Dive Medic IDEA

INDEX

Chapter 1 - Introduction p. 5
Chapter 2 - First Aid Kit p. 14
Chapter 3 - Anatomy, Diagnostic Signs & Symptoms p. 21
Chapter 4 - First Aid p. 35
Chapter 5 - Diving Accidents p. 77
Chapter 6 - Quick Reference Guide p. 87

©IDEA Europe
Dive Medic Manual
June 2001

Via Mulino di Pile 3 - 67100 L’Aquila (Italy)

Phone +39 0862 318499 - Fax +39 0862 318542

Internet IDEA Europe:

www.idea-europe.com
www.idea-europe.org

Duplication and reproduction, even partially,

of this manual is prohibited unless with written authorization.

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IDEA Dive Medic

SCOPE AND PURPOSE

OF THE IDEA DIVE MEDIC SPECIALTY TRAINING
Beginning in 1980, IDEA initiated the first IDEA Dive Medic courses.
The first IDEA Dive Medic specialty courses were Dive Medic I and
Dive Medic II. These courses were taught by IDEA Scuba Instructors
who were also certified as Emergency Medical Technicians and Para-
medics. There have been many changes to both the Emergency Med-
ical System and First Aid since these first Instructors started teaching
the IDEA Dive Medic courses.
The American Heart Association and American Red Cross have
updated and simplified CPR (Cardio Pulmonary Resuscitation) for the
lay person. Both the American Heart Association and The American
Red Cross have programs that include the use of Automatic External
Defibrillators (AED). These programs may be incorporated into each
agency’s CPR program. For more information on training in the use of
Automatic Defibrillators ask your IDEA Instructor or contact the local
branch of the American Heart or American Red Cross. The Ameri-
can Red Cross has for many years offered excellent training in Basic
First Aid. There are also industrial First Aid courses available to the
general public. In the past there was a gap between the First Aid
provider and the EMS system. The EMS system consists of certified
Emergency Medical Technicians and Paramedics of various levels.
To address this GAP, a new level of care was introduced, “The First
Responder” program. The First Responder program has been a
great success and many lives have been saved with its advent. How-
ever, the First Responder program is generally used by the fire ser-
vice and has a minimum training program of over forty hours. The
First Responder program is generally beyond the interest of the aver-
age individual or scuba diver. There may also be legal implications
involved that may influence the scuba diver or individual to not pursue
certification as a First Responder. IDEA developed the revised Dive
Medic Specialty to bridge the gap between the basic First Aid pro-
vider and First Responder.
The Dive Medic course offers an intermediate level of basic life sup-
port and First Aid to assist in the care of sick or injured persons. The
new IDEA Dive Medic specialty is a combination of the DAN Oxygen
Provider, basic CPR certification and First Aid. Dive Medic offers two

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levels of training. The first level (Dive Medic I) consist of first aid, CPR,
primary survey, secondary survey and training individual to adminis-
ter blood pressure checks. With the addition of DAN Oxygen provider
training the student will qualify for the Dive Medic II rating. With the
addition of blood pressure training and DAN Oxygen Provider training
IDEA Dive Medics will be able to provide a higher level of care for the
sick or injured.

The four most important factors of the IDEA Dive Medic program are:

1. The ability of the IDEA Dive Medic I & II to conduct a primary

and secondary survey of the victim to determine the best course of
action and treatment.

2. The ability of the IDEA Dive Medic I & II to perform Mouth to

Mouth Resuscitation and CPR on a victim.

3. The ability of the IDEA Dive Medic I & II to administer Basic Life
Support and First Aid to the victim of illness or accident.

4. The ability of the IDEA Dive Medic II to administer the DAN

Oxygen Provider Program to the victim if necessary.

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IDEA Dive Medic

CHAPTER 1

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Dive Medic IDEA

Chapter 1

INTRODUCTION

1. Prerequisites
2. Capabilities
3. Emotional Reactions of the Victim
4. Legal Responsibilities

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IDEA Dive Medic

INTRODUCTION
The IDEA Dive Medic is required to possess certain capabilities and
skills. The IDEA Dive Medic is required to complete the prescribed
course of study required by IDEA. The basic First Aid required for the
IDEA Dive Medic course may be conducted by the IDEA Dive Medic
Instructor or an individual designated by the Dive Medic Instructor.
ndividuals designated must be certified in basic First Aid. CPR instruc-
tion may be conducted by a instructors certified by either the Ameri-
can Heart Association or Red Cross organization.
The IDEA Dive Medic must be able to handle a variety of medical
emergencies. These emergencies may vary from a simple applica-
tion of a band aid to the administration of oxygen during CPR. We
will divide these skills into three main categories during our course of
instruction.

CAPABILITIES OF THE IDEA DIVE MEDIC

There are certain skills, procedures and capabilities that must be pro-
vided to a victim of accident, injury or illness. Properly trained and
motivated individuals can make a major difference in the comfort and
care of the victims of accident, injury or illness. Your efforts to obtain
a higher level of skills and knowledge are commendable. Feel free to
ask questions of your IDEA Dive Medic Instructor during your course.
IDEA Dive Medic Instructor is limited to the materials contained in the
Dive Medic text. Many IDEA Dive Medic Instructors are also MDs,
Nurses, EMTs, and Paramedics.

I. The IDEA Dive Medic must be able to:

- Conduct a primary survey
(A) Establish and maintain a patent airway
(B) Control accessible bleeding
(C) Administer Cardio - Pulmonary Resuscitation (CPR)
- Administer the DAN Oxygen Provider program (Dive Medic II
requirement)
- Take a blood pressure and recognize abnormal blood pressures
- Take a pulse to determine victim’s heart rate and function
- Recognize breathing rates and patterns
- Recognize and treat for shock

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Dive Medic IDEA

- Immobilize and stabilize victims with suspected Cervical and Spinal

injuries
- Treat for ingested or inhale poisons and toxic fumes
- Treat for animal and snake bites

There are other conditions which are not life threatening but must be
treated prior to the arrival of EMS personnel. In these cases, early
treatment may be required so that the problem does not escalate or
turn into a life threatening situation or create irreversible damage to
the victim.

II. The IDEA Dive Medic must be able to:

- Clean, dress and bandage wounds

- Clean, dress and cover burns
- Splint fractures
- Splint or immobilize sprains

There are some important non medical skills the IDEA Dive Medic will
need. These non medical skills will assist the Dive Medic with all the
necessary skills needed to care for victims of accident, injury or ill-
ness.

III. The IDEA Dive Medic must also be able to:

- Assemble a properly equipped Dive Medic Kit

- Maintain the Dive Medic Kit and supplies
- Give verbal and written communication
- Evaluate your personal safety and the safety of others in hostile or
hazardous situations
- Plan and execute proper rescue and extrication procedures in the
water and on land
- Direct less qualified persons to assist you

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IDEA Dive Medic

EMOTIONAL REACTIONS OF THE VICTIM

In most cases a victim of an accident or illness will cooperate with the
care giver. The Dive Medic should identify himself to the victim and
any family or persons assisting the victim. Always reassure the victim
and explain to them what you plan of action is to assist him. At times a
victim may appear to be over reacting to what appears to be a minor
accident or injury. At other times when there is an obvious problem
they may not show any signs of pain, illness or injury. What ever the
circumstance is never question a victim’s complaints. Take the com-
plaints at face value and let the arriving EMS personel determine the
next step in the care of the victim. Your job is to assist the victim to the
best of your training and ability until a higher level of care is available.
Calmly appraise the situation and the victim’s condition. Be courte-
ous, use the proper tone of voice and show confidence in your ability
to administer First Aid to the victim.
Victims, such as children, elderly or mentally handicapped persons,
may be confused or terrified of the situation. Always show compas-
sion and sincerity in your care of these special persons. Your reas-
surance and kind words will help in the administration of the care you
are giving the victim. Your actions will also reassure bystanders and
family members of your abilities and the quality of care you are pro-
viding the victim.
There may be the possibility that you may be called upon to assist in
a situation that involves a fatality.We hope that you never have to face
this type of situation. In the event of fatality, it is extremely important
that the deceased be handled with respect and dignity. It is generally
an accepted practice to cover the body and minimize exposure. It is
advisable not to move a body. Wait for law enforcement and EMS to
arrive. Also keep in mind that only a medical doctor can pronounce
a death. What may appear to be an apparent death may be decep-
tive. Unless there is obvious death from a traumatic injury such as
decapitation or sever trauma to the body never assume a victim is
deceased. Always continue basic life support until EMS arrives.
If you are in the process of administering CPR, follow the recommen-
dations of your CPR certification agency. Most agencies recommend
that you continue CPR until you are relieved by another CPR pro-
vider, EMS arrives or you are no longer physically able to continue.

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Dive Medic IDEA

There may be possibilities of charges of abandonment if you stop

CPR before arrival of EMS. The physician at the emergency facility
will determine when to cease life support actions.

Legal responsibilities of the Dive Medic

Everyone is concerned about the legal implications involved in ren-
dering emergency First Aid to victims of accidents or illness. State
laws differ widely but most offer some protection to the individual who
assists a sick or injured person. Generally speaking a “Good Samari-
tan” has little to fear if he or she has acted in his capacity in a reason-
able manner and followed accepted First Aid procedures.
In some states, persons having been trained in First Aid may have
a duty to act. In most cases this duty to act only applies to profes-
sional persons such as EMT’s, Paramedics, Nurses or Doctors. The
passerby or lay person with First Aid training usually is not held to the
“duty to act” or standards of a professional.
Remember that the “Good Samaritan Laws” differ state by state.
These laws are intended to offer protection to the volunteer who ren-
ders First Aid to a victim of an accident or sudden illness. They do
not offer protection in the case of gross negligence or misconduct that
results in exacerbating the injury or illness. The best protection you
can have is by giving proper and prudent care to the victim. It is advis-
able to check with your local or state standards on the “Good Samari-
tan Laws” for your area.

Implied consent
The following are a few examples of implied consent. A person who
is at risk of death from an action on his part or the part of others.
A victim that is unconscious or is unable to make a verbal consent
for care would be considered implied consent. Situations in which
a person cannot make a rational decision concerning his health or
safety would be covered under implied consent.

Informed consent
Informed consent may be given by the victim or next of kin if the victim
is unconscious. It is always a good idea to ask a conscious victim if

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you may care for him. It is not very often that your assistance will be
rejected.

Minors consent
Generally speaking, minors do not have the knowledge or maturity to
recognize the seriousness of an injury or illness. If a parent or guard-
ian is not present to give informed consent, the consent is implied.
Not all minors’ consent is implied. If you are dealing with a conscious
and alert teenager, the consent can also be informed consent. When
a minor is at risk and no parent or guardian is present to give informed
consent, care should be rendered under implied consent.

The right to refuse treatment or care

Adults have the right to refuse treatment. If a situation occurs where
a victim is in need of treatment or care and he refuses, you must
comply with his wishes. However, if a law enforcement officer is pres-
ent or is summoned, he may at his discretion place the victim under
the Baker Act. The Baker Act may be used by law enforcement offi-
cers if a person is in need of care and the officer determines that the
person is not competent to make a logical decision. Care may then be
given. If a law enforcement officer is not available, continue to reason
with the victim. If the victim loses consciousness, you may assume
that the consent is now implied.
The information that is provided on consent varies from state to state
you should check with your state emergency medical services divi-
sion for up to date and current rules and regulations.

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IDEA Dive Medic

CHAPTER 2

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Dive Medic IDEA

Chapter 2

FIRST AID KIT

1. Components
2. Container
3. Oxygen

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IDEA Dive Medic

FIRST AID KIT

Many of the best dive locations are not
easily accessed by the general public.
Many times the best dive sites are in remote
areas or are only accessible by boat or a
four wheel drive vehicle. For this reason,
each diver should carry a First Aid kit con-
sisting not only of the basic First Aid sup-
plies, but also oxygen and items for specific
injuries.

The following supplies should be considered when putting

together a kit:
- DAN Oxygen Kit
- List of emergency telephone numbers
- Cold packs and Hot packs
- Decongestant, Non drowsy (Sudafed or Actifed)
- Extra strength pain reliever - Non aspirin
- Extra strength pain reliever - aspirin
- Extra strength pain reliever - coated or buffered aspirin
- Antibacterial ointment
- Antipruritic (anti itch) cream
- Sterile gauze pads of varying sizes
- Benzalkonium chloride pads (antiseptic towelettes)
- Bottle of isopropyl alcohol
- Elastic bandage
- Triangular bandages
- Single edged razor blades or razor knife with extra blades
- Adhesive bandages of varying sizes and types
- Adhesive tape
- Needle nose tweezers
- Small pair of scissors
- Stainless steel multi tool
- Emergency blanket (Foil, thermal)
- Seasickness medication
- Cotton swabs
- Tongue depressors

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Dive Medic IDEA

- Dental temporary repair kit

- Padded bite stick (tongue depressor)
- Roll bandages
- Feminine hygiene pads (for large wounds)
- Pocket mask with non return valve
- Benadryl (for Anaphylactic (allergic) reactions)
- Stethoscope and blood pressure cuff (adult and children’s)
- 1 quart of home brew sting kill (5% Isopropyl Alcohol, 5% Ammonia
and 90% bottled water)
- 1 quart of home brew disinfectant (5% to 10% chlorine bleach
(Clorox©) 95% to 90% bottled water)
Note: Home brew should be discarded and re-brewed every couple
of months so that you will always have a fresh and potent supply in
your kit.
- 1 quart of clean bottled water
- Disposable latex gloves - large size (fits all)
- Disposable medical face masks
- Disposable red plastic hazardous materials bags
- Disposable plastic garbage bags
- Disposable face shield
- Disposable long sleeve medical scrub top
- Zip lock bags of assorted sizes

Your kit may consist of a variety of over the counter drugs. The deci-
sion to use these drugs must be left up to the individual. Many per-
sons may not be able to take certain over the counter drugs. Many
people may have an adverse reaction
to an over the counter drug. Remember
the choice to use the over the counter
drug must be the decision of the indi-
vidual and not the Dive Medic. Like the
home brew, you should regularly check
your supply and the expiration dates.
Replace any out of date products with a
fresh supply.
The above list may seem large but is
merely a starting point for a First Aid

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kit. You may think of more items that will enhance your First Aid Kit
by the time your course is completed. The components that are listed
will meet most needs of the Dive Medic in the field. During your class,
discuss with your instructor and classmates any items that you feel
should also be included.

First aid kit containers

Now that we have listed a
wide variety of items for a
first aid kit, we will need a
container to carry them in.
The most popular style of car-
rier used is a medium sized
heavy duty nylon gear bag.
Most fire and rescue person-
nel prefer this type of soft
nylon bag. The term used for
this style bag is “jump bag”. he second most popular carrier is a large
fishing tackle box. The larger size with the fold out trays is the most
popular. Fishing tackle boxes can be quite expensive and are not as
popular as the nylon jump bags.
Generally when packing the box or bag the larger items such as a BP
cuff, stethoscope, and liquid containers are placed in the bottom of
the box along with a large supply of 4 in. x 4 in. gauze pads. The 4x4s
take up any extra room and hold the heavier items in place. The items
we have mention for your first aid kit may seem like a lot to carry but
they are the basics for a good kit. As you put your own first aid kit
together you will soon find a place for everything and still have room
left for extras.

OXYGEN EQUIPMENT
The use of oxygen in an emergency may mean the difference between
life and death of the victim. You should make every effort possible
to complete the DAN oxygen provider course required to be certified
as an IDEA Dive Medic II. Oxygen administration is vital in the
care of victims of asthma and respiratory distress. Drowning and
other serious diving problems (air embolism, decompression sick-

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ness, mediastinal emphysema, subcu-

taneous emphysema, pneumothorax)
should be treated with oxygen admin-
istration. There are several units avail-
able, the continuous flow unit, the
positive pressure unit, and the demand
unit. Of these mentioned, only the
demand unit is suitable for use in appli-
cations where oxygen must be admin-
istered by non emergency medical
trained personnel. The positive pres-
sure units are for use only by trained
emergency personnel, while the continuous flow units are wasteful of
the oxygen supply.
The demand unit has a demand regulator much like the one used in
diving regulators. They only supply oxygen when the victim inhales.
The units supply 100% oxygen, and can be switched over to continu-
ous flow if needed. At this time, Diver’s Alert Network (DAN) markets
a demand unit that is in wide use throughout the diving community.

