Is it time to sink the CESA?

[wetb4igetinthewater]

@Ken Fischer

Sorry to hear about this. I wouldn't be too harsh on your instructor. Hindsight is perfect, but the problem is more of the system. Using PADI as an example (but I think any agency with teaches the (C)ESA is also to blame), they do not have on their slate of "wait 1 minute prior to descending again." Some CDs will teach this in the IDC, but many will not.

Too much is learned while doing, instead of being mandated/required to be taught. That's one contributor to accidents. There's too much "the instructor should have known." Fortunately, I haven't had such incidents, but I do think when I started out, I could have.

 

[The Chairman]

I permanently damaged the hearing in my right ear due to the CESA skill in my Open Water certification.

Just wow. I agree with everything you posted, but this is just tragic.

It's not like training is of any use when you are so confused. It's not like your instructor could see inside your head and avert your hearing loss. But, if we no longer had a CESA, you would still have hearing in that right ear, right? There are better and safer ways to improve diver confidence. Most would even admit that the 'once and done' real world training strategy has no possibility to effect any real training. This is a dangerous macho driven adrenaline rush that is nothing more than an underwater stunt. It should be relegated to the fin pivot and Buddha hover as an antiquainted hazing that instructors foisted on their students. The horizontal CESA is much safer, both to student and instructor, and is endlessly repeatable without increasing exposure to harm. It is as 'non-real world' as the vertical CESA, but it lacks that macho level of "I beat the odds!"

 

[Angelo Farina]

I permanently damaged the hearing in my right ear due to the CESA skill in my Open Water certification.

I did the CESA ascent successfully, but then my instructor and I _immediately_ (less then 30 sec on the surface) descended to resume the dive. On the descent, I slipped into a dreamlike subconscious “split mind” state - which caused me to not equalize properly. (I recall having one part of my mind screaming to swim up, and the other part of my dream-like state telling me to get down to depth.) When I did start to “come to” I tried to equalize with a forced Valsalva maneuver. Goodbye hearing in my right ear.

I’ve had the feedback that better practice would have prevented this accident - but I’m not sure how I could have trained myself to handle a situation where my brain literally got spiked by the “bounce dive.” It’s hard to deploy training correctly when your mind isn’t working properly.

So, yes - I really wish my instructor and I had rested on the surface for a few minutes.

There are good medical reasons for diving down again immediately after a CESA: if some smart bubble is going to form, if you immediately go down the bubble is recompressed and redissolved, causing no harm.
However your experience is not uncommon: after the CESA, both your body and brains are upset, and it is easy that having to go down again quickly the student forgets to equalize.
Of course better and longer training can prevent this issue, and I still do not understand why Valsalva is taught at all, when much better equalizing techniques are known since 40 years (BTV, Frenzel, Marcante-Odaglia)...
Eliminating CESA by training is definitely one option, and some agencies did follow this route. However I did always think that not training CESA is feasible only if the students are trained to always dive with proper redundancy. The most frequent case needing a CESA is an out-of-air situation, which can be prevented carrying a pony tank of proper size, or using a compact twin set (as we always were using in the seventies) with two complete and independent regulators.
A third alternative which I was employing when I was working as an instructor was to always train my students as free divers (for 2-3 months!) before giving them a scuba system.
This means that if the OW course will enable to go down to 18m, the student must be able to reach this depth free diving, staying down some 10 seconds, and then resurface. If he proofs to do that, of course he will be able to do a CESA from the same depth. The only thing to be further taught is to exhale during ascent, but this can be verified safely with just a 5m ascent, without the need to going up to the surface.
Final point: regulator in mouth or out? I was of the school to train this partial ascent without regulator. For several reasons:
1) The instructor better sees if the mouth is open and air flowing out
2) If the student exhales with the regulator in mouth, there is no proof that he will remember to exhale in case he needs to make a CESA having lost his reg.
3) In case the student does not exhale, it is easier for the instructor to manually insert his fingers in his mouth and force the glottis open (I had to do this a couple of times for avoiding lung over-expansion)
I know that some agencies instead suggest to do the CESA up to the surface and with regulator in mouth. I did always find it quite unsafe...

 

[Sifossifoco]

My issue with CESA is different (apart from the fact that I hated teaching it...). CESA reinforces the natural instinct to jump to surface when something is wrong, and this may become dangerous when people move to more advanced diving. I sure know of few deaths with rebreathers, where in few meters of water the diver had the 02 closed and quickly jumped to surface instead of bailing out or checking the valve. I wonder how much of that behavior can be an unconscious memory from previous CESA training, and I do not know of any rebreather instructor that, apart from teaching how to unlearn buoyancy, also teaches how to unlearn CESA.

 

[The Chairman]

if you immediately go down the bubble is recompressed and redissolved,

It can also cause bubble pumping, which can result in AGE.

Of course better and longer training can prevent this issue,

I heartily disagree. You can't train for confusion.

CESA reinforces the natural instinct to jump to surface when something is wrong

I hadn't really thought of it in that regard, but this is so true. It reinforces flight over reason.

Many, many OOAs are caused by bad buoyancy. Divers who are constantly going up and down fighting their buoyancy are less likely to remember to check their air.

 

[Angelo Farina]

It can also cause bubble pumping, which can result in AGE.

True. Particularly a problem for the instructor, who makes perhaps 3 or 4 rapid ascents one after the other, with different students.
Another good reason for avoiding Cesa altogether

I heartily disagree. You can't train for confusion.

I was referring to training for proper equalisation, and particularly the BTV method.
Once you learn it, equalizing is a not issue, as it becomes fully automatic and does not require any voluntary action... Nor closing the nostrils.

 

[60plus]

It is probably useful for students to practice sufficient number of CESA from minimal depths to get the feel of their lungs expanding if they hold their breath. It is trying to hold breath (a basic instinct underwater) that is likely to cause serious injury during ascent. I would think such practice can be done from 6 or 7 meters with the instructor staying at the bottom and observing the bubbles from slow exhale as the trainee ascends.

 

[Raphus]

It is probably useful for students to practice sufficient number of CESA from minimal depths to get the feel of their lungs expanding if they hold their breath. It is trying to hold breath (a basic instinct underwater) that is likely to cause serious injury during ascent. I would think such practice can be done from 6 or 7 meters with the instructor staying at the bottom and observing the bubbles from slow exhale as the trainee ascends.

This is not possible in reality. The instructor has to be above the student, so he can immediately stop the ascend, if the student holds the air.. I saw this a few times. It does happen, even when told 100 times before the cesa.

 

[Ayisha]

...Final point: regulator in mouth or out? I was of the school to train this partial ascent without regulator. For several reasons:
1) The instructor better sees if the mouth is open and air flowing out
2) If the student exhales with the regulator in mouth, there is no proof that he will remember to exhale in case he needs to make a CESA having lost his reg.
3) In case the student does not exhale, it is easier for the instructor to manually insert his fingers in his mouth and force the glottis open (I had to do this a couple of times for avoiding lung over-expansion)
I know that some agencies instead suggest to do the CESA up to the surface and with regulator in mouth. I did always find it quite unsafe...

I think the reason for keeping the regulator in the mouth during a CESA is so that the person can potentially draw a breath or even two as they go shallower.

 

[boulderjohn]

Final point: regulator in mouth or out? I was of the school to train this partial ascent without regulator. For several reasons:
1) The instructor better sees if the mouth is open and air flowing out
2) If the student exhales with the regulator in mouth, there is no proof that he will remember to exhale in case he needs to make a CESA having lost his reg.
3) In case the student does not exhale, it is easier for the instructor to manually insert his fingers in his mouth and force the glottis open (I had to do this a couple of times for avoiding lung over-expansion)
I know that some agencies instead suggest to do the CESA up to the surface and with regulator in mouth. I did always find it quite unsafe...

When the UHMS study on CESAs was released a couple decades ago, it found it was the number one cause of fatalities during instruction--by far. Having the regulator out of the mouth the was primary reason. If a student inhaled, that would begin the drowning process, and that process might not be stopped. Since then, almost all agencies worldwide made keeping the regulator in the mouth a point of emphasis. It was not just good for safety, it was good for training, because a person with a regulator in the mouth can draw air from the regulator as ambient pressure decreases.

So, in quick summary, scuba agencies around the world (with a couple of exceptions, notably in Belgium) insist that the regulator be in the mouth throughout the exercise. If, as an instructor, you follow Angelo's advice and your student dies, you will likely be sued for using practices not considered safe by almost all the agencies in the world. If you are in one of them that sill allows it, notably in Belgium, where CESA deaths during instruction are still the number one cause of fatalities, you may get by for following standard practice. If not, you will not do so well. In my view, you will be guilty of murder.

Your choice.