DAN Medical Frequently Asked Questions

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Rescuing divers and swimmers

In general, safe and effective in-water rescues require a degree of skill that can only be achieved through proper training. There are numerous organizations that offer such courses. Early recognition of an emergency situation is key to a successful outcome in any water rescue.The information here cannot replace formal training in rescuing an injured or distressed diver or swimmer or delivering oxygen first aid. Before attempting any of the following measures, you should complete a formal course of instruction to gain the necessary knowledge and skills.
Performing a water rescue: Early recognition of an emergency situation is key to a successful outcome in any water rescue. These are the recommended procedures:
* Ensure the safety of yourself and of the injured swimmer or diver. Be aware of high-risk conditions, such as strong currents or tides, limited visibility, and hazardous marine life; these are just a few of the many complications that can influence the success or failure of a water rescue and can even place bystanders, including the rescuer, at risk.
* If possible, provide assistance from the surface or shore, without entering the water. This may mean casting the victim a line, a flotation device, or even a small watercraft — all of which offer a greater degree of safety for the rescuer than an in-water rescue.
* Rescues that require in-water assistance can be complicated and typically require knowledge and skills well beyond the scope of this guide. However, the following points highlight a few of the fundamentals involved with in-water rescues.
** Solicit topside assistance from observers:
*** Enlist the support of bystanders to spot and track the victim's position.
*** Summon help from emergency medical services, the Coast Guard, etc.
** Equip the rescuer with appropriate personal safety equipment, such as fins, mask, snorkel, floatation gear, etc. A rescuer needs to be properly equipped to perform a rescue safely and effectively.
** Conduct a victim assessment and communicate with the victim, if possible; this will dictate the following:
*** The rescuer's manner of approaching the victim.
*** The need for physical contact with the victim.
** Gain control of the situation, such as through verbal communication and/or physical contact with the victim:
*** Avoid physical contact with the victim if it's not necessary. If the victim can follow commands, it is sometimes possible to talk someone through a self-rescue.
*** Remember that making physical contact with a panic-stricken diver or swimmer can place the rescuer at significant risk.
** Establish positive buoyancy:
*** Remove any weight belts and/or drop any heavy loads.
*** Inflate both the rescuer's and the victim's buoyancy compensator.
** Transfer the victim to a boat or the shore, while ensuring that:
*** The victim's airway is protected.
*** The rescuer and the victim maintain positive buoyancy.
*** The rescuer remains in control.
*** Topside support is ready to assist when necessary.
** Begin CPR and rescue breathing as soon as the victim is on a stable surface. Administering CPR in the water is ineffective and can delay the victim's extrication from the water.
In general, safe and effective in-water rescues require a degree of skill that can only be achieved through proper training. There are numerous organizations that offer such courses.

Administering emergency oxygen: Respiratory arrest, cardiac arrest, drowning, and many scuba diving injuries interrupt or impair your cardiovascular system's ability to supply oxygen to your body's tissues. In such cases, it can be important to administer supplemental oxygen. In case of diving injuries, victims should receive the highest oxygen concentration possible. Providing emergency oxygen first aid for injured divers is one of the most important measures that can be taken before professional medical care and hyperbaric treatment are available.

The first step is to assess the diver's breathing status and then determine the oxygen delivery device that will provide the highest concentration of oxygen possible in the circumstances:
* For breathing injured divers, use one of the following (any of these devices is of great value in supporting diving activity in remote areas, where long delays in reaching definitive medical aid are to be expected):
** A nonrebreather mask with a minimum oxygen flow rate of 15 liters per minute (Lpm).
** A demand inhalator valve with an oronasal mask (such a device is more effective than a nonrebreather mask, both at conserving oxygen supplies and at delivering a high inspired fraction to the victim).
** Any other oxygen delivery device capable of providing high concentrations of oxygen, such as a closed-circuit oxygen rebreather (a closed-circuit oxygen rebreather is even more effective at conserving oxygen supplies).
* For nonbreathing injured divers, the following device is recommended:
** An oronasal resuscitation mask (also referred to as a DAN mask) with a minimum oxygen flow rate of 15 Lpm.
The next step is to position the diver properly, to facilitate CPR and the provision of oxygen first aid. The appropriate position depends on the diver's condition, as follows:
* Injured divers who are responsive (that is, able to communicate) may be placed in either the recovery position (on one side, usually the left, with their head supported) or a semirecumbent position (comfortably reclining).
* Injured divers who are unresponsive but still breathing should be placed in the recovery position (on either side, with their head supported) to help maintain an open airway and to reduce the likelihood that they'll aspirate vomitus in their lungs.
* Injured divers who are unresponsive and not breathing should be placed in a supine position (on their back, face up), so rescuers can perform CPR.
Note that the use of supplemental oxygen should always take place within the context of basic life support (BLS) procedures and should not delay the administration of lifesaving techniques such as CPR. Note as well that the information in this guide is not a substitute for formal training in oxygen first aid. DAN highly recommends formal training in administering oxygen. Furthermore, keep in mind that oxygen is a prescription drug in many countries and that the improper handling and maintenance of oxygen equipment can cause serious injury, including death, to both victims and rescuers.

Finally, a few points are of note regarding the use of supplemental oxygen on private boats:
* Be sure you have enough oxygen on board so an injured diver can be transported from the farthest dive site to the nearest emergency medical services.
* Remember that oxygen first aid should not be considered a substitute for definitive care by a trained health-care provider.
* Do not overlook the priority of monitoring the victim's circulation, airway and breathing while providing emergency oxygen.

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