Author Topic: DAN Case Study: It Started on an Open Water Diving Course (It happens in Malaysi (Read 2459 times)

ikan · « **on:** July 08, 2010, 01:51:37 PM »

Just for info.

Case Study: It Started on an Open Water Diving Course

By Mel Cefai

Some months back, a mother (Sue*) and daughter (Sarah*) were enjoying a holiday together in Malaysia. Living in different countries, this was an opportunity for mother and daughter to enjoy some time together. Sarah decided to undertake an Advanced Open Water Course and Sue signed up for an Open Water Course.

Getting Started

Sue’s incident took place during the first open water dive on the course. It took place at a depth of between 16m-18m when her mask was full of water and she couldn't breathe. Although having undertaken basic skills training the previous day, in Sue’s moment of panic she simply did not know how to remedy the situation. She desperately wanted to ascend. The instructor kept signalling for her to breathe but she was suffocating. Unfortunately the instructor did not take further control by physically assisting Sue in clearing the mask, so Sue surfaced, quickly, because she could not breathe. Sue was choking while exiting the water and immediately felt pain in her neck and head as well as nausea. These symptoms were relayed to the instructor. The instructor told her to sit, rest, drink a lot of water, and was happy for Sue to take part in the second dive once she had rested.

Sue could not move, she had her head in her hands for a while and rested because she could not walk. Soon she needed to vomit so managed to get to the bathroom. She joined the other students for a while and just tried to get through what she was feeling.

Taking Control of the Situation

Feeling no better, Sue decided that there was no way she could do the second dive so went back to her room. Unfortunately, none of the staff were concerned with Sue’s condition. Luckily, Sarah ran into her mum on the way back to her room and witnessed how awful she looked. Sue was in tears as soon as she saw Sarah. Once in the room Sue rested on the bed and relayed what happened to Sarah, who immediately ran for help. As a diver, Sarah knew that having ascended so quickly, and exhibiting such blatant symptoms, which now extended to pain at the base of her skull in the nape of her neck and radiating up the back of her head, indicated that she could very well be suffering from DCI. Once Sarah found help, the wheels were set in motion. The resort staff administered oxygen for a short period; however, Sarah noted that the tank was leaking so Sue was not receiving the full benefit of the oxygen.

Sue was referred to the nearest hospital and was transferred by speedboat to the hospital on the mainland, some 45-minutes away. Unfortunately, Sue was not provided oxygen throughout this journey.

Chamber Treatment is Not Needed

Sue was admitted to the emergency room. She was given oxygen, and had a chest x-ray performed (results all clear). They also tried to administer an IV, but that went totally sour when they couldn't do it properly and caused Sue further excruciating pain. So Sarah instructed them to stop and instead provided Sue with water consistently in place of the IV.

They were then transferred to the inpatient ward, where they had to stay for observation for 24-48 hours. The doctor suggested that oxygen was the best treatment. Based on the doctors analysis of Sue he decided that treatment in the recompression chamber wasn’t necessary at the time. Sarah, as a certified diver was not happy with this recommendation. Based on her previous readings and the superficial checks she personally performed on her mum, she knew that treatment in a chamber was imperative.

So I Called DAN

By this stage, some 14-hours had passed since Sue had shot to the surface, following that first open water dive. In a complete state of despair, watching her mum suffer as she was, Sarah contacted DAN.

DAN AP Executive Director, John Lippmann and I were in John’s car driving to a meeting when we received a call from Sarah. This was a great opportunity for me to witness first hand the work of DAN and the significant role that DAN plays in diving emergencies. Sarah was in a highly stressed state, she clearly felt helpless watching her mum as she suffered in the hospital bed, feeling that her mum was not being given the level of care she needed. She just needed somebody to step in and help her.

During this call, John Lippmann conferenced into the conversation a diving doctor at the DES Hotline and also a diving doctor in Malaysia. John and the DES doctor asked Sarah questions on behalf of her mother in order to learn more about Sue’s symptoms to facilitate a diagnosis of Sue’s condition. The conclusion to this call? Get Sue into a Hyperbaric Chamber immediately. This was soon arranged and Sue was admitted to the nearby hyperbaric chamber.

ikan · « **Reply #1 on:** July 08, 2010, 01:52:08 PM »

Cont ...

Finally, relief

I could hear the relief in Sarah’s voice. Clearly it was of value for Sarah to be speaking to people who had a great understanding of diving-related illnesses and their associated symptoms in order to be able to identify the treatment Sue required. Sarah was very grateful for DAN’s involvement after having felt so alone and scared for so many hours since the incident first occurred.

What I haven’t mentioned is that Sue was not a DAN Member. So while DAN was there to assist Sarah with advice, we were not in a position to organize or pay for the evacuation/treatment. Had she been a Member and immediately called DAN, it is highly likely that Sue would have already commenced her treatment in the chamber, rather than still trying to get the attending physician to recognise the symptoms and acknowledge how serious the situation actually was.

