Out of air incident-psychological perspectives.

[Ed Jackson]

May 8 2021, West Palm Beach

After approximately 50 minutes at 60 feet of water I saw an elderly gentleman in distress. He was holding his regulator in his hand and mouthing the words "I'm out of air!" Several divers were around but did not notice or were in denial about what was happening. (True emergencies are rare and mixed in with a lifetime of ordinary events). I put my regulator in the divers mouth and checked his gage which was indeed empty. I had about 1000 lbs of air left so I planned to make a slow ascent and even do a safety stop. During the ascent, the diver appeared mildly panicked but was acting erratic. He took the regulator out of his mouth several times during the ascent and tried to give it back to me. I continued to give him the regulator and made the ascent with the assumption that he was cognitively impaired from anxiety and probably could not assist in a controlled ascent. He could not. I had to deflate his BC several times and pull him down to prevent him from shooting to the surface. I was able to do a one minute safety stop with him but chose not to continue due to his rapid breathing. One of the experienced divers I was with became task fixated on untying a knot on the spool of the surface marker. I believe was related to the stress of the event. We were able to reach the surface unharmed but the diver was still impaired and unable to inflate his BC without help. I declared an emergency to the boat which initially angered staff because it appeared not to be an emergency. (They saw three conscious divers on the surface.) Once on the boat, the affected diver had full body tremors from anxiety and emotional distress but physically unharmed. He and his wife were very appreciative at the dock and vowed never to dive again.

Psychological aspects to consider:

1) Several divers present who were in denial of the out of air incident. Emergencies are rare and people are less likely to act when in a group compared to being alone.
2) Panic can impair judgement- Not a new concept but remarkable to witness first hand. -The diver removing the regulator from his mouth several times during ascent
3) Task loading under stress- Diver become fixated on unimportant task- Untying a knot during rescue
4) Staff on boat seeing three conscious divers declaring an emergency-"True emergencies are rare and mixed in with a lifetime of ordinary events."

 

[Marie13]

Was the OOA diver showing the standard OOA signal - slashing his hand across his throat or was he only mouthing the words “I’m out of air?”

 

[Ed Jackson]

I did not see any OOA sign. I am sure he knew the sign but the psychological stress took that away. He was frantic and was holding his regulator. When I got closer he seemed to be mouthing "I'm out of Air!"

 

[Marie13]

I did not see any OOA sign. I am sure he knew the sign but the psychological stress took that away. He was frantic and was holding his regulator. When I got closer he seemed to be mouthing "I'm out of Air!"

I was just wondering if the lack of the standard OOA sign might not have been noticed by his dive buddies.

 

[Jcp2]

Was his wife his buddy?

 

[poseident]

This is a great situation for discussion....I'm glad everything turned out OK in this case:

1) Several divers present who were in denial of the out of air incident. Emergencies are rare and people are less likely to act when in a group compared to being alone.

P: This is a "sphere of awareness" issue. Divers who go through more and more training start to notice more and more about what's going on around them. Those who are "vigilant types" tend to keep those habits. Those who aren't, get over it. I fall into the former camp. I have a hard time relaxing and really enjoying a "fun dive" unless I know everyone in the water and that they are "good to go." Others' mileage may vary, but that's just how I'm wired. (Having spent years as a lifeguard as a kid, then gone into the military, then worked through SCUBA ratings--spending years as a Divemaster where I was "responsible" for dive safety before finally becoming an instructor.) I've been in the water with people who are absolutely oblivious to everything except whatever they are fiddling with throughout the dive. When you try to talk to these people, they have no idea what you are trying to say to them. They'll completely deny having even touched whatever it was (inflator, mask strap, computer, whatever it is.) All you can do is understand that's what to expect from that person and decide to either 1) Stick to them like glue or 2) Stay as far away from them as possible.

2) Panic can impair judgement- Not a new concept but remarkable to witness first hand. -The diver removing the regulator from his mouth several times during ascent

P: Totally! Panic can completely WIPE OUT judgement. This is why "elite" performers of any skill spend so much time practicing. Practice helps tremendously, but bad days can still happen.

3) Task loading under stress- Diver become fixated on unimportant task- Untying a knot during rescue

P: Again, totally! Human nature. Practice helps. But I don't think I've ever seen a group of divers "practice" for an emergency outside of a Rescue course, or a military/commercial setting.

