Diving Accident, Self-Responsibility and Balance

[MMM]

What he said. It takes me a long time to get ready, mostly because I wear a lot of neoprene but also because I have a particular order of doing things and I don't like to be rushed while I run my routine. So I make a bit of a joke on the boat while I start my process. Some men teased me, good naturedly, just the other day, saying they were married and totally GOT women taking a long time. We laughed and talked about my make-up needing to be applied yet. Good divers don't care if you actually ARE getting ready. The time to notice missing gauges is before you get in the water! I love having my own equipment because of the comfort it brings in knowing how everything works and that it DOES work. They are making some lightweight travel equipment these days. Yesterday a guy showed me his weight integrated (no more slipping weight belt) travel BCD that weighs 4 lbs! Buy a lightweight set of regs and a computer and you can probably safely rent the rest of what you might need.

I mentioned in an earlier post that it takes time to process these sorts of events. Sounds like you are, and will come out of it a better diver. Thanks for sticking with us and your continued good humor while taking it all in.

Thea -

Don't ever worry about slowing the dive group down getting into the water. It's one thing if you were talking on your cell phone or trying to take pictures of the dive captain, it's quite another if you are taking your time going through your equipment and your buddies, checking and double checking that everything is correct.

 

[doctormike]

All divers would get a fight or flight response to disabling root causes like hypoxia, hypercapnia, hyperoxia... whatever brings about those conditions (poor equipment or medical problems)...

OK, maybe I misunderstood what you are saying. Are you using the term fight or flight response to mean a good thing which will help you survive an underwater event? That in this context, "fight" means figure out what the problem is and fix it?

Because from your previous post it sounded like you were blaming the fight or flight response as the cause for her problems with the weight belt and BC on the surface, and that these problems were inevitable once the response was activated.

 

[TSandM]

On occasion, you WILL get pushback from dive operators for taking the time to do a pre-dive check. We had an INSTRUCTOR on a boat in the South Pacific start to make sarcastic fun of me and my husband for doing ours . . . Peter went down his throat. Of course, if the dive requires precise timing for the drop, you need to make sure you start getting ready early enough to get the checks done so that you don't delay the boat. But NO ONE should ever try to stop you from doing a thorough pre-dive check. It doesn't actually take very long. This is how I do it:

Goals -- where are we going, and what do we hope to do? This could include such simple things as "we're going to drift this reef until we hit minimum gas", or something as complex as, "We're going to go down on the stern of the wreck, swim along the starboard deck, take some photographs in the wheelhouse, and come back to the anchor line."
Team -- who's my buddy? Who's leading? If we are following a guide, he is effectively team leader, but that doesn't mean the buddy pair doesn't make an effort to stay together.
Equipment -- is anything special needed for the dive? For boat diving, I always have a surface marker buoy and spool, and a noisemaker of some sort. Different dives require different things; if someone has a camera, that should be mentioned, because it changes the way they dive.
Exposure -- how deep do we plan to go? How long do we expect to dive? If you know that you go through gas quickly, this is the place to mention that.
Deco -- this is ascent strategy. The DMs in the Philippines were clear about doing 3 minute stops at 15 feet. Whatever you do, you and your buddy should agree on it.
Gas -- How much do we have, and of what? This is where you should know what size tank you are diving, and whether that tank is full.
Environment -- do we expect current? Is the bottom silty? Are there overheads (swimthroughs)? Is the visibility limited? Anything environmental that affects or could affect the dive is discussed here.

Then we quickly go over our gear, head to toe -- hood, mask, primary reg, backup reg, inflator/BC dump valves, dry suit inflator and dump, gauges, weights, pocket contents (or auxiliary gear, if you aren't using pockets), fins.

It sounds horrible, but it takes about 2 minutes, once you have memorized the drill. Many easily solvable problems are encountered and fixed on the boat doing this. Checking both regs will identify having your gas turned off . . . checking your dump valves makes sure you know where all of them are, particularly important if you are using the resort's equipment.

