Wow ...
Dive boat procedures for administering O2
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This is an interesting thread from a couple of directions. We are responding to a story we heard. I am a DAN Instructor so I am trying to think of a respone from what "I think I know." I am not going to go grap a book and look up an answer.
We know that an injured diver is usually in denial. In the DAN Neurological assesment class we teach a responder to examine an injured diver in hopes of convincing him to seek treatment if need be. Arm twisting is another method.
We know that they asked about DAN insurance but we know that has nothing to do with calling DAN.
We know that the captain made a decison based upon talking to DAN, and the injured diver. I know of no requirement to evacuate or run right in or abandon the second dive with or without O2.
I know of no red tape requirement. They decide to use O2 or not use O2.
We do not know the captains qualifications or why his decesion was made. He had a lot of things to consider and did so. If he screwed up he has H**l to pay. If he made the right decesion then a bunch of divers got in there second dive.
Be informative to hear the other side.
tnx don O
We know that an injured diver is usually in denial. In the DAN Neurological assesment class we teach a responder to examine an injured diver in hopes of convincing him to seek treatment if need be. Arm twisting is another method.
We know that they asked about DAN insurance but we know that has nothing to do with calling DAN.
We know that the captain made a decison based upon talking to DAN, and the injured diver. I know of no requirement to evacuate or run right in or abandon the second dive with or without O2.
I know of no red tape requirement. They decide to use O2 or not use O2.
We do not know the captains qualifications or why his decesion was made. He had a lot of things to consider and did so. If he screwed up he has H**l to pay. If he made the right decesion then a bunch of divers got in there second dive.
Be informative to hear the other side.
tnx don O
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I don't think that there are two sides it a case as described. Once begun it needs to wind to a procedurally defined conclusion.
tonka97
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The reported incident is outrageous. I have cleaned up the syntax and presentation a bit; please correct any errors.
Hard to believe your group took another dive with a DCS victim on board.
Thanks for the report!
plongeursousmarin:
Hard to believe your group took another dive with a DCS victim on board.
Thanks for the report!
Donoo
This is a fair point to make, and I think you are right to suggest that we be privy to that perennial “other side” that often gets lost in the mix. And I suppose by extension the desire by many to quickly point fingers and assign blame is the outcome you would like people to avoid. This is sage advice for sure.
That said, I’m still quite troubled by the notion as a human being with moderate diving experience that fellow human beings would choose to go back in the water when a diver in their presence had a paralyzed leg and was showing what many people consider to be symptoms of substantial DC sickness.
Like everyone else here, I can’t really say for sure what that conversation with DAN entailed. Did the Captain edit important details about the diver’s condition to DAN based on the diver’s insistence that he was okay? Did the captain decide on his own that this diver was okay and then flavor the conversation with DAN in a way that mitigated what was really going on? Perhaps DAN gave options with varying degrees of prudence, such as wait it out and see what happens to advising him to take the diver back for precautionary reasons. Perhaps the captain chose from this menu of options for convenience sake instead of what was best for his customer and then failed to mention those choices he disregarded to the others on the boat. Stranger things have happened in the world.
Maybe the symptoms in the OP in this thread are misleading from the get-go, or perhaps remembered incorrectly, exaggerated, etc. We could draw up several scenarios wherein doubt could be injected from any number of angles; so is the beast of internet bulletin boards and the casual exchange of information.
You are right to suggest that we should be wary of abridged or one-sided accounts in these cases. And you are also right to point out that we really only have what info is posted here and for that reason we can only comment according to the perceptions derived from our own agendas and from what we glean in other posts.
All circumstantial considerations aside, then, and based entirely on what information we do have from the horse’s mouth so to speak, I still think at the crux of this issue lies the very thing that is most disturbing in this informal case study: other divers (including the original poster), notwithstanding procedural considerations, bottom line liabilities, and “red tape” justifications, displayed what I believe is very selfish behavior by going back in the water when someone was in duress after a dive.