Pocket mask (non return valve)

A very handy device for providing mouth
to mouth resuscitation is the pocket
mask. Pocket masks are available from
IDEA, the Red Cross, or medical supply
businesses. The pocket mask allows
a rescuer to provide ventilation’s to a
victim without direct contact with that
person. Make sure that the pocket mask
is equipped with a one way, non return,
valve. This will provide the user with a barrier between the victim and
the care giver. The non return valve will stop body fluids or contami-
nation from being exchanged between the victim and the care giver.
A pocket mask can easily be carried in a buoyancy compensator
pocket for use in the event of an in water emergency. A separate
mask should be carried in your first aid kit. If you do carry a mask
in your BC pocket, check it on a regular basis. The mask should be

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cleaned and rinsed after each dive. Pay special attention to the non
return valve. Be sure that it seals properly and is not ruffled on the
edges or torn. Make sure that it is still in the pocket and in good work-
ing condition prior to each dive.
There are several position techniques that can be applied when using
the pocket masks in the water. The pocket mask allows the rescuer
to work from either side of the victim. The other method is employed
when the rescuer is positioned above the victim’s head while towing
the victim. The technique employed will best be decided by the res-
cuer, one style may be preferred over the other.

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CHAPTER 3

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Chapter 3

ANATOMY, DIAGNOSTIC SIGNS & SYMPTOMS

1. General and Topographic Anatomy

2. Interpretation of Diagnostic Signs & Symptoms
3. Primary Survey
4. Secondary Survey
a. Pulse
b. Blood Pressure
c. Respiration
d. Temperature
e. Skin Color
f. Pupils of the Eyes
g. State of Consciousness

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IDEA Dive Medic

ANATOMY, DIAGNOSTIC SIGNS & SYMPTOMS

General and Topographic Anatomy

The surface of the body has many definite landmarks. These features
serve as guides to structures that lie beneath them. This is called
Topographic Anatomy. General anatomy would be the head, neck,
chest, abdomen, buttocks, arms, hands, legs, and feet.
Inspection is the simplest part of the primary and secondary survey
conducted on a victim. These surveys cause little or no pain or fur-
ther discomfort to the victim. They do, however, give the care provider
information that will assist the provider with the correct diagnosis and
treatment of the victim. These topographic landmarks are needed to
make a correct diagnosis. They are also necessary to communicate
the victim’s condition and other information to EMS personnel on/or
before EMS arrival.
Picture the human body standing, face forward, arms at the sides with
palms facing forward. The terms right and left refer to the victim’s right
or left. The main regions of the body are the head, neck, chest, abdo-
men and the extremities - the arms and legs. The surface of the front
is called the anterior surface and the back side is called the posterior
surface. Now picture an imaginary vertical line from the top of the
head to the floor. This is called the mid line. If you wanted to describe
a wound above the left nipple of a victim you would describe it as:
The victim has an anterior, two inch laceration, four inches superior to
the left nipple. If the wound was located below the landmark we would
describe it as inferior to the left nipple. If the wound was to the left of
the nipple we would call it lateral, if it were to the right we would call it
medial. Proximal and distal are terms used in describing locations of
wounds or marks on the extremities (arms and legs). A wound located
on the leg that is close to the knee would be proximal to the knee. A
cut on the mid to lower arm would be described as distal to the elbow
or proximal to the wrist. These landmarks and terms are simple and
useful.
If, however, you find it difficult to use these terms, don’t worry. Plain
talk is acceptable. If you use plain talk be sure to keep your description
and explanations short and to the point. It’s perfectly all right to say for
example: “The victim has a deep cut about four inches above the knee

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Dive Medic IDEA

cap on his left leg”. With a little study and

application you can easily learn the cor-
rect medical terms also.
Another important part of the anatomy
are the underlying arteries that pass
between the skin and a bony prominence.
It is important to the first aid provider to
know the exact locations of these pres-
sure points. Generally, bleeding may be
stopped at the site of the wound by using
direct pressure on the wound itself. In
some cases the bleeding is so severe
that it must be stopped at the nearest
pressure point. If this fails, you must try
using a combination of direct pressure on
the wound and a pressure point. If the
wound is located on an extremity, ele-
vation of the wound may also help stop
the blood flow. If these methods fail you
may have to resort to the least desired
method, using a restrictive band. The
absolute last resort is a tourniquet. We will discuss stopping blood
loss in more detail later in the text.
Generally most of the arteries that are close to the surface of the skin
and over a bony prominence is a good place to take a pulse. As noted
in the diagram you will see the pressure points that a pulse may be
obtained.

The easiest to find and most important pulses are:

1. Temporal (temples)
2. Carotid (neck)
3. Brachial (upper & lower inside arm)
4. Radial (wrist)
5. Femoral (groin)
6. Popliteal (located behind knee)
7. Dorsalis Pedis (starting at top of foot at ankle down to big toe)

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IDEA Dive Medic

INTERPRETATION OF DIAGNOSTIC SIGNS AND SYMPTOMS

The Primary and Secondary Survey

As a first aid provider it is important to quickly conduct a survey of the
victim’s condition. This first inspection of the sick or injured person is
called a Primary Survey. The most important factors of the primary
survey are the A,B,C’s: Air way, Bleeding And Circulation. Each of
these are required to support life. All three are to be given equal
importance. It will do the victim no good, if one or more of the life
sustaining factors are not attended to. When conducting a primary
survey, it must be done very rapidly; usually in less than one minute.
If any one or more life sustaining factors is not functioning, it
must be corrected immediately.

(A) Make sure that the victim has a patent (clear and open)
airway and is breathing
(B) Stop any serious bleeding
(C) Make sure the victim has a heartbeat

During the Primary Survey, make sure you talk with the victim. Ask
questions about the current medical problem. Ask the victim if he has
any prior or existing medical problems. If the victim is unconscious,
check for medical alert necklaces, bracelets or cards. After this quick
survey has been conducted, the Secondary Survey may begin. The
basic diagnostic signs can be observed quickly. Try and determine
what happened to cause the current situation of the victim.

1. Ask if anyone was present and saw what happened to thevic-

tim?
2. How was he noticed?
3. How was he found?
4. Is the victim conscious?
5. Was the victim conscious earlier?
6. If so, did he give any verbal information concerning his illness
or injury?
7. If the victim was injured, what were the mechanics of the injury.

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Any and all information obtained should be acknowledged and

recorded for later use. This information is important to the immediate
care of the victim. It will also play an important role in the care given
on arrival of EMS personnel.

The Secondary Survey diagnostic signs are:

1. Pulse
2. Respiration
3. Blood pressure
4. Body temperature
5. Skin color
6. Status of the pupils of the eyes
7. State of consciousness; ability to communicate
8. Ability to move
9. Reaction to pain or stimuli

All of these diagnostic signs can be obtained in less than five min-
utes with minimal equipment. Together with the observations of the
victim’s injuries and condition we can make a basic diagnosis. With
the information we have gathered, we may then attend to the immedi-
ate medical care of the victim. It is important that the information we
have obtained be passed on to the EMS Professionals on their arrival.
It will save them time in their formulation of a plan of action for the
care of the victim.

Pulse
The pulse is the pressure that is created by the
beating of the heart and is propagated through
the arteries. The standard pulse rate for adults
is between 60 and 80 beats per minute at
rest, with no physical activity. The pulse rate
for children is normally between 80 and 100
beats per minute at rest, with no physical activ-
ity. Individuals that are emotionally upset may
have a much more rapid pulse rate due to their
emotional status at any given time. In most cir-
cumstances a pulse can be felt in most of the

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IDEA Dive Medic

pressure points of the body where the artery passes over a bony
prominence or lies close to the skin. Usually the pulse is taken at
the base of the thumb over the wrist. The radial artery is quite super-
ficial. In an emergency situation it may be difficult to find the radial
pulse. The best place to check
for a pulse is at the carotid arter-
ies located on either side of the
neck. It is best to palpate (feel)
the carotid pulse with the victim
sitting or laying down. This pulse
will be stronger and easier to pal-
pate and record. If you are unable
to palpate a pulse you must either
place your ear against the chest
over the heart or use a stetho-
scope to hear the actual heartbeat. For a pulse to be audible or to
palpate it, a certain blood pressure (systolic) must be present. To be
present, a Radial pulse requires a systolic pressure of at least 90 mm,
and a Carotid pulse of 60 mm.
The normal pulse has a strong regular beat and usually reflects a full
blood volume. Changes in the rate or volume may be an indicator of
the appropriate treatment needed. A rapid and weak pulse is usually
an indicator of shock from blood loss. A rapid and pounding pulse
can indicate hypertension or fright. The complete absence of a pulse
means that a specific artery is blocked or that the heart has stopped
beating. The pulse should be taken immediately in the primary survey
and checked periodically during treatment of the victim. Always record
the findings and note if the pulse is weak or strong, regular or irregu-
lar.

Blood pressure
As the heart pumps blood through the arteries it creates pressure on
the walls of the arteries. This is called blood pressure. Blood pressure
is determined by a diagnostic tool known as a sphygmomanometer
(sometimes referred to as a blood pressure cuff) and a stethoscope.
The blood pressure cuff is wrapped around either arm above the
elbow. It is then inflated with a rubber bulb. There is a dial indicator

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attached to the cuff. As the bulb

is pumped, the needle will rise.
The taker is watching the needle
rise. He is also listening with
the stethoscope that has been
placed over the brachial artery
which lies medially at the front of
the elbow in an area know as the
antecubital fossa. As the needle
rises it will pulsate with the heart-
beat. You will also be able to
hear the heartbeat through the
stethoscope. Somewhere between 150 to 200 millimeters of mercury
the needle will stop pulsating with the heartbeat. When this point is
reached, stop pumping the bulb and slowly release the air from the
blood pressure cuff. You will also note that you no longer hear the
heartbeat through the stethoscope. As the needle falls, note the read-
ing when the first sound of the pulse is heard. This is the systolic
blood pressure. Continue monitoring the needle and
note the reading when the sound of the pulse stops.
This is called the diastolic blood pressure. Again, the
reading are in millimeters of mercury. Blood pres-
sures vary with the age and sex of the individual. A
good rule of thumb for normal systolic blood pres-
sures for an adult male is 100 mm hg. plus their age.
This is usually close up to a level of 140 - 150 mm
hg. The normal diastolic pressure for an adult male is
between 60 - 90 mm hg. For the adult female you will
find that the normal pressures are 8 - 10 mm hg. less
for both systolic and diastolic.

Respiration
The normal rate of breathing is between 12 and 20 times per minute
for teenagers and adults. Shallow or unusually deep breathing may
indicate a medical problem. Make note of the breathing rate and
check it periodically for any change. Rapid, shallow respiration’s may
be an indicator of shock. Deep, gasping or labored breathing may indi-

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cate an airway obstruction, heart dis-

ease or pulmonary problems such as
emphysema. The lack of any respi-
ration may indicate a blocked airway
and require the standard procedures
for a blocked airway or for treating a
victim of choking. The lack of respi-
ration’s requires immediate attention.
Always check for breath sounds by
listening with your ear close to the
mouth of the victim and also listen
with the stethoscope for both breath
sounds and a heart beat. If the heart is beating normally, CPR is not
needed. Pulmonary ventilation should be given to victims that have
a heart beat but are not breathing. Don’t give heart compression’s if
the heart is still beating. Unneeded heart compression’s may cause
damage to the heart and create more problems.

Temperature
The normal body temperature is 36,5 degrees Celsius.
Change from the normal body heat may occur in the event
of injury or illness. The temperature of a victim is a
useful tool in diagnosing the medical problem.
Most temperatures are taken orally if the
victim is conscious and awake. If the
victim is unconscious an axillary tem-
perature may be taken under the
arm pit. Axillary temperatures
are not as accurate but will
give you an indication if a high
temperature is present. If a victim is sweating and the skin is cold and
clammy you may suspect shock. The body can lose heat rapidly by
the process of sweating. The victim should be covered and treated
for shock. Exposure to cold usually produces cool dry skin. The expo-
sure can not only reduce skin temperature but reduce the body’s core
temperature (heart & lung area) creating a dangerous situation. This
condition is called Hypothermia. Hypothermia is a very serious condi-

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tion and must be treated immediately. The victim should be covered

and warmed as soon as possible.
Hot dry skin may be caused from illness or by exposure to excess
heat. Our concerns here would be heat exhaustion and heat stroke.
Both of these conditions are dangerous and present themselves dif-
ferently. We will discuss both later in the text.

Skin Color
Skin color can provide the care giver with a great deal of information
about the victim. Persons with light colored skin are more easily
observed for changes. Color changes in dark skinned people are
more easily observed by examining the fingernail beds, sclera of the
eyes (whites) and under the tongue. The color changes that are impor-
tant in the observation of victims are red, blue and white. A cherry red
color may indicate the first stages of carbon monoxide poisoning, high
blood pressure or sunstroke. Persons in advanced stages of carbon
monoxide poisoning may appear blue. Lack of oxygen causes a blue
or ashen color is called cyanosis. Cyanosis is seen in victims with
heart failure, airway obstruction, shock and drowning. Victims that are
cyanotic require immediate oxygen administration. Since we are dis-
cussing skin color you may come across a someone that have a yel-
lowish tint to their skin. This person most likely suffers from a chronic
liver disease. The only care the Dive Medic can offer a person with
liver disease is DAN oxygen protocol, treat for shock and make them
as comfortable as possible until EMS personnel arrive.

Pupils of the Eye

Normally the pupils of the eyes
are regular in shape and equal
in size. When checking the
pupils, be aware of contact lens
and prostheses (false eyes).
Variations in the size of one or
both pupils are signs to watch
for. Dilated pupils indicate an
unconscious or relaxed state.
Constricted pupils may be an

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IDEA Dive Medic

indication of drug use or a disease of the central nervous system.

Pupils that are uneven are an indication of head injuries or strokes.
The pupils should be monitored every few minutes while the victim is
under your care. Should a change occur because of underlying head
injury it is imperative that the EMS providers be notified as soon as
possible. Provide a patent airway; administer oxygen as directed by
the DAN protocol.

State of Consciousness
It is important to observe the state
of consciousness of an ill or injured
victim. Normally people are alert and
oriented. Normal consciousness is
observed when people know where
they are, know the date, day and
year and can answer questions. Per-
sons that are unable to answer you
or acknowledge their surroundings
may be ill or injured. There is also
the possibility that the person may actually be asleep, hard of hearing
or deaf. Make sure that this is not the case when you are determining
if the person is alert and oriented. Always try to alert the person of
your presence. You don’t want to startle or scare them. If it appears
that your communication efforts are not working you may try other
means. The level of consciousness may sometimes be determined
by a slight pain stimulus. A light and gentle sternum rub or an object
like a pen or pencil stroked on the bottom of the bare foot often will
get a response. Persons that have rapid loss of consciousness may
have a head injury, may have ingested a large overdose of drugs or
may suffer from diabetes or seizures. In any of these cases make
the victim comfortable, maintain a patent airway, treat for shock and
administer oxygen.

Common Faint
The exact cause of the common faint is not clearly understood. Appar-
ently it is relative to a slowing of the pulse without an increase in
blood flow per heartbeat. The result is diminished cerebral function.

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Persons that experience a lightheadedness or near faint can usually

avoided unconsciousness by laying down quickly and elevating the
legs. This will increase the return of the blood to the heart, which in
turn counteracts the effect of the slowing of the pulse; and cerebral
blood flow then becomes adequate to sustain consciousness. Most of
us have had the experience of standing quickly and becoming light-
headed or faint. n many cases we can simply sit back down and lower
our head for a few minutes to overcome the problem.

Seizures
Seizures may be cause by numerous problems. Seizures may be
induced by alcohol, drugs, head injuries, toxic fumes or medical prob-
lems such as Epilepsy or Diabetes. Except in the case of seizures
caused by Diabetes the care giver is limited in the help they may
render. Seizures caused by Diabetes will be discussed later.
Epilepsy is a common condition that is normally controlled by medica-
tion. Epilepsy can be caused from an injury to the brain, birth defects,
brain tumors, cerebral embolus or illegal drug use that has caused
damage to the brain. There are two types of seizures or convulsions.
Grand Mal and Petite Mal. The petite mal seizure does not normally
cause convulsions and many times may go unnoticed. Any convul-
sions that present as body movement are considered grand mal.
Grand mal seizures are the concern of the care giver. The grand
mal seizure is caused by a burst of brain cell activity leading to
uncontrollable contractions of the muscles throughout the entire body.
The victim will lose consciousness and flail about uncontrollably.
The grand mal can cause the victim to lose bladder and bowel con-
trol. There is also the possibility of
the victim having contractions of the
jaw muscles that can cause biting to
his lips or tongue. After the seizure is
over, the victim will be extremely dis-
oriented and exhausted. The proper
care to the victim of a grand mal
seizure is to assure an open airway
and proper respirations during the
unconscious state. Protect the victim

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IDEA Dive Medic

from injury but don’t try to restrain the

victim unnecessarily. Protect the vic-
tim’s head, arms and legs but do not
rigidly restrain them. Move any objects
the victim may come in contact with
that can cause injury. A padded bite
stick may help avoid injury to the vic-
tim’s mouth, lips and tongue if the mus-
cles of the jaw are effected. Never
place your fingers in the victim’s mouth.
You may receive a severe injury from
the teeth of the victim. Do not place
any unpadded or hard object in the victim’s mouth. This will increase
damage from the biting and jaw movement. Standard BLS procedures
should be followed for the seizure victim. Activate the EMS by calling
emergency as soon as possible.

