Notes – Dive (SCUBA) Injury/Accidents

Dive (SCUBA) Injury/Accidents

Patient Safety Considerations

  1. If the patient is still in the water, seek safest and most rapid means of removal safe (within your scope of training) while minimizing risk of further injury
  2. Seek assistance early for special rescue/extrication and transportation needs
  3. Check for multiple patients (e.g. group dive table calculation error(s) or contaminated dive gases)

Notes/Educational Pearls

Key Considerations

  1. Rescue efforts should be coordinated between all responding agencies to ensure that the patient is rapidly accessed and safely removed from the water if diver unable to do so themselves
  2. If air medical transport is necessary, the patient should be transported with the cabin pressurized to lowest possible altitude. If an unpressurized aircraft is used (e.g. most helicopter (HEMS) services), patient should be flown at the lowest safe altitude possible
  3. Decompression illness may have a variety of presentations depending on system affected (e.g. skin, joint(s), pulmonary, neurologic)
  4. SCUBA accidents/incidents can result in a variety of issues, including barotrauma, air embolism and decompression illness

Pertinent Assessment Findings

  1. Vital signs findings
  2. Neurologic status assessment findings
  3. Respiratory assessment findings (e.g. oxygen saturation, respiratory rate)
  4. Subcutaneous emphysema

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914211 – Injury-SCUBA Injury/Accidents
  • 9914091 – Injury-Diving Emergencies

Key Documentation Elements

  • Water temperature, if available
  • Dive history
    • Number of dives in recent history (days)
    • “Bottom time” in dives
    • Dive profiles
    • Maximum depth
    • Rate of ascent
    • Safety stops utilized, if any
    • Dive gas (e.g. air vs. mixed gases such as Nitrox, Heliox or Trimix)
  • Timing of onset of symptoms
  • History of altitude exposure after diving (air travel)
  • Any associated injuries or exposures

Performance Measures

  • Recognition and appropriate care of pulmonary/respiratory complaints
  • Patient transported to nearest appropriate facility (HBOT if available and indicated)
  • Need for HBOT recognized and communicated to receiving facility if indicated

References

  1. Doolette DJ, Mitchell SJ. Recreational technical diving part 2: decompression from deep technical dives. Diving Hyperb Med. 2013;43(2):96-104.
  2. FAA Aeronautical Information Manual – Decompression Sickness after Scuba Diving. http://www.faraim.org/aim/aim-4-03-14-536.html. Accessed August 28, 2017.
  3. Fock A, Harris R, Slade M. Oxygen exposure and toxicity in recreational technical divers. Diving Hyperb Med. 2013;43(2):67–71.
  4. Fock AW. Analysis of recreational closed-circuit rebreather deaths 1998-2010. Diving Hyperb Med. 2013;43(2):78–85.
  5. Gordy S, Rowell S. Vascular Air Embolism. Int J Crit Iln Inj Sci. 2013;3(1):73-6.
  6. Madden D, Lozo M, Dujic Z, Ljubkovic M. Exercise after SCUBA diving increases the incidence of arterial gas embolism. J Appl Physiol (1985). 2013;115(5):716-22.
  7. Mitchell SJ, Doolette DJ. Recreational technical diving part 1: an introduction to technical diving methods and activities. Diving Hyperb Med. 2013;43(2):86–93.
  8. Muth C-M, Tetzlaff K. [Scuba diving and the heart. Cardiac aspects of sport scuba diving]. Herz. 2044;29(4):406–13.
  9. Sykes O, Clark JE. Patent foramen ovale and scuba diving: a practical guide for physicians on when to refer for screening. Extrem Physiol Med. 2013;2(1):10.
  10. Türkmen N, Okan A, Selçuk C, Bülent E, Murat SG, Umit NG. Scuba diver deaths due to air embolism: two case reports. Soud Lék. 2013;58(2):26-8.
  11. Winkler BE, Muth CM, Kaehler W, Froeba G, Georgieff M, Koch A. Rescue of drowning victims and divers: Is mechanical ventilation possible underwater? A pilot study. Diving Hyperb Med. 2013;43(2):72–7.
  12. Vann RD, Gerth PJ, Denoble CF, Pieper CF, Thalmann ED. Experimental trials to assess the risks of decompression sickness in flying after diving. Undersea Hyberb Med. 2004 Winter;3(4):431-44.