Diving Accident, Self-Responsibility and Balance

[Greenjuice]

Whoa! Might need some time out here! Thread is getting hot.

My comment was a saying "Carrot or the Stick" Softly approach or the Hard approach. I was not suggesting anyone was an animal.

This made me chuckle! I had this vision of you holding out a carrot in your hand to Thea. She might not even like carrots!

More seriously though:

Panic causes you to be unable to do anything to help yourself. Control the panic, and you have a good chance to survive.

I saw an "Emergency 999" TV documentary recently where a woman found herself choking on food when on her own, and no one around her to do the Heimlich maneuver. I'm not sure if I would have had the presence of mind to do what she did.

She got up and threw herself (on her abdomen) onto the back of the chair to simulate the Heimlich. She had to do this three times in the few seconds she would have had before passing out. By doing this, she saved her own life.

It is a slight deviation from this thread, but it came to mind as we discuss breathing difficulties and panic. If posting it here saves one person then it would have been worth it. A close colleague of mine (aged 42) died a few years ago from choking at a meal.

What parts of the current training system exactly weren't taught to her also that would have changed anything?

Perhaps there is a wider issue here that is not about training, but of the maintenance of skills. I don't want Thea to think that she is some kind of outlier. Those who have been around long enough will have witnessed any number of worse near miss incidents. If anything, by posting her experience here she has taken a step towards separating herself from what I suspect is a great many others who are diving with much higher risk profiles and no insight.

Speaking for myself, I know that just because I happen to dive frequently enough not to require a Scuba Review, I haven't actually *had* to do a full mask clearance, dump my weights or demonstrate a BC exchange for some time. Thea's posting has made me re-evaluate some of the assumptions I make about my own capabilities as I get older and further away from my training.

 

[gianaameri]

Panic explains everything from her loss of buoyancy control to the shortness of breath and cyanosis.

T.C., please can you explain how panic can cause cyanosis?

Panic causes hyperventilation (which is not an issue of oxygen deficiency), and cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes due to excessive concentration of deoxyhemoglobin (hemoglobin without oxygen) in the blood.

So, you do not get deoxyhemoglobin in the blood with hyperventilation from panic.

Cyanosis exists only in hypoxia.

Thea went hypoxic (not hyperoxic) and given her age and being a smoker and overweight it would be sensible (as a precaution) to have her ticker (and lungs/arteries) checked.

 

[Greenjuice]

This is pretty good.

In a strange sort of way, if the breathing difficulty was *not* due to an unexplained medical illness or EIB, it might be a better outcome for Thea to get back into what she so clearly enjoys doing, armed now with some insights to achieve a lower risk profile.

I imagine a Dive Med Clinic in Missouri (apologies to any Dive Medics out there, as this is pure fantasy!):
Faced with a young fit commercial diver, I expect they would bust their guts to try and help him/her get back in the water.

Faced with a 49 year old smoker, slightly overweight and out of condition, 60 dives over 2 years, husband non-diver, a bit casual about pre-dive preparation & buddy pairing and a bit rusty on dive skills; now presenting with a suspected unexplained 'medical event' while diving which is going to take a lot of detailed testing to get to the bottom of it. I am wondering if this might introduce some bias into their approach?

p.s. Thea, I am still saying you should go. This is not to put you off getting checked out.

 

[TONY CHANEY]

T.C., please can you explain how panic can cause cyanosis?

Panic causes hyperventilation (which is not an issue of oxygen deficiency), and cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes due to excessive concentration of deoxyhemoglobin (hemoglobin without oxygen) in the blood.

So, you do not get deoxyhemoglobin in the blood with hyperventilation from panic.

Cyanosis exists only in hypoxia.

Thea went hypoxic (not hyperoxic) and given her age and being a smoker and overweight it would be sensible (as a precaution) to have her ticker (and lungs/arteries) checked.

You are right and wrong at the same time. It is called the Bohr effect or left shift of the oxygen dissociation curve.
Hyperventilation syndrome - Pathogenesis and pathophysiology
https://thebreathingman.wordpress.com/article/bohr-effect-202i29i90v7sn-4/

 

[Mike]

...and that is the flight response which the amigdala activated in her brain which is why she went up and not down.

She corked to the surface uncontrolled, it wasn't her choice. It was part of what started her panic.

 

[T.C.]

You missed my point completely. My comment was a saying "Carrot or the Stick" Softly approach or the Hard approach. I was not suggesting anyone was an animal. perhaps you are not familiar with this saying

You're saying there is only two ways to teach adults. I disagree. You can use positive reinforcement, negative reinforcement, and then an approach that involves teaching adults and using their motivation and willingness to learn.

Adults generally do not respond well to negative reinforcement, and quickly tire of positive reinforcement. However, engaging them and using their motivation and eagerness to learn the materials is what gets the best results. Remember, everyone who signs up for a scuba class is there because they want to be there, not because they have to be.