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Dive Medic IDEA

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IDEA Dive Medic

CHAPTER 4

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Dive Medic IDEA

Chapter 4

FIRST AID

1. Bleeding
a. Control
b. External
c. Direct Pressure
d. Pressure Points
e. Restrictive Bands and Tourniquets
f. Epistaxis
g. Bleeding or Fluid from the Ears
h. Internal Bleeding
i. Universal Precautions
2. Shock
a. Types
b. Signs and Symptoms
c. Treatment
3. Insulin Shock and Diabetic Coma
4. Fractures
5. Splinting
6. Neck and Spinal Injuries
7. Poisons, Stings and Bites
8. Injuries and Illnesses from Marine & Aquatic Fish and Animals
9. Dyspnea
10. Unconscious Victim, Unknown Reasons
11. Communicable Diseases

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IDEA Dive Medic

FIRST AID

Scene Surveys
Before any care is given, it is important that the care giver conduct a
scene survey. scene survey is very important to the safety of the care
giver and the victim. The survey is done quickly and is an audio visual
task. The scene survey was developed by the fire service as a safety
measure for fire rescue personnel. The term used by the fire service
is “circle size up”. The term is almost self explanatory. Any scene is
viewed with the accident or victim as the center with an outer circular
boundary. The boundary is determined by the type of accident. The
more hazardous the situation the larger the boundary. Providing there
are no extenuating scene mechanics, in the case of illness or an acci-
dent the boundary is usually not large. If the accident or injury or ill-
ness was caused by a downed power line, a gas leak ect. special
care must be used and the boundary extended. If there is a possibil-
ity of a gas leak or toxic chemicals always approach up wind. Never
enter an area that is toxic. You will also become a victim. In the case
of a contaminated area of toxic fumes, leave the rescue and the vic-
tim’s care to the professionals. Call 911. Explain the perceived emer-
gency. Remain up wind in a safe area. Warn others of the situation
and dangers.
To conduct a scene survey, start with a slow approach. The victim
or accident area should be physically circled, quickly looking for any
signs of potential hazards. Hazards to look for are downed power
lines, fuel leaks from auto accidents, gas leaks from broken gas lines
of damaged tanks, chemical spills, suspicious by standers, animals
etc. The scene survey is an important tool and will provide a level of
protection for both the victim and the care giver.

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ABC’s
As we mentioned previously,
the basics of all first aid ren-
dered to a victim are the
ABC’s. The ABC’s are the first
things that we check in the
Primary Survey. Make sure
that the ABC’s are properly
established before providing
other care.
A - Check for, establish or maintain an open airway
B - Control visible blood loss
C - Circulation
After following the ABC’s, basic first aid care may be rendered.

Bleeding
Bleeding and hemorrhage mean the same thing. Most people will use
the word hemorrhage when bleeding is profuse. Bleeding may be
internal or external and is caused by a break in the vascular system
from either an artery or a vein. The average adult has about six liters
of blood in his body. Loss of one liter of blood in an adult or 500 mil-
liliters in a child or 25 milliliters in an infant can lead to shock. This is
known as hemorrhagic shock. This is a true emergency and immedi-
ate first aid is needed. Blood from an artery spurts with each heart
beat and is usually bright red. Blood from a vein is slow with a steady
flow, its color is much darker. Blood flow from the upper areas of the
skin may be from capillaries and usually is a slow steady ooze. The
rapidity of blood flow is very important. Rapid blood loss must be
addressed immediately.

External Bleeding
External bleeding is obvious and is easily detected by the
care giver. The different types of wounds are: Lacera-
tions, Abrasions, Avulsions and Puncture wounds. Small
or minor wounds will usually stop bleeding within 6 to
10 minutes. leeding is stopped by the normal body func-
tion provided by different protection mechanisms of the

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IDEA Dive Medic

circulatory system. The cut vessel will react by

constricting at the cut ends. Under normal con-
ditions the wound will clot and stop the blood
flow. If the wound is large or does not stop flow-
ing there are several methods that can be used
to slow or stop the blood flow.

Direct Pressure
Direct pressure will stop most blood flow and is the most effective
method. Direct pressure may be applied by exerting pressure directly
over the wound by a finger, hand or pressure bandage. ressure is
exerted until the blood flow is stopped. Periodic checks will be neces-
sary to determine when the blood flow has stopped.

Pressure Points
For bleeding that cannot be stopped with direct pressure a pressure
point may be used. Pressure points are located where an artery is
close to the skin’s surface and the artery passes over a bone. Rarely
can blood flow be stopped completely by using a pressure point. The
blood flow can be reduced significantly when the pressure point is
used along with direct pressure. The major pressure points are: Axil-
lary, Brachial, Radial, Ulnar, Femoral, and Popliteal.

Elevation of the Wound

Don’t overlook the possibility that simple elevation of the wound or cut
will also help stop or slow the blood. Obviously this will work best if
the wound or cut is located on an extremity. If the victim is not show-
ing any signs of shock he may be placed in a sitting position. Victims
with minor cuts or wounds to the head may benefit from the sitting
position.

Restrictive Bands and Tourniquets

Restrictive bands and tourniquets are
used only as a last resort. If a restrictive
band or tourniquet is used it should be a
minimum of four inches wide and should
not be overly tight. The band should only

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Dive Medic IDEA

be tight enough to stop or slow the blood flow as much as possible.

When used, it is important that the victim receive EMS care as soon
as possible. Do not loosen a restrictive band or tourniquet once it
has been applied. Only EMS or a Medical doctor should loosen the
band or tourniquet. In most cases the band or tourniquet will not be
released until the victim is under a doctor’s care in the emergency
room.

Tourniquets and amputations

In the case of a boating accident there is the possibility of an ampu-
tation caused by the propeller. Propellers can cause severe cuts,
broken bones and traumatic amputations. You may be surprise that
there is not always a large blood loss from an amputation. When an
traumatic amputation occurs the muscle and tissues usually draw up
and cut off a considerable amount of blood flow. Even so it is impor-
tant to use a tourniquet close to the wound and bandage the exposed
wound. Watch for a renewed blood flow, treat for shock and activate
the EMS system.
Epistaxis
Epistaxis is commonly know as “nosebleeds”. In most cases
nosebleeds are not serious. However, when a person experiences a
nosebleed from an accident or injury, a nosebleed may be a sign of a
more serious medical problem. A nosebleed could possibly be a sign
of:
1. A fractured skull
2. Facial injuries
3. Barotrauma injuries to the sinuses
4. Sinusitis or infections
5. High blood pressure
6. Bleeding diseases

Care and treatment of nosebleeds

Most common nosebleeds can be treated by tilting the head back and
applying direct pressure to the nostrils. Ice may also help to stop the
bleeding. For severe bleeding treat for shock and seek EMS care as
soon as possible.

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IDEA Dive Medic

Bleeding or Fluid from the Ears

Any bleeding or fluid from the ears should be treated as an emer-
gency. Bleeding or fluid from the ears may indicate a severe head
injury or fractured skull. Protect the head, neck and spine by immo-
bilization, treat for shock and activate the EMS system. Seek EMS
assistance as soon as possible.

Internal Bleeding
Internal bleeding is a very serious situation demanding immediate
medical care. Bleeding internally from injuries to soft tissues, closed
fractures or lacerated liver, spleen or lungs is difficult to detect.
The victim’s blood pressure will be an
important factor in recognizing inter-
nal bleeding. A low blood pressure
is an indication of loss of blood
or shock. Internal bleeding should
be considered a serious condition
which can quickly lead to death if
not treated. Treat for shock and acti-
vate the EMS system quickly. Time is
important if the victim is to survive.

Universal Precautions
When assisting a victim of accident or injury, the possibility of coming
in contact with blood or body fluid is likely. Any time that you have the
possibility of exposure to blood borne pathogens or body fluids you
should take precautions not to expose yourself. Special disposable
equipment is available that can be used to decrease your exposure
to blood and body fluids. Plastic face shields, coated long sleeve
disposable (medical scrub tops) shirts, latex gloves and nose and
mouth protective shields are available. These throw away items are
not expensive and are available from medical supply stores and phar-
macies. You should also have a few red hazardous materials plastic
trash bags for soiled protective gear. You may ask EMS personnel or
the medical facility to dispose of the hazardous material bags prop-
erly for you. These items should be part of your first aid kit also. If
you are exposed to any blood or body fluids report it to the EMS per-

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Dive Medic IDEA

sonnel and have them record it in their written report of the incident.
Follow the recommendations covered in the communicable disease
section. Make sure that you follow through with a visit to a medical
doctor immediately.

SHOCK
Types and causes of Shock
- Hemorrhagic shock (blood loss)
- Respiratory shock (inadequate oxygen supply)
- Neurogenic shock (loss of vascular control by the nervous -
system)
- Psychogenic shock (fainting)
- Cardiogenic shock (inadequate function of the heart)
- Septic shock (severe infection)
- Metabolic shock (loss of body fluid)
- Anaphylactic shock (allergic reaction)
- Insulin Shock (too much insulin)

Signs and Symptoms of Shock

The signs and symptoms are similar in all types of shock.
1. Restlessness and anxiety
2. Weak and rapid pulse
3. Cold and clammy skin
4. Profuse sweating
5. Pale or cyanotic skin
6. Shallow, labored, rapid breathing
7. Dull eyes, dilated pupils
8. Nauseated
9. Low or falling blood pressure
10. Victim faints

Treatment of Shock
Victims that exhibit any of the signs or symptoms should be aggres-
sively treated for shock immediately. It is important to recognize the
possible cause of shock so that the treatment can be administered
accordingly. Many of the principles of shock treatment can be applied
to all victims in shock. If in doubt, always treat for shock. The treat-

42
IDEA Dive Medic

ment for shock is unlikely to cause any further problems and could
possibly save the victim’s life.

The proper treatment for shock is:

1. Maintain a clear and patent airway - administer oxygen if needed.
Do this first before anything else.
2. Control all obvious bleeding.
3. Elevate the lower extremities about twelve inches, providing the
victim’s injuries do not make it impossible.
4. Splint any fractures. In doing so, bleeding is lessened, pain and
discomfort is reduced and will not continue to aggravate the shock
condition of the victim.
5. Avoid any rough or excessive handling and moving of the
victim.
6. Prevent the loss of body heat by covering the victim. If the victim
is a diver remove the victim’s wet suit. Wet suits do not hold body
warmth and will cause possible hypothermia in the victim. Cover
the victim with dry warm blankets to conserve their body heat.
7. Keep victim supine (laying flat on their back) if possible.
Victims in shock after a heart attack or with lung disease such as
emphysema can’t breathe as well while laying flat. You may have
to accommodate the victim by placing them in a sitting position if
this is a problem.
8. Record the victim’s initial pulse, blood pressure and breathing
rate. Keep checking and recording these every five minutes until
EMS arrives.
9. Do not let the victim eat or drink.

TREATMENT OF SPECIFIC TYPES OF SHOCK

While the treatment of shock in general will apply to all types of shock,
there are two types of shock that the Dive Medic can address with
additional care.

Hemorrhagic Shock
The emergency treatment for hemorrhagic shock caused by external
bleeding is, of course, to stop or decrease the bleeding as much as
possible. After making sure that the victim is breathing properly, use

43
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the direct pressure or a combination of methods to stop the bleeding.

If there is a fracture, splint it if possible. Hemorrhagic shock is caused
from the loss of blood. The vascular system needs the proper amount
of fluid to function correctly. If the victim was in the care of a hospital
or EMS professional the victim would receive intravenous fluid or a
blood transfusion. By replacing the lost fluid the shock will be elimi-
nated. As a Dive Medic we can increase blood flow to the brain and
vital organs by elevating the victim’s lower extremities. Summon EMS
as soon as possible - the victim is in an extremely dangerous condi-
tion. For victims that may have internal bleeding, elevate the lower
extremities and keep the airway clear. Make sure that the victim does
not aspirate any vomitus into his lungs. If he should vomit, roll the
victim to his side and clear the airway. Again the victim is in extreme
danger - summon EMS as soon as possible. If there is no local EMS
Rescue Unit, the victim must be transported to the nearest medical
facility as soon as possible. Call 911 and notify the local law enforce-
ment agency of the situation. Law enforcement will assist you in coor-
dinating transportation of the victim.

Anaphylactic Shock
Anaphylactic shock presents special signs, and treatment is more
involved for the care giver. Anaphylactic shock may be caused from a
reaction to drugs, insect bites, marine life stings and bites or food aller-
gies. Anaphylactic shock is a true emergency and can be extremely
dangerous. Respiratory and cardiac arrest may occur and is common
to Anaphylactic shock. Victims that are not allergic to the over the
counter drug Benadryl may take the prescribed dose. Benadryl is
helpful in relieving the symptoms in many cases. Make sure you have
a supply of Benadryl in your first aid kit. Individuals who are allergic
to foods, insect bites and stings may carry a personal injection for
emergencies. These devices are simple to use and come with com-
plete instructions. Look for medic alerts and question the victim if
conscious. Treat the victim for shock and summon EMS immediately.
Anaphylactic shock is very dangerous. Follow the same protocol as
you would for Hemorrhagic shock. If there is no local EMS Rescue
Unit, the victim must be transported to the nearest medical facility
as soon as possible. Call 911 and notify the local law enforcement

44
IDEA Dive Medic

agency of the situation. Law enforcement will assist you in coordinat-

ing transportation of the victim.
More information on Anaphylactic shock is located in the dangerous
marine life section of this text.

Insulin Shock and Diabetic Coma

A normal person will have a certain amount of sugar present in his
blood stream. The cells of the human body require an energy source
to function properly. Sugar is the source of fuel. Normally the body
controls the level of glucose (sugar) naturally. ndividuals that are dia-
betic are no longer able to produce natural insulin. Persons with dia-
betes must control their blood glucose (sugar) levels by taking man
made insulin in the form of tablets or injection. Persons with diabetes
must walk a thin line in control of the diabetes. Blood glucose that is
too high or too low causes premature failure of the vital organs of the
body. There are two conditions to be concerned with when dealing
with Insulin Shock and Diabetic Coma. Generally speaking the most
dangerous is Insulin Shock. Insulin Shock has a rapid onset which
could be in a few minutes or a few hours after receiving insulin. Insu-
lin Shock is caused by too much insulin. On the other hand Diabetic
Coma has a slow onset that may take days or weeks. The high level
of insulin may be caused from actually taking too much insulin or by
not eating the proper amount or enough carbohydrates prior to taking
the insulin. Excessive exercise can also cause an imbalance to occur.
Persons with the onset of Insulin Shock will feel weak and rapidly
lose consciousness. Insulin Shock may also occur while the person
is sleeping. The brain requires a constant supply of glucose just as
it requires a constant supply of oxygen. If there is a lack of blood
glucose to the brain, unconsciousness and permanent brain damage
can quickly occur. The loss of consciousness is especially critical in
scuba diving or swimming. It is quite obvious that an unconscious
person would surely drown. Diabetics are required to obtain written
approval from a medical doctor before participation in scuba training.
Diabetics should only participate in water sports with a buddy or a
partner who is aware of their condition and can act appropriately to
assist in case of a problem.