4) Staff on boat seeing three conscious divers declaring an emergency-"True emergencies are rare and mixed in with a lifetime of ordinary events."

P: I've seen this before too, and it's always perplexing. Here, you'd expect the above advice about "practice" to have taken place and help, but it doesn't always. I worked for one dive boat operator that did a good job of initial training with crew, with annual-ish refreshers, but I think that's rare in the industry. Once, while crewing I saw a diver surface unconsciously about 20 yards from our stern. Our boat had a 2-way PA so the captain upstairs could hear the lower deck, so I sounded the alarm, called for O2 and hit the water. I recovered the diver and got her to our deck where our procedures worked well. Gear off, diver up, gear recovered. She was unresponsive and frothing, but breathing weakly. She wasn't one of our divers, and the markings on her gear tied her to a different boat that was unmoored and hovering in the area--but watching what was happening on our boat. Our captain hailed them. They responded, but didn't react. We were moored, with divers on our hang-bar and couldn't move, but this woman clearly needed to get to EMS and the chamber (nearby) quickly. It took us about 10 minutes to get the other crew to rally and to transfer the diver to them. I give them some leeway for being worried about coming in overtop of other divers, but we gave them a clear lane of approach and had someone on the surface at the hang-bar telling everyone to "hold." (Part of our emergency plan for this kind of scenario). I didn't hear about the diver again, but there were no reports of a fatality, so luckily I think she pulled through.

The moral of all this is that practice and experience help a lot. You've now gotten some of both. Good on-ya for a successful assist.

 

[poseident]

By the way, I love diving WPB. What site were you on?

 

[Marie13]

About the crew not recognizing an emergency.

I was once diving a Great Lakes wreck. Surface current was strong. After moving down the side of the boat on a line (can’t remember what you call it), I was unable to get to the ladder at the stern. I couldn’t catch the trailing mermaid line either. I was kicking all I had and not making any headway. I wasn’t panicking. The captain was at the stern looking directly at me. I yelled “Current - throw me a line!” He just stood there, still looking at me. I had to yell the same thing 1-2 more times before he threw me a line. His reaction time was really crappy.

 

[Jafo19D]

People react very differently to any one situation. In Iraq and Afghanistan AO was pretty calm when others were freaking out. During one firefight I made it a point to laugh to calm some of my guys. Even had to tell the machine gunner to return fire because eje was in such shock that he wasn’t thinking straight.

I’m the kind of guy that will jump in and help but will first look at my surroundings to see the big picture and see what else might become a problem; in other words I try to not get tunnel vision which is common in high stress situations.

On one of my last dives the DM brought a friend who panicked at 34M and qu joy became low on gas. Had I been alone with this guy I would have helped him myself but since the DM had things under control I purposely kept my distance - no need for both of us to get into trouble if he started freaking out again.

 

[boulderjohn]

2) Panic can impair judgement- Not a new concept but remarkable to witness first hand. -The diver removing the regulator from his mouth several times during ascent

I believe I can explain the science there. The panic cycle is a process that begins with minor panic and escalates as a natural result of the panic itself.

As a person panics, that person tends to breathe in rapid, shallow pants. It is almost as if there is an artificial barrier at the top of the lungs, preventing oxygen-rich air from getting in and carbon-dioxide laden air from getting out. The body's natural reaction to carbon-dioxide build up is panic, so the more the CO2 builds up, the greater the panic. The greater the panic, the more the panicked breathing pattern makes it worse.

Because of this, the panicked diver senses (there really isn't a loft of rational thought involved) that the regulator is not providing the necessary air, so the natural reaction is to discard it.

Years ago, during a pool instructional session, a student was struggling to equalize on our first descent to the deep end. I was right next to him, trying to help, with our heads maybe 3 feet below the surface. Suddenly he ripped the regulator out of his mouth and went into a frenzied panic. I had no trouble getting him to the surface. When we talked later, he told me for the first time that he was prone to unprovoked panic attacks in his daily work. (Nice to know!) I asked him if he realized he had discarded his regulator, and he said he did not know that. I realized what had happened--while equalizing, he had stopped breathing, causing a CO2 buildup leading to full blown panic. I explained the mechanism above and asked him if his work-related panic attacks happened when he was concentrating on a difficult problem, and, if so, did he hold his breath while doing that? It was a revelation to him. Yes, he did hold his breath when in deep concentration. He was absolutely exuberant and went on to pass the class with ease.