My friend just got her OW and she's been diagnosed with DCS

[tholden1]

I didn't do fish ID. I did photography, wreck, and bouyancy. This might have been part of the "photography" part. My exercise for photography was "take some pictures and we'll compare later."

@Karibelle: So who's playing buddy to your AOW student as he conducts his Fish ID survey?
And you're OK with the AOW student pointing out aquatic critters to you while you're supposed to be watching over the basic OW student on her first OW class dive?

I just wouldn't feel comfortable multi-tasking like that. Perhaps I don't share your point of view because I don't have as much experience working with novices. From my perspective, it unnecessarily increases the chances of something bad happening during the dive. In my book, the benefits of double-dipping like this just aren't worth the risks.

 

[tholden1]

She was in a poorly fitting BCD, she was on her third dive ever and the first dive below 30 feet, and she was playing with a camera that she just got and was unfamiliar with.

He should have been right by her side. Forget my AOW, forget me. She was the priority. She was in a bad position to begin with since all of the above conditions were in play.

I know based on my OW experience, my instructor first of all would have changed out my BCD, then he would never have let me take my camera I don't care how pissed I got, and he would have been right there beside me.

As I've said, his wife. In my example, the AOW student and his wife (already AOW) are a buddy pair. Then I said that it's not my job to point out critters to him on his Fish ID dive, it's his job to find fish and identify them, once given the proper tools to do so.




Well, in my example, it was OW #3, and by that point, I would have evaluated this hypothetical OW student well enough to know whether or not this would be appropriate. Furthermore, as I've pointed out from MY view of the standards, I don't even need to be in the water with the AOW student, so having them tag along on the dive should not really interfere with my supervision of the OW student, as the AOW needs so little of my attention.




FWIW, I do think this is your lack of experience. I'm not saying I'm super duper experienced or anything, but frankly, as the AOW student in my hypothetical example was REAL, I can easily say that if I had an OW student on dive #3, I'd much rather bring Mr. 250 dives and his AOW wife along to do the Fish ID dive than a second (or 3rd, or 5th, or 8th) OW student on that same dive. You know I can do that, right? Bring EIGHT OW students on a single open water dive? Talk about multi-tasking! Compared to that scenario, throwing in an AOW student who has that much experience and who is doing the activity in my example is peanuts.

My point was that I didn't agree with your original generalization, that it would ALWAYS be poor judgment. I still don't agree with that generalization and just wanted to offer a different perspective that illustrated that for me, it's about GOOD judgment.

As I said, your mileage may vary, and we certainly don't have to do things the same way.

 

[tholden1]

Thank you for your input. She informed me today that she doesn't want to post anything more about her. I doubt that she would cooperate in disclosing anything at this point. Basically, she doesn't want to get the shop in trouble and feels bad about the whole thing.

However, I have every right to disclose my observations and will do so. I didn't see any of the rash or anything. I only know what she's told me.

I would pass along your info, or the info of anyone here, and ask her to respond if I felt she actually would. She's not going to respond. She feels anything she says is something that might get the shop in trouble.

She has much less experience to draw from. I had a great OW experience and I have something to compare it to. She doesn't, and therefore she doesn't realize how bad it really was.

I think the shop tried to do the best job it could with the resources it had. But, that doesn't mean that a good job was done. And, it doesn't mean that mistakes weren't made. BIIIG mistakes.

I'll keep telling here that there are people that are intersted in what happened with her and that want to help her and perhaps she will come around and agree to share more details about the incident.

tholden1,

This whole case sounds a little puzzling to me. These are pretty conservative dives. I'd be interested to see photos of the skin rash if you have them. I'll PM you my work email in case you don't feel comfortable posting them here.

The "choking" feeling could be anything from panic to a tight wetsuit to subcutaneous or mediastinal emphysema (air under the skin or around the heart and trachea). Subcu/mediastinal emphysema is a result of pulmonary overinflation, which may have happened if she was holding her breath on the way up. If that's what it was, then she's very lucky on a couple of counts: it resolved at depth, and she didn't have a gas embolism on top of it. Pulmonary decompression sickness, on the other hand, is caused by a large amount of venous bubbles obstructing the pulmonary circulation. The relatively low inert gas load from this dive makes pulmonary DCS unlikely.