I can assume this much. The poster knows whether or not he and the others did that 45 minute dive after something happened. We know the captain allowed for this dive to take place, and for all intents and purposes he made the decision to allow this later dive based on a best case scenario as opposed to one with a worst case codex. It seems incredibly risky thinking if in fact this man’s leg was paralyzed as stated in the OP—incredible beyond the coattails of any technicalities of diving manuals or the semantics of dive boat operations as far as I am concerned. That able bodied, free thinking human beings would choose to enter the water with this happening seems a serious point of contention. I see little wiggle room in this conclusion, though I am aware that in practical terms I don’t have all sides of the story. I wish I did.
Cheers!
This is a fair point to make, and I think you are right to suggest that we be privy to that perennial “other side” that often gets lost in the mix. And I suppose by extension the desire by many to quickly point fingers and assign blame is the outcome you would like people to avoid. This is sage advice for sure.
That said, I’m still quite troubled by the notion as a human being with moderate diving experience that fellow human beings would choose to go back in the water when a diver in their presence had a paralyzed leg and was showing what many people consider to be symptoms of substantial DC sickness.
Like everyone else here, I can’t really say for sure what that conversation with DAN entailed. Did the Captain edit important details about the diver’s condition to DAN based on the diver’s insistence that he was okay? Did the captain decide on his own that this diver was okay and then flavor the conversation with DAN in a way that mitigated what was really going on? Perhaps DAN gave options with varying degrees of prudence, such as wait it out and see what happens to advising him to take the diver back for precautionary reasons. Perhaps the captain chose from this menu of options for convenience sake instead of what was best for his customer and then failed to mention those choices he disregarded to the others on the boat. Stranger things have happened in the world.
Maybe the symptoms in the OP in this thread are misleading from the get-go, or perhaps remembered incorrectly, exaggerated, etc. We could draw up several scenarios wherein doubt could be injected from any number of angles; so is the beast of internet bulletin boards and the casual exchange of information.
You are right to suggest that we should be wary of abridged or one-sided accounts in these cases. And you are also right to point out that we really only have what info is posted here and for that reason we can only comment according to the perceptions derived from our own agendas and from what we glean in other posts.
All circumstantial considerations aside, then, and based entirely on what information we do have from the horse’s mouth so to speak, I still think at the crux of this issue lies the very thing that is most disturbing in this informal case study: other divers (including the original poster), notwithstanding procedural considerations, bottom line liabilities, and “red tape” justifications, displayed what I believe is very selfish behavior by going back in the water when someone was in duress after a dive.
I can assume this much. The poster knows whether or not he and the others did that 45 minute dive after something happened. We know the captain allowed for this dive to take place, and for all intents and purposes he made the decision to allow this later dive based on a best case scenario as opposed to one with a worst case codex. It seems incredibly risky thinking if in fact this man’s leg was paralyzed as stated in the OP—incredible beyond the coattails of any technicalities of diving manuals or the semantics of dive boat operations as far as I am concerned. That able bodied, free thinking human beings would choose to enter the water with this happening seems a serious point of contention. I see little wiggle room in this conclusion, though I am aware that in practical terms I don’t have all sides of the story. I wish I did.
Cheers!
ArcticDiver
Contributor
From what has been presented and assuming it is indeed fact there is no "other side". What there is is a callous crew hauling a bunch of callous divers. All of whom value their dives higher than the health, and maybe life, of others. Even the poster failed in, what to me, was his obligation to his fellow humans.
I'd go further than TS&M; I'd like to know which boat it was and who the divers were so I could avoid all of them. That is if they survived my rage.
How does any human live with themself after not helping another when such help involves no risk?
I'd go further than TS&M; I'd like to know which boat it was and who the divers were so I could avoid all of them. That is if they survived my rage.
How does any human live with themself after not helping another when such help involves no risk?
Dadvocate, very well said.
