Koh Tao Christmas Day

[GregT943]

I have been meaning to post this incident for a long time and just haven't gotten around to it until now. All names of people involved and dive operations involved have been left out.

Like the title suggests this incident happened the morning of Christmas Day 2010. We were doing a double dive out at Chumpon Pinnacle, one of our best dive sites. For those not familiar with the site, it is about 45 minutes away from Koh Tao. It is a rock Pinnacle that rises from the sea bed at around 30 meters to a depth of about 15 meters. There were 3 boats out on the site that morning. Our boat, another boat, and then Crystal Dive was tied up at the far end of the site a good distance away, and they had no part in this incident.

The conditions at the dive site were a little unusual. Usually there is no current or very very little current, but on this day the current was relatively strong. I actually ended my dive early because I could tell the customers I was leading were getting tired. The viz was normal, about 20 meters with a thermocline at a depth of around 25 meters where the viz was reduced to around 10 meters.

It was during our surface interval, we had finished our first dive about 20 minutes prior. I was sitting up on the top sun deck of our boat talking to some customers when two divers from the other boat surfaced. One diver began towing the other back to their boat. They didn't seem to be in any distress at all (other than the obvious fact one diver was being towed), they didn't yell for help or anything, he was just calmly towing the other diver back to the boat. The diver who was being towed was moving and at this point was conscious. I signaled to them asking if they were OK, the diver doing the towing looked at me but made no effort to communicate back. So I just assumed that the diver was just tired from battling the current during his dive, and went back to talking with the customers. (There were about 20 people on our boat, this included a couple of DMs and 3 or 4 instructors. Myself and the few customers on the sundeck were the only ones who observed the divers surfacing and being towed. Everyone else down below didn't see this.)

The ladder on the other boat was on the far side of the boat and out of our view. So the diver towed the other diver to the ladder and out of our view. A few minutes later a woman on the other boat starts yelling to our boat. She didn't speak English very well and no one knew what she was yelling. I immediately knew something was definitely wrong having seen the diver being towed to the boat. I jump down to the first deck to see everyone else just looking over at the woman confused. I say to the head instructor on our boat (lets call him Bob) that the woman is yelling for help. He immediately jumps in and starts the 20 meter swim to their boat and I am in the water right after him.

(The only people on the other boat was a woman (non-diver) and the Thai captain. Everyone else was still in the water diving.)

I swim around the front of their boat to see the diver who was being towed propped up on the ladder unconscious, labored breathing, with his eyes rolled back in his head. Now this diver was very big and clearly in very poor physical shape, 6 feet tall, about 250 pounds. The diver who towed the victim to the boat had removed the victims gear but wasn't strong enough to get the victim up the ladder. Bob gets underneath the victim and I climb up the side of the ladder up onto the boat to help lift the victim into the boat. We get him on the boat and I immediately yell to the captain to get their oxygen out. The victim was going in and out of consciousness and having a hard time breathing. The diver who towed the victim and the woman on the boat didn't speak english and clearly didn't have any rescue training. Not knowing what exactly happened, the only thing we really could do was put the victim on O2 and monitor his vitals. The captain pulls out their oxygen kit which Bob quickly begins to assemble. We quickly realize that their OXYGEN KIT IS INCOMPLETE!! Their pocket mask was missing the top valve piece and they had no demand valve, which is what we needed in this situation, because the victim was taking deep but labored breathes. The only working option they had was the non-rebreather mask with the bag for weakly breathing victims. We put this mask on the victim and every breath he took would completely collapse the bag. We called over to our boat and had them pull up next to the other boat. We grabbed our oxygen kit and set it up with the demand valve and administered it to the victim. Another instructor on our boat called the clinic to let them know that there has been an incident and to be waiting at the pier.