The only downside to this conversation is that it messed up John’s navigation and we became lost for a while, but still managed to get to the meeting on time! However, it really does show the reality. DAN and its Hotlines receive calls for help at all hours of the day, and often the middle of the night. When a call is received the DAN Team stop whatever they are doing to give the caller the attention required to effectively deal with a situation. And seeing the organisation in action, and the level of care that is provided, really highlights how beneficial a support network like DAN really is.

On the Way to Recovery

The patient received an almost five-hour treatment in the chamber at the Semporna Naval Hospital and was notably in better condition afterwards, much to Sarah’s relief. Sue was more alert, conversational and in much less pain. The following day, Sue still had pain in her neck, a sore lower back and some occasional shooting pains in her head. The doctors conducted neurological tests and Sue was much more stable on her feet. She could stand with one foot in front of the other with her eyes closed for one minute, as well as complete the heel to toe test steady on her feet with no problem. Just 24-hours earlier Sue could not achieve either.

John Lippmann continued to stay in contact with Sarah via phone and email for the coming days and weeks to make sure Sue was recovering well and to monitor her after various homeward flights. Many months later we are delighted to advise that Sue has made a full recovery but is not looking to complete her Open Water course any time soon.

Thank you to all involved

Sue and Sarah pass on the following thanks:

Thank you for all your help and support John! You’ve been truly wonderful. I appreciate the advice and concern of Dr Suzy Szekely (from the DES), Dr Tony Lee and yourself, despite us not being members. I was just completely alone with no support, little information and no proper medical support/attention for 14 hours prior to receiving your call (despite being in hospital), so I took matters into my own hands by reaching out to anyone who could provide me with sound advice and second opinions with regards to diving issues/treatment. DAN seemed like a good place to start. You've been more than helpful. I assure you I wouldn't have been nearly as comfortable with the situation had I not had your guidance. There's nothing worse than feeling helpless, especially when it involves the health of your family in a foreign country, and you were a huge factor in keeping me productively involved

tulip · « **Reply #2 on:** July 08, 2010, 02:30:24 PM »

ish ish i was just there

Leafy · « **Reply #3 on:** July 08, 2010, 04:02:26 PM »

the disturbing part about this incident is that the diving staffs especially the instructor did not recognize that there's something wrong with her, given all the symptoms clearly shown. then, the lack of properly functioning equipments at the hospital added with lackadaisical attitude of its staffs. sigh.

nanda666 · « **Reply #4 on:** July 09, 2010, 04:08:48 PM »

I'm a firm believer in prevention rather than cure.

Firstly, why is the first dive in an OW course at a depth of 16 - 18m???

from PADI instructor manual standards:

You must conduct the Open Water Dives at a dive site with conditions
and environment suitable for beginning divers. The maximum planned
depth for Open Water Dives 1 and 2 must not exceed 12 metres/40 feet.

During the pool sessions, I let my students practise coughing while holding the regulator in place. This gives them the confidence that in the unlikely event they do get some water in their mouth/throat and start coughing, they need not accend to the surface. On the surface, we also discuss circumstances when an emergency accend to the surface would be likely and clear all their doubts about "shooting to the surface". (A major no no!!)

Exercises such as mask removal and the no mask swim further elaborates to the student how they can handle a mask problem in water.

As the incident indicates, many countries, including ours, are not fully equipped to handle diving related problems or injuries. (This includes stings from potentially lethal animals such as the blue ring octopus, etc.)

The good work by DAN could have saved the day for the person involved here but it is best to prevent yourself, your friends or your students from getting into similar situations.

Good write up, Ikan!

vash_h · « **Reply #5 on:** May 16, 2011, 08:27:43 PM »

im seriously shocked by this.. and the unprofessional dive centre and dive instructor.. this is down right dangerous..

MACHA · « **Reply #6 on:** May 16, 2011, 09:45:37 PM »

Dey Ikan.....thanks for sharing!

oldturtle · « **Reply #7 on:** May 17, 2011, 04:51:07 PM »

maybe in this part of the world ,some dive operators consider dive accident(DCS) as a potential image wrecker . so they would go all the way to delay admitting they required assistance like involving DAN. It makes them look bad in this business. I often heard dive operators and Instructor talking about who and who got Customers and Students developing this sickness(DCS),and implying those operators failed to conduct safe diving.

Probably because of such harmful attitude , unfortunates divers are often not given the best possible assessment .

Then again,it is possible that , dive instructors sometime become overly confidence on their own medic training ,they would 'play doctor' and causes disastrous result too.

DAN Case Study: It Started on an Open Water Diving Course (It happens in Malaysi