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Dive Medic IDEA

Signs and Symptoms of Insulin Shock

1. Normal respiration’s
2. Pale, moist skin, profuse sweating
3. Dizziness, headache
4. Rapid pulse
5. Normal blood pressure
6. Varying degrees of unresponsiveness. Unable to answer simple
questions (day, date, year, etc.)
7. Fainting, seizures, coma

Treatment of Insulin Shock

In most cases diabetics can feel an insulin reaction coming on. By
acting quickly they can eat a sugar cube or sugar packet. The sugar
will be absorbed into the blood stream faster by letting it dissolve in the
mouth rather than swallowing it. It is important that the victim immedi-
ately eat food that is high in carbohydrates. The sugar may offset the
insulin reaction but the results of the sugar are short termed.
If a person is found unconscious check for any medical alert brace-
lets, chains or cards. You may also look for glucose tablets or a Glu-
cose Emergency Kit. The emergency kit contains a small syringe and
a bottle with a single tablet of high concentrate glucose. The kit has
instructions for mixing the solution and administering the contents
with the syringe. Some kits will have the liquid already in the syringe.
You take the cap of the bottle with the tablet and inject the solution
into the bottle. The liquid will dissolve the tablet immediately. You then
draw out the mixed solution and inject it into the victim. You may also
find a Glucose Kit that has an empty syringe with the liquid in one
bottle and the tablet in another. If this is the case you would draw out
the liquid and then inject it into the bottle with the tablet. The next
step would be to draw the solution out and inject it into the victim. The
Glucose Emergency Kit is simple and easy to use. Do not hesitate to
use the kit if it is available. If you have never given an injection before,
don’t worry, it is really not difficult. The needle in the kit is very small
and sharp. It will take a minimal amount of pressure to puncture the
skin and tissue. Press it in firmly and push the plunger to inject the
solution. The fatty area of the victim’s arm is a good injection site.
Remember to follow the instructions in the kit.

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IDEA Dive Medic

If in doubt between Diabetic Coma and Insulin Shock always give

sugar to the conscious victim. If a victim is actually suffering from Dia-
betic Coma the added sugar will not cause any additional problems.
However, if it is Insulin Shock, it may save the victim’s life. If the victim
is semi conscious, granular or powered sugar under the tongue will
help revive them enough to administer a sugar solution. Orange juice
is often used, but any drink with sugar will help offset the insulin. You
may add a couple of extra spoonfuls or packets of sugar to enhance
the victim’s recovery. If you do not have any soft drinks or orange juice
you may add four or five sugar packets or teaspoonfuls to plain water.
If the victim is unconscious do not attempt to administer any sugar or
solution. Prompt medical attention by EMS is required.

Diabetic Coma
Diabetic Coma is considerably different from Insulin Shock. Diabetic
Coma has a slow onset and is not usually associated with emergency
treatment. Diabetic Coma is a result of the lack of proper insulin man-
agement or the victim is unaware that they have Diabetes. Diabetic
Coma is caused by high levels of blood glucose. Many adults become
ill with Type II (Adult onset Diabetes) later in life. They may not have
any idea that they have diabetes. The classic signs of Type II Diabe-
tes is an excessive thirst and rapidly failing vision. Diabetic Coma will
not suddenly manifest itself and is not usually a medical emergency.
It is rare that a first aid provider would see this medical problem.

Signs and Symptoms of Diabetic Coma

1. Rapid, deep, sighing respiration’s
2. Dehydration, dry warm skin
3. Sweet, fruity acetone odor of the breath
4. Rapid weak pulse
5. Normal or slightly low blood pressure
6. Varying degrees of unresponsiveness

Treatment for Diabetic Coma

The proper emergency treatment for Diabetic Coma is to guard the
victim’s airway and call EMS support quickly. If in doubt between Dia-
betic Coma and Insulin Shock always give sugar to the conscious

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victim. As a matter of priority the victim in insulin shock is far more

critical and likely to have brain damage than the victim in Diabetic
Coma. The additional sugar will not harm a victim in Diabetic Coma
but will help the victim in Insulin Shock. Both Diabetic Coma and Insu-
lin Shock are dangerous to the victim; call for EMS as soon as pos-
sible or transport the victim to the nearest Emergency Care facility.

FRACTURES, DISLOCATIONS, & SPRAINS

Injuries of the bones, joints, muscles and tendons are common. The
first aid provider should check for theses types of injuries. Injuries of
these types may not always be apparent. A close inspection of the
body by sight, feel and questions to the conscious victim will play a
major part in recognition of these type injuries. Immediate care by the
care provider will decrease the pain and possibility of shock or further
injury occurring to the victim.
A fracture is a break in the continuity of a bone. Some fractures may
be only a crack. In others the bone may be broken completely and
separated. Some fractures may be angulated or actually protrude
from the skin. here may be swelling and discoloration along with the
pain caused from a fracture. These types of fractures are obvious
while others are not. Fractures that are not obvious to the eye are
detected by X-Rays.
Signs of fractures
Deformity - An arm or leg that is lying in an unnatural position or is
angulated where there is no joint is a sign of a fracture.
Tenderness - Tenderness localized at the site of the injury is a sign
of a possible break. By gently pressing along the bone with the finger
tips, the care provider can often locate the fracture.
Grating - A grating sensation under the skin can be felt when the
broken ends of the bone rub together.
Swelling and discoloration - Generally swelling to some degree is
always present with fractures. The swelling is caused by injury to the
soft tissues or from bleeding.
Inability to move extremity - In some cases the complete or partial
loss of movement of the extremity is present. It is best not to move a
fracture any more that necessary to prevent further injury.

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IDEA Dive Medic

Major classes of fractures

There are two major classes of fractures - Closed (simple) Fractures
with no bone protrusion and Open (compound) Fractures with bone
protrusion. he Open Fracture may have only a small cut where the
bone has protruded and returned or the bone may actually extend
out from the skin. Open Fractures are much more serious than a
Closed Fracture. The possibility of blood loss and contamination is
much more likely. Care must be given to stop any bleeding with a
direct pressure bandage. Cover the Open Fracture and prevent any
further contamination. The possibility of infection is great when there
is an open fracture. Make sure that the EMS personnel are aware of
any contamination of the wound. The victim is in need of immediate
care from an emergency medical facility. Be aware that there can be
a large blood loss from both open and closed fractures. When a bone
breaks there is bleeding from inside the bone and from surrounding
tissues. Because there can be a large blood loss, care should be
taken to check the victim’s blood pressure and pulse. The possibility
of hypovolemic shock should not be overlooked. It is best to immobi-
lize any injury to prevent further trauma to the area and discomfort to
the victim.

Types of Fractures
Fractures are also classified according to the type of break in the
bone.
Greenstick fracture - This fracture is an incomplete break which
passes only part of the way through a bone. It usually only occurs in
children because of the flexibility of the growing bone. Adult bones
have less flexibility and usually break completely.
Transverse fracture - A transverse fracture is a break line that is
straight across the bone at a right angle to the bone’s long axis.
Spiral fracture - The spiral fracture line twists around and through the
bone.
Oblique fracture - This fracture line crosses the bone at an oblique
angle.
Comminuted fracture - The Comminuted fracture is a bone that is
broken in more than two pieces.

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Impacted fracture - The broken ends of the bone are jammed into
each other with a impacted fracture.

Fractures of the Clavicle (collarbone)

Fractures of the clavicle are most common in children. The injury
usually occurs when the person falls on the outstretched hand. This
break is an indirect injury and can cause a lot of pain in both children
and adults. A person with a broken clavicle usually holds his arm on
the injured side with the other arm pulled close to the chest. There is
swelling, tenderness, deformity in the area and inability to move the
arm due to the pain. The best first aid treatment for a broken clavicle
is a sling to support the arm and a swath to immobilize the arm close
to the chest.

Dislocations
Dislocations are displacements of the bone
ends that form joints. Bones that are not in
proper contact are considered dislocated and
may cause extreme pain and possible shock.
Immediate care should be given to dislocations
to make the victim more comfortable and reduce
the pain that may come with a dislocation.
Splinting a dislocation will prevent motion of the
bone or joint that can further damage the joint,
bone or soft tissue.

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IDEA Dive Medic

Sprains
Sprains are a partial tearing or over stretching of the
ligaments around a joint. Sprains generally occur
from twisting or stretching a joint beyond its normal
range of motion. Sprains can vary in severity. The
most common sprains are to the ankle or the knee.
Sprains are best treated by immobilizing the joint
and using a cold pack on the injured area.

SPLINTING
Rendering proper emergency care to a victim
with a fracture or dislocation will decrease the
possibilities of causing further injury and compli-
cations. Splints can be made from any material
or appliance which will prevent the movement
of a fractured or dislocated extremity. Splints
can be fashioned from rolled up newspaper,
sticks, boards and metal. Commercial splints
are readily available and are not expensive.
The use of splints can alleviate pain by mini-
mizing movement at the injury site. It can also
prevent damage to muscles, nerves and blood
vessels. Remember to check for a pulse below
the suspected injury. Don’t wrap the to tightly
when splinting you don’t want to slow or cut of
the blood supply to the extremity.
The General Rules of Splinting are:
1. Clothing must be removed or cut away from the suspected frac-
ture or dislocation.
2. The fracture or dislocation must be immobilized above and
below the injury.
3. Check and record the pulse and neurological (feeling) status
distal to the injury. Don’t wrap the area to tightly. Make sure there
is a blood supply to the effected extremity.
4. Dislocation or fracture with a deformity near a joint can be a
serious injury. Damage to the adjacent nerves and blood vessels
is possible. Summon EMS as soon as possible.

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5. Cover all wounds with a sterile dressing. Do not wrap the

wound, EMS will need to see the injury to treat it on their arrival.
6. Pad the splint to prevent discomfort and excessive pressure.
8. Neck and spinal injuries should not be moved except to clear
the airway.
9. When in doubt, splint.
10. Splint in the position of the break. If the break needs to be
straighten EMS personnel are qualified to realign the break if nec-
essary.
Most of the time when splinting an arm you will also need to fashion
a sling to support the extremity. Commercial slings are available and
are inexpensive. You may of course use any type of cloth that is wide
enough to support the full length of the arm.

Types of splints
Many different types of materials are used for splints. plints may be
purchased from medical supply houses or fashioned from almost any
type of material that is close at hand. There are several type of splints
available - rigid splints, soft splints (air splint, pillow splint or sling
splints). Splints may be made of newspaper, cardboard, wood dowels,
etc. The main object is to immobilize the area of concern.

Neck and Spinal Injuries

The spine is a column of thirty three fused and separate bones. The
spine extends from the base of the skull to the tip of the coccyx. Each
segment surrounds and protects the spinal cord and nerve roots.
Damage to these bones can cause associated damage to the spinal
cord or nerve roots. This damage can cause paralysis or death. With-
out X-ray studies, damage cannot be determined. It is very important
to stabilize and immobilize anyone in which possible damage to the
spine is suspected. The only treatment that can be rendered is to
keep the victim completely still or on a backboard until EMS arrives
to take over the care of
the victim. Never ever
move a victim that has
a possibility of a spinal
injury. In some cases,

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IDEA Dive Medic

such as in water or an auto accident, it

may be necessary to move the victim if
imminent danger is present. If you must
move a victim, make sure that the victim
is moved on a backboard and the spinal
integrity is in alignment. Traction must be
held on the head with no movement as
the victim is being moved to a safe area.
If the victim is not breathing and mouth to
mouth resuscitation is necessary, do not
hyperextend the neck. Under no circumstance should the victim be
allowed to move. Even the smallest amount of movement may sever
or damage the spinal cord. Damage to the spinal cord may cause
paralysis or death. Keep the victim immobilize until EMS arrives.

POISONS, STINGS, AND BITES

There are many different poisons, stings, and bites that the unlucky
victim may come in contact with both on land and in the water. In all
cases, the best treatment for any of these is avoidance. No sane indi-
vidual seeks to become poisoned, stung or bitten. In most cases
the problem can be simply being in the wrong place at the wrong
time. The best way to prevent these problems and accidents is edu-
cation and using common sense. If you are educated and cognizant
of your surrounding, these accidents are less likely to happen. Many
of the same type of accidents related to poisoning, stings or bites can
happen in a business area, a remote dive site or in the water. Always
be aware of your surroundings, your personal actions and conduct.
Many times the cause of poisoning, stings and bites is simple care-
lessness. The first aid provider is limited to the care they can provide
in the case of poisons, stings and bites. Prompt action is required in
the care and activation of the EMS system.

Poison
The basic definition of a poison is any substance that produces a
harmful effect on the body processes and functions. Poison may
modify the normal metabolic functions of cells or directly destroy them.
Poison can be inhaled, ingested, injected or absorbed through the

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skin. Common symptoms of poisoning are nausea, vomiting, abdomi-

nal pain, pupil dilation or constriction, diarrhea, excessive sweating ,
salivation, abnormal respiration’s or inadequate breathing and cyano-
sis (bluish color of lips and skin)

Ingested Poison
Poisons that are most likely ingested are foods, drinks, drugs and
household products. Most of these types of poisonings are related to
children. The possibility of an adult ingesting poison is less but it still
happens. A great deal of poisonings each year are due to the inges-
tion of poisons that are not marked and are in food containers. The
unsuspecting victim may assume a glass or cup may hold a soft drink
and take a drink before realizing that they have just gulped down a
cup of bleach or some other toxic substance. These type of accidents
occur every day and are quite common. Treatment for ingested poi-
soning should begin as soon as possible. A great majority of people
think that there is a medical antidote for most poisonous substances.
This is not true, in fact there are very few antidotes for the thousands
of different poisons. After calling 911 the first step in treatment should
be to call your state poison control center. They can guide you in the
correct first aid treatment of a poisoned victim. In most cases the dilu-
tion or removal of the poison is important. Removal requires the care
of a medical professional to pump the victim’s stomach to remove the
stomach contents and the poison. The first aid provider’s only option
is to dilute the poison by having the conscious victim drink one or two
glasses of milk or water. If the victim is conscious and alert the next
step would be to consider inducing vomiting. In some cases inducing
vomiting will cause more harm than good. If there is any doubt, seek
advice from EMS, a physician or from the Poison Control Center.

Do not induce vomiting under the following circumstances

1. If the victim is unconscious or convulsing.
2. If the ingested poison is a corrosive such as acid, lye, drain
cleaner or if it has caused burns on the lips and throat.
3. If the poison contains kerosene, lighter fluid, gasoline, furniture
polish or other petroleum products.

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IDEA Dive Medic

If vomiting is the appropriate treatment, the

most effective way for victims one year of
age or older is to use syrup of ipecac. Use
one tablespoonful of the syrup of ipecac
followed by a glass of water. Most victims
will vomit within fifteen to twenty minutes. If
no vomiting has occurred in twenty minutes
of the first dose you may repeat the dose
only once. Do not attempt to administer any
additional doses. If vomiting is induced,
the victim must be closely observed at all
times. It is very important that the victim
does not aspirate the vomitus into their lungs. If vomiting is induced,
have a receptacle handy. Vomiting is an unpleasant experience for
both the victim and the care giver. Be prepared and the experience
will not be as unpleasant.

Absorbents
Activated charcoal has long been used as an effective absorbent of
many toxic substances. The first aid provider should check with an
EMS, a physician or the poison Control Center to see if it’s use is indi-
cated. If ipecac has been administered, the activated charcoal should
be used only after the victim has vomited. The activated charcoal
inhibits the vomiting action of the ipecac. Make sure the victim has fin-
ished the vomiting episode completely before administering the acti-
vated charcoal. Activated charcoal is administered by the mouth. Mix
one or two tablespoonfuls in eight ounces of water immediately prior
to giving it to the victim. Stir it briefly immediately before giving it to
the victim. Make sure that the charcoal is suspended in the water. If
you let the water sit too long it will settle to the bottom of the glass
making it difficult to swallow. Both syrup of ipecac and activated char-
coal are available without a prescription from your local pharmacy. n
some cases soothing agents are useful in relieving some of the irri-
tation and discomfort to the stomach and gastrointestinal tract. The
most common soothing agents are Milk of Magnesia type antacids
and milk. These agents have both a soothing and demulcents effect.

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Inhaled Poisons
Poisons that are inhaled offer a special problem for not only the victim
but also the first aid provider and rescue person. Due to the possibil-
ity of the first aid and rescue person also becoming a victim, special
precautions must be used. The first rule in aiding the victim is not
to become a victim also. Make sure that you have someone to back
you up that is upwind from any possible toxic fumes or gases. Do
not enter the area unless you are sure you will not be overcome by
toxic fumes or gases. In many cases your only choice is to wait for
professional and properly equipped help to arrive. If you are able
to evacuate the victim to a safe area, the administration of oxygen
and standard care is given. Remember don’t add to the problem by
becoming a victim yourself.

Injected Poisons
Injected poisons are usually related to the use of illegal drug use.
There is little a first aid provider can do for the victim. The correct care
would be to activate the EMS system. Care should be given to the
respiratory system and to guarding the victim’s airway. Make sure that
the victim does not aspirate any vomitus and keep the airway open.
In some cases the victim may require Mouth to Mouth resuscitation
and/or CPR. Closely monitor the victim until assistance has arrived.

Contact Poisons
Some poisons that come in direct contact with the skin or other body
parts may cause irritation or poisoning. The substances include acids,
alkalies and other corrosive chemicals. These substances can cause
chemical burns or poisoning of the body from contact with them. The
proper emergency treatment for this type of exposure is to quickly
flush all body parts the skin and eyes with large volumes of water. It
is best not to attempt to neutralize acids and alkalies. The best treat-
ment is to flush with plenty of water until help arrives.

