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Earfuls of Trouble

Written by DAN Staff

Ear injuries make up the overwhelming majority of medical complaints from divers. It makes sense because we put our ears through a lot of stress in a dive, and that especially applies to professionals who are up and down, and in and out of the water all day long.

In the first metre/three feet of a descent your ears experience 10 percent greater pressure than they did at the surface. At two metres/six feet that percentage doubles, and at four metres/10 feet there is enough pressure to rupture ear drums, burst blood vessels and draw fluid into our inner ears. Despite this, many divers equalize their ears as an afterthought, or forget to equalize as they try to keep up with others divers while descending.

Ear injuries can occur quickly and without notice, but by firmly establishing the importance of equalization early and often during training, you can help your student divers avoid trouble. Let’s review the most common ear injuries, so you can give your students an “earful” of good information.

Perforated Eardrum

A rupture of the tympanic membrane, or eardrum, is generally the result of a failure to equalize the middle ear, or a too-forceful Valsalva maneuver. The condition often presents with pain, although the rupture may relieve the feeling of pressure on the ear. Vertigo may follow. Most perforations will heal spontaneously within a few weeks, although some cases may require surgical repair. Factors like congestion, inadequate training, and excessive descent rates can increase a diver’s risk of eardrum perforation.

Inner-Ear Barotrauma

Like an eardrum perforation, inner-ear barotrauma can be caused by a failure to equalize, or an inappropriately aggressive Valsalva maneuver. A significant differential between external and middle-ear pressure can cause an outward bulging of the round window of the ear, which can cause inner-ear injuries without a rupture. Should the round window rupture, the loss of fluid in the inner ear can lead to damage of the hearing and balance organs, and surgical repair may be required. Divers with inner-ear barotrauma often experience severe vertigo, hearing loss, tinnitus, a feeling of fullness in their ear, and involuntary eye movements known as nystagmus.

Middle-Ear Barotrauma

A middle-ear barotrauma is a condition in which pressure in the tympanic cavity (the air-filled space in the middle ear) is significantly lower than the pressure outside of the ear, resulting in a relative vacuum that causes the eardrum to bulge inward, the tissue of the ear to swell, and the fluid and blood from ruptured vessels to leak into the tympanic cavity. This can be caused by a failure to equalize or an obstruction of the Eustachian tubes on descent. Divers with middle-ear barotrauma will generally report initial discomfort that may intensify to severe pain and the feeling of clogged or stuffy ears.

Facial Baroparesis

Facial baroparesis is the reversible paralysis of the facial nerve due to increased pressure in the middle-ear, which in some individuals can stop circulation to a facial nerve that is located close to the ear. This can happen while flying or diving, and symptoms usually include numbness, tingling, weakness,and paralysis of the face. Facial droop can sometimes be seen and  cause concern, but facial baroparesis often resolves spontaneously. Divers who exhibit symptoms of facial baroparesis should seek medical attention to rule out other serious conditions.

2019 Instructor Development Update

We are pleased to invite you to join us at one of the Instructor Development Update events taking place in EMEA during 2019. These events will cover the revised IDC curriculum due for launch later in the year.

These live events will give you the opportunity to be fully updated on the latest standards changes to the Instructor Development Course revision, and provide a broader overview of the exciting PADI developments planned for 2019 and beyond. As a PADI Course Director, attendance at one of these events will provide you with credit towards the 2020 ID Update which will include essential information on the revised curriculum due for launch later in 2019. Places at these events are limited and all IDC Staff Instructors, Master Instructors and Course Directors are welcome to attend. This program will meet Active Status Course Director requirements and will also count towards seminar credit for master Instructor and CDTC applications.

This Update will cover the following topics:

  1. What’s New – Standards and Curriculum
  2. Revised eLearning and Digital Materials
  3. Knowledge Development Evaluation changes
  4. Confined and Open Water Evaluation changes

 Dates and locations are listed below

DateLocationPrice (+VAT where applicable)
3rd March 2019Dubai, UAE£157
21st March 2019Sliema, Malta176 Euro
22nd March 2019Madrid, Spain176 Euro
30th March 2019Lisbon, Portugal176 Euro
22nd April 2019Hurghada, Egypt£157
24th April 2019Dahab, Egypt£157
28th April 2019Santa Margharita, Italy176 Euros
29th April 2019Copenhagen, Denmark176 Euros
18th May 2019Amsterdam, Netherlands176 Euros
22nd May 2019Paphos, Cyprus176 Euros
30th May 2019Lanzarote, Canary Islands176 Euros
30th September 2019Moscow, Russia£157

Please register by completing this registration form and returning it to id.emea@padi.com. Please provide a telephone number that we can call you on to then take payment details over the phone.