By this time the divers of the other boat began to surface and were extremely surprised to see one of their divers lying on the floor on oxygen. Unfortunately the victims 16 year old daughter was one of those divers who surfaced and did not react well to seeing her father in that way. The instructor on the other boat surfaced and immediately started asking us questions, which we didn't have any answers to. The victim was breathing and on oxygen and we couldn't do anything else for him on the boat. The only thing left to do was to get the victim back to land. Myself and Bob jumped back on to our boat and the other boat took off back to the island. Our boat stuck around to pick up the other boats remaining 2 divers who were still in the water.

We then returned to the pier because we no longer had emergency oxygen on board which meant we couldn't do a second dive.

Once we got back to the pier we were able to get the details about what exactly happened. They looked at the victims dive profile and it was fine. Turned out the victim was in diabetic shock and was not suffering from DCI. The doctor gave the victim a shot of insulin or something and then he was completely fine. But this incident brought up a couple of issues.

Always check to make sure the operator you are diving with has up to date and a complete oxygen kit. Especially in other countries like Thailand where regulations are not the strictest. What if the diver was suffering from DCS and we weren't there to help?

The other issue that this issue made me think about was a hole in dive training.There were many PADI rescue divers on our boat who did nothing because they admitted they didn't know what to do. Why is more extensive O2 training not include within the PADI rescue diving course? What good is it when you have the training to get the victim out of the water but after that can't do anything? Does PADI not include more extensive O2 provider training in the rescue course simply so they can make you pay for more training? Or is there a legitimate reason why they leave that out of the rescue diver course?

 

[Steve50]

The shop and 40 other instructors I work with does extensive O2 training with the rescue class. PADI shop.

Were the people on your boat a group, rescue trained at the same place?

 

[Quero]

PADI Rescue standards require the teaching of the basics of providing oxygen. It's not extensive training with scenarios and repeated manipulation of the equipment, but there is hands-on training stipulated in the course along with a discussion of non-rebreather and demand valves, flow rate, etc. Did your own Rescue training minimize this aspect of the course, Greg? Did you do that course on Tao?

 

[BUGBAGGER]

If I am not mistaken, PADI NOW requires the Emergency First Responder course (or an equivalent) as a prerequisite to Rescue Diver. However, for many years this was not the case. For some agencies like SSI it is still not the case.

In addition, for years, minimal if any training in the practical use of O2 equipemnt was included in most Rescue courses. That is why the DAN O2 class was then and still is today an excellent addendum to any Rescue class. There is even an advanced O2 class now. Similarly, even though a rescue class is essential training in my book it is made much more effective and complimented well with additional first aid and safety training. DAN programs are particularly helpful to divers but more advanced first aid and emergency management course through the Red Cross and other organizations also can truly round out a diver's or anyone's preparedness. I like to think of each class I take as a stepping stone in the path to the next one.

Sure these things cost money and you have to decide whether or not they are worth it to you. For me, it's about having more piece of mind and more and better developed skills for times when I may need to act quickly and safely with little warning and potentially little help.

 

[GregT943]

The shop and 40 other instructors I work with does extensive O2 training with the rescue class. PADI shop.

Were the people on your boat a group, rescue trained at the same place?

No they were a trained all over the place. All the rescue courses I have seen just briefly cover O2 training and do not extensively cover it. In PADI instructor manual it has them practice 2 scenarios of O2 administration. The PADI course requirements for the rescue course do not include extensive training with lots of different scenarios and repetition. If you and all the other instructors with you are doing so, then you are going above and beyond what is technically required by PADI and I agree with what you are doing 100%.

But it is clear not all instructors teach the course this way. I just think that PADI should include the more in depth training of the O2 Provider specialty course within the rescue course.

 

[GregT943]

PADI Rescue standards require the teaching of the basics of providing oxygen. It's not extensive training with scenarios and repeated manipulation of the equipment, but there is hands-on training stipulated in the course along with a discussion of non-rebreather and demand valves, flow rate, etc. Did your own Rescue training minimize this aspect of the course, Greg? Did you do that course on Tao?

Yeah this is what I mean, all the rescue courses I have seen do not go as in depth as I feel they should. They just briefly go over it. I have seen some instructors tell students that you are not legally allowed to administer oxygen unless you have your O2 provider specialty. I don't know if this is true, or if they are trying to get more money by selling the O2 provider specialty.

