related efficiencies, such as using a hand trolley or dive bag with wheels to carry gear. Inexperienced divers also need to be reminded to hydrate and apply sunscreen or find shade. Learning something new is exciting, but it can also be stressful for student divers. Part of dive safety is taking the time to instill good habits to reduce risks.
Prepare For The Worst
You know that even if you do everything right, you can’t completely eliminate DCS risk. This means that even on the most ordinary training dive in great conditions, you must be prepared for the worst. Having an emergency plan that includes contact information for emergency services and the location of the nearest medical facility is key. Also, preparing your response to an injury by having the proper equipment and emergency oxygen is critical. The more remote the dive site, the more oxygen you’ll need along with a reliable way to transport an injured diver to medical care. DAN can help you locate the nearest chamber and provide medical consultation as needed.
For more information on DCS and risk management, visit DAN.org/Health