As for my approach, I am hard on her for a reason. Years ago, when I wanted to become an NCO, the crusty sergeant who supervised me came over and asked, "How do you take care of Soldier's?" I hemmed and hawed, and gave some BS answer about making sure they were well-paid and their families are taking care of and they were happy.

He told me, in no uncertain terms, I was wrong. You take care of Soldiers by ensuring they are well-trained, and can perform their jobs under fire. Otherwise, they will likely die, and everything you did for their families will be meaningless.

Being softy on her will not accomplish anything. She will not listen. But, it has been the tough approach that has made her start to admit her panic.

---------- Post added February 26th, 2014 at 07:59 PM ----------

T.C., please can you explain how panic can cause cyanosis?

Panic causes hyperventilation (which is not an issue of oxygen deficiency), and cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes due to excessive concentration of deoxyhemoglobin (hemoglobin without oxygen) in the blood.

So, you do not get deoxyhemoglobin in the blood with hyperventilation from panic.

Cyanosis exists only in hypoxia.

Thea went hypoxic (not hyperoxic) and given her age and being a smoker and overweight it would be sensible (as a precaution) to have her ticker (and lungs/arteries) checked.

As the body panics, it concentrates blood in the core for the brain, heart, lungs, and big muscle groups to use to fight, or run. Blood leaves the capillaries, the same as it leaves your skin when you get cold. This produces cyanosis.

This is is why scared people shiver, and you feel a flush when your become scared. You body is preparing for either fight or flight.

It it has nothing to do with blood oxygenation.

---------- Post added February 26th, 2014 at 08:04 PM ----------

I saw an "Emergency 999" TV documentary recently where a woman found herself choking on food when on her own, and no one around her to do the Heimlich maneuver. I'm not sure if I would have had the presence

She got up and threw herself (on her abdomen) onto the back of the chair to simulate the Heimlich. She had to do this three times in the few seconds she would have had before passing out. By doing this, she saved her own life.

Yes. The Self-Heimlich maneuver. An excellent example of clear thought making it possible to save yourself.

---------- Post added February 26th, 2014 at 08:17 PM ----------

Sure, she did not see it coming till it was too late.

of course not. Because she was blissfully ignorant, of her poor health, smoking, and how these can affect her diving, followed by her not noticing her violations of her training, in blindly following the DM, and not having a buddy.

Then, when it all came together, she was overwhelmed and panicked.

---------- Post added February 26th, 2014 at 08:28 PM ----------

Yep, being in the medical community myself I'm familiar with the concept.

There's also a phenomenon called "tunnel vision" in which multiple relevant issues present themselves but an individual focuses only on one and ignores the rest, often to the detriment of the patient.

Best regards,
DDM

I know. My sister told me another medical analogy as well. "When you hear hoof beats, think horses, not zebras."

She displayed EVERY sign of a panic attack. It fits PERFECTLY. It explains EVERY symptom. It is the most likely cause, and I see no evidence for her magical EIB. She's using that as a crutch to escape blame for panicking.

She he should be medically examined, if only to see if she has COPD from smoking. But until then, I'm going with the best fit and most likely cause. Panic Attack.

 

[razorbackdiver]

Thea, I’m not going to enter the panic verses medical event debate of this thread, but in the first paragraph of your post you say “what should you have done differently.” Without saying that you had a panic attack I think if you understood the panic cycle and developed a plan for breaking the cycle, you might have avoided the rest of this event.
The short medically uneducated way of explaining the panic cycle is that it is usually minor stressors that build on each other until they are no longer minor. I don’t think it is in any manual that I have read but I have three strike rule for minor stressors I follow on an average dive. Two strikes on advanced dives. I set this rule for myself after reading to many threads about when to thumb a dive.
Let’s look at your dive with this in mind. You state “My videos show the surge tossing us around after we reached the wreck.” I think since you thought enough to mention it,this was your first minor stressor. It might not be a stressor for everyone, but as it appears other divers were dealing with it, it was for you.
Next you state “I had some trouble with my weight belt slipping, and had to fuss with that a bit.” Although, it seems minor this is still another stressor.
Third you state “I remember being unable to hover.” Apparently, hovering is a skill you possess but you’re unable to execute it on this particular dive. Frustration at not being able perform is the third stressor,for me that means it is time to head for the boat or the surface.
Would you have avoided a medical event if you thumbed the dive at this point? I honestly, don’t know. What I do know is it probably wouldn’t have made things any worse. Would you have avoided a panic attack if you had thumbed the dive at this point? I bet you would have.
At any rate, it is something to think about and I’m glad you are OK.

 

[NWA395]

I tried to grab the "dead coral" to pull myself up and over the reef, but couldn't get to it. Every time I reached out, the surge grabbed me and dragged me up and away. Swimming hard, I would go forward two feet, then get pulled back ten feet. .....And suddenly, I was tossed to the surface and all hell broke loose.

the dive depth at its deepest was 27 feet..... I was near the top of the reef we were crossing, maybe 8 feet below the surface when I became unable to control the ascent.