I took my rescue course a few years ago in Hawaii and it did not include extensive O2 provider training. They basically had me set up the system once, and briefly told me what mask to use in what situation. Since then I have done the PADI O2 provider course as well as a Red Cross O2 course which was MUCH more in depth. I just feel PADI doesn't require enough O2 training in the rescue course.

I have done my dive training all over the world. Here in the US, Australia, Vanuatu, and Thailand. All the rescue courses I have seen or assisted with have included a small amount of O2 training.

 

[GregT943]

If I am not mistaken, PADI NOW requires the Emergency First Responder course (or an equivalent) as a prerequisite to Rescue Diver. However, for many years this was not the case. For some agencies like SSI it is still not the case.

In addition, for years, minimal if any training in the practical use of O2 equipemnt was included in most Rescue courses. That is why the DAN O2 class was then and still is today an excellent addendum to any Rescue class. There is even an advanced O2 class now. Similarly, even though a rescue class is essential training in my book it is made much more effective and complimented well with additional first aid and safety training. DAN programs are particularly helpful to divers but more advanced first aid and emergency management course through the Red Cross and other organizations also can truly round out a diver's or anyone's preparedness. I like to think of each class I take as a stepping stone in the path to the next one.

Sure these things cost money and you have to decide whether or not they are worth it to you. For me, it's about having more piece of mind and more and better developed skills for times when I may need to act quickly and safely with little warning and potentially little help.

PADI does require EFR and CPR training as a prerequisite to the course. I recently renewed my EFR and CPR/AED training through the red cross but that didn't include any O2 provider training. I don't know much about SSI but that's crazy they wouldn't require it, unless that training is covered extensively within their rescue course.

I just think more O2 training should be included within the PADI rescue course. Or perhaps require the student to complete the O2 Provider course just like they require the student to complete the EFR/CPR course. Just my thought, I am glad to see some instructors doing so though.

 

[DandyDon]

Great save! :medal:

Checking O2 kits is a failing of mine, even tho the one time I called for one - it failed. Luckily it was a false alarm.

 

[DevonDiver]

When I book on a charter boat, I make sure to ask about O2 (if it isnt mentioned in the boat brief). A good dive operation would physically check the O2 system at the beginning of every diving day - at least, that's what I'm used to from the operations I have worked for.

PADI has an O2 provider course now. It goes into greater depth than the basic O2 training (set-up and provision) that is taught on a rescue diver course. Nonetheless, any trained rescue diver should have the knowledge to assemble and provide O2 to a casualty.

In terms of legality, in most countries there is no legal requirement for an O2 provider course before you can use O2 within primary casualty care. However, in highly litigous countries, I am guessing that there is the potential to sue someone if they don't have that certificate and something goes wrong. Normally these things are covered under Samaritan laws.

 

[alibi 2]

I teach NAUI, PADI, TDI. The rescue courses are similar in how they handle what I would describe as an overview to Emergency O2, CPR, AED and First Aid. The NAUI certification requires additional training in these areas as well as Foreign Body Obstruction and Blood Borne Pathogens. The professional level card requires training with the AED, 2 person CPR and infant CPR. The card is good for two years.

The red cross (at least not in our area) does not teach Emergency O2, Marine or Aquatic Injuries as part of their First Aid course.

I just lead a trip to Cozumel, MX. Although the dive operation stated that they had the O2 and First Aid kit available and personnel available to operate them I boarded early on the first day and inspected the kit. I had them assemble the unit, checked the status of O2, make sure that they had demand valves, both non-rebreather and pocket masks and the first aid kit. I always bring both masks with me just in case. They did not hesitate to do as I asked and were proud of their equipment and training. Not all dive operations in the area had these safety items.

The statement that some instructors go above the required level of training mandated and you are right. I applaud these people and am confident that their certification signature is their personal validation that this person is ready to dive safely and responsibly.