Can’t make these dates? Don’t worry – an online update will also be available later in 2019 to retain Active Teaching Status! Please note: Attending an online update will not enable you to teach the revised IDC curriculum when launched in 2019. CDs have a choice to attend a Live update in either 2019 or 2020, to be able to teach the new curriculum. Only after completing a Live update can a CD teach the new curriculum.

** Not an IDC staff Instructor? Contact the Training Department to find out how to become one.

Thinking Like a Diver When Wreck Diving

The PADI® Open Water Diver and Advanced Open Water Diver courses provide a strong foundation for teaching divers to think through diving scenarios to make sound decisions. As you mentor divers at all levels, you can build on this by providing dive scenarios relevant to the course you’re teaching, and offer questions that help them think like a diver as they evaluate the scenario and share their decisions with you. This helps you assess understanding and how they apply what they’re learning. It’s a great way to coach thoughtful and deliberate decisions. In this example, the scenario promotes using sound judgment in deciding whether to enter a wreck in the PADI Wreck Diver Specialty course.

Entering a Wreck

When a diver wants to enter a wreck, the primary-decision-making goal must always be to have a safe exit. That means being able to find a way to an exit, and being able to handle any emergency situation that could arise while in that overhead environment. Wreck-entry methods include two classifications: swim-throughs and penetrations.

  • Swim-throughs – In a swim-through, the diver enters through one opening and exits through another. In a basic swim-through, the diver will always be able to see two exit points to open water using natural light. The path between them will be free of significant obstacles, entanglements or silt. The combination of the distance to an exit point and up to the surface should not exceed 40 metres/130 feet for Advanced Open Water Divers and higher, and in other circumstances the distance should be the depth for which the diver is qualified.
  • Penetrations – In a penetration, the diver enters more than a few metres/feet into the wreck intending to return to the entry point, either because there is no other exit or the diver is not sure there is another one. The diver may go beyond the point that the entry is still clearly visible and must run a line to ensure a safe return to the exit. The path should be well lit and free of obstacles, entanglements or silt. As with swim-throughs, the distance to the exit and then to the surface should not exceed 40 metres/130 feet.

Using Sound Judgment

Either situation calls for good, reasonable judgment. Answers to the following questions can help a diver shape an appropriate decision:

  • Are the exits big enough to allow my buddy and me to swim through side by side?
  • How much light is there? Is there enough that I will always be able to see the light of the exit?
  • Is there anything big enough to be a dangerous obstacle?
  • Is there enough silt to have potentially obscure my vision to the extent I couldn’t find my way out?
  • For my planned maximum distance, is the nearest exit close enough to allow me to leave the wreck and with ample time to handle an emergency?

Also factored into the decision should be the diver’s experience, training, skill and equipment. Two different divers looking into the same wreck can make two totally different, yet appropriate decisions. For example, divers with little wreck experience entering a silty environment could obscure visibility creating a potential hazard. A diver trained in non-silting kicking techniques may not have a significant issue with silt. A diver with excellent buoyancy and trim skills can pass around obstacles that could challenge a less‑skilled diver.

Good judgment can also allow divers with more experience and training to go beyond some of the penetration guidelines. A diver with technical training, such as cave training that includes effective use of suited lights, will be able to work in areas without clear daylight.

When teaching the PADI Wreck Diver Specialty course, mentor your divers on how to think like a diver and make good decisions regarding wreck penetration based on the specific wreck circumstances and their individual training and experience. Apply similar decision-making mentorship in all courses as appropriate to the diver level, environment and course topic.

Reference the PADI Wreck Diver Instructor Guide (Product 70232) for information about this specialty diver course.

A version of this article originally appeared in the 3rd Quarter 2018 edition of The Undersea Journal®.

Our Unshakable Foundation

Amid everything the PADI® organisation does in a rapidly changing world, we need to always build on the foundation for everything the PADI family does. It’s what John Cronin and Ralph Erickson laid down first when they established PADI in 1966, it’s our foundation today and it will carry us into the future. That foundation is, of course, education: diver training. What we teach and how we teach have, will and must continue to change. But, that we teach will never go away. It can’t, because it’s not what we do, but who we are.