Poison Plants
Each year there is a high incident rate for people coming in contact
with poisonous plants. Because there is such a high incident rate, the
indications are that most children and adults are not aware of the dan-

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gers that arise from eating or nibbling innocent looking plants. There
are many plants worldwide that can cause illness or death. Poison-
ous plants can affect the central nervous system, circulatory system,
and gastrointestinal system. Plants that have an affect on the circula-
tory system usually start within thirty to fifty minutes following contact
or ingestion. The classic signs of circulatory collapse are rapid heart
rate, falling blood pressure, cyanosis, sweating and weakness. Like
other types of poisoning there is no antidote for most plant poison-
ings. The treatment for circulatory collapse is the same as any other
cause of shock. Place the victim in a supine position with the legs
elevated, keep them warm, activate the EMS system immediately or
transport to the nearest emergency facility. If the victim is conscious
and alert you may induce vomiting with syrup of ipecac. Collect a
sample of the vomitus and take a sample of it and the ingested plant
to the hospital if possible.

Plants that may cause circulatory collapse are:

- Autumn crocus
- Baneberry
- False hellebore
- Foxglove
- Green hellebore
- Indian poke
- Lantana
- Lily of the valley
- Mistletoe
- Monkshood
- Mountain laurel
- Oleander
- Poison hemlock
- Potato (sprounts)
- Rhododendron
- Rosary pea
- Snakeberry
- Yew

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Some plants can produce reactions to the central nervous system.

The symptoms are depression, hyperactivity, hyperexcitement, stupor,
mental confusion, or coma. The primary treatment and concern
should be with basic life support. If the victim is unconscious or stu-
porous do not induce vomiting. There is the possibility of the victim
aspirating the vomitus into his lungs. Monitor the victim and activate
the EMS system.

Plants that may cause Central Nervous System disturbances

- Apple (seeds)
- Apricot (pits)
- Autumn crocus
- Baneberry
- Indian poke
- Poison hemlock
- Bleeding heart
- Jimson weed
- Rhubarb (blade)
- Cherry (pits)
- Larkspur
- Rhododendron
- Daffodil
- Monkshood
- Rosary pea
- Fly mushroom
- Green hellebore
- Hemp
- Peach (pits)
- Potato (sprouts)
- Precatory bean
- False hellebore
- Water hemlock
- Morning glory
- Narcissus
- Oleander
- Yellow jessamine

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IDEA Dive Medic

Everyone is familiar woth some of the notes poisonous plants such

as Oleander, Poison ivy, Poison oak and Poison sumac. Simple skin
contact can cause irritation from some plants. The contact can cause
severe itching, burning and cause blisters and rashes to form.

Plants that cause skin irritation

- Buttercup
- Christmas rose
- Dumbcane
- Four o’clock
- Iris
- Mayapple
- Oleander
- Poinsettia
- Poison ivy
- Poison oak
- Poison sumac
- Yew

There is one plant that most people are not familiar with and may
not recognize as a potential danger. This plant is called Dieffenbachia
or Dumbcane. This plant is used extensively as a house plant and
is seen daily as a decorative plant for both homes and offices. This
plant, if ingested even in a small amount, can cause severe swelling
of the airway. In some cases the airway may be completely closed
and can cause the victim to suffocate. The treatment is basic life sup-
port and the administration of oxygen until EMS arrives or the victim
is transported to the nearest medical facility.

Insect Stings
Stings are common and most present
no major danger to humans. There
are, however, many individuals that do
have allergic reactions to insect stings.
It is estimated that between five and
ten percent of the population of the
United States are hypersensitive to

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insect bites from scorpions, wasps, hornets and

bees. In the case of a sting from a scorpion there is
an antivenin available only for the sting of the scor-
pion found in the southwestern United States. The
antivenin must be administered by a physician. It is
imperative to get the victim to a medical facility as
soon as possible. When dealing with wasps, hor-
nets and bees, it does not take multiple stings to
cause serious illness or death. The allergic reac-
tions vary among individuals. The reaction can
range from simple swelling of the affected area
to a complete shutdown of the victim’s cardio-
vascular and respiratory systems. Anaphylac-
tic shock is possible and is a very dangerous
condition. Immediate care must be given to
these victims. Most individuals that are allergic to insect stings carry
an emergency kit that consists of an injection to counteract the poison
of the sting. The kits are simple to use and should be used as soon as
possible. The kit syringe is pre filled and will have complete instruc-
tions on the proper use. Be prepared to provide mouth to mouth
resuscitation and CPR if necessary. If the stinger
is still in the skin, you may remove it. Clean the
area with soap and water. Apply a cold pack to
slow down the poison. If the victim is conscious
have him take two Benadryl tablets or capsules
to help counteract the poison. Keep the victim
calm and provide basic life support if needed.
Continue monitoring the victim until EMS arrives
or a medical facility is reached.

Insect Bites
Spider bites can also be dangerous should the
spider be a poisonous variety. In the United
States the two poisonous spiders that we may
encounter are the Black Widow and the Brown
Recluse. Both the Black Widow and the Brown
Recluse are small spiders with a bad bite.

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IDEA Dive Medic

While not usually fatal, a bite from either one is to be taken seriously.
Treatment for both of these spider bites are the same - clean the area
with soap and water. Apply a cold pack to slow down the poison. If the
victim is conscious and not allergic to Benadryl, have them take two
Benadryl tablets or capsules to help counteract the poison. Children
and the elderly may have a more serious reaction to stings or bites.
Keep the victim calm and activate the EMS system. Continue to moni-
tor the victim until EMS arrives or the victim reaches a medical facil-
ity.

Snake bites
Because of the nature of our sport, some of best
dive sites are in remote areas. any of the dive
sites are in wooded or swampy areas. These
areas are habitats for many species of wild-
life including snakes. A great deal of scuba
diving in the United States is in fresh water areas
. The possibility of running across a poisonous
snake, such as a water
moccasin, is always
there. There is also a
chance of finding other
snakes, both poisonous and non poisonous. Mammals are drawn to
these areas by the water, and, in turn, snakes are drawn to the area by
the smaller mammals. Although it rarely happens, underwater snake
bite to a human is possible. It is more likely that the human will be
bitten on dry land. Imagine that you are at a remote dive site, possibly
in a swampy area with a minimal amount of clothing and protection for
your feet. You’re excited about the dive and you’re not watching where
you put your hands or feet. Bang! You just met a snake and you’re
back stepping. Your chances of being bitten have just gone up. Over
fifty thousand snake bites are reported in the United States each year.
Very few of these have anything to do with dive sites.
Of the fifty thousand reported bites, between seven and eight thou-
sand are from venomous snakes. While these figures seem high it
should be noted that approximately only thirty percent of the bites
by venomous snakes show evidence of envenomation. In the major-

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ity of these snake bites, there is no injection of

poison. The average death rate from poi-
sonous snake bite is less than twelve each
year. There are approximately 120 species of
snakes in the United States, only twenty of
these are poisonous. Because of the many
different kinds of poisonous snakes, it
is important to identify the snake as
accurately as possible. The best sce-
nario would be to bring the snake
(preferable dead) for positive identifica-
tion at the hospital. With accurate identifica-
tion the correct antivenin can be used. If the snake can be identified
in the field, let the hospital know in advance of the arrival of the victim.
Antivenin is available, but may not be on hand, and may have to be
ordered from a central location.
The majority of poisonous snakes in the United States are pit vipers.
Pit vipers have two hollow fangs attached to the poison glands of the
snake. There is a pit between the snake’s eyes and nose. The pit is a
heat sensing organ and is capable of detecting heat changes. The pit
is used to locate warm blooded mammals which make up the major
part of the pit viper’s diet. Another characteristic that is found in pit
vipers is the snake’s head is triangular in shape. Variations of Rattle
Snakes, Copper Heads, and Water Moccasins make up the pit vipers
in the United States.

Signs and Symptoms

A bite from a pit viper
will have a severe burning
pain and immediate swell-
ing around the fang marks.
Swelling and pain will usually happen within five to ten minutes and
spread slowly over the next eight to thirty six hours. If no signs have
occurred within a few hours, there was most likely no injection of
poison. Although it may be slow in taking effect, the poison is quick
to cause systemic problems. Weakness, sweating, fainting, nausea,
vomiting, tachycardia (rapid heart beat) and hypotension (low blood

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IDEA Dive Medic

pressure) may set in quickly. Generally speaking, if the victim says

that the bite stings like a bee sting or wasp sting, there was little or
no venom injected with the bite. If the victim is in excruciating pain
and says it feels like a hot poker or extreme burning, the snake has
injected venom. n the case of injected venom, quick administration of
the antivenin is of the utmost importance. Keep in mind just the fact
that a person has been bitten by any kind of snake is going to be quite
a traumatic experience. Treat all snake bites as an emergency. Never
assume that venom was not injected.

Treatment
Reassure the victim. Have them remain as calm as possible. Explain
that many times a snake does not inject venom, the poison is slow
acting and there is antivenin for the bite. In the last few years the
treatment for poisonous snake bite has changed. The old methods
of cutting the bite, sucking the wound, restrictive bands, cold packs
and ice are no longer used. These old methods can actually create
more problems for the victim. The latest method calls for treating the
victim for shock and activating the EMS system immediately. Identify
the snake to EMS as soon as possible so that the correct antivenin
can be located and ready for immediate use on the victim. Keep
the victim quiet and reassure the victim. Explain that in most cases,
snakes do not inject venom. This could be a major factor in calming
the victim. Reassure the victim that you can help him. Check the vic-
tim’s vital signs and continue to monitor them. Treat for shock. Admin-
ister artificial ventilation with oxygen if needed. If there is a delay with
the arrival of EMS, the victim should be safely transported to the near-
est medical facility as soon as possible. If you have a cell phone, stay
in contact with the 911 operator. Follow their instructions and informa-
tion they provide.

Coral Snake
The other poisonous snake that is native to the United States is the
Coral Snake. The Coral Snake is generally docile and shy. It will, how-
ever, bite if provoked. A Coral Snake is very colorful with bright red,
yellow and black rings circling its body. Coral Snakes have a color
sequence of Red on Yellow and then Black. Coral Snakes are small

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snakes usually less than two feet in length. They do not have the large
fangs of the pit vipers. The fangs are small and grooved. The Coral
Snake because of its size would usually bite the victim on a small part
of their body. In the case of a human, most bites are to the hands, feet
or a fleshy part of the body. Because of the small size of the mouth
and short fangs the snake must chew to inject the venom. A bite from
the Coral Snake will only be one or more tiny punctures or scratches
in the area of the bite. Remember if the snake has Red and Yellow
bands that touch it is a Coral Snake. There is a non poisonous snake
that has similar colors and is harmless. The Scarlet King snake looks
a lot like the Coral Snake but the adjoining bands are not in the same
sequence. Remember Red and Yellow Kill a Fellow.

Signs and Symptoms

The bite of a Coral Snake is a great concern if venom is injected.
Coral Snakes belong to the same group of poisonous snakes as the
Cobra, Mamba and Krait. The venom of a Coral Snake is the most
toxic venom of the poisonous snakes in the United States. The venom
of the Coral Snake is a neurotoxin. Because of this the signs and
symptoms of the bite are completely different from a pit viper’s bite.
The neurotoxin will attack the central nervous system. Victims may
complain of depression, apprehension or even euphoria. Neurotoxins
will affect the cranial nerves resulting in paralysis of the respiratory
system.

Treatment
Immediate care is needed because of the quick effect of the neu-
rotoxin. Activate the EMS system. Advise them the victim has been
bitten by a Coral Snake. Keep the victim quiet and reassure the victim.
Explain that in most cases snakes do not inject venom. This could be
a major factor in calming the victim. Reassure the victim that you can
help him. Flush off the area of the bite with plenty of water. The flush-
ing will wash away any venom left on the skin. The most important
factor is getting the victim to a medical facility for administration of the
anti venom as quickly as possible. Check the victim’s vital signs and
continue to monitor them. Treat for shock. Administer artificial ventila-
tion with oxygen if needed. If there is a delay with the arrival of EMS,

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IDEA Dive Medic

the victim should be safely transported to the nearest medical facility

as soon as possible. If you have a cell phone, stay in contact with the
911 operator. Follow their instructions and information they provide.

Other poisonous snakes

Consideration should also be given to the possibility of an
imported poisonous snake from other parts of the world.
There are many captive poisonous snakes that are not
indige- nous to the United States being kept and displayed. It
would be unlikely that we would come in contact with an
exotic poi- sonous snake, but it could happen.
Remember that a good accurate description of the snake
is very impor- tant. If you can bring the snake
in (again prefer- ably dead) for positive identification
it will help in the treatment and administration of the cor-
rect antivenin. Be very cautious with
the snake. Whether the snake is dead
or alive the venom is still toxic. The cap-
ture of live poisonous snake should not be con-
sidered or attempted. Dealing with live poisonous
snakes is best left to the experts. Having another
victim of snake bite presents additional prob-
lems. In the case of a human life being at
risk, dispatch the snake and place it in a con-
tainer for identification. Extreme care
should be taken in not getting close
enough to the snake to be bitten.

Summary
Needless to say, all snake bites should be treated aggressively and
quickly. When you have a victim of a poisonous snake bite, call 911
and explain the situation and condition of the victim. Nine one one
operators have a protocol for different types of emergency care. The
operator can direct you and also start an emergency response team
to your location. In many areas of the United States, special centers
are established to stock antivenin and direct EMS and hospital phy-
sicians in the proper care for venomous snake bite. The best bet to

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find the proper antivenin is to call the nearest Zoo. Most Zoos keep
a stock of different antivenins. The Herpetology section of the Okla-
homa City Zoo has for many years maintained an Antivenin index.
They can provide Physicians or Hospitals with information of available
supplies of antivenin and information on patient care. The day time
phone number is 1-405-424-3344. During the night or weekends it is
1-405-271-5454. The director of the Herpetology section is Mr. David
Grow, ext. 283.
Also a noted expert on snake bite is Maynard Cox of Orange Park
Florida. In the event of a poisonous snakebite, Mr. Cox is available
on a 24 hour a day basis to Medical facilities and Physicians for
consultation on emergency snake bite treatment. Mr. Cox may be
reached by contacting the Clay County (Florida) Sherriffs office at
(904) 264-6512 (24 hour number).

Animal bites
Animal bites from both domestic and wild mammals such as dogs,
cats, raccoons are not uncommon. There is a possibility that you will
encounter a victim of animal bite in just about any area. If the animal
is still present, care must be used so that you or someone else does
not become an additional victim. The first course of action you should
take is to have a bystander call for EMS and local Law Enforcement.

Treatment of animal bites

The general treatment for an animal bite depends on the severity of
the wound. In most cases, an animal bite will consist of a simple punc-
ture wound. Generally, there will not be a large amount of bleeding
from a puncture wound unless the bite has punctured a vein or an
artery. If a vein or an artery has been punctured, use direct pressure
to stop the bleeding. If direct pressure fails to stop the bleeding, then
use the pressure point method. If the wound is on an extremity, raise
the extremity. This may have an effect on slowing or stopping the
blood flow. If both these methods fail, use a restrictive band. Apply
a restrictive band lightly. Do not cut off any arterial or deep venous
blood flow. Next, clean the wound thoroughly with soap and water.
If you have an anti bacterial cleanser such as betadene or physohex

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IDEA Dive Medic

soap, use it. Hydrogen peroxide will also help in cleaning the outer
area of the wound.
Because most of the trauma and damage of puncture wounds occurs
beneath the skin, the cleaning is strictly superficial. Puncture wounds
are notorious for infections and must be treated immediately by a phy-
sician with antibiotics. Even though we can’t do a great deal of clean-
ing, it is important that we make the effort and clean the exterior of
the wound and surrounding area as much as possible. lso look for
additional scratches that may have been made by the animal’s teeth
or claws. These wounds should receive the same care and cleansing
as the primary wound or wounds.
Animal bites that are tears or lacerations should also be cleaned with
soap and water or an anti bacterial soap. o not use hydrogen peroxide
for deep open wounds. The hydrogen peroxide may cause damage
to the tissue cells and actually kill the cells and cause irreparable
damage. Hydrogen peroxide should only be used on shallow wounds
or scratches. In some instances, a bite may cause a tear that creates
a flap of skin or scalp. This type of tear is called an avulsion. Avulsions
may be shallow or deep tears. The same treatment should be used
on this type of wound. In the case where an animal bite is especially
vicious or severe, the wound should be treated as a trauma. Remem-
ber that an animal attack can be very traumatizing to the victim. Some
animal attacks can be very vicious and pose immediate life threaten-
ing wounds. Pay special attention to the victim and look for signs of
shock. If the signs of shock are present or you think the possibility of
shock is present always treat for shock.

