Medical Emergencies

[Lab Rat]

I don't normally post here (normally on the deco stop), so I'll do a quick intro:
I'm an ER doc, former full-time technical instructor/cave diver/RB diver/ etc. and currently work as a hyperbaric medicine physician in Durham.

A couple of points:

1)You guys could benefit from one of the formal classes mentioned above, you got cookie-cutter advice from good paramedics on your end, but not dive-related training.

2) be careful with CPAP in diving injuries (could be overexpansion injuries/AGE) it could worsen the situation and usually isn't needed. Totally agree CPAP is great for the things you mentioned...I use it all the time in the ED to stave off intubations.

3)I also ran a wilderness SAR team a long time ago...as far as the medical info: we had docs suggest a common form, laminated that form and sealed all of them in an envelope that the team medic carried.
>> Allergies, past medical history, past surgical history, medications, immunization (tetanus), smoker Y/N, emergency contact info, any other pertinent history.
>>you should have a form that you can fill out that includes: dive depth, duration, gas mix, dive history prior to last dive, time to onset of symptoms, treatment given and when started, neurological exam, any events during dive (unexpected loss of control/buddy history/blowups, onset of symptoms at depth, deco obligation, etc.) and protocols for securing equipment. Send the computer with the diver if possible.

4)send a medic or two to an official course if you can. You can also contact me for several ideas on things to consider. The NOAA manual has almost everything you could want and is a much quicker read than the Navy manual...plus the scientific diver mission more closely approximates your diver needs.

5)the medical control MD for the paramedics can review the c-collar and board requirement for divers

6)you need to be able to give O2 and fluids (normal saline, not D-5 anything)...all else other than airway control is just supplemental for a transport.

7) you CAN fly an injured diver…IF you (1) have a 1 ATA pressure capable plane (many medical jets can do this) or (2) the helo can stay below 1500’ (some prefer 1000’, some say higher is OK…I like lower, when safe to do so).

Hope this helps,

Richard

 

[PSD-LT22]

Lots of good advice guys so ty for that, I do have a question though, if you think this should be a new thread please let me know but...I am the coordinator for a new dive team for our FD. We have a hospital and chamber right in town. Out team is a mix of MRT,EMT & Paramedics, 10 divers & 10 tenders. What is a good dive specific ems course to take? Where should we start? Thanks.

 

[ditch-diver]

DAN O2, Advanced O2 and DAN Diving First Aid for Professional Divers is a good start.

With the chamber in town...., get a couple guys to get their chamber operators ;^)

 

[PSD-LT22]

Thanks for the reply, I will have my medical officer look into those classes.

 

[muddiver]

Ditch the back board and carry a stokes litter. An unconcious diver is a real pain to drag and lift out of the water unless you require the diver to wear a commercial diver type harness during all dives. A BC will not help the rescue team pull the diver out of the water. Lose the divers weights and cylinder as soon as you hit surface to make it eaisier for your team to pull him out.

Also, don't always jump to the conclusion that he is out because of AGE or DCS. If you are using voice communication you will have clues as to the injury and wasting time running to a chamber when there is a perfectly good ER around the corner is not good if the condition is non-breathing or no-pulse related.

The DAN courses are really good and some like the field neuro exame are very important for any diving/work related abnormality. The Navy teaches their divers to do a quick nero before and after every dive. A dive could have problems that might go un-noticed otherwise.

 

[ditch-diver]

Thanks Mud.., forgot about the Neuro..... that is a good one too. We have used it on several occasions

 

[Cave Diver]

First off, let me say that I'm in not a PSD and in no way qualified to comment on most of the stuff in this forum.

BUT

If I'm reading the OP correctly, the question was geared towards medical emergencies and most of the answers have been geared towards diving emergencies.

I get this:

You're bang on thinking that MI and CVA is your number 1 worry but the cause of each of these is usaully from Arterial Gas Embolism in the diving setting - serious crap if it does occur. So rapid transport to a chamber is the definitive treatment.

but is this type of stuff the biggest worry of PSD divers?

I guess I was thinking more along the lines of crushing hazards (recovering something) cutting hazards (searching for something) pressure injury (hand sucked into a pipe?) as more tangible injuries that a PSD might encounter. Am I way off track thinking about those types of injuries?

Sorry for the de-rail.

 

[ditch-diver]

Oh..., I dunno. Buddy said they were a new PSD team and were all MRT, EMT and Paramedics. I assumed they were talking about dive emergencies because they'd (hopefully) know how to deal with the injuries you mention.

You were not off base, trust me we think about those types of things every dive and try work every detail out before anyone splashes to try to best control those hazards

 

[Garth]

4 years ago when I was in college I was CPR certified but have never resucitated anyone. I was a lifeguard. Now ACLS/BLS certified and working in a trauma/surgical ICU as an RN I can now say I’m familiar with the process, but no one could have prepared me for the first time I pounded on someone’s chest. I’m sure all of you who have had to do so would agree. Staying calm yet vigilant with assessments including a quick neuro exam is paramount.
I agree with Lab Rat about preventing more harm with unnessesary treatment, but I’m not so sure CPAP is strong enough to cause the barotrauma he is suggesting unless he is suggesting it would worsen existent barotrauma. But I don’t think I will be carrying any needles along with me on a dive nor a CPAP machine so I think we’re okay here.
To the first responders out there, I give you credit because you are faced with no access, limited airways and frantic bistanders. For me I need a vent, cordis and a level-1.

 

[Jorbar1551]

So a bump to this thread:

I have been placed in charge of giving my Assistant Chief a list of medical supplies that we should have due to the budget coming up soon. We have a pretty good BLS jump bag which we carry on us at all times. What else would you guys recommend? i've put in a recommendation for a propane heater, because the water we are in is anywhere from 40-65 degrees, and most of our divers are diving wet.