In Case of Emergency – The Five Minute Neuro Exam.

Michael and I have been diving for years without incurring or observing any serious accidents taking place. We follow all the rules, as we have a strong aversion to the possibility of getting a case of the bends. Even when obeying EVERY rule, however, a person may be physiologically susceptible to, or just be plain unlucky enough, to develop symptoms caused by breathing air at depth. If there is a diver who surfaces, or exits the water with complaints that lead you to believe he may have suffered a dive related incident, or if you notice someone acting strangely, be sure to incorporate The Five Minute Neuro Examination as learned in your Stress and Rescue course while awaiting the input of medical personnel. Components of the test are as follows:

1. Do an orientation check. Ask the diver his/her name, the date, and to explain what happened on their dive. Answers to these questions may demonstrate the diver has some confusion. Even if answers to these questions are correct, make sure general conversation is making sense.
2. Eye test- With the head held still, have the diver follow your hand while it moves in upwards/downwards, and in side to side directions. Your hand should be placed approximately 18 inches from the person's face. The eyes should track smoothly in every direction and should not exhibit any jumping/bouncing around while tracking. Look at their peripheral vision - when are they able to see an object coming around from behind their head? Is it symmetrical on both sides? Shine a flash light in their eyes. Do their pupils get smaller, then larger again when the light is removed?
3. Forehead - With the divers eye's closed, lightly touch their forehead and face. Are they able to feel your touch and is it the same on both sides of the face? Check strength by trying to open the divers eyes (from above their brow) after they have shut them tightly. Ask them to furrow their brow. Is there a difference between right and left brows?
4. Observe the divers face. Is the diver able to pucker his lips to whistle? Is the diver able to smile? Have them clench their jaw and have the examiner feel if both sides of the jaw are exhibiting equal strength. Is sensation present?
5. Check the ears. With the divers eyes closed, ask them if their hearing seems normal. Hold your hands 2 feet from the divers ear. Rub your finger and thumb together, and gradually move closer until the diver is able to hear you.
6. Check the gag reflex. Does the diver's "Adam's apple" move up and down when you ask him to swallow?
7. Have the diver stick their tongue out. Make a note whether the tongue comes straight out or moves to one side or the other.
8. Check the shoulder strength. With your hands firmly positioned on the divers shoulders, ask them to shrug their shoulders. Is one side stronger than the other? Do the shoulders have any sensation here?
9. Check arm strength. Ask the diver to squeeze your fingers. Is one hand stronger than the other? Have them raise their arms to chest level straight in front of them. Push down gently, then pull on elbows with the diver attempting to resist the motion. Is one side stronger than the other? Are they able to feel both their arms?
10. With the diver's eyes closed, check sensation their chest.
11. With diver lying flat, have diver raise and lower their legs with resistance. Note if there differences in strength between sides. In standing, check balance and coordination by asking them to walk in a heel-toe fashion. Guard closely, as falls should be avoided. Is sensation in the legs present?

If the diver is unable to complete one of these tests, indicate which test was omitted and why.

Repeat the tests every hour. Make sure results are documented and present them to medical personnel.

Notice how the exam moves in a head to toe direction. The body parts are highlighted, and work their way from mind/brain to the feet. These two things may help you remember the steps of a complete exam. Hopefully this tool is one you'll never have to utilize, but as a responsible diver, you should review and practice it frequently so that if you find a diver in need, you'll be able to step up and help.

-- Shannon

http://www.finforyourself.com

Pre-Dive Safety Check

How to perform a Buddy Check

One of the most important aspect of every dive is to perform a pre-dive safety check, which is known as a buddy check. Pre-dive safety checks are taught by most certifying organizations. You should always perform this check with your buddy before beginning any dive.

This pre-dive safety check has a few functions: you make sure that your buddy's equipment is working as it should. You should also familiarize yourself with your buddy's equipment. this familiarization will make you aware of how to release their weights, use their deflator, and use their alternate source of air, all of which may be necessary in the event of any emergencies during the dive.

This check should always be performed once the equipment has been donned, with the exception of the mask and fins. It's ideal to perform this check while on the boat before entry or on the shore before any shore dives. If this check does slip you mind, it can be performed during decent.