No mention of a medical condition or breathing difficulty until after "all hell broke loose" from an uncontrolled ascent from a depth of 8 feet?

Obviously a combination of contributing factors here including a diver who did not possess the skill sets to handle the situation she found herself in.....and panicked..

Most of the best lessons I have learned have been the hardest ones..

Thea, I am glad you made it through this and am glad you are seeing a physician.

 

[Peter69_56]

You're saying there is only two ways to teach adults. I disagree. You can use positive reinforcement, negative reinforcement, and then an approach that involves teaching adults and using their motivation and willingness to learn.

Adults generally do not respond well to negative reinforcement, and quickly tire of positive reinforcement. However, engaging them and using their motivation and eagerness to learn the materials is what gets the best results. Remember, everyone who signs up for a scuba class is there because they want to be there, not because they have to be.

No I am not saying there are only two approaches, it was a general statement (after all I am not writing a 5000 page technical book here, just speaking in general terms). I agree there are a number of approaches from totally strict to sickeningly soft. My comment was to suggest you were being harder than was necessary (in my opinion).

You can use positive reinforcement, negative reinforcement, and then an approach that involves teaching adults and using their motivation and willingness to learn.

Adults generally do not respond well to negative reinforcement, and quickly tire of positive reinforcement. However, engaging them and using their motivation and eagerness to learn the materials is what gets the best results. Remember, everyone who signs up for a scuba class is there because they want to be there, not because they have to be.


Being softy on her will not accomplish anything. She will not listen. But, it has been the tough approach that has made her start to admit her panic.

You state that one should engage adults as they are at the course because they chose to be, and I totally agree with this. Then you go on to say she will not listen and needs the big stick approach. This I disagree with. You try and change her whole thought process and thinking by a simple post here. It smacks of "I have spoken and you did not listen, so now I will beat you until you do" Metaphorically speaking.

As for my approach, I am hard on her for a reason. Years ago, when I wanted to become an NCO, the crusty sergeant who supervised me came over and asked, "How do you take care of Soldier's?" I hemmed and hawed, and gave some BS answer about making sure they were well-paid and their families are taking care of and they were happy.

He told me, in no uncertain terms, I was wrong. You take care of Soldiers by ensuring they are well-trained, and can perform their jobs under fire. Otherwise, they will likely die, and everything you did for their families will be meaningless.

I totally agree with the reasoning here when dealing with soldiers in the army. I understand you must break them and then rebuild them into people who will do as commanded no matter the consequence to them. There are a number of reasons why soldiers are made this way, some I totally agree with; reacting without hesitation to prevent a death of a comrade or ones self. Achieving a near impossible goal by willpower etc. I very much do appreciate the intent by your sergeant. I do however disagree with the "Use soldiers as mindless tools to achieve meaningless victories for egotistical generals and politicians (but that's an argument for another forum and not here).

"We are not soldiers here we are free thinking civilians". We are all free thinking divers who may have varying opinions. The object of this forum is to be able to chat and offer up ones thoughts to assist and help others. Were this me making the original post, my reaction to your hard approach would be to say (in less than pleasant terms) go away and then switch off totally to your future posts. Any comment by you would then be meaningless which I am very sure is not your intent. I have no doubt that your intent would be well meaning and a wish in the end to help. If however you wished to discuss the event in a logical manner, without the hard approach I would be more than willing to listen and take on board what I thought was fair comment. It is my belief that the contributor feels the same way and thus why she has reacted as she has. I would be very interested (if she is still reading this post and we have not scared her away) to know her opinion on this?

I could be wrong here, but I sense a reaction to your posts by many, not because your posts are necessarily wrong (or right), but simply because you are being (in my words), heavy handed with the contributer. I am not suggesting that we should be totally softly softly, but we should work with the person who posted, as you said yourself, "engage the person", (I would suggest) not "beat them to death with the proverbial big stick".

My personal opinion is that with this event, there was some panic regardless of anything, perhaps some medical condition underlying which needs attention, and some lack of experience/training that also requires attention. I don't believe it is just one thing or another but a combination of things that lead her to where she ended up. Why not go get checked out by a specialist and remove that possibility? It then not only deals with a possible health problem, but removes any doubt in her mind which would remain if she didn't get checked.

 

[gianaameri]

As the body panics, it concentrates blood in the core for the brain, heart, lungs, and big muscle groups to use to fight, or run. Blood leaves the capillaries, the same as it leaves your skin when you get cold. This produces cyanosis.

This is is why scared people shiver, and you feel a flush when your become scared. You body is preparing for either fight or flight.

It it has nothing to do with blood oxygenation.

None of that produces cyanosis. You are talking B.S.

You body is ready for fight or flight, adrenalin is released, you are oxygenated and an unstoppable force (not entirely though).

Respiratory distress and shock would instead produce cyanosis.