There's a difference between, "Oof, my shoulder's kind of sore", or even, "My right fingers are a little tingly," and, "I can't move my leg!" We all know that diving involves some aches and pains, and I got a pretty good scare a couple of times before I realized that hauling major weight from my shoulders gave me some cervical disc symptoms. Had I not had the training I've had, I might well have gone to an ER -- or denied the symptoms.
But clearcut paralysis isn't normal wear and tear. Clearcut paralysis is emergent, no matter WHAT the cause. If the patient had a stroke, there's a very short time period for lysing the clot that caused it. If the patient has ruptured a disc which is producing complete paralysis of muscle groups in the leg, that's an indication for emergent decompression. There just isn't ANY way that paralysis isn't something which should be evaluated by a physician ASAP. And if it's DCS, which may well be the most likely diagnosis for a diver, O2 is the first line of treatment. In short exposures on the surface, it is harmless, and sometimes may resolve the symptoms.
In the US, patients are always allowed to refuse treatment of any kind, even life-saving treatment, if they are judged to be compos mentis. Therefore, since O2 is considered medical treatment, we are taught to ASK the patient if he is willing to accept the mask. It's how we do things.
But, as I well know from my profession, you can influence the answer you get to the question. You CAN lean on people and get them to change their minds. Or, if you're presenting a treatment you don't want to provide or don't really think is indicated, you can flavor things that way, too. I can just hear the boat crew saying, "Well, we don't really think you've suffered a hit, but the book says we're supposed to offer O2, but if we do, you're going to have to go to the hospital. Do you have any medical insurance?" Not to say that's what they did, but if you want somebody to say, "No, I don't think I need it," that's the way to do it.
This story is amazing, and not in a good way. A whole boat full of people stood around and looked at a diver with a paralyzed leg, and proceeded about their business. Wow.
There's a difference between, "Oof, my shoulder's kind of sore", or even, "My right fingers are a little tingly," and, "I can't move my leg!" We all know that diving involves some aches and pains, and I got a pretty good scare a couple of times before I realized that hauling major weight from my shoulders gave me some cervical disc symptoms. Had I not had the training I've had, I might well have gone to an ER -- or denied the symptoms.
But clearcut paralysis isn't normal wear and tear. Clearcut paralysis is emergent, no matter WHAT the cause. If the patient had a stroke, there's a very short time period for lysing the clot that caused it. If the patient has ruptured a disc which is producing complete paralysis of muscle groups in the leg, that's an indication for emergent decompression. There just isn't ANY way that paralysis isn't something which should be evaluated by a physician ASAP. And if it's DCS, which may well be the most likely diagnosis for a diver, O2 is the first line of treatment. In short exposures on the surface, it is harmless, and sometimes may resolve the symptoms.
In the US, patients are always allowed to refuse treatment of any kind, even life-saving treatment, if they are judged to be compos mentis. Therefore, since O2 is considered medical treatment, we are taught to ASK the patient if he is willing to accept the mask. It's how we do things.
But, as I well know from my profession, you can influence the answer you get to the question. You CAN lean on people and get them to change their minds. Or, if you're presenting a treatment you don't want to provide or don't really think is indicated, you can flavor things that way, too. I can just hear the boat crew saying, "Well, we don't really think you've suffered a hit, but the book says we're supposed to offer O2, but if we do, you're going to have to go to the hospital. Do you have any medical insurance?" Not to say that's what they did, but if you want somebody to say, "No, I don't think I need it," that's the way to do it.
This story is amazing, and not in a good way. A whole boat full of people stood around and looked at a diver with a paralyzed leg, and proceeded about their business. Wow.
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Try this one on for size:
You're out in the middle of the North Atlantic, 4 days away from the nearest helicopter evacuation point. A diver comes up a computer that went into deco but never violated having emptyed his tank between 20 and 10 feet. The diver has a rash on his back that itches and may be skin bends or maybe drysuit squeeze. He also has a "nagging" elbow that could also be "tennis elbow".
There is an ongoing science program and the ship plus the science party represents about $25K per day (not to mention the shear impossibility of rescheduling this party of scientists onto any ship in the near future, plans are made at least two years in advance).
What do you do?