This safety check is broken down into several components which are abbreviated with the acronym BWRAF. There are many mnemonics that can help you remember the steps in this safety check. You should use whatever you'll remember best. Here are some of the most common mnemonics.

• Begin With Review And Friend
• Because We Really Are Friends
• Bunnies Will Run Away Fast

Buoyancy

You want to ensure your buddy's BCD is working properly.  To do this, begin by inflating their BCD.   Do not infate it complely   You will also want to deflate the BCD to ensure that the deflator is working properly.

Weights

Check your buddy's weight system.   How this performed will depend upon what weight system being used by your buddy.

• Weight Belt: Check that your buddy's weight belt is on properly and secured.  Check that the quick release is free of obstructions and easily accessible.   Weight belts with excess length should should not be tied or tucked into the BCD or around the belt in such a way that it's difficult to perform a release.
• Integrated Weights: Check that your buddy has their weight pockets in their BCD (with weights in them!), that they are properly secured, and that you know how to release them.   For those BC's that use Velcro for the weight pockets, make sure the Velcro is not to worn that it prevents the pockets for being properly secured.

Releases

Check that all of your buddy's releases are properly secured.  This includes, but not limited to Velcro waist bands, shoulder clips, boot straps, and etc.   Many BCDs will have a chest and stomach clips. It's a good idea to touch each clip as it is checked.  Remember to check the tank strap and clip as well. You can do this by placing one hand on the bottom of the tank and the other on the first stage regulator and trying to move the tank up and down to see if the moves up and down in the secured tank strap.   If the tanks slides while doing this, resecure the tank.   It is often a good idea to wet the strap before securing it to the tank.

Air

Check that your buddy's air is turned all the way on and half a turn back. Have your buddy take one or more breaths from their regulator while you watch their SPG. While you look at the SPG, ensure that the tank is full (approximately 200 bar or 3000 psi) and that the needle doesn't dip as they breathe. If the needle dips this is a sign that the air isn't turned all the way on or there is a problem with the regulator. You should also test your buddy's alternate air source by taking two breaths from it.

Final OK

Check that your buddy has all other necessary equipment such as mask and fins. Ask your buddy if they're ready to go and if all is ok you're ready to dive.

Diver Panic

By James Costello

What is the most serious condition a diver can experience underwater?

DCS (bends), narcosis...?

It's probably panic, for the simply reason that once a diver starts to panic he/she looses all rational thought processes. In most cases the irrational thinking renders the diver giving self-help almost impossible. The diver is not able to 'think there way out of a problem'; below is an example:

You are diving a famous wreck in local waters, the depth of the wreck is at 40m and the visibility is around 10m. The pre-dive excitement and anticipation are high as you enter the water, once you and your buddy reach the wreck you are overwhelmed by its size... You both spend the next few minutes swimming around the wreck until suddenly you look around and can't see your buddy. Then your dive computer starts to beep as you run out of bottom time, you realize your some distance from the ascent line; so you make a made swim for it. In your haste to get to the ascent line, you don't see the mass of fishing line and it gets entangled around one of your feet/fins. The more you struggle the more you get entangled, with no one to help, you start to panic. No bottom time, limited air supply (at that depth on a single tank)...

It's easy to say, but not so easy to practice; BUT if you stop for just a few seconds try to calm yourself before you hit the panic stage. You can think about your predicament more logically... Relax and slow your breathing (to conserve your air and reduce CO2 build-up), which will make you feel more relaxed and less stressed. Look down identify the problem, maybe removing your fin will make it easier to untangle! If you have a knife or EMT shear (which are highly recommended), take them out and start cutting.

Even if you exceed your bottom time by a minute or two, your diving computer will still prompt you as to what to do (safety stop, ceiling etc); and obviously in this kind of situation it would be advisable to stop diving for a 24hr period if your no decompression limits are been exceeded.

A simple trip to break the circle of panic in a diver is to get them to perform a very simple task for themselves. This shows them that they are in control, and help clam and reduce the level of panic.

By James Costello, SDI Intructor Trainer #13056; visit my website Dolphin Dive Adventures & Services for more information about scuba diving.

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