Everybody who dives with me knows I am really a PITA about this. The whole check gets done, even if our max depth is planned at 20 feet. Things really are much easier to deal with if you do it BEFORE you're underwater.

 

[gianaameri]

OK, maybe I misunderstood what you are saying. Are you using the term fight or flight response to mean a good thing which will help you survive an underwater event? That in this context, "fight" means figure out what the problem is and fix it?

Because from your previous post it sounded like you were blaming the fight or flight response as the cause for her problems with the weight belt and BC on the surface, and that these problems were inevitable once the response was activated.

The fight or flight response activates our reptilian brain and anything which is learned externally and cognitively that is not consistent with the basic coding in our primitive/reptilian brain we either don't do or we can't do it.

Plus with increased heart beat and irregular breathing we lose dexterity.

So, we may fumble to inflate the BCD, but we are unable to do it, or release the belt buckle, but not actually ditch the belt... or we know we'd be better off switching to a different reg. around our neck, but we don't or can't make the switch.

Simple stuff which Thea was taught to do and could do under normal circumstances, but couldn't do after the fight or flight response was activated and due to her cardiopulmonary state at that point of the dive.

She had one single drive and that was up and air and the tools her brain was coded to achieve that was leg, arms, and mouth and nose (not BCD, weight belt buckle, and reg.).

The primitive coding made her refuse the reg. because to the primitive brain it was a foreign object constricting her ability to breathe once she reached AIR.

External training that is not consistent with the coding of our primitive brain we generally can no longer do when we are in physical distress and the fight or flight response triggers.

In the cinema fire example the environment is designed to be consistent with our instinctual behavior (outward pushing emergency exits).



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[doctormike]

The primitive coding made her refuse the reg. because to the primitive brain it was a foreign object constricting her ability to breathe once she reached AIR.

External training that is not consistent with the coding of our primitive brain we generally can no longer do.

So am I correct in summarizing your point as follows? Sorry, I don't mean to put words in your mouth, but I just want to understand:

1) Fight or flight (FOF) is an inevitable reaction to a significant stressor, in this case the presumed episode of EIB.

2) FOF then caused her to lose the ability to perform procedures that she had previously been able to do.

3) This loss of ability was inevitable given the FOF, and there was nothing that could have stopped it, making her need for rescue also inevitable.

 

[Basking Ridge Diver]

Thea -

Don't ever worry about slowing the dive group down getting into the water. It's one thing if you were talking on your cell phone or trying to take pictures of the dive captain, it's quite another if you are taking your time going through your equipment and your buddies, checking and double checking that everything is correct. No real diver is ever going to hold anything against you if you're taking time doing your checks, real divers understand the importance of it and while they are waiting for you they are probably eyeing your equipment watching you check it, doing their own mental/visual check out, this is what a real diver does. Don't ever let yourself be rushed.

Secondly, if you turn the corner and start diving with a dive buddy, you will have a buddy who is checking your equipment while you are checking theirs.

Thirdly in regard to your weight belt you should see about learning the way that you can twist your belt while putting each weight on it, this prevents your individual weights from moving around on the belt from one side to the other, doing this you can arrange your individual weights so they are distributed on each of your hips and equally balances and not have to worry about them moving. When a dive master or boat crew hands me a weight belt with the weights just strung on them with no twists, I will take the time it takes to take the weights off and re-string it correctly.

It looks like this or a variation of it

Although I follow this method - once I get down below 60 feet my semi-dry does shrink and the weight belt itself does shift. It will rotate around my hips - I either stop and re-tighten the belt or I note where the buckle is so I can be ready to ditch if needed. So the twist does keep the weights in place but the belt itself will still shift. At least for me it does.

 

[gianaameri]

So am I correct in summarizing your point as follows? Sorry, I don't mean to put words in your mouth, but I just want to understand:

1) Fight or flight (FOF) is an inevitable reaction to a significant stressor, in this case the presumed episode of EIB.