Also, 24 hours should have been long enough to wash out any residual inert gas from those dives. It's really strange that she would have symptoms after flying, even if she was already symptomatic. DCS symptoms from flying after diving are related to residual inert gas coming out of solution at altitude, and the gas should have been gone. The bubbles from DCS damage blood vessels, so maybe the lower O2 content of the airplane cabin was enough to tip the balance and cause her symptoms - if so, her case might be worth publishing or at least discussing in a case conference here. I'd like to talk to you more about it.

I concur with DAN in that if she did indeed have DCS, hyperbaric oxygen treatment probably won't do her any good at this point. It's very likely that she will recover fully, but it may take a while.

Best regards,
DDM

 

[tholden1]

PADI standards weren't followed here. The deep and wreck dives were combined. And, this new OW student followed me down to 77 feet with this being her fifth dive. I suppose going below 60 feet for an OW (and yet a new one) was also against PADI standards.

I think the group did two dives at the wreck: one which counted towards deep and the other which counted towards wreck. At least that would be consistent with PADI standards.

It's possible that this instructor was signing off the AOW student on the other AOW dives (boat, UW nav, PPB?) while conducting OW class dives #3 and #4 for the basic OW student. FWIW, I don't know whether running classes in this way conforms to PADI standards. DevonDiver's quotation of PADI rules in this thread (Post #43) would seem to prohibit this kind of double-dipping.

 

[tholden1]

And let me say one more thing. The more she tells me that she's in pain and the more I hear about the dive shop offering her free dives and so forth, the more upset I'm getting.

She's in pain and she still has problems breathing and such. I recommended this shop to her because they were highly regarded on TripAdvisor for Cancun, and because they were highly regarded on here. And, now this has happened to her. I made the best decision I could based on the information I had, and it still fell apart.

And I keep thinking about things like, why was she allowed to take a camera on her third certification dive. And, why wasn't the instructor right by her side the entire time. And, why didn't I go up when she did and insist that she not go down again and insist that she be put on oxygen just to be safe. And even more so, why didn't the instructor do those things! And, why didn't they swap out her poor-fitting BCD? And, why didn't I ditch my camera so I could be right by her side. Why...Why...Why. Hindsight is 20/20 and it's a pain in the ass sometimes.

 

[DandyDon]

The multi-quote option can help when you want to reply to several different posts, but it can backfire if you're not used to posting & editing here on the board too. Not sure who or which posts you were addressing but thanks for sharing. Just a few notes...

It's what she wanted. And, I've never seen an OW course done in Mexico. This was a first. Clearly, not a good idea, at least in this case.

Well, it's not the same anyway. There is a lot more leeway from how things are done in the US with little chance of being sued or anything. Some fine divers and instructors have posted here about how things should be done, but when you go south from the US - expect changes. Many have bragged about the instruction and courses they got in Mexico and around the Caribbean, and it's all fun and games if nothing goes wrong.

You can report to Padi and it might be a good idea, but I doubt that it'll matter much. If you were to name the Operator here tho, you just might get sued for libel; it's happened here. Sometimes you just don't have any good options other than to cut losses and find better ways. I do hope you and your friend continue diving. I don't know where you are in the big Lone Star state but I do know of good Insts, shops, and practice dive sites all across it. Want suggestions? I think you two diving with an LDS Inst in a local hole before another trip would be very helpful before the next trip.

I asked the dive shop about that. I said that I was surprised that since she was at the surface for five minutes, that he didn't go to the surface. The shop said they weren't sure, but the instructors dive all day and in rescue training they teach that it's better to have one casualty, than two. So, the message there is that if the instructor had surfaced with her or after her, then he might have compromised his own safety and both of them would have been in trouble.

Nope, that does not apply to him. Instructing can be hard, especially accompanying several divers on CESAs in one day for example, but Insts accept that - and they do not leave OW students alone on the surface or anywhere. He failed.

In my opinion though, we both could have surfaced and ended that dive for all three of us. If we had done that, and then got her on oxygen just to be safe then she might not have gotten DCS.

There are pros and cons to that discussion. Sometimes it's not possible to say what is best - which is part of why this thread has gone on so long.

For future dives, my rule #1 is buddies descend together, swim together, ascend together - and if anything fails, they leave the water together. I've seen lots of exceptions made to that, but I've seen lots of divers leave in ambulances too - and read about many worse outcomes. So you two do some diving, together.

And let me say one more thing. The more she tells me that she's in pain and the more I hear about the dive shop offering her free dives and so forth, the more upset I'm getting.