Training is PADI’s foundation, but the heart of it is not the PADI System, eLearning, instructor cue cards and the like. These are powerful modern tools, but in 1966, several years before all of these existed, you could take PADI courses and earn PADI certifications because our training foundation was already there, entrusted where it is today – in the hands of you and your fellow PADI Instructors, Assistant Instructors and Divemasters. Without you, the PADI System – the best education system in diving by a long shot – can’t do what it does so well, much as a Steinway piano can’t sound like a Steinway without a master at its keys.

Even with all the innovations in instructional technology, such as the rise of artificial intelligence and dynamic online learning systems, human teachers still bear the weight of the best education. Innovations are important to keep PADI training relevant in today’s dynamic, personalized online world, but you still need great instructors to have great training. As American author William Arthur Ward explained it: “The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.”

That describes the PADI family – more than 130,000 people who inspire others to learn, to dive and to care. Together we motivate divers to rise to new challenges, to have underwater adventures, to heal and help others with scuba, and to protect our fragile world. PADI Course Directors shape the future by passing our collective -wisdom to a rising generation of dive leaders, who will in turn inspire divers to do things we have not even imagined yet. Everything the global PADI organisation does today has its roots in training, and that training has its roots in you, me and the rest of the PADI family.

Aristotle said, around 2,300 years ago, “Educating the mind without educating the heart is no education at all,” and that hasn’t changed – the PADI family doesn’t “teach diving”; we educate the heart and transform lives. That’s what makes PADI’s training foundation solid.

Good luck, good teaching and good diving,

Drew Richardson Ed.D.
PADI President and CEO

This article originally appeared in the 4th Quarter edition of The Undersea Journal.

Risk Management Tips

As diving instructors, we have a duty of care to the students we take into the water. We are the experts, and therefore we need to be prepared to make decisions on behalf of our students as well as on behalf of ourselves, taking into consideration their current skill levels and general comfort.

PADI standards provide a fundamental structure within which instructors can operate. For example, the student to instructor ratios represent the maximum number of participants an instructor could take in ideal conditions – instructors can then use this to work back to an appropriate ratio for their personal environment, experience and students.

Ensuring students have appropriate equipment is another example of good risk management. Consider whether their thermal protection is appropriate for the water temperature anticipated at your prospective dive site.  Also consider their likely air consumption – students who are nervous will breathe air far more rapidly than an experienced instructor. Even in relatively shallow water, an Open Water Diver course student or Discover Scuba Diving participant may go through their air very quickly. Consider how often you will need to monitor their air supplies, taking the prevailing water conditions into account.

Sometimes the most mundane factors can be overlooked, however a thorough briefing and debriefing after each dive, along with a clear plan for how your dive will be executed, can be very important in the event of an incident underwater. In some parts of the world, a certified assistant is required by law, but in other areas the instructor is responsible for determining whether they wish to take an assistant with them. Consider your supervision of the divers at all levels, and how you will handle a large group if one of them has a problem.

PADI standards also help to enforce good risk management practices from the very start of a diver’s experience. The Statement of Risks and Liability / Liability Release & Assumption of Risk form outlines the risks inherent in scuba diving activities to your students so that they are suitably informed. Similarly, the Medical Statement is used to help screen out divers with possible medical contraindications to diving. This screening is a crucial risk management tool, and failure to use the relevant medical statement – or failure to act appropriately upon the answers from a medical statement by ensuring that written approval is obtained from a physician prior to any in-water activities if there are any “Yes” answers on the medical questionnaire – represents a serious risk to your students as well as compromising your own legal position in the event of an incident.

Adhering to standards and always being safety conscious when supervising others is your best approach to minimise the likelihood of an unfortunate incident from occurring, and ensure you provide your students with the best possible training experience.

Teach the Project AWARE Speciality course this winter

AWARE Week 2018 was a great success around the United Kingdom, with many UK Dive Shops participating in a number of ways. The week entailed film nights featuring ocean conservation films, Dive Against Debris® events, beach cleans and even a baby lobster release.