Summary
There are some special considerations concerning animal bites. arlier
I mentioned the possibility that the animal responsible for the bite may
still be around. If this is the case, the animal may be docile or it
could present a danger to anyone else in the area. Caution must be
used by the first aid provider and any other persons in the immediate
area. Law enforcement must be notified. In most states, it is required
by law that any animal bites be reported and investigated by local
law enforcement officers. If the police, fire/rescue, sheriff’s deputy or
game warden is present, let him handle the problem with the animal

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or its owner. If at all possible, the animal should be detained. The

animal should be examined by the health department to determine
if there is the possibility of Rabies. Rabies is a very serious disease
and can be fatal to humans if not treated immediately. Do not place
yourself or others in danger of being bitten by the animal by trying to
detain or capture it. If it is a pet, you may end up in a dangerous situ-
ation with the pet owner. Let the authorities handle the animal and its
owner. The priority of the first aid provider is to the victim of the bite
or attack. Care for the victim until EMS arrives or the victim is trans-
ported to the nearest medical facility.

INJURIES AND ILLNESSES FROM MARINE

AND AQUATIC ANIMALS AND FISHES
Divers have little to fear from marine and aquatic animals and fishes.
Provided they are left alone, most marine and aquatic animals and
fishes are of little concern to the diver. There are over one thousand
species and types of marine animals that are poisonous to eat, or that
are capable of injuring humans. hese may divided into two catego-
ries.
1. Things that Sting, Stick, Bite or are Poison.
2. Major types of injury mechanisms.
Both categories are listed in the following chart. Whether they stick,
sting, bite or are poisonous, each type of injury has its own treatment
procedure as outlined in the chart. The exception would be in the
case of consuming poisonous fish or shellfish. The care needed for
ingesting poison fish or shellfish requires hospitalization and the care
of a physician as soon as possible. Standard BLS protocol is to
be followed until arrival of EMS or transportation to the nearest medi-
cal facility. The most noted fish poisoning by ingestion is Ciguatera.
Ciguatera occurs from eating fish that have acquired the disease
from eating small reef fish that feed off the corals of the reef. The
most notable carrier is the Barracuda. It seems that Barracuda have
acquired a reputa-
tion for carrying the
Ciguatera microbe.
Usually Ciguatera
is only found in

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IDEA Dive Medic

older and larger fish. Ciguatera may sometime be found in snapper,

grouper and pelagic fish in tropical waters.
Each type of injury has it own first
aid treatment. The first aid treat-
ment usually results in a definitive
cure. In most cases the injury is
more of a short term discomfort
that has no lasting effects. Caution
should still be used no matter how
slight the wound. Even though first
aid is administered and the main complaint or problem has subsided,
an examination by a physician is still required if the skin has been
broken, lacerated or punctured. In the last few years there have been
numerous cases of the extremely dangerous “Flesh Eating Bacteria”.
This bacteria is usually associ-
ated with cuts and wounds that
have been caused by marine life
such as crabs, oysters and barna-
cles. The bacteria has also been
found and contracted miles from
any water, marine or aquatic life.
There seems to be more of a
chance of encountering the bac-
teria when associated with marine and aquatic life wounds. Two of the
signs and symptoms of this dangerous bacteria are immediate infec-
tion of the wound with pain to the touch within a few hours after con-
tact. Because of the difficulty of treating this drug resistant strain of
bacteria, any injury even a scratch should be followed up with a medi-
cal examination by a physician.
In terms of occurrence, injuries from marine, aquatic animals and
fish are not common place. Most of the
injuries are self-inflicted or caused by
the swimmer or diver. Its really uncom-
mon for a jellyfish or spiny sea urchin to
crash into an unsuspecting human. hink
about it for a minute. Ice melts a hun-
dred thousand times faster than a sea

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Dive Medic IDEA

urchin moves in a month. But with the tremendous draw the ocean
has to humans, we still manage to get stung, stuck or bitten by this
gentle, slow moving marine creature.
Their are three common injuries
that occur when diving in the
ocean. Number one is stepping
on a stingray or sea urchin. Two
is swimming into the tentacles of
a jellyfish or Portuguese man of
war. Three is sticking our hand
into a hole to grab a lobster and
finding his roommate the Moray
Eel. As far as the dangers of aquatic life, the main problems would be
snakes and turtles. Both of these are pretty easily avoided. There
are many streams and rivers that flow into the sea that also host a vari-
ety of marine life in the brack-
ish waters. Crabs and many
saltwater fishes and jellyfish
can often be found in waters
thought to only contain fresh
water species. Sharks and
other salt water fish and ani-
mals have been found in
rivers many miles from the
ocean.
Divers who are in areas that may present a hazard should make
sure they have added a few extra first aid items to their kit. ome of
the items may seem a little out
of the ordinary, but all have
a special purpose or use in
the field. Three of the items
are a solution of alcohol and
ammonia, meat tenderizer and
talcum or baby powder.
Stings seem to be the occur-
rence most often needing first
aid.

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IDEA Dive Medic

Treatment
The three items mentioned will be used as the first aid treatment.
Have a quart bottle filled with a mixture of 25% ammonia 75% rubbing
alcohol. This solution will kill the thousands of stinging cells known as
nematocysts. Thousands of these single cell nematocysts make up
the tentacles of the jellyfish, Portuguese man of war, and fire corals.
Pour this solution over the affected area, then sprinkle meat tender-
izer over the area. Meat tenderizer breaks down protein based stings
(jellyfish, Portuguese man of war, fire coral, etc.) Make sure the meat
tenderizer has a high percentage of Papaya in it. he Papaya is a natu-
ral fruit that will break down proteins. Next use talcum or baby powder
to dry the area. The powder will not only dry the area but will make
it possible to scrape or wipe the area clear of the nematocysts caus-
ing the discomfort and pain. You may then make a paste of the meat
tenderizer and spread it over the area to further ease the discomfort.
There are a couple of other items that may be added to the first aid
kit if you have room. One is a lightweight aluminum pan that is large
enough to soak a diver’s foot or hand in. The other is a Sterno stove
and a can of Sterno gel. A person that is unlucky enough to step on
a sea urchin or a stingray will most likely be in excruciating pain. The
poison toxin that is introduced into the wound is highly sensitive to
heat. Soaking the wound in hot water or hot water with Epsom salts
will work quickly to ease the pain. The heat from the hot water works
to destroy the toxins in the poison. Care must be given not to get the
water too hot. The possibility of scalding or burning the victim should
be taken into consideration. The pain from the wound may mask the
victim’s sensitivity to the hot water.

RESPIRATORY PROBLEMS

Dyspnea
The definition of dyspnea is the “sensation of shortness of breath”.
Difficulty breathing may be caused by a variety of medical reasons or
may be caused from a trauma. Dyspnea caused by trauma generally
limits the action a first aid provider can render. As an DAN Oxygen
Provider, you will be able administer oxygen. We will also monitor
the victim’s blood pressure. These two skills and procedures should

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be used until arrival of EMS. We will direct our information toward

dyspnea from non traumatic causes. Care for traumatic dyspnea is
treated the same as non traumatic and is used in conjunction with
basic life support procedures.
Medical problems that cause dyspnea are:
1. Acute pulmonary edema
2. Airway obstruction
3. Emphysema or chronic bronchitis
4. Asthma or allergic reactions (Anaphylactic shock)
5. Dyspnea without lung abnormalities (hyperventilation)

Acute pulmonary edema

Acute pulmonary edema is quite a complicated
pulmonary illness. We don’t want to make our
explanation of the illness too complicated. Our
main goal will be more concerned with sup-
porting the dyspneic victim. Basically, the prob-
lem with most lung disorders is the restriction
of the pulmonary blood flow. Slowing of the
blood flow in the lungs will prevent exchange of
gases in the lungs. Without the gas exchange
the dyspnea will increase rapidly.

Treatment
Proper care would be to establish a patent airway, maintain the airway
and administer oxygen. BLS support may be required with artificial
respiration. Follow the standard protocol for BLS and oxygen adminis-
tration.

Emphysema and chronic bronchitis

Emphysema and chronic bronchitis are usually found in middle aged
to elderly persons. Emphysema is almost always caused by smoking
or chemical exposure to the lungs. Chronic bronchitis is similar in that
both emphysema and chronic bronchitis are reductions in function of
the alveoli (air sacs of the lungs). Both of these diseases of the lungs
will cause dyspnea to the victim.

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Treatment
The proper first aid for the victim would be administration of oxygen
and monitoring of the respiration rate. Encourage the victim to breathe
deeply. It is very important to note that the stimulus for breathing is
changed because of the nature of the disease. In normal individuals,
the stimulus to breathe is the build up of carbon dioxide in the blood.
The stimulus for the person with an obstructive lung disease is low
oxygen content. If the victim receives too much oxygen, his breath-
ing rate may slow. Monitor the victim closely. If the breathing rate falls
below twelve times per minute you may have to assist the victim’s
breathing. Use a non return pocket mask and continue oxygen admin-
istration. Activate the EMS system and continue to monitor the victim
until EMS arrives or victim is transported to nearest medical facility.
Dyspnea may occur in unconscious and semi conscious individuals
as a result of the position of the head. Simple repositioning of the
neck may relieve the problem. Remember, caution must be used and
manipulation should only be done after it has been determined there
is no cervical injury present. If opening of the airway does not cor-
rect the breathing problem, look for an upper airway obstruction. Any
individual, adult or child who has been eating just prior to the dyspnea
should be a prime suspect for an upper airway obstruction. Use the
standard protocol for obstructed airway.

Asthma
Asthma is a direct contraindication to
scuba diving. There are some major
dangers of having asthma and scuba
diving. One would be the possibility
of having an asthma attack while
diving. The air in the lungs cannot be
exhaled normally and will almost cer-
tainly cause a barotrauma that can
range the entire spectrum of pressure
related injuries. There is an extremely
high probability that the diver will have a severe barotrauma. Divers
who are already certified and develop asthma should definitely recon-
sider diving as an activity. These individuals should seek expert medi-

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cal advice from a physician specializing in respiratory problems. In

most cases, potential student divers are eliminated by their own phy-
sician after filling out the medical form required to participate in scuba
instruction.
There is always a possibility a first aid provider may encounter a
person experiencing an asthmatic episode. The correct term for
asthma is bronchial asthma. Bronchial asthma may occur at any age.
The disease is caused by abnormal spasms of the airway passages.
The classic signs of asthma are wheezing and obvious respiratory
distress. The whines and wheezes may be heard without the use of
a stethoscope. The problem is caused by the constriction of the air-
ways known as bronchi. The victim is able to draw air in without too
much difficulty, but is not able to expel the air normally. Being unable
to expel the inspired air that is heavy with carbon dioxide is a major
problem. The asthmatic victim is truly in distress and care should be
started immediately.

Treatment
First determine if the victim is choking or having an asthmatic epi-
sode. The first thing you should do is ask the victim if he is having
an asthmatic attack. He may not be able to speak but may indicate
by shaking his head yes or no. If he indicates no and you still hear
the sounds of whines and wheezes you may assume a couple of pos-
sibilities. He may be having his first asthmatic episode or he may have
a partially obstructed airway. If he says yes, ask if he has an asthma
inhaler (puffer). If he indicates that he has an inhaler, have him use
it several times. The victim may also have other medications for his
condition. If he has other medications have the victim use them also.
If oxygen is available, then place him on oxygen. Make him as com-
fortable as possible until EMS arrives or he has been transported to
the nearest medical facility. Asthma is a true medical emergency. It
should never be taken lightly. A victim of asthma will soon lose con-
sciousness and may need artificial respiration until EMS arrives.

UNCONSCIOUS VICTIM FROM UNKNOWN REASONS

There are times when you may find a person that is not conscious.
Normally we would ask any friends, relatives or bystanders if they

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IDEA Dive Medic

have any knowledge of the victim or his condition. If no one knows

what caused the unconsciousness or there is know one present, the
treatment is limited to BLS. There are many causes for an individual
to lose consciousness. The common faint, epilepsy, head injury or
drug overdose are just a few of the many possibilities.

Treatment
Whatever the cause may be, start with the ABC’s, check the vital
signs, treat for shock, establish an open airway and monitor the victim
closely until EMS arrives.

COMMUNICABLE DISEASE
Communicable disease has always been a concern of all individuals
involved with the care of the sick or injured. The first aid provider
should be just as concerned as the medical professionals. Disease
may be transferred to the unprotected care givers of all levels. First
aid providers are no exception. A communicable disease is a dis-
ease that is contagious and may be transmitted from one person to
another. Disease transmission may be from direct or indirect contact.
It may be transmitted by body fluids or by airborne particles from an
infected individual. Other means of contact may be from soiled dress-
ings, clothing, bedding, food, coughs or sneezes. Some diseases are
spread by intravenous needle sharing by drug users or accidental
sticks received by the unsuspecting care giver. The two main con-
cerns over the last ten years have been the HIV Virus and Hepatitis.
Both of these diseases are very dangerous. They have no cures and
may be fatal.
Even though communicable diseases are dangerous they can be
avoided if proper measures to protect the care giver are used.
Remember we are care givers of first aid. We are not professional
EMT or Paramedics. They deal with victims daily as a professional
and are well equipped to handle medical emergencies and situations.
As first aid care givers we must protect ourselves from exposure to
communicable diseases. There are some basic precautions that we
may take to protect ourselves.

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Dive Medic IDEA

Prevention and Precautions

if we are working around body fluid or
blood, every effort should be made to not
come in contact with these body fluids.
Protective latex gloves are readily avail-
able at local pharmacies and drug stores.
The same is true for surgical type face
masks used by EMS when they suspect
an airborne disease such as Tuberculo-
sis. If a victim is coughing excessively
use a face mask. Some face masks have
a clear shield that covers your eyes. If
the victim is not having trouble breathing you may request that he also
wear a face mask. If you are exposed to body fluids or blood you may
disinfect yourself with a mixture of 5 % to 10% percent household
chlorine bleach and water. This mixture will kill most all communicable
diseases, including the HIV virus. A quart of this homemade disinfec-
tant should also be part of your first aid kit. Make sure to mark the
disinfectant properly. After rinsing the contaminated area with the dis-
infectant solution, wash the exposed area thoroughly with soap and
water. When dealing with communicable disease the adage. “A ounce
of prevention is worth a pound of cure” is definitely true. If any part
of your body comes in contact with blood, mucus or any body fluids
you are considered contaminated. If you are exposed to a communi-
cable disease you will need to tell the EMS personnel at the scene,
have them record the your contamination in their written report of
the incident. You must seek the advice of a medical doctor immedi-
ately. You do not know if the person
you assisted was a carrier of an infec-
tious disease or not. Your doctor will
advise you on the proper precautions
and any testing you will need. Take
the proper precautions not to expose
family or friends until you are checked
out by your doctor. Remember it is a
communicable disease and you don’t
want to continue the spread.

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IDEA Dive Medic

CHAPTER 5

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Chapter 5

DIVING ACCIDENTS

1. Air Embolism
2. Pneumothorax
3. Mediastinal Emphysema
4. Subcutaneous Emphysema
5. Decompression Sickness
6. Drowning
7. Near Drowning

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IDEA Dive Medic

DIVING ACCIDENTS
The first concern of the diver performing rescue and victim care must
be with victim retrieval and resuscitation. In so far as diving is con-
cerned, most first aid courses are general in nature. They simply do
not cover all the possibilities that can be present when diving acci-
dents occur. The IDEA Dive Medic course will cover as many of these
possibilities as possible.

DIVING SPECIFIC PROBLEMS

The following problems are potentially life threatening. All Dive Medics
must be able to recognize the signs and symptoms of each diving
injury or illness. Dive Medics must also understand the various causes
of diving accidents and the proper first aid.

Air Embolism
An air embolism is caused by expanding
air within the lungs when a diver ascends
without breathing properly. The expanding
air within the air sacs (Alveoli) of the lungs
may pierce or leak through the sac wall.
The leak may allow air to enter the blood
stream. The danger is, air in the blood
stream may block small capillaries sup-
plying oxygen enriched blood to tissues.
The most serious blockage could occur to
an area supplying the brain. (Cerebral air
embolism). The brain can be deprived of
oxygenated blood for only a matter of min-
utes before permanent damage can occur. An air embolism may
also occur in divers who make normal ascents but have lung prob-
lems which can trap air. Among these problems are: asthma, mucous
plugs, scar tissue, tumors, etc. A diver may be unaware of his risk.
Some conditions may go undetected even with a medical exam. It is
a good idea for every diver to have a chest x-ray each year with his
annual physical. Smokers may have an increase in risk even during
normal ascents.