She's in pain and she still has problems breathing and such. I recommended this shop to her because they were highly regarded on TripAdvisor for Cancun, and because they were highly regarded on here. And, now this has happened to her. I made the best decision I could based on the information I had, and it still fell apart.

And I keep thinking about things like, why was she allowed to take a camera on her third certification dive. And, why wasn't the instructor right by her side the entire time. And, why didn't I go up when she did and insist that she not go down again and insist that she be put on oxygen just to be safe. And even more so, why didn't the instructor do those things! And, why didn't they swap out her poor-fitting BCD? And, why didn't I ditch my camera so I could be right by her side. Why...Why...Why. Hindsight is 20/20 and it's a pain in the ass sometimes.

I think I understand. I'd be pissed too. As far as recommendation go here, it's a lot easier to find those than criticisms of the same Ops. If one asked about that Op by name today on the Mexico forum, there would probly be positive replies and those who didn't like them would probly not respond. You did the best you could under the circumstances. Cut your losses and move on to better dive plans.

I wonder what your friend might do to help her body heal? I have seen some experts posting here, but no suggestions along those lines so I guess it'll just take time and aspirin or iduprophen? You cannot find a better source for info than from our member posting as Duke Dive Medicine, altho several others posting are also very qualified in dive medicine, and he says he expects her to recover fully in time. I do hope she will consider talking with him personally, by email or phone. The tone of his posts makes me think a lot of good could come from that.

best wishes to you both...!

 

[Bubbletrubble]

@tholden1: I feel horrible about all of this.

I feel bad for your friend. She deserved better instruction. This is the kind of experience that can turn her off of the sport. She deserves better follow-up, too. If she's still in pain, I think it might be worthwhile to look into whether she was actually covered by DAN during her OW training. If her pain is persistent and there's even a slight chance that she might benefit from hyperbaric chamber treatment, perhaps she should explore getting some additional medical attention.

I feel bad for you. You should have never been placed in that situation. Try not to beat yourself up too much over it. It's tough to be assertive and call out an authority, in this case a PADI instructor, when you think something might not be quite right. I think you learned several very good lessons. At this point, the best thing you can do is listen to your conscience. Let the chips fall where they may.

In a strange way, I feel bad for the dive op and the instructors. They took a chance by not following PADI guidelines because apparently they didn't have the proper teaching resources on hand. The instructor did some things that were outside PADI standards. Despite all of these mistakes, the odds were still in their favor for students to complete certification without incident. Unfortunately, DCS is not well understood, and it's the kind of thing that, even if a diver follows all of the "rules," he/she can still experience a hit. In this case, your friend, the instructor, and the dive op were unlucky. Now they have to deal with the consequences. Sad situation. I'm sure that the dive op and instructor are very likable people.

Thanks for sharing your story. I think we've all learned from it.

 

[DandyDon]

Bubble, I doubt that she had DAN or other dive insurance, but many medical policies and many trip insurance policies will cover some treatment. Even if she did not have dive insurance, she my still be covered. Not that anyone should dive without DAN or similar, but in this case - some other coverage for some treatment may exist.

 

[Bubbletrubble]

Bubble, I doubt that she had DAN or other dive insurance, but many medical policies and many trip insurance policies will cover some treatment. Even if she did not have dive insurance, she my still be covered. Not that anyone should dive without DAN or similar, but in this case - some other coverage for some treatment may exist.

@DandyDon: During my OW training, I did not personally sign up or pay for DAN diving insurance. However, I was informed by my instructor that I was covered by DAN for any incident which occurred during OW training. Perhaps there was something special that my instructor had to do to make this happen. Maybe all PADI students are automatically covered through some agreement between PADI and DAN. I don't know. It might be worth it for the student who experienced the hit to look into this.

 

[DandyDon]

@DandyDon: During my OW training, I did not personally sign up or pay for DAN diving insurance. However, I was informed by my instructor that I was covered by DAN for any incident which occurred during OW training. Perhaps there was something special that my instructor had to do to make this happen. Maybe all PADI students are automatically covered through some agreement between PADI and DAN. I don't know. It might be worth it for the student who experienced the hit to look into this.

It wouldn't hurt to ask, but even in the US many Insts do not bother. I asked about this on a thread once and some do, some don't. It's free, but the Inst has to file for it - and I just have a hunch that this Op doesn't do any more than required.