To compliment AWARE Week, PADI® and Project AWARE® announced the launch of the updated Project AWARE Speciality course. This course can be taught by all Instructors and Assistant Instructors. PADI Divemasters who have completed the Speciality Instructor training with a PADI Course Director and applied at their PADI Regional Headquarters also qualify to teach this course.

The newly revised Speciality course provides information and support to help individuals take responsibility for ocean health, based on Project AWARE’s 10 Tips for divers. The purpose of the course is to unite scuba divers and water enthusiasts to make a difference. It makes individuals aware of the most pressing problems facing aquatic environments and how to protect them.

The participant’s prerequisites are that they only need to have an interest in the aquatic environment to enrol. There is no minimum age or experience requirement and it is run as a dry course, or “fins off” as Project AWARE like to call it.

With the winter months starting to close in, the Project AWARE Speciality course gives you a chance to get your dive team and customers together to learn about the pressing problems facing our oceans as well as the everyday actions that can be taken to help protect them. This is also a great course to reach out to youth groups and schools to get involved with, in order to teach young people about the importance of ocean protection. If you are a Centre and would like to know more about the PADI Approved Youth Training Scheme for your Centre then please contact your PADI Regional Training Consultant – Emily Petley-Jones (Emily.petley-jones@padi.com).

There is a 10 Tips for Divers Toolkit on the Project AWARE website which includes Divers Handout and the poster. The instructor guide is on the PADI Pro’s site available as a free download and there are also lesson guides to help you in running your courses (Training Essentials> Curriculum> Specialities> Project AWARE Speciality Instructor Outline – v30).

The Project AWARE Specialty focuses on guiding participants toward the following personal commitments and actions they can take to help the environment…

10 Tips for Divers to Protect the Ocean Planet

  1. Be a Buoyancy Expert
  2. Be a Role Model
  3. Take Only Photos – Leave Only Bubbles
  4. Protect Underwater Life
  5. Become a Debris Activist
  6. Make Responsible Seafood Choices
  7. Take Action
  8. Be an Eco-tourist
  9. Shrink Your Carbon Footprint
  10. Give Back

 

Immersion Pulmonary Edema: What You Need to Know

Written by DAN Staff

As the number of divers of retirement age rises, dive safety researchers are increasingly interested in immersion pulmonary edema (IPE). Also called swimming-induced pulmonary edema (SIPE), the condition may occur in young and healthy swimmers and divers, but the risk increases with age and age-related health changes. While IPE can be fatal, divers who are able to recognize the symptoms early and exit the water often have good outcomes, and spontaneous resolution is common.

Here’s what you need to know about IPE:

What is it?

IPE is the accumulation of fluid in the air sacs of the lungs (alveoli) caused by immersion in water. The condition occurs when the pressure in the alveoli is less than that of the fluid pressure in the surrounding capillaries, which causes fluid to seep into the alveoli. Some fluid in the alveoli is normal, but when too much of that fluid is present it can obstruct breathing and cause chest pain, frothy pink sputum and dyspnea (difficulty breathing).

IPE symptoms typically begin to improve immediately after exiting the water, but the condition can cause serious complications, and advanced medical interventions are necessary in some cases.

What are the risk factors?

There are several risk factors that, when combined with immersion, can increase the likelihood of IPE. Exposure to cold water will exacerbate the shunting of fluids to the chest. High blood pressure, overhydration, heart conditions such as left-ventricular hypertrophy, and some genetic predispositions may increase the risk. High-intensity exercise and elevated work to breathe, which may occur with a poorly performing regulator or an inappropriate gas at a deep depth, can also increase the likelihood of IPE by disturbing the fluid balance in the lungs.

Divers can reduce risk by using appropriate thermal protection, avoiding extreme effort in the water, maintaining physical fitness and addressing any potential health-related risk factors before getting in the water.

How should you respond?

If you or your student divers experience symptoms of IPE during a dive, it’s imperative to end the dive as quickly as possible. If symptoms are mild, make a relaxed ascent. However, if symptoms are quickly worsening or are interfering with the ability to breathe, make a direct ascent, get out of the water and seek help.

A diver with symptoms of IPE should breathe 100 percent oxygen and be immediately transported to qualified medical care regardless of whether or not symptoms are improving. It’s possible that the symptoms may have been caused by an underlying cardiac issue that must be addressed by a physician. IPE is likely to reoccur if relevant risk factors are not identified and addressed.

For more information on IPE or safe diving practices, visit DAN.org/Health.