Diving Accident, Self-Responsibility and Balance

[Thea Strassburg]

P2190161 - YouTube

Tony, this is the 10 minute video I talked about. It comes on apparently around the time I surfaced. Listening to it, I think I was already physically wasted by the time I popped up.

The top of the reef is about 6 feet below me. I did not surface on purpose, I just couldn't get hold of the reef to drag myself over it into deeper water on the other side. Thank you again for helping me clarify this chain of events. It took a toll.

---------- Post added February 24th, 2014 at 07:13 AM ----------

When I got to the clinic my O2 registered at 85% and my BP was 180/140. "Basically, a saturation of 97% of the total amount of hemoglobin in the body is filled with oxygen molecules. A range of 96% to 100% is generally considered normal. Anything below 90% could quickly lead to life-threatening complications. The margin between "healthy" saturation levels (95-98%) and respiratory failure (usually 85-90%) is narrow."

If the DM's had stood back and let me "wear myself out", I would be dead right now. I was not fighting or flailing, I was very still, limp actually, in the water. I am not sure why so many are determined to call this a panic attack, it wasn't. It was an acute medical emergency that I had never experienced before. Obviously related to my smoking and the strength of the current I was fighting.

Lots of DM's smoke, I do not think they should be left to die in the ocean, as they would if they were left to "wear themselves out". Thank you for support though, I know it is hard to really understand a real-life event from not so well written words!

---------- Post added February 24th, 2014 at 07:18 AM ----------

I was flopped on the deck, unable to move, when the O2 came. I didn't see anything but the masks. Really, I think, after reading all these posts, those guys did everything exactly as they should have and the only way they could have. I think they were almost as frightened as I was.

It was the O2 issue that bothered me the most.

---------- Post added February 24th, 2014 at 07:36 AM ----------

Thank you Richard. I think, with all the input, (I love your meadow v. open ocean comparison), I have a good idea what happened. I had a pulmonary medical event, like an asthma attack, related to my smoking history. I was likely working harder than I realized.

I can say that O2 on a dive boat should be ample and easily available. I love the SMB idea and will do so next time, just for me. In the meantime, I am getting completely medically checked out before I dive again. Thanks so much for taking the time to post here.

 

[gianaameri]

Thea,

consider having your heart valves checked (and your lungs and arteries) by non-invasive techniques (i.e. CT Scan + echocardiogram).

Does not seem like panic to me, and if you did not have O2 handy and administered it could have been pretty bad.

What was the colour of your skin (as reported by those who recovered you)?

If you were blue, you'd definitely need to look further into it before diving or doing other sports.

 

[Thea Strassburg]

It saddens me really, to think we are all just out there alone. I was not alone though, I just felt that way. I have re-watched the video my camera took of the first ten minutes of the rescue. A diver popped up by me within seconds. The DM was with me within less than 2 minutes. 10 minutes later, another DM swam out with a rope and towed all three of us in.
It had not occurred to me that the DM on the boat had to stay with the boat. There were divers still in the water. I had a severe and unpredictable medical event, and they saved me. I hugged the stuffing out of ALL of them, once the clinic let me go.

The ONLY other thing anyone could have done was smacking the right mask on in the right position with enough O2 to get a distressed diver back to the shore. When things go well for so long, it is an easy thing to over look. And SUCH an easy way to save a life.

So, DM's, if I get on your boat for a dive, and ask you show me your ER O2 set up, are you going to get all cranky with me?

---------- Post added February 24th, 2014 at 07:52 AM ----------

You hit the nail on the head. My O2 sats were 85% when I got to the clinic, BP 180/140 and my feet, as the nurse said, were visibly blue. I can't go back into the water until I get all this checked out.

I had a medical event, everyone did everything right. Except have adequate O2 on board and someone who knew how to hook it up. BUT, they did get it hooked up and had enough to almost get me back to shore. Thank you.

 

[gianaameri]

You hit the nail on the head. My O2 sats were 85% when I got to the clinic, BP 180/140 and my feet, as the nurse said, were visibly blue. I can't go back into the water until I get all this checked out.

I have seen this movie before.

I am surprised the nurse did not put you on IV and stood ready to administer life-saving drugs.

 

[Thea Strassburg]

I am surprised a bit at how some folks here do not really advocate for diving buddies. We did not have dive buddies on this trip, we just followed the DM. I noted it but was not really concerned. I need a physical, the bottom line for me, my health is not what it should be. My bottom line on this incident, I would encourage DM's etc., to check their ER O2 set up, and make sure the DM's know how to use it.

A non-diver on the boat said it took the DM several tries to hook up the mask, then they had to switch that mask out for another one, and they were unsure what position the mask should be in on my face. A quick refresher on occasion can really make a difference.

---------- Post added February 24th, 2014 at 08:17 AM ----------

I would say you are far more prepared than the guys on my boat were.

I was one diver, and it was a 10-15 minute jaunt back to shore. The DM had trouble getting the ER O2 tank out, then couldn't figure out how to attach the tubing to it, then didn't know how to place it so the air coming out of the hole went into my nose, not my ear.