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Symptoms
The symptoms that cannot be seen, but are felt by the victim of air
embolism are: dizziness, visual problems, chest pain, weakness, and
paralysis. The signs (can be seen) are bright bloody froth from mouth
or nose, convulsions, and unconsciousness. Most often the onset of
signs and symptoms occur very shortly after a diver surfaces.

Treatment
The first aid is treat for shock, with oxygen administration. Activate
the EMS system as soon as possible. Prompt recompression in a
hyperbaric chamber is mandatory. In addition to air embolism there
are other problems which are associated with non vented air during
ascent. The conditions listed may or may not be associated with air
embolism. The occurrence of any of these disorders means that the
lung has been injured and an air embolism should be suspected. All
first aid should be aimed at treatment of air embolism, even if signs
and symptoms do not seem to indicate so. In all cases, immediate
first aid, BLS and activation of the EMS system is necessary. Be pre-
pared to administer resuscitation and CPR if necessary. Transporta-
tion to a hyperbaric chamber is required for proper treatment for all
barotrauma.

Pneumothorax
A pneumothorax is caused by air being
forced through the lung itself. The air then
enters a potential space between the lung
and the chest wall. This air then creates a
positive pressure that overrides the pres-
sure reduction within the lung and the lung
collapses. Fortunately, people can survive
on one lung. A pneumothorax is not usually
life threatening. In fact, prior to the days
of “wonder” drugs, tuberculosis was treated
by the affected lung being deflated in this
manner so it could “rest”.

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IDEA Dive Medic

Symptoms
Look for signs of difficulty breathing, and pain in the chest area. Other
signs are rapid, shallow breathing, and possible discoloration of the
skin (blue). Recompression is not mandated for this problem. A physi-
cian may insert a chest tube, withdraw air from the chest cavity, and
reinflate the lung. Pneumothorax is a very serious condition if it is in
both lungs. The victim will be straining to breath and it will be difficult
to ventilate the victim. You will notice possible expansion in the chest
and a hardness. In this case the victim is in extreme danger EMS
must be summoned quickly.

Treatment
Even though a minor case of Pnemothorax is not necessarily a life
threatening injury, the extent of the injury can only be diagnosed in
a medical facility with the proper care and equipment. In the field we
can’t always see signs of other barotrauma that could also be present.
Proper first aid would include BLS, immediate activation of the EMS
system, administration of oxygen and treat for shock. Be prepared to
administer resuscitation and CPR if necessary. Monitor victim closely
until EMS arrives or victim is transported to the nearest medical facil-
ity.

Mediastinal Emphysema
Mediastinal emphysema is caused by air
escaping from a damaged lung into the
space between the two lungs, the medi-
astinum. This area contains the heart and
large blood vessels.

Symptoms
Pain in the middle of the chest, under the
breastbone (Sternum), shortness of breath,
and possible feeling of faintness. Signs are
difficulty in breathing and possible hoarse-
ness in the victim’s voice.

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Treatment
The person is not necessarily recompressed, unless signs of air
embolism or decompression sickness are present. Proper care would
include BLS, immediate activation of the EMS system, administration
of oxygen and treat for shock. Be prepared to administer resuscita-
tion and CPR if necessary. Monitor victim closely until EMS arrives or
victim is transported to the nearest medical facility.

Subcutaneous Emphysema
Subcutaneous emphysema is caused by
air escaping from a lung injury. Subcutane-
ous emphysema is most often caused by a
mediastinal emphysema injury. The escap-
ing air is trapped just under the skin in the
area of the neck.

Symptoms
The symptoms are tightness in the area of
the neck. Signs are a change in the victim’s
voice, due to air pressure on the voice box
(larynx), swelling or a bulge in the neck
area, and crepitation (crackling) of the skin
when the area is touched.

Treatment
This condition is not normally serious; however, the person should be
monitored for possible air embolism. The person should be examined
by a physician. First aid is to treat for shock. In most cases there is no
need for oxygen administration. If the victim complains of shortness
of breath there may be other underlying problems. Oxygen adminis-
tration should always be used if the victim is in any respiratory dis-
tress. Proper care would include BLS, immediate activation of the
EMS system, administration of oxygen and treat for shock. Monitor
victim closely until EMS arrives or victim is transported to the nearest
medical facility.

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IDEA Dive Medic

Decompression Sickness
Decompression sickness is normally caused by inadequate decom-
pression following an exposure to increased pressure. While most
cases reported are not life threatening, all should be treated by
recompression to prevent long term tissue damage. Decompression
sickness can cause death or permanent paralysis. Decompression
sickness should never be taken lightly.

Symptoms
The skin may show red rash (skin bends), pain in the joints, stagger-
ing, coughing spasms, and unconsciousness. Signs and symptoms
usually appear anywhere from 15 minutes to 12 hours after surfacing.
In severe cases, signs and symptoms may appear before surfacing or
immediately thereafter.

Treatment
Proper treatment for decompression
sickness is prompt recompression.
In water recompression should never
be attempted. Proper treatment in
a hyperbaric chamber by qualified
medical personnel is required. The
first aid provider should ask a
bystander to activate the EMS
system. Aggressively treat the victim
with BLS procedures and administer
oxygen. Be prepared to administer resuscitation and CPR if neces-
sary. Have a bystander call DAN and arrange for transportation to
the nearest medical facility with a hyperbaric chamber. The mode of
transportation is also an important factor in the victim’s treatment. If
a medical helicopter is available, by all means use it. The local EMS
system will make the arrangements for air transportation and direc-
tions of the EMS crew to the injury site. Make sure the EMS dis-
patcher knows exactly what your problem is and your exact location.
Have your bystander helper stay in contact with the EMS dispatcher.
Give periodic reports of the victim’s condition and vital signs to the
dispatcher for relay to the responding EMS units.

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Dive Medic IDEA

Drowning (Near Drowning)

This problem is fairly rare in scuba
diving. At many dive sites we
will also encounter swimmers. For
this reason it is quite possible
that you find yourself present at a
drowning of a swimmer or a diver.
If the victim is a diver, drowning
is usually associated with inade-
quate positive buoyancy after the
diver surfaces.
Drowning (where death occurs), does not occur instantly. When res-
cues can be started within a short period of time, the probability of
recovery greatly increases. This is why it is important for a rescue
effort to be generated in a short period of time. Usually, a person that
is drowning holds his breath for a period of time after he submerges.
It is only after unconsciousness occurs that the breathing reflex is trig-
gered. Drowning victims, even though unconscious, will tend to swal-
low water rather than to breathe water. This explains why drowning
victims have large amounts of water in their stomachs. It is during this
‘swallowing’ period where the chance of recovery from drowning is
still high. At some point, the victim will cease the reflex swallowing
and take a deep breath. It is estimated that after a victim submerges,
underwater breathing will begin in 3 to 4 minutes. If recovery is made
prior to this breathing, chances of recovery are very good. There
are certain circumstances that may account for variations in the time
that a rescue and successful resuscitation may be successfully com-
pleted. One of these is the factor of cold water. The colder the water,
the better the chance of recovery is, even after periods of long sub-
mersion.

Treatment
The proper treatment for a near drowning would be to administer
oxygen, treat for shock, activate the EMS system and monitor the
victim closely until EMS arrives. The victim must be transported to the
nearest medical facility. Near drowning victims may seem to recovery
quickly but minutes or hours later have a major medical problem. This

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is due to swallowing water. Swallowing fresh and salt water cause dif-
ferent problems. Fresh water is absorbed readily from the lungs into
the bloodstream. The fresh water dilutes the normal body salts found
in the body. The dilution directly damages blood cells of the pulmo-
nary membranes (alveoli) and may cause them to rupture. Salt water
attacks the body differently. The salt water is two or three times
more concentrated in salt than the normal body fluids. Because of
this difference, it tends to pull water out of the body tissues and into
the lungs. This condition is known as pulmonary edema. Pulmonary
edema causes difficulty in transporting oxygen across the membranes
(alveoli) into the blood. There is also the possibility of contaminates
found in the water also causing medical problems. Drowning victims
should be treated with artificial respiration’s and CPR if needed. In
both near drowning and drowning, the victim may sometimes quickly
respond to artificial respiration. Spontaneous breathing may result
after administration of artificial respiration. In all cases drowning and
near drowning must be ultimately treated in a hospital. Standard BLS
protocol for CPR and BLS should be followed.

Oxygen Toxicity
Due to the increase in the use of Nitrox, Tri-mix and
Rebreathers, consideration must be given to the pos-
sibility of encountering a victim suffering from oxygen
toxicity. In the past, the possibility of a diver suffering
from oxygen toxicity was virtually nonexistent in sport
diving. With more training and equipment available to
the sport diver, the possibility of an oxygen toxicity
victim is more likely. Oxygen toxicity occurs when a
mixture of pure or enriched oxygen is used instead
of normoxic air. The partial pressure of oxygen is
increased as a diver descends. Sport divers using
normal (normoxic) air in scuba tanks are not in danger
of oxygen poisoning (oxygen toxicity). Diving within
the sport diving range of five atmospheres does not
increase the partial pressure of oxygen to a danger-
ous level. When diving with mixtures that contain higher levels of
oxygen, the maximum safe depth is decreased. A diver that is not

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trained and certified to use Nitrox or Tri-mix should never attempt to

dive with these special mixtures. The possibility of a fatal accident is
high.
The problem with oxygen toxicity is that in most cases there may be
no warning signs or symptoms. The first symptom will most likely be
an uncontrollable convulsion. Needless to say, if this occurs, a diver
will have little or no chance of survival unless his buddy is close at
hand. Even with a buddy close at hand, would they be able to control
the victim having a convulsion? It would be very difficult to control
a victim having a convulsion, while attempting to keep the victim’s
regulator in place. Adding to this scenario, consider the difficulties
in trying to compensate for both the victim’s and rescuer’s buoyancy
while making a safe controlled accent.
Oxygen toxicity is best to avoid in the first place. Divers should not
place themselves or their dive companion in a situation that would
require a rescue. The decision to use Nitrox or a Tri-mix requires strict
adherence to special rules and strict regulations. The use of these
special breathing gases also require that the users demonstrate a
high level of maturity and responsibility. There is absolutely no room
for error when using Nitrox or Tri-mix. If an accident does happen, the
most important concern of the rescuer is to assist the victim in a safe
and controlled ascent to the surface. The victim’s regulator should
be held in his mouth to help prevent water from entering the airway.
Tilt the victim’s head upwards slightly to keep the airway open. Use
the standard rescue ascent procedures from your Rescue Diver train-
ing. Once the victim is at the surface, check for an open airway and
breathing. When the victim reaches land or is on the boat conduct
a primary survey. Follow the ABC’s and then conduct the secondary
survey. Take into consideration the possibility of air embolism or other
barotrauma. Administer oxygen and activate the EMS system. Moni-
tor the victim’s vital signs until help arrives.

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CHAPTER 6

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Chapter 6

QUICK REFERENCE GUIDE

1. General First Aid

2. First Aid for Choking
3. Mouth to Mouth Resuscitation
4. CPR
5. Basic Life Support and the Trauma Victim

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QUICK REFERENCE

Basic Life Support & General First Aid

Information found in the Quick Reference section follows general first
aid procedures. Artificial resuscitation and cardiopulmonary resus-
citation in this text follow recommendations and procedures of the
American Heart Association and the American Red Cross. IDEA Dive
Medic I and II are required to complete a certification program by the
American Heart Association, American Red Cross or other nationally
recognized CPR program.

1. (A) Restore normal breathing. Open airway, start mouth to

mouth resuscitation if necessary. Use of pocket mask recom-
mended for better ventilation’s and communicable disease control.
2. (B) Stop severe bleeding. Use these methods in this order,
direct pressure on wound, pressure points, if these fail to stop
bleeding of an extremity use a restrictive band or tourniquet as a
last resort.
3. (C) Check for pulse and heart beat and administer CPR if
absent.
4. Keep victim lying down.
5. Send for assistance, call 911.
6. Reassure victim.
7. Check for other injuries.
8. Remove restricting clothing or gear if the victim is a diver. Make
sure that the head, neck and spine are protected in case of pos-
sible cervical or back injury.
9. Do not leave victim unattended.
10. Give the maximum first aid or medical care you can provide.
11. Be able to recognize symptoms of diving accidents.

TREAT FOR SHOCK

Elevate the victim’s feet with the body turned on it’s left side. If air
embolism is suspected, use the modified shock position with the
entire body elevated 30 degrees with victim on his left side (Breathing
Victims Only).
CALL 911

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After calling 911 if the victim is a diver also call

DAN (Divers Alert Network)
(919) 684-8111 (CALL COLLECT IF NECESSARY) State that you
have an emergency, and ask for the diving physician.

FIRST AID FOR CHOKING

Conscious victim
1. Ask the victim:” Are you choking?”
2. If the victim can speak, cough or breath, do not
interfere.
3. If the victim cannot speak, cough, or breath,
apply the Heimlich maneuver. Use a sub dia-
phragmatic abdominal thrust. Repeat the maneuver
numerous times until the foreign body is expelled
or the victim loses consciousness.

Victim becomes unconscious

1. Open victim’s mouth and perform a finger sweep. Visually
observe for foreign objects. Remove any food, foreign objects or
dentures.
2. Open airway and try to venti-
late victim.
3. If unsuccessful, with victim
laying flat on his back, straddle
the victim and apply 6 to 10 sub
diaphragmatic abdominal thrusts.
4. Be Persistent. Don’t give up.
It may take numerous attempts to
free the foreign object. Remem-
ber to activate the EMS system as
soon as possible. Call 911 !

Mouth to mouth resuscitation

The human heart will usually beat for several minutes after breathing
has stopped. These first few minutes are vital for the victim’s survival.
Many times simply opening the victim’s airway will allow for spontane-

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ous respiration’s by the victim. If this fails, resuscitation is necessary.

Mouth to mouth resuscitation is a skill. Like any skill mouth to mouth
resuscitation must be practiced for the user to be proficient. IDEA rec-
ommends that all persons obtain mouth to mouth resuscitation train-
ing from either the American Heart Association or the American Red
Cross. Both of these organizations have excellent training programs
in the administration of mouth to mouth resuscitation. After certifica-
tion and training in mouth to mouth resuscitation, you should renew
your certification at least every two years. In between renewal of your
certification, a refresher course is a good idea. It is important to
keep these vital skills sharp and be able to act quickly without hesi-
tation. Practicing on a mannequin is an excellent way to keep your
skill level up. Never practice mouth to mouth resuscitation skills on
another person. Prac-
ticing on a person that
is not in need of actual
mouth to mouth resusci-
tation may cause injury
or even death. Never
practice on another
person. The techniques
presented in this mate-
rial are used by the
American Heart Asso-
ciation and the Ameri-
can Red Cross.

1. Determine if the victim has simply fainted. Shake the victim

and shout “ARE YOU OK?”. If there is no response, ask bystand-
ers for assistance, and have someone call 911.
2. Place victim on his back, gently tilt the head back to open the
airway, Place your ear close to the victim’s mouth and nose, look to
see if the victim’s chest is rising and falling from breathing. Listen
and feel for the noise or movement of air from the victim’s nose
and mouth.
3. If not breathing, start mouth to mouth resuscitation (the use of
a pocket mask is recommended for better ventilation’s and protec-

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tion from communicable disease). Make sure that the head, neck
and spine are protected in case of possible cervical or back injury.
Tilt the head back gently, pinch the victim’s nostrils closed with
your thumb and forefinger, place your palm on the forehead. With
your other hand pull down on the chin to hold open the victim’s
mouth. Place your mouth over the victim’s and give two full venti-
lation’s. These breaths are slow, full ventilation’s lasting 1 1/2 to
2 seconds each. Watch for the victim’s chest to rise. If the chest
doesn’t rise, check for obstructions in the mouth and/or reposi-
tion the head making sure the airway is open.
4. Check for a heart beat by placing two finger on the carotid
artery located next to the trachea. If you feel a pulse the heart is
still beating. If the victim is still not breathing ventilate at the rate of
1 breath every 5 seconds. Recheck the pulse every few minutes
for a heart beat.
5. If the heart is not beating then CPR must be started. CPR
requires specialized training. If you know CPR, start immediately.
If not, continue ventilation’s until help arrives. Ask the bystanders “
DO YOU KNOW CPR?”. If someone knows CPR, let them assist
you or take over. Do not exhaust yourself or your helper. Pace your-
self and your helper, making sure the victim receives the proper
amount of ventilation’s and compression’s.