2) FOF then caused her to lose the ability to perform procedures that she had previously been able to do.

3) This loss of ability was inevitable given the FOF, and there was nothing that could have stopped it, making her need for rescue also inevitable.

Well, in the cinema example, because the emergency exit is designed to be consistent with the fight or flight response (i.e. let's push the door open and let's get the f-out of here) the door design combined with the ACTH, adrenaline, noradrenaline is quite conducive to self-rescue.

Underwater the ACTH, adrenaline, noradrenaline help, but given that the tools we have seem to conflict with our brain primitive coding ability to operate them, we need someone else to activate them for us.

Had it not been for the buddy system and the OW environment, despite the boost/kick from ACTH, adrenaline, noradrenaline... Thea could have easily drowned.

BUT after breaking the surface had she found something to grab and hold onto, she would have completed her self-rescue.

If that would have been enough without O2 and broncodilators for her to stay alive thereafter, you'd need to ask a Doctor.

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[TSandM]

I do believe that, once a person has reached a certain degree of panic, rational thought is beyond them and they cannot self-rescue.

What training does is push the threshold where that occurs farther away. As we said in my residency, "Your panic button gets pushed so often, it doesn't work any more." I am quite sure that, despite all the training I have, there is some point at which I would panic. On the other hand, if you read denisegg's account of her IPE event, she maintained rational thought and volition despite severe symptoms and intense fear. This is a good example of how someone can exert significant control over the reptile brain response. People in combat remain functional in situations where I'm sure I would be completely disabled by fear.

I don't know whether experience and exposure lessens the catecholamine response to a given situation, or whether we learn to override the physical manifestations of those hormones, but the fact is that self-control can be learned. That is one of the reasons I recommended further training to the OP. She may well have been short of breath, but losing her ability to function in the face of it was more a mental problem than a physical one (I have seen LOTS of patients very functional with O2 sats in the mid to high 80's).

 

[gianaameri]

Just a though that came up from the old memory store.

A good instructor many many years ago told me that one strategy she once adopted due to the circumstances of one of her dives was to remove her belt and ascend holding it with her arm extended cause if she passed out that would have ensured she'd make it up to the surface.

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[Thea Strassburg]

Your instincts and thoughtfulness for others is very strong. That is commendable and my wife does this too. But choose your moment for self-sacrifice wisely.

***I really want to dive again, and am going to see if I can take the whole PADI course over. I have heard there are other international dive agencies, maybe I should try one of them if they are in my area. My passivity and total abrogation of responsibility for my own safety were, in hindsight, dangerous not just for me but my fellow divers. I can be assertive, and in the future will use that skill to ensure I follow my gut, use my training, and maybe even annoy a couple of divers anxious to get in the water.

It is good that by going over things again, some new light is shed. This will be useful information for the dive medic because the 'E' of 'EIB' had not happened yet.

***Oddly, it had never occurred to me to think back to the pre-dive safety check. Ugh... this is all so embarrassing. Most of you reading this must be mortified they ever let me into the water, I don't blame you.

I don't want to be too picky, but am touching on it here because I did notice you posting something similar before. Just wanted to check you know that you were not checking your O2. A minor point which will be useful if you ever move to using Nitrox, something worth considering as one gets older.

***As I think about it, this is quite possible. I was so focused on getting pics and video to show off to friends and family, I know now I was not paying attention to several, more important aspects of the dive. Someone mentioned that earlier, and I smugly disregarded it. My husband and I watched for then first time two other videos I took on the dive and it is obvious that I was fighting the current, unbalanced and DETERMINED to get a pic of something. The camera really distracted me and that was bad.


Apologies for being a cranky!

***Like I said, cranky is just caring and trying to protect professional DM's and divers from people like me. I would feel the same way in the face of such irresponsible behavior. Thank so much!