You're out in the middle of the North Atlantic, 4 days away from the nearest helicopter evacuation point. A diver comes up a computer that went into deco but never violated having emptyed his tank between 20 and 10 feet. The diver has a rash on his back that itches and may be skin bends or maybe drysuit squeeze. He also has a "nagging" elbow that could also be "tennis elbow".
There is an ongoing science program and the ship plus the science party represents about $25K per day (not to mention the shear impossibility of rescheduling this party of scientists onto any ship in the near future, plans are made at least two years in advance).
What do you do?
Ana
.
This is a perfect example of the old “different people behave differently”.
People go on with their lives ignoring the suffering of others, every single day. There are accidents on the road and people keep on driving, unless you have a family member in the military the war doesn’t stop anyone from their daily grind, the list could go on. Why would be different in a dive boat?
If the captain doesn’t call off the dives, I will be more than happy to get in the water for my second dive, wouldn’t give a fraction of a thought. If they asked my opinion I would suggest to 02 and prompt transportation to a medical facility, otherwise I would mind my own business.
With that said, early on my diving life I realized that I’m better off assuming that I will be surrounded by useless people when things go the wrong way. While I was doing aggressive dives I made sure to have my own 02 and a frame of mind that didn’t include any concern about ruining other people’s dives. I haven’t need assistance yet, but when I do, there won’t be any subtleness. I sure won’t wait for anyone; I’ll be breathing 02 while I tell the Capt. to get going to the closest point where I can connect to a medical facility.
Most of the replies in this thread point fingers to the “heartless” behavior of the crew and other divers, how about the spineless victim? Oh poor guy… voooo hoooo. Give me a break. As divers we have a responsibility to ourselves, to dive within our limits, to take care of our gear and our body. You feel funny then figure what in the world is happening. A PARALIZED LEG and the guy didn’t want to call attention? Is this for real?
Let’s face it; if you have a leg that doesn’t move and you wait for someone else to make a call, the leg is the least of your problems.
People go on with their lives ignoring the suffering of others, every single day. There are accidents on the road and people keep on driving, unless you have a family member in the military the war doesn’t stop anyone from their daily grind, the list could go on. Why would be different in a dive boat?
If the captain doesn’t call off the dives, I will be more than happy to get in the water for my second dive, wouldn’t give a fraction of a thought. If they asked my opinion I would suggest to 02 and prompt transportation to a medical facility, otherwise I would mind my own business.
With that said, early on my diving life I realized that I’m better off assuming that I will be surrounded by useless people when things go the wrong way. While I was doing aggressive dives I made sure to have my own 02 and a frame of mind that didn’t include any concern about ruining other people’s dives. I haven’t need assistance yet, but when I do, there won’t be any subtleness. I sure won’t wait for anyone; I’ll be breathing 02 while I tell the Capt. to get going to the closest point where I can connect to a medical facility.
Most of the replies in this thread point fingers to the “heartless” behavior of the crew and other divers, how about the spineless victim? Oh poor guy… voooo hoooo. Give me a break. As divers we have a responsibility to ourselves, to dive within our limits, to take care of our gear and our body. You feel funny then figure what in the world is happening. A PARALIZED LEG and the guy didn’t want to call attention? Is this for real?
Let’s face it; if you have a leg that doesn’t move and you wait for someone else to make a call, the leg is the least of your problems.
pickens_46929
Contributor
Thalassamania:
So the answer is... "It depends..."
Knowing that it's rare to have a deco chamber on board these science vessels (though there are some that do) and even rarer that they have the new inflatable deco chambers (yes they exist)... so assuming there isn't one on board...
Most of the guys I know that'd be doing this kind of diving would probably ask for an O2 bottle and head back down to 20 or 30 ft. for a bit to alleviate the pain and symptoms... ok, even deeper than that. They would likely do in water deco since it's a mild hit.
Know several that routinely (monthly?, quarterly?) get mild hits for strange reasons (ok, they don't dive conservatively and they dive often)... do this.
Dave
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