Medical Emergencies

[Jorbar1551]

So last month our dive team had training regarding what happens if we have a medical emergency. We had AMR paramedics, the 911 ambulance provider come out and give us their advice, regarding what we should do to help the victim/patient before 911 gets there.

Our county EMS protocol, states that all submerging accidents, require the patient be c-spined(patient on a backboard). Our team talked about that, and although there is always a possibility of a spinal accident, we thought that there would be a greater likelihood of one of our divers or surface personnel having a heart attack or stroke while underwater.

The paramedics told us the best thing that we could do, would be to collect as much information as possible, and to keep the patient warm, dry, and exposed. Our paramedics told us that if we do have an accident, and that 911 is not on scene by the time we get the patient out of the water, they want the patient stripped, and as dry as possible. If you have an emergency blanket(space blanket), those work very well to keep the body temp up.

They also needed to know important information such as depth of the water, time the diver was in the water, water temperature, dry suit/wet suit, any idea of what happened?

they also wanted to know the persons HAM: history, allergies, and medications. since if the person is out cold, there is no likely way to get find out, our dive team decided to have all of this information pre filled out in a locked container with us at all times.

Since this kind of information can be touchy, and very personal, we are trying our best to keep it confidential. I'm trying to get everyone to fill out on a piece of paper, their name, emergency contact info, insurance plan and number, past medical history, allergies to food and medications, and medications they take if any. All of this information will be sealed in an envelope, and put in a box that will be kept on our trailer which is with us at all times.

What do you think about this idea? Has your team practiced not only contingency drills, but what to do after you rescue or recover the person? Do you have any other ideas?

 

[tc]

100% Oxygen. Immediately.

You need to identify the two closest hyperbaric chambers that are capable of handling a dive accident and work directly with their staff to educate the local EMS community on the correct protocols to follow in a dive accident. Not all chambers are capable of handling divers, some may be able to handle a minor DCS hit but not an embolism, it's better to know in advance.

About 5 years ago our team started sending folks through the EDAM (Emergency Dive Accident Management) and ERD (Emergency Response Diver) programs at the Catalina Hyperbaric Chamber, see the link in my sig line.

We also have most of our team certified as DAN Diving Emergency Specialists. I'm now pushing to upgrade them to DAN's Diving Medicine for Divers program. (I teach that one now as well )

 

[tc]

If you're using dive computers, bottom timers, sensus or any device that records the dive that should be transported with the injured diver as well. Some chambers will be able to download them so they can see the dive profile.

 

[ditch-diver]

Like TC, for us it is 100% O2 and then work out the transportation to the nearest chamber (which is figured out and covered in the briefing before anyone gets wet). We do not do much with the local paramedics as our teams have advanced DAN training, most are Instructors in numerous DAN specialties and to be honest are better versed in dive first aid than paramedics who need to know a lot about everything.

 

[bridgediver]

100% O2 for sure - but to add. If they are concious and can hold a regulator the O2 should be positive pressure; NOT if they are unconcious though. Most EMS providers aren't aware of this benefit to diving accidents and cringe when "positive pressure" O2 is mentioned but its pretty much the same as how N2O2 is administered on BLS ambulances.

You're bang on thinking that MI and CVA is your number 1 worry but the cause of each of these is usaully from Arterial Gas Embolism in the diving setting - serious crap if it does occur. So rapid transport to a chamber is the definitive treatment. Call DAN as soon as anything is occurs right after 911. They can set the wheels in motion to get your diver to a chamber probably quickier than the EMS/ER route. I've seen/heard of too many docs that don't do this until too late.
What follows AGE is usually DCS.

Don't bother with C-spine for a diver unless he potentially hit his head on an ascent. Getting GOOD oxygenation is the most important thing - harder to do if they're on a BB.

Space blankets are OK for maintaining body temp but if the person is already cold it won't improve things - especially since we almost always are wet and cold after a dive. get a wool blanket to place on the guy beneath the space blanket with the O2 and you've got a good recipe.

Get some DAN training for your guys too - I agree they are the best at this stuff.

Most of our department are all medic/FF and all of our team members are medics as well so we've managed to cross train most of our non-team guys to what needs to be done but as ditch says most EMS agencies aren't to adept in handling diver injuries

 

[jfa_16]

High flow oxygen and supportive care is the best treatment for a diver suffering from a dive related illness. Taking C-Spine precautions for an unresponsive PSD seems to be a bit unnecessary unless there is reason to suspect a head or neck injury. If a diver comes up unresponsive, a head injury would be low on the list of possible causes for me to consider. Being a paramedic for the last 8 years and a new diver for my service's river rescue unit, my eyes have been opened to the potential medical problems that divers can experience. Don't assume that the paramedics that cover your area will be familiar with the signs and symptoms of DCS along with the treatments. My service puts each diver through a dive medicine course that is very informative. It reviews the pathophysiology of AGE, DCS, and other dive injuries and treatments. NONE of which were covered in paramedic class. Sure, we were taught about pulmonary embolisms and strokes, but there was nothing taught in paramedic class about the potential for these to occur during diving. I must say that my approach to treating an unconscious diver will be different than a paramedic who is not a diver and doesn't know anything about diving injuries. As was previously stated, find out where your closest hyperbaric chamber is and if they can handle dive injuries. Some cannot. Some can treat multiple patients simultaneously. All of this information is good to know BEFORE a diver has an issue. In Pittsburgh, we have 3 chambers, all are capable of treating a diver. We were lucky enough to have the doctor that oversees the hyperbaric chamber at our biggest hospital come in and give us a dive medicine lecture covering signs/symptoms/treatments of AGE and DCS. It was very informative and showed that he has an in depth knowledge of diving and the medical problems associated with it. It's good to know that there are doctors like this working where you are diving.

Bottom line, pre-planning is key. Develop a protocol and follow it. High flow oxygen and supportive care is the best possible pre-hospital treatment for an unresponsive diver. Transport to a facility with a recompression chamber is paramount. Also consider that if your closest chamber is a considerable distance away, flying the diver is NOT an option. The pressure changes from flying will make an AGE worse! Always ground transport a diver suspected of having DCS or an AGE. Lastly, don't assume that the paramedics that cover your area will have an understanding of dive medicine. I knew very little about dive medicine before becoming a PSD.

 

[tfd86]

No cringe here, CPAP is a great option for many medical emergencies in the field.

 

[jfa_16]

Huh? How many medical emergencies do you think CPAP is appropriate for?

 

[tfd86]

COPD, ARDS, CHF, which are just the top 3 respiratory ailment that are acute life threats during exacerbated sttus.

 

[tfd86]

No reply yet jfa 16? You were so quick to disintegrate the option of CPAP for in field emergencies.