DAN Medical Frequently Asked Questions

Back to Medical FAQ List
Bookmark and Share

Inverted on the Descent Line

A handicapped diver with a faulty regulator nearly drowns after getting inverted in the water.
(2012, USA)Dale was born with spina bifida. Although he can walk unassisted on land, he does not possess the fine motor coordination he would need to use his legs underwater. His wife gave him the gift of scuba diving one Christmas, and he has been hooked ever since. Without the use of his legs underwater, he does not wear fins; he maneuvers solely with his hands. Underwater he can, for a time, forget his legs and simply enjoy unlimited freedom.

Alan is an able-bodied diver on the same trip who signed up for relaxation and enjoyment. He was working on his advanced diver certification; he was neither a rescue diver nor an instructor. He and his buddy looked forward to serene, beautiful and uneventful diving.

One morning the divers were on the boat preparing for dives. The sea was calm, and the current was minimal. This was an advanced dive to a wreck at 105-115 fsw (32-35 msw), and visibility was good. Dale and Alan, all suited up, were among the first to splash. As Dale pulled himself down the line, he realized that he had become completely inverted, beyond his ability to rectify. He tried to stay calm but found himself struggling to right himself.

Dale's gear was 10 years old, and his regulator was hard to breath. The next breath he took was only water, as was the breath after that. He reached for his octopus and got it out, but darkness closed around him. He began to spiral downward toward the wreck, out of control. He thought to himself, "I'm about to die."

Alan, who was behind Dale on the descent line, saw all of this happening in front of him. No one else, including Dale's buddy, seemed to notice that Dale was in trouble. Alan swam to Dale as fast as he could, intercepting him at 20 fsw (6 msw). Dale's BCD was flared open, and he was reaching for his octopus. Alan wrestled and grappled with the uncooperative diver, unaware that they were both continuing to descend. He managed to pull Dale right side up and shoved his octopus into his mouth. Aware that Dale was having air trouble, Alan turned him around to make sure his valve was open.

Now realizing that they were both still descending, Alan added air to Dale's BCD via the power inflator. When Alan looked Dale in the face he saw that Dale's eyes were blank and his mouth was slack. There was no regulator in his mouth. At 83 fsw, Alan arrested their descent. He put Dale's regulator into his mouth and held the purge button down, hoping to force air into his lungs. No change. He quickly inflated Dale's BCD and his own and escorted him to the surface.

At the surface the boat crew saw immediately that something was wrong. The divemaster jumped in and swam out to assist with the rescue. Together, they cut off Dale's gear and pulled him back to the boat. The captain and crew lifted Dale out of the water and removed his mask. There was blood in it, and Dale was not breathing. The boat captain looked at Alan and said, "He's gone."

As Alan stared back in horror, he suddenly realized that he had ascended directly and rapidly from 83 fsw (25 msw). Without a word, he slipped back underwater to complete a rather late safety stop. He hung on the line at 20 fsw (6 msw), in shock at what had just happened and unable to process his part in it.

Meanwhile, the captain of the dive boat radioed for emergency Coast Guard assistance, while the divemaster worked to clear Dale's airway. The Coast Guard's nearest vessel was only 10 minutes away. By the time the zodiac intercepted the dive boat, Dale was not only alive, he was talking. He was evacuated to the nearby hospital and was told there he may have had a laryngeal spasm that shut his airway and prevented flooding his lungs and drowning.

After the dive, Alan went out to lunch. Suddenly, his right hand and right foot began to tingle. As he stood up, he felt a wave of dizziness and a peculiar pressure in his head. He went to the same hospital where Dale had been taken and was diagnosed with decompression illness (DCI) and treated for 4 hours and 45 minutes in a recompression chamber. By the time Alan was released, Dale was waiting for him. They stood looking at each other for a moment before Dale extended his hand in gratitude and admiration for the man who had saved his life.

NOTE: There are an increasing number of disabled scuba divers. Each special need comes with its own set of considerations. In Dale's case, he now knows that he needs a regulator that is capable of breathing in any orientation. While he is a skilled diver, he is handicapped and has his own limitations.

Alan now knows that upon any emergency ascent he should exit the water and seek oxygen whenever possible.Handicapped divers need able-bodied buddies who are aware of their condition and trained to assist them. There are a number of agencies that provide such training.

Spina bifida is one of the most common birth defects, with a worldwide incidence of about 1 in every 1,000 births. It consists of an incompletely closed spinal channel that leaves a part of the spinal cord less or more unprotected. There are many shades of this condition, and fitness to dive must be evaluated on an individual basis.

Alan made a great effort to save Dale and put his own life at risk. He did everything right, but he could have brought Dale directly to the surface without trying to put the regulator back in his mouth. As it turned out, Dale's lungs were not flooded anyway. The Undersea and Hyperbaric Medical Society (UHMS) has issued recommendations for rescuing an unconscious diver.

If this was Alan's first dive of the day, it was very short and unlikely to cause DCI. Arterial gas embolism (AGE) should be suspected in case of an emergency ascent like this, but the delay of symptom onset seems to exclude it. It is not clear if the symptoms Alan experienced were still present and verified at the time of admission or if he was treated just because he reported subjective symptoms that were already gone. While the treatment in such cases is justified, the DCI diagnosis is not very likely.

If the symptoms are not present at time of admission and the transitory postdive symptoms were not witnessed, the dive computer record of the dive could help with the attribution of the symptoms.

— Petar J. Denoble, MD. D.Sc.


Other Case Summaries FAQs