Cardio Pulmonary Resuscitation

Cardio Pulmonary Resuscitation (CPR) is a skill.
Like any skill CPR must be learned and prac-
ticed for the user to be proficient. IDEA recom-
mends that all persons obtain CPR training
from either the American Heart Association or
the American Red Cross.
Both of these organizations
have excellent training pro-
grams in the administration
of Cardio Pulmonary Resuscitation. After certi-
fication and training in CPR, you should renew
your certification at least every two years. In
between renewal of your certification, a refresher

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course is a good idea. It is important to keep these

vital skills sharp and be able to act quickly without
hesitation. Practicing on a mannequin is a excellent
way to keep your skill level up. Never practice CPR
skills on another person. Practic-
ing on a person that is not in need
of actual CPR may cause injury
or even death. Never practice on
another person. The techniques
presented in this material are used by the Amer-
ican Heart Association and the American Red
Cross.

Basic One Person CPR

1. Assessment:
Determine if the victim is in need of CPR.
Shake the victim, Shout “ Are You Ok?”

2. Call 911:
If no response, Activate the Emergency Medi-
cal Services system.

3. Airway:
Position the victim then
open the airway by using
tilting the head and lift-
ing the chin.

4. Breathing:
Check for breathing. Look at chest for move-
ment, listen for the sounds of breathing.
If victim is breathing and there is no evidence
of trauma, place the victim on his side in the
recovery position. Make sure the airway is still
open. This will also help if the victim vomits.
Monitor the victim until EMS arrives.

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5. Not Breathing:
If victim is not breathing, pinch nostrils closed,
make a tight seal around victim’s mouth, give 2
slow breaths of 11/2 to 2 seconds per breath.
Watch for victim’s chest to rise. Allow thelungs
to deflate between breaths.

6. Circulation:
Place two fingers on
the Adam’s apple.
Slide the fingers into
the groove between
the Adam’s apple
and neck muscle.
Feel for the carotid
pulse.

7. Pulse:
If the victim has a pulse, perform rescue
breathing. 12 breaths per minute (1 breath
every 5 seconds).

8. No Pulse:
If no pulse, start first cycle of CPR. Find the
lower third of the sternum (breastbone).
Place heal of your hand two fingers below
sternum.
Place other hand on top of hand and com-
press straight down 11/2 to 2 inches.
Establish a rhythm by counting “one and,
two and, three and, four and, five etc.
The compression rate for adults is between
80 and 100 times per minute.
After every 15 compression’s give 2 slow
rescue breaths.

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9. Check Pulse:
At the end of 4 complete compression
and breathing cycles, check for return
of pulse.
If pulse returns but there is no breath-
ing, give one breath every 5 seconds.
If there is still no pulse continue cycle
of 15 compression’s and 2 ventila-
tion’s. Continue to monitor for pulse or
breathing every 4 cycles.

10. 2nd Rescuer:

If another rescuer arrives, switch
places and assess the adequacy of
the second rescuer’s performance.
Watch for the victim’s chest rise
during rescue breaths.
Check pulse during chest compres-
sion’s.
When the rescuer tires take back
over the rescue efforts.
Rescuers should alternate until EMS
arrives.

One Rescuer CPR for child 1-8 years old

CPR for children has four major differences from adult CPR
1. If you have no help, administer about 1 minute of CPR before
activating the EMS system.
2. The heel of one hand is used for chest compression’s not both
hands as with an adult.
3. Depress the sternum one third to one half the depth of chest,
about 1 to 11/2 inches only.
4. Give 100 compression’s per minute, with 1 rescue breath for
every 5 chest compression’s.

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Airway
1. Determine unresponsiveness. Tap or gently shake the shoulder
and shout “ Are you OK?”
2. Call out “Help!”
3. Position the victim on his back. Take time to support the head
and neck in case of injury.
4. Open the airway. Use the head tilt - chin lift method.

Breathing
1. Determine if the victim is breath-
ing. Listen with your ear over the
child’s mouth, look for chest rise
and feel for breath while keeping the
airway open. If the victim is breath-
ing and there is no evidence of injury
or trauma, place him in the recovery
position.
2. If the victim is not breathing, give
2 rescue breaths mouth to mouth.
Each breath should be 1 to 11/2 sec-
onds per breath. Look for the chest
to rise with each breath.

Circulation
1. Determine if the victim has a pulse.
Use two fingers to feel for the carotid
pulse with one hand while maintain-
ing the head tilt with the other. Guard
against head or neck injury or hyper-
tension of the neck of children.
2. Start chest compression. Find the
sternum using the same techniques
as for an adult. Remember to only
use the heel of one hand. Compress
the chest 100 times per minute. Give
1 rescue breath for every 5 compres-
sion’s.

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3. Complete 20 cycles of compression’s and rescue breaths.

4. Activate the EMS system, Call 911.
5. Check pulse.
6. If no pulse, continue CPR.
7. Check pulse every few minutes.
8. If pulse returns, check for spontaneous breathing. If there is not
breathing, give 1 breath every 3 seconds and monitor the pulse.
If the victim is breathing, place him in the recovery position,
maintain an open airway, monitor breathing and pulse.

2nd Rescuer
If another rescuer arrives, have them check for a pulse, if no pulse
the second rescuer takes over CPR. First rescuer assesses the ade-
quacy of the second rescuer’s performance. Watch for the victim’s
chest rise during rescue breaths. Check pulse during chest compres-
sion’s. When second rescuer tires take back over the rescue efforts.
Rescuers should alternate until EMS arrives.

OBSTRUCTED AIRWAY FOR CHILD

1 TO 8 YEARS OLD
First aid for choking in children 1 to 8 years old is
the same as adults and older children. There is one
change however. Instead of using the blind finger
sweep use the tongue - jaw lift. Look down into the
airway and use your finger to sweep the foreign body
out only if you can actually see it.

ONE RESCUER CPR FOR INFANT

LESS THAN 1 YEAR OLD
Special considerations must be used when perform-
ing CPR on infants. Because of their size and vul-
nerabilities there are several differences for CPR and
choking.

Airway
1. Determine if the infant is unresponsive. Gently tap or shake
the shoulder.

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2. If no response call for “Help”

3. Position the infant on his back on a firm surface. Make sure to
support the head and neck.
4. Open the airway by using the head tilt - chin lift. Do not hyper-
extend the head too far back.

Breathing
1. Determine if the victim is breathing. Listen with your ear over
the child’s mouth, look for chest rise and feel for breath while keep-
ing the airway open. If the victim is breathing and there is no evi-
dence of injury or trauma place him in the recovery position.
2. If infant is not breathing, cover the infant’s mouth and nose,
maintain on open airway and give 2 gentle rescue breaths. Watch
for the rise and fall of the chest. Each breath should be 1 to 11/2
seconds in length.

Circulation
1. Check for a pulse. Use the brachial pulse located on the inside
of the upper arm. Use two fingers of one hand while maintaining
the head tilt with the other hand.
2. Start compression’s. Trace an imaginary line between the nip-
ples, in the exact center of the chest. Place your index finger
slightly below the imaginary line. Next place middle and your ring
finger (third and fourth fingers) next to the index finger. Use only the
middle and ring finger to compress the
sternum. Because of wide variations in
the sizes of the rescuers hands and
the infant’s chest it is important that
you do not compress over the xiphoid
process. Compress the chest between
1/2 to 1 inch ( approximately 1/3 to
1/2 the depth of the chest ). Compres-
sions should be at least 100 times per
minute. After each five compression’s
give one rescue breath.
3. Complete 20 cycles of compres-
sion’s and rescue breaths.

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4. Call 911. Activate the EMS system quickly.

5. Check for a brachial pulse.
6. If there is no pulse, continue CPR.
7. Check for a pulse every few minutes.
8. If a pulse is present, check for spontaneous breathing also. If
there is still no breathing, give 1 rescue breath every 3 seconds.
If there is breathing and a pulse, place in the recovery position.
Maintain an open airway and continue to check the breathing and
pulse.

OBSTRUCTED AIRWAY FOR CONSCIOUS INFANT

LESS THAN 1 YEAR OLD
This procedure is to be performed only on a completely obstructed
airway. Evidence of airway obstruction is: ineffective cough, no strong
cry, no air flow from infant, serious breathing difficulty, foreign object.
If the infant is crying this is an indication that air is moving and actions
should not be taken for an obstructed airway. Continue to monitor the
infant for breathing. If the obstruction is caused by infection or illness
and swelling is present the infant needs immediate attention. If there
is rescue service in your area call 911 immediately. Keep in mind that
rescue in most cases can respond quicker than you could reach a
medical facility safely. If necessary, transport the infant to the near-
est emergency medical facility. Continue to follow the protocol for
obstructed airway on a conscious infant less than 1 year old. If you
have access to a cell phone keep in contact with 911 for medical
instructions and directions.
1. Assess for airway obstruction. No
breath sounds, no crying or weak
cry, breathing difficulties, dusky color,
blue lips or face, cyanotic appear-
ance.
2. Place the infant face down the
length of your arm. Place the infant,s
face in the palm of your hand with
your fingers spaced (take care not to
cover the mouth or nose) and sup-
porting the cheeks. The length of your

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arm supporting the infant’s body. Lower the infants head lower
than the trunk of the body. Deliver up to 5 back blows forcefully
between the shoulder blades with the heel of your other hand.
3. Turn the infant over and switch hands. Support the infant’s
head and body with your arm. Keep the infant’s head and body
in a downward position. This may help to expel the foreign object.
Using the same landmarks as those you use for infant chest com-
pression’s deliver up to 5 thrusts in the mid sternal area. Use the
same ring and index finger as you would use for compression’s.
Deliver these chest thrusts slower than when doing chest com-
pression’s.
4. Continue to repeat steps 2 and 3 until the foreign object is
expelled or the infant becomes unconscious.

If the infant becomes unconscious

1. Place infant on his back and at the same time call for “help”. If
someone comes to your aid have them call 911 and activate the
EMS system immediately.
2. Use the tongue - jaw lift. Don’t perform a blind finger sweep.
Remove foreign body only if it is visible.
3. Attempt to give rescue breaths. Open the airway with the head
tilt - chin lift method, try to give rescue breaths.
4. Try again to give rescue breaths. If this fails, reposition the head
and try again to give rescue breaths.
5. Reposition infant and give up to 5 back blows,
6. Turn infant to chest thrust position and give up to 5 chest
thrusts.
7. Perform tongue - jaw lift and remove any foreign body that is
visible.
8. Attempt to again give rescue breaths. Keep the airway open
with the head tilt - chin lift.
9. Repeat steps 4 through 8 until successful.
10. If alone and your efforts are not successful activate the EMS
system after about one minute of trying to clear the airway. Con-
tinue to call for help periodically or EMS arrives.
11. If obstruction is removed, check for breathing and a pulse.

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12. If there is breathing, place the infant in the recovery position.

Closely monitor the breathing and pulse. Maintain an open airway.
If there is no breathing, give 20 rescue breaths per minute and
monitor the pulse.
13. If there is no pulse, give 2 breaths and start CPR. If a pulse is
present, open the airway and check for breathing.

Obstructed Airway for Unconscious Infant

Less Than 1 Year Old
1. Determine unresponsiveness by gently shaking or tapping the
infant’s shoulder.
2. Call for “Help”.
3. Place infant on his back. Use a hard firm surface, making sure
to support the head and neck.
4. Open the airway using the head tilt - chin lift. Be careful not to
hyperextend the neck by tilting the neck back too far.
5. Determine if the infant is not breathing. Maintain an open airway,
place your ear over the infant’s mouth and listen for breath sounds.
Feel for breath movement on your ear. Look at the chest for the
rise and fall of breathing.
6. If there is no indication of breathing, attempt to give rescue
breaths using the mouth over mouth and nose seal method.
7. Attempt again to give rescue breaths. Reposition head and
check mouth over mouth and nose seal.
8. Activate the EMS system. If there is help, have them activate
the EMS system while you continue your efforts.
9. Continue your efforts, deliver up to 5 back blows.
10. Deliver up to 5 chest thrusts.
11. Use the tongue - jaw lift and look for any foreign object. If you
see an object, remove it.
12. Attempt to give rescue breaths.
13. Repeat steps 9 through 12 until successful.
14. If you are alone and have no success in you efforts, activate
the EMS system after about 1 minute of trying to clear the airway.
15. If obstruction is cleared, check for breathing and a pulse.
16. If the infant is breathing, place him in the recovery position
and monitor his breathing and pulse. Make sure to keep an open

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airway. If there is no breathing, give 20 rescue breaths per minute

and check pulse.
17. If there is no pulse, administer two rescue breaths and start
CPR. If there is a pulse open the airway and check for breathing.

BASIC LIFE SUPPORT AND THE TRAUMA VICTIM

It is imperative to recognize and provide immediate Basic Life Support
intervention for all trauma victims. Resuscitation should begin as soon
as possible after an injury. Improper resuscitation and failing to main-
tain an open airway has been identified as a major cause of prevent-
able trauma deaths.
Pediatric victims of trauma require close and meticulous support of
the airway, breathing and circulation. Airways can easily be blocked
by soft tissue injury, blood or dental fragments.
When a head or neck injury is suspected in children or adults, the
cervical spine must be completely immobilized with an open airway.
The best way to handle this is a combination using the jaw - thrust and
spinal stabilization methods. Extreme caution should be used while
establishing an open airway. Use only the minimal amount of manual
control necessary to prevent cranial and cervical motion. Do not use
the head tilt - chin lift. It may cause additional damage or worsen the
injury. If two rescuers are present, the first rescuer should open the
airway with a jaw - thrust while the second rescuer ensures that the
head and cervical spine is completely stabilized in a neutral position.
The objective is to conduct the needed ABCs without doing any fur-
ther damage to the cervical spine.
Immobilization of the cervical area
should be accomplished before the
victim is moved. After checking the
ABC’s, the most important action is
splinting the cervical area or spine. If
911 has been called and their arrival
time is short (5 to 15 minutes) simple
hand held traction of the cervical
spine may be adequate. This may
be accomplished by having a helper
or bystander hold gentle traction on

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both sides of the head. There must be absolutely no movement, no

matter how slight, by the victim or person holding gentle traction. Is
very important that no movement occurs. If the victim of a cervical
spine fracture moves even the slightest amount, the single move may
cause death or paralysis. If the arrival time of EMS is longer than 15
minutes, the victim’s cervical area and spine should be immobilized.
Improvised head restraints may be made from a diver’s soft weight
belt or a standard weight belt wrapped in towels for padding. If the
injured victim is in the water, provide the ABC’s and immobilize the
victim in the water before attempting to remove the victim. Paralysis
and death has been attributed to attempts to move an accident victim
without immobilizing the cervical area and spine.

IDEA DIVE MEDIC TEXT SUMMARY

No First Aid course can cover all that an individual needs to know
about First Aid. There are thousands of scenarios that can present
themselves to the first aid provider. Adding a few basic skills and
knowledge can offer a higher level of care to sick or injured victims.
IDEA’s Dive Medic I and II courses increase the level of care you
may provide until relieved by EMS personnel. Responsible divers
will recognize the importance of successfully completing courses
in oxygen administration, and cardiopulmonary resuscitation (CPR).
These courses may be taken as part of the IDEA Dive Medic course
or obtained individually by Instructors from the American Heart Asso-
ciation, American Red Cross or DAN. Individuals trained as IDEA
Dive Medic I are required to complete certification in artificial resus-
citation and CPR. The IDEA Dive Medic II certification also requires
training and certification in oxygen administration. Diver Alert Network
(DAN) is the program endorsed by IDEA. Other Oxygen Provider pro-
grams may be used with approval from IDEA headquarters.
IDEA Dive Medics should familiarize themselves with the signs,
symptoms, and treatment of lung expansion injuries. Lung expansion
injuries may present themselves more frequently than other diving
accidents. Recognition and treatment of other pressure related (Baro-
trauma) injuries is also required. Review the signs and symptoms of
diving accidents on a regular basis. The Dive Medic should be pre-
pared and ready to act in the event first aid care is needed. More than

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likely the first aid provider will encounter many more first aid situa-
tions that are not caused by diving accidents. By having a complete
first aid kit, oxygen administration training and training in first aid and
CPR you will have a positive effect on the care of a victim of illness,
accident or injury. The quality of care you can provide until EMS units
arrive will have a direct effect on the victim’s recovery and survival.
Quality pre hospital care begins with first aid.
If you have enjoyed the additional first aid skills that you learned in
your IDEA Dive Medic course, IDEA recommends that you consider
taking a First Responder course. First Responder courses are offered
by many fire and rescue departments, technical schools and commu-
nity colleges. You may also enjoy participation as a member of a dive
rescue team with your local fire, rescue or law enforcement agen-
cies.

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