Then, one of the DM's took that mask away and switched it for another, different mask and put that one on so the air was gently coursing over my right ear.
Then, the air ran out.
I gave ALL those guys big hugs, huge thanks, and a gigantic apology for putting them through this. I scared the hell out of them, as well as my husband and the other divers. ALL those guys, I know now, did exactly what they should have done and I am alive because of it.

 

[doctormike]

The top of the reef is about 6 feet below me. I did not surface on purpose, I just couldn't get hold of the reef to drag myself over it into deeper water on the other side.

I'm assuming that you are welcoming of these critical comments, and that you posted as part of an effort to become a better diver. With that in mind, this statement is concerning, and suggests another thing to work on in your future training...

if you did not surface on purpose, that is an uncontrolled ascent. An uncontrolled ascent is potentially lethal, and may have contributed to your symptoms (although as I mentioned above, unlikely given your quick improvement with O2). Under no circumstances should it be necessary to grab ahold of anything to prevent an uncontrolled ascent, and no dive plan should involve grabbing a reef (dead or living).

But I guess if you were having a medical emergency and if your buoyancy skills were a bit rusty, that might have contributed to the spiral and chain of events that led to where you ended up.

BTW, pulse oximiters are notoriously unreliable - was your 85% O2 sat by an arterial blood gas? Lots of things can cause transient desaturation like this. Did it stay normal once you were off O2? Because if you are a smoker, you may have an elevated A-a gradient (that reflects damage to the lungs causing problems with oxygen transfer at baseline), and breathing supplemental O2 would push you back into normal range. COPD can also cause some people to be chronically hypoxic with O2 sats in the 80s (via a different mechanism). What is your baseline O2 sat?

But again, we weren't there, so we really can't make any specific diagnosis. What we can do is comment on the likelihood of contributing factors based on our experience as divers.

FWIW, I actually asked a buddy of mine who is a pulmonologist about this, and he agreed that while O2 can make someone with bronchospasm feel better, it won't reverse the airway constriction and hypoventilation - that either takes time or bronchodilators. Also, the only way to actually diagnose this would be with pulmonary function tests and some sort of controlled inducement study like a methacholine challenge. Breath sounds (i.e. wheezing) can be abnormal in a number of conditions, including hyperventilation from anxiety or laryngospasm associated with water aspiration. So while your home doc might have made an educated guess about EIB, I'm not sure if you have actually had that workup yet, couldn't tell from the thread.

I am surprised a bit at how some folks here do not really advocate for diving buddies. We did not have dive buddies on this trip, we just followed the DM.

Well, some of us have trained and certified as solo divers, and we have carefully considered the pros and cons of buddies and feel that in certain limited circumstances, solo is as safe as diving with a buddy, if not safer.

But I'm not sure why you seem to be both surprised that people wouldn't always advocate for the buddy system, but then go ahead and do a solo dive without training. Because that is what you just claimed that you did - you "just followed the DM".

Let me ask you, if the DM had been with you underwater during the start of your problems and was helping you, then who would have been taking care of any other diver who had a problem during that time? So you, as a qualified open water diver, chose a dive plan that was beyond the limits of your training, and not up the the near-universal safety standards of recreational diving.

These two issues (acceptance of a "trust me" dive following a DM into an overhead environment, and reliance on grabbing the reef to prevent an uncontrolled ascent) seem to be much greater risks to your health than the lack of O2. Oxygen is great if available, and it did help me on the day I took a chamber ride, but many small boats taking new divers on shallow dives with little risk of DCS might not have it.

If you truly have EIB and want to continue diving anyway, I guess you should make sure of the presence of adequate O2 and crew training before booking a dive in the future. Remember, though, O2 is NOT a treatment for EIB, and if you really had that and had a severe attack in the future (especially underwater) it wouldn't save you. So if you are truly convinced that this is the case, then I'm not sure why you would dive, even with adequate O2 on board.

 

[kwinter]

SOunds to me like you had a panic attack and were hyperventilating and building up CO2 due to bad air exchange.

Not going to add much here, but my first experience with getting overloaded with CO2 came much later in my diving. It was still pretty terrifying and sounds very much like what happened here. Once you get CO2 overloaded panic is right around the corner.

Incorrect. Hyperventilation causes reduced CO2, not increased. Lowered pCO2 is the trigger to breathe more rapidly, hence the feeling of not getting enough air.

she was breathing so fast it caused rapid shallow breathing (hyperventilation). Despite what most think, this does not increase the amount of carbon dioxide in the body, it actually reduces the amount of carbon dioxide in the blood.... The solution is to actually make the patient breathe back some carbon dioxide. The normal way that this is done is to get the person to breathe into a paper bag and breathe back the higher carbon dioxide air. Eventually this will slow your breathing back to normal.

That is correct. But it does not explain why her sat rate would have been decreased to 85%, especially so far along after the initial problem. There is more to this than a simple explanation of panic attack or hyperventilation. Symptoms are one thing, and could be explained in a lot of ways that sometimes seem contradictory because they are so subjective. Objective signs such as a pulsox of 85 are a different matter. EIB is a possibility. IPE is another, although she did not indicate any symptoms of edema such as coughing. I appreciate the OP's candor, but there are clearly some things missing.

This thread seems to be going in 2 different directions. One about the medical issue and the other about the preparation and reaction of the boat crew. Completely separate issues.

 

[gianaameri]

Thea,

If the facility was PADI, they are required to file an incident report.

For a good laugh, or to acquire facts from the perspective of the Dive Center, ask PADI for a copy of the incident report.

Buddy or Solo info. should be also in the report.

Sent from my GT-I9195 using Tapatalk

 

[uncfnp]

No, I am not doctor. But the physician they called to the clinic on the island was, as well as my primary care physician at Washington University Medical Center here in St Louis. Panic attacks do not cause O2 sats to plummet to 85%, or raise your BP to 180/140. Nor do they cause your feet to turn blue from lack of oxygen. EIB is caused by extreme exertion in environments with little moisture and dehydration (Google it). Below is a link. Basically it is an environmentally caused asthma attack in people with no history of asthma.

Exercise-induced bronchoconstriction - Wikipedia, the free encyclopedia

There is no shame in having a panic attack. Had that been the case, I would not have posted this. Panic attacks are quite real and quite terrifying in people prone to experiencing them. I am quite familiar with and sympathetic to how debilitating and painful these episodes can be. Luckily, I have never had one.

---------- Post added February 23rd, 2014 at 06:48 PM ----------

Thank you, and will do. This forum has cleared up so many things for me. I hugged and thanked and apologized to all the staff on the boat that day, for getting myself into that position. I understand now what happened. I feel lots better. And will in the future pay heed to all this information. Scuba simply rocks.

Just a few thoughts.

I encourage you NOT to use Wikipedia for definitive answers to medical issues. The internet can be a blessing and a curse. If you do search for answers to health issues on the web please use established medical sites. One of my favorite sites for patient information is the Mayo Clinic and they just happen to have a page on EIB :

Exercise-induced asthma Definition - Diseases and Conditions - Mayo Clinic

Here is another good site with info about wheezing in general and some of the MANY causes of bronchospasm:

Wheezing: MedlinePlus Medical Encyclopedia

Remember, not all that wheezes (or spasms) is asthma. And sometimes the initial working diagnosis may change when a more thorough investigation is completed. Please keep an open mind when you follow up with your doctor. This event may be a wake up call and a blessing if it serves to get you healthier regardless of your future dive plans.

 

[Rich Keller]

I can only guess what went wrong based on your account of the facts and you were not in a position to know all the facts. My guess is that you were having a panic attack which would also make your recollection of the facts questionable at best.

You already understand the problems your general physical condition can cause and choose to dive shallow because of that which was the right thing to do.

Getting in the water when you felt the conditions might be beyond your abilities was a mistake but a very common mistake.

The swim through was a big mistake in every respect. First I would never go into any kind of overhead environment on scuba. Second they knew that there would be a problem when you got to the other side and told you to clime the coral to get out. You should have never been put in that position. Last once you got out you were in 5' of water with 2'-3' waves, another position you should never have been put into.

If you had not already overexerted yourself on the wreck you did so trying to get out of the hole after the swim through. You are only going to make your situation worse by trying to swimming against a current that is too strong. It worked out only by chance that you were ejected from the hole. This was the point at which you should have considered dropping the weight belt to get out rather then trying to swim against too strong a current.

Once you were at the surface you did exactly the right thing by dropping the weight belt, that was the best choice you made all day.

You knew that you were panicking and did all the right things to try and reduce that. Again dropping the weight belt was good but if you did not need the BCD inflated to stay afloat doing so would only increase your profile in the water making it harder to swim against the current.

You may not have been the only one to panic that day either. The DM should have tried to got your panic under control before trying to get you back to the boat. That being said it also might not have worked depending on how far gone you were at the time.

If they could not bring the boat to you due to the depth they could have swam you to either side or just drifted down current until you were in deep enough water for the boat to reach you. I do not know the site so this may not have been possible.

The DM on the boat was doing the exact right thing, you already had enough help in the water and he had to wait until you got within range of the rope he was going to swim out to you before he got in the water.

The exhaust fumes were probably not that big a deal but it did fuel your panic even more.

The captain and the DM should have known how to operate their own O2 system and had it setup and ready to go before you got back on the boat. The O2 reg has the first and second stage built into the same piece, and the IP can be set on the reg. It sounds like it was set too high causing the tank to run low faster then it should have. Once they ran out of O2 the only other option that might have been available would be to have you breath off a nitrox tank if there were any onboard.

Even if the mask was not fitting perfectly the oxygen you were getting should have been enough to get the O2 level in your system back to normal. I would guess that at this point you were hyperventilating from the panic alone.

As I said at the start this is just my read on what probably happened based on only partial information. If you feel anything I said was mean or too harsh, that was not my intention but sugarcoating things would be of no real help to you either.

I would suggest you get back in the water as soon as possible and start putting in more hours diving at home as well as on vacation. The more hours you have in the water and the shorter the gaps are between your dives the